Simulation in Nursing Education: Current Regulations and Practices

Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study

BACKGROUND

Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings.

OBJECTIVE

To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies.

DESIGN

Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis.

SETTING

Simulation laboratories in one university nursing school in Australia.

PARTICIPANTS

21 final year nursing students in seven teams.

METHODS

Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies.

RESULTS

Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness.

CONCLUSIONS

Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

The mediating role of flow in the relationship between simulation design and simulation educational satisfaction in korean nursing students: a cross-sectional study

BACKGROUND

In Korea, there has been recent interest in nursing simulation education. In nursing, simulation education has many advantages, such as improving nursing students' problem-solving and judgment skills. Simulation education satisfaction is an indicator for evaluating educational performance from the learners' perspective and an important criterion for the development and progress of nursing education. Therefore, based on NLN/Jeffries simulation theory, this study aims to identify the relationship between simulation design and educational satisfaction and to confirm the mediating effect of flow.

METHODS

This cross-sectional study was conducted using 143 fourth-year nursing students who had participated in classes using simulations at three universities in Seoul, Daegu, and Jeonbuk. Data were collected from April 24 to May 3, 2023. Demographic data, simulation design scale (SDS), flow in simulation, and the educational satisfaction scale in simulation were collected via an online questionnaire. The collected data were analyzed through t-test, ANOVA, Scheffé test, and Pearson's correlation coefficient using SPSS 25.0. The mediating effect of flow was analyzed through the three-stage mediation effect procedure using hierarchical regression analysis and the Sobel test.

RESULTS

The simulation educational satisfaction had a statistically significant positive correlation with simulation design (r = .65, p < .001) and flow (r = .47, p < .001), and simulation design was positively correlated with the flow (r = .55, p < .001). The simulation design had a statistically significant effect on flow, which was the mediating variable (β = 0.55, p < .001). Additionally, simulation design had a statistically significant effect on simulation educational satisfaction (β = 0.56, p < .001). The significance of the mediating effect of flow on the relationship between simulation design and simulation educational satisfaction was investigated using the Sobel test, and the mediating effect of flow was found to be statistically significant (Z = 5.36, p < .001).

CONCLUSION

The significance of the current study lies in its confirmation of the link between simulation design and simulation educational satisfaction, as well as the mediating function of flow. Nursing students can achieve simulation educational satisfaction through simulation-based education if simulation educators follow best practices that improve flow through well-organized simulation design.

Students’ experiences of using a writing-intense programme to facilitate critical thinking skills on an online clinical training platform: A pilot study

Background: Coronavirus disease 2019 (COVID-19) and the subsequent lockdown altered traditional clinical training for speech language pathology students, thus forcing training institutions to implement innovative and responsive clinical training strategies in the midst of the pandemic. As such, a writing-intense programme was piloted in an online clinical training programme with second-year speech language pathology students.Objectives: This study explored speech language pathology students’ experiences with a writing programme used during an online clinical training programme implemented during the COVID-19 pandemic.Method: The study used a qualitative survey design. Purposive convenient sampling was used to recruit 29 second-year speech language pathology students. Online student reflections guided by 10 open-ended questions were used to elicit responses from students. Data were analysed using deductive thematic analysis.Results: Findings revealed that the written component of the programme facilitated the acquisition of clinical knowledge and improved clinical processes of writing among students. Feedback that students received on their written tasks improved learning. The clinical component of the course enabled students to learn in a less stressful environment and helped them gain confidence in their knowledge and clinical skills. Connectivity challenges and the lack of motivation from some students negatively impacted the programme.Conclusion: Using a writing programme to clinically train students can have positive effects in applying theory to clinical application because it affords students time to consolidate and process theory with practice as the jump from first year to second year can be cognitively taxing. A writing-intense programme can also improve students’ writing skills.

Effects of high-fidelity simulation teaching on nursing students' knowledge, professional skills and clinical ability: A meta-analysis and systematic review

OBJECTIVE

This meta-analysis was designed to systematically determine the effect of high-fidelity simulation teaching on nursing students' knowledge level, professional skill level and clinical ability.

BACKGROUND

High-fidelity simulation is an increasingly popular pedagogical approach in nursing education. It provides students with opportunity to practice in a variety of simulations before entering clinical practice through a variety of real-life situational experiences and many institutions and educators have embraced this method for enhancing access to clinical skills. However, evidence for the effectiveness of the method in nursing teaching remains scarce.

DESIGN

A meta-analysis and systematic review.

METHODS

The following Chinese and English databases were searched for relevant articles: PubMed, Embase, Cochrane library, Web of Science, CNKI (China National Knowledge Infrastructure) and Wangfang. The search encompassed the establishment of these databases up until November 2021. Two reviewers separately entered the data into Review Manager Software 5.3.

RESULTS

A total of 15 studies were included in this study. High-fidelity simulation significantly increased nursing students' knowledge acquisition (SMD = 1. 37, 94％CI:0. 73-2. 00，P ＜0. 0001), enhanced nursing students'professional skills (SMD = 0. 90, 95％CI:0. 36-1. 44，P = 0. 0001). In terms of clinical practice ability outcomes, high-fidelity simulation significantly improved the levels of critical thinking ability (SMD = 0. 58, 95％CI:0. 09-1. 07，P ＜0. 00001), Clinical judgement ability (SMD = 1. 34, 95％CI:0. 38-2. 31，P＝0. 006) and communication skills (SMD = 2. 62, 95％CI:1. 84-3. 40，P ＜0. 001) of nursing students.

CONCLUSIONS

We found that high-fidelity simulation have strong educational effects in nursing education, helping nursing students to increase knowledge acquisition, enhance professional skills and cultivate their clinical practice ability (critical thinking ability, communication skills and clinical judgement ability). These findings can provide guidance for nursing educators, indicating that the use of High-fidelity simulation teaching represents an effective solution for transitioning students from the learning environment to clinical practice.

Nursing Education Practice Update 2022: Competency-Based Education in Nursing

INTRODUCTION

Competency-based education (CBE) is increasingly emphasized in nursing. Professional organizations and regulatory bodies are calling for radical transformation in nursing education along with increased emphasis on developing clinical judgment.

METHODS

This practice update article provides a brief history of CBE in a variety of educational settings including health professions education and demonstrates the value of CBE strategies. The article also provides examples of the application of CBE to nursing education.

CONCLUSION

CBE offers the opportunity to enhance interprofessional education, increase the use of simulation, and improve clinical judgment in new graduate and advanced practice nurses.

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

Aim

To explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.

Background

The World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.

Design

Cross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.

Methods

A cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.

Results

Of 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.

Conclusions

Students were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.

Using Simulation to Teach Home Health Care

To describe development, use and outcomes of a Home Healthcare (HHC) simulation experience. Quasi-experimental pre/posttest. Setting: A simulation center for nursing students (N = 108) completing an 8-hour simulation experience, followed by data collection on perceived benefits to their learning; and influence on their desire to work in HHC. 93% (n = 101) reported the simulation was helpful; 57.4% (n = 62) reported participation increased their desire to work in HHC. Use of a HHC-focused simulation had positive learning outcomes in this setting. In this sample, results suggest value in maintaining the simulation experience for future cohorts.

Identifying and Addressing Statewide Nursing Simulation Needs

ABSTRACT

A statewide simulation assessment was conducted in one southeastern state using the Program Assessment Survey for Simulation. Simulation coordinators from 22 prelicensure nursing programs were interviewed. The findings revealed several areas where faculty education was needed: theory, design, facilitation, debriefing, interprofessional education, and evaluation. A free online simulation fundamentals course was effective in addressing the areas where education was required.

Baccalaureate nursing students' experiences with high-fidelity simulation: protocol for a qualitative systematic review

INTRODUCTION

High-fidelity simulation (HFS) can bridge the gap between theoretical knowledge and nursing practice and improve safety and quality of patient care in baccalaureate nursing education. Although inconsistent assessment instruments or lack of high-quality research designs affect the strength of the evidence and limit the generalisability of the results, quantitative studies generally demonstrate the effectiveness of HFS in baccalaureate nursing education. Synthesis of the existing evidence of baccalaureate nursing students' experiences with HFS is crucial for the improvement and revision of simulation design and teaching.

METHODS AND ANALYSIS

A comprehensive search for qualitative studies on baccalaureate nursing students' experiences with HFS will be conducted in the following databases: PubMed, Embase, CINAHL, ProQuest, Web of Science, PsycINFO, the Cochrane library, China Biology Medicine disc, China National Knowledge Infrastructure and VIP Database for Chinese Technical Periodicals. This review considered studies reported in English or Chinese, and studies that were conducted between January 2000 and December 2019 in view of the launch of International Nursing Association for Clinical Simulation and Learning. The literature search will be conducted by two independent reviewers, and any disagreement will be adjudicated by discussion or with a third reviewer. The two independent reviewers will use the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research to assess the methodological validity, following which the JBI standardised data extraction tools will be used to extract relevant data. The JBI meta-aggregation method will be subsequently used to synthesise the data, eventually forming themes, categories and synthesised findings. The final synthesised findings will establish confidence levels based on the JBI ConQual approach.

ETHICS AND DISSEMINATION

This review does not require formal ethical review since it is based on available published literature. Findings will be disseminated through publication in a peer-reviewed journal, and, if possible, presented in scientific conferences.

Simulation in Undergraduate Education

Simulation is an integral component of undergraduate nursing education because it allows for a safe, timely, and prescriptive approach to meet learning objectives at the levels of individual simulations, courses, and academic programs. This review of the literature provides an overview of steps taken to move simulation forward in undergraduate nursing education, and it highlights educational theories, research, best practices, and policy statements underpinning modern nursing simulation. This chapter outlines simulation and curriculum integration approaches and provides examples of participant, course, and program outcomes.

Escape Room Relay Race: "Go for the Gold" in Formative Assessment

BACKGROUND

Immersive learning activities, such as escape room educational gaming in nursing simulation laboratories, have proven to be effective teaching strategies that promote communication and teamwork. These activities also provide educators with opportunities to assess clinical skills competencies, as well as providing them with a means for evaluating the transfer of didactic knowledge to clinical practice.

METHOD

An obstetrical skills relay race with an escape room element was created as a formative evaluation method to determine if nursing students were able to demonstrate competency related to the identified learning needs.

RESULTS

The competitive aspects of this learning activity were perceived as exciting and motivating by the educators and students.

CONCLUSION

An escape room-themed relay race incorporated into an obstetric skills laboratory is considered an innovative and formative evaluation method, as well as an engaging and motivating learning activity for nursing students. [J Nurs. Educ. 2020;59(11):646-650.].

Simulation as a pedagogical learning method for critical paediatric nursing in Bachelor of Nursing programmes: a qualitative study

BACKGROUND

In the national education plan for Bachelor of Nursing in Norway, it is emphasized that focus areas for practical studies must include experience related to paediatric nursing. However, given the paucity of children's wards in Norwegian hospitals, few students are offered this. The purpose of this study is to explore undergraduate nursing student's perception of using simulation as a learning method to obtain knowledge and skills in delivering quality healthcare to children and their parents in emergencies.

METHOD

A total of 36 students participated in focus groups. The students were asked to reflect on their learning outcomes regarding the educational method during the simulation. In addition, the students were encouraged to discuss whether this pedagogical method was useful in preparing them to deal with critical medical situations in relation to children and their parents. The interviews were transcribed and analyzed using qualitative content analysis.

RESULTS

Three subjects emerged from the analysis. The first, simulation as an educational method, showed that the students thought that simulation gave a greater degree of realism and seriousness than other learning activities. The second subject, preparedness for later practice, showed that the students perceived simulation as one of the ways in which they were best prepared for the profession as a nurse. The students emphasized the benefit of having concentrated on children and their parents. The third subject, stress and leadership, showed that simulation as a method was stressful to most students, and lack of knowledge and anxiety about conducting other students kept them from taking the lead. However, the students experienced that they learned a lot about themselves and how they appear as nurses.

CONCLUSION

The bachelor-level student nurses experienced simulation as a realistic and effective educational method for gaining knowledge in the critical healthcare of children and their parents. Simulation made them reflect on a nurse's area of responsibility in emergencies. When offered practical experience in children's wards, the use of simulation as a didactic method may help students develop sufficient competence to act appropriately and expediently in critical paediatric nursing settings.

TRIAL REGISTRATION

The study (number 52776) was approved by the Norwegian Centre for Research Data.

Simulation Modeling as a Novel and Promising Strategy for Improving Success Rates With Research Funding Applications: A Constructive Thought Experiment

Writing a successful grant or other funding applications is a requirement for continued employment, promotion, and tenure among nursing faculty and researchers. Writing successful applications is a challenging task, with often uncertain results. The inability to secure funding not only threatens the ability of nurse researchers to conduct relevant health care research but may also negatively impact their career trajectories. Many individuals and organizations have offered advice for improving success with funding applications. While helpful, those recommendations are common knowledge and simply form the basis of any well-considered, well-formulated, and well-written application. For nurse researchers interested in taking advantage of innovative computational methods and leading-edge analytical techniques, we propose adding the results from computer-based simulation modeling experiments to funding applications. By first conducting a research study in a virtual space, nurse researchers can refine their study design, test various assumptions, conduct experiments, and better determine which elements, variables, and parameters are necessary to answer their research question. In short, simulation modeling is a learning tool, and the modeling process helps nurse researchers gain additional insights that can be applied in their real-world research and used to strengthen funding applications. Simulation modeling is well-suited for answering quantitative research questions. Still, the design of these models can benefit significantly from the addition of qualitative data and can be helpful when simulating the results of mixed methods studies. We believe this is a promising strategy for improving success rates with funding applications, especially among nurse researchers interested in contributing new knowledge supporting the paradigm shift in nursing resulting from advances in computational science and information technology.

Experiences of Nursing Students during the Abrupt Change from Face-to-Face to e-Learning Education during the First Month of Confinement Due to COVID-19 in Spain

The current state of alarm due to the COVID-19 pandemic has led to the urgent change in the education of nursing students from traditional to distance learning. The objective of this study was to discover the learning experiences and the expectations about the changes in education, in light of the abrupt change from face-to-face to e-learning education, of nursing students enrolled in the Bachelor’s and Master’s degree of two public Spanish universities during the first month of confinement due to the COVID-19 pandemic. Qualitative study was conducted during the first month of the state of alarm in Spain (from 25 March–20 April 2020). Semi-structured interviews were given to students enrolled in every academic year of the Nursing Degree, and nurses who were enrolled in the Master’s programs at two public universities. A maximum variation sampling was performed, and an inductive thematic analysis was conducted. The study was reported according with COREQ checklist. Thirty-two students aged from 18 to 50 years old participated in the study. The interviews lasted from 17 to 51 min. Six major themes were defined: (1) practicing care; (2) uncertainty; (3) time; (4) teaching methodologies; (5) context of confinement and added difficulties; (6) face-to-face win. The imposition of e-learning sets limitations for older students, those who live in rural areas, with work and family responsibilities and with limited electronic resources. Online education goes beyond a continuation of the face-to-face classes. Work should be done about this for the next academic year as we face an uncertain future in the short-term control of COVID-19.

The effects of training with simulation on knowledge, skill and anxiety levels of the nursing students in terms of cardiac auscultation: A randomized controlled study

BACKGROUND

The use of simulation methods in nursing education is important in terms of decreasing anxiety of students in a safe and realistic environment due to the improvement of knowledge and skills of students in terms of cardiac auscultation and their attitudes to prepare for clinical applications.

OBJECTIVES

The aim of this study is to compare the effectiveness of high-fidelity simulator and traditional teaching method on nursing students' knowledge and skill development in terms of cardiac auscultation and their anxiety levels.

DESIGN

Randomized controlled study.

SETTING

The study was conducted in the simulation laboratory of the Nursing Department in the Health College and in the inpatient clinics of the Medicine Faculty Hospital.

PARTICIPANTS

72 first-year nursing students (simulation group = 36, control group = 36).

METHODS

The students were randomly distributed to the simulation and control groups. The students in the simulation group received a cardiac auscultation training by using a high-fidelity simulator while the students in the control group received training with the traditional teaching method. After the training sessions, all students practiced their skills in the laboratory and on real patients in clinical setting under the supervision of the researcher. The data were collected by using the Demographic Information Form, Knowledge Assessment Form for Cardiac Auscultation, Skill Evaluation Form for Cardiac Auscultation and State Anxiety Inventory (SAI).

RESULTS

High-fidelity simulators and traditional teaching method were found to be effective in increasing the students' knowledge and skill levels in terms of cardiac auscultation. However, it was found that the high-fidelity simulator method was more effective than the traditional teaching method to increase the students' knowledge (p = 0.001) and skill (p < 0.001) levels; this increase was significant. In addition, it was found that the students in the high-fidelity simulator group showed a significant decrease in anxiety scores compared to the students who were trained with traditional education method (p < 0.001).

CONCLUSIONS

The results showed that the use of high-fidelity simulator in nursing education was more effective than traditional method in terms of improving the students' knowledge, skill levels for cardiac auscultation and reducing their anxiety.

High-value care for older adults with complex care needs: Leveraging nurses as innovators

BACKGROUND

Our health care system is facing unprecedented and complex challenges in caring for older adults and their families. A paradigm shift is needed that recognizes new roles and competencies for nurses to play a leadership role in the design and implementation of high value care models.

PURPOSE

The purpose of this paper is to introduce a series of recommendations for leveraging nurses to generate innovative tools and solutions for the delivery of value-based care for older adults living with complex health and social needs and their families.

METHODS

These recommendations were generated by a Think-Tank of national experts based on review of current evidence and focus groups with older adults.

FINDING

The generated recommendations focus on positioning nurses to assume leadership roles in implementing evidence-based care models, preparing nurses to serve as health innovators and catalysts of system transformation, and fostering system-level infrastructure that leverages the contributions of nurses for current and emerging roles.

DISCUSSION

Nurses as innovators can address the challenges in providing high quality care for older adults with complex needs and their families. System-level infrastructure, including resources for training and implementation of well-established programs, is necessary to leverage the contributions of nurses and facilitate innovative approaches to care.

Comparison of Mental Health Nursing Student Academic Achievement and Satisfaction: Classroom Versus Online Education in Teaching Therapeutic Crisis Management Techniques

BACKGROUND

Mental health nurse educators use online education in an effort to offer students the ability to practice varying skills in a safe environment.

PURPOSE

The purpose of this study was to compare the effectiveness and student satisfaction of live classroom versus online education in delivering therapeutic crisis management skills content to pre-licensure nursing students as measured by overall grade point average (GPA), test scores, class grade, and student satisfaction survey results.

METHODS

This quasi-experimental, post-hoc comparative study had a two-group post-test design. The participants were pre-licensure psychiatric mental health nursing students who were presented a 30-min lecture followed by group work with case studies and interventions.

RESULTS

There were no statistically significant differences between the live classroom and online education group.

CONCLUSIONS

This study indicates that therapeutic crisis management techniques can be taught a variety of ways for academic success and may validate the feasibility of online education within mental health nursing curricula.

Improving clinical judgment by simulation: a randomized trial and validation of the Lasater clinical judgment rubric in Chinese

BACKGROUND

The development and assessment of clinical judgment ability are essential in nursing education. The Lasater Clinical Judgment Rubric (LCJR) was shown to be valid in evaluating nursing students' learning outcomes and skills in western cultures but has not been validated in mainland China. This study aimed to compare a simulation-teaching model with a traditional teaching method in enhancing the clinical judgment ability of nursing undergraduate students and to validate the Chinese version of the Lasater Clinical Judgment Rubric (C-LCJR).

METHODS

Four classes of nursing students (n = 157) at Hubei University of Chinese Medicine, China, were randomly assigned to two control and two experimental classes. The experimental classes were taught using simulation teaching with standardized patients, while the control classes were taught using traditional teaching methods. At the end of the experiment, students in both kinds of classes evaluated their clinical judgment using the C-LCJR. Teachers also rated the students but without knowing who had received the simulation teaching. Confirmatory factor analysis and a Multiple Indicators Multiple Causes (MIMIC) model with Bayesian estimation was fit to the rating data to investigate measurement properties and experimental effects.

RESULTS

Compared to the control classes, students in the experimental classes performed better in all subdomains of C-LCJR (noticing, interpreting, responding, and reflecting). The measurement properties of the C-LCJR were found to be satisfactory with high factor loadings and reliabilities and no bias from age, gender, and raters.

CONCLUSIONS

The simulation teaching model is more effective than the traditional (non-simulation-based) teaching method in improving clinical judgment of Chinese nursing students. The C-LCJR is a valid and reliable instrument for measuring clinical judgment in nursing students in China.

An International Scoping Exercise Examining Practice Experience Hours Completed by Nursing Students

BACKGROUND

There is global acceptance of the need for prelicensure nursing students to complete practice experience hours during their program of education. Yet questions remain about these practice experiences, including those related to duration.

METHOD

This article reports findings of a scoping exercise that compared the number of practice experience hours mandated for students undertaking courses that lead to RN licensure in Australia, New Zealand, the United Kingdom, and the United States.

RESULTS

Substantial differences were evident between the four countries regarding the number of mandated practice experience hours. There is no clearly linked research evidence to justify the decision made in relation to the mandated number of hours.

CONCLUSION

Internationally, there is a need to reexamine the rationale for mandating a minimum number of practice experience hours for students in programs of education that lead to licensing as an RN. [J Nurs Educ. 2019;58(1):33-41.].

Enhancing Nursing Education Through Affordable and Realistic Holographic Mixed Reality: The Virtual Standardized Patient for Clinical Simulation

Nurses serve a valuable role in the healthcare industry. Nurses are trained with the skills and knowledge to thrive in a fast-paced, evolving environment. In order to meet the complex and diverse needs of patients, nurses must be able to assess and prioritize care to produce safe and high-quality outcomes. Simulation is an established method of educating nursing students and preparing nurses to respond appropriately to situations they are likely to encounter in practice. Traditional nursing simulation devices are prohibitively expensive for many nursing education institutions. The development of augmented, mixed, and virtual reality simulation delivery offers a new platform for simulation, known as immersive simulation. Immersive simulation can virtually place nursing students in situations that are difficult to arrange in actual clinical practicums or that occur rarely but for which nurses need to be prepared. Additionally, the hardware required to deliver immersive simulation is much cheaper than that of traditional nursing simulation devices. This chapter describes the virtual standardized patient application delivered via mixed reality immersive simulation. This chapter also discusses the research initiative currently underway to assess student perceptions to this modality of health training simulation.

Review of Use of Standardized Patients in Psychiatric Nursing Education

BACKGROUND

Simulations using standardized patients (SPs) are increasingly used to teach and assess competencies in psychiatric/mental health (PMH) nursing education. To advance the field, it is important to identify current knowledge, practice, and evidence.

OBJECTIVE

To determine the current knowledge, evidence, and practice of using SPs in PMH nursing education by conducting an integrative review of the empirical research on the use of SPs in PMH nursing education, and by providing a supplementary descriptive review of non-research articles on PMH simulations using SPs.

DESIGN

A comprehensive search using electronic databases was conducted to identify both research and simulation description papers meeting inclusion criteria. The research literature was reviewed using an integrative review approach and a simple descriptive review of the non-research simulation literature was also conducted.

RESULTS

Six research studies and 18 simulation description articles were included in the review. Although there are several PMH SP simulation descriptions in the literature, and anecdotal indications that they are a valuable educational tool, there is insufficient research evidence regarding their effectiveness as a method in psychiatric nursing education due to few published studies and methodological limitations of existing studies.

CONCLUSIONS

Well-designed research studies are needed to develop an evidence base for this promising and increasingly employed teaching method.

Clinical Simulation in Psychiatric-Mental Health Nursing: Post-Graduation Follow Up

In psychiatric-mental health, creating an innovative strategy to help students learn content that may not be frequently seen in a clinical setting is challenging. Thus, simulation helps narrow this gap. Using Kirkpatrick and Kirkpatrick's model of evaluation to guide the current study, faculty contacted baccalaureate nursing program graduates who completed a psychiatric-mental health clinical simulation scenario featuring a hanging suicide and wrist cutting suicide attempt scenario in the "Behind the Door" series as part of the clinical component of their undergraduate psychiatric-mental health course. Eleven nurses responded to a survey regarding their post-graduate encounters with these types of clinical situations, and their perception of recall and application of knowledge and skills acquired during the simulation experience to the clinical situation. Nursing graduates' responses are expressed through three major themes: emotional, contextual/behavioral, and assessment outcomes. Data from the survey indicate that nursing graduates perceived the "Behind the Door" simulations as beneficial to nursing practice. This perception is important in evaluating knowledge transfer from a simulation experience as a student into application in nursing practice. [Journal of Psychosocial Nursing and Mental Health Services, 54(10), 40-45.].

A systematic review: Children & Adolescents as simulated patients in health professional education

Simulated patients (SP) contribute to health professional education for communication, clinical skills teaching, and assessment. Although a significant body of literature exists on the involvement of adult SPs, limited research has been conducted on the contribution of children and adolescents. This systematic review, using narrative summary with thematic synthesis, aims to report findings related to children/adolescents as simulated patients in health professions education (undergraduate or post-graduate). A systematic review of qualitative and quantitative literature published between 1980 and September 2014 was undertaken using databases including CINAHL, Ovid Medline and Scopus. The lack of literature related to the employment of children and adolescents in nursing education dictated the expansion of the search to the wider health professions. Key search terms related to the employment of children and adolescents in health professional education programs. A total of 58 studies reduced to 36 following exclusion based on abstract review. Twenty-two studies reached full text review; following application of inclusion and exclusion criteria, 15 English language studies involving children and/or adolescents in simulation formed part of this systematic review. Five key themes emerged: Process related to recruitment, duration and content of training programs, support and debriefing practice, ethical considerations, and effects of participation for key stakeholders such as children and adolescents, parent and faculty, and learner outcomes. The results suggest that the involvement of children and adolescents in simulation for education and assessment purposes is valuable and feasible. The review identified the potential for harm to children/adolescents; however, rigorous selection, training and support strategies can mitigate negative outcomes. The ability of children to portray a role consistently across assessments, and deliver constructive feedback remains ambiguous.

Policy issues related to educating the future Israeli medical workforce: an international perspective

A 2014 external review of medical schools in Israel identified several issues of importance to the nation's health. This paper focuses on three inter-related policy-relevant topics: planning the physician and healthcare workforce to meet the needs of Israel's population in the 21(st) century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. All three involve both education and health care delivery. The physician workforce is aging and will need to be replenished. Several physician specialties have been in short supply, and some are being addressed through incentive programs. Israel's needs for primary care clinicians are increasing due to growth and aging of the population and to the increasing prevalence of chronic conditions at all ages. Attention to the structure and content of both undergraduate and graduate medical education and to aligning incentives will be required to address current and projected workforce shortage areas. Effective workforce planning depends upon data that can inform the development of appropriate policies and on recognition of the time lag between developing such policies and seeing the results of their implementation. The preclinical and clinical phases of Israeli undergraduate medical education (medical school), the mandatory rotating internship (stáge), and graduate medical education (residency) are conducted as separate "silos" and not well coordinated. The content of basic science education should be relevant to clinical medicine and research. It should stimulate inquiry, scholarship, and lifelong learning. Clinical exposures should begin early and be as hands-on as possible. Medical students and residents should acquire specific competencies. With an increasing shift of medical care from hospitals to ambulatory settings, development of ambulatory teachers and learning environments is increasingly important. Objectives such as these will require development of new policies. Undergraduate medical education (UME) in Israel is financed primarily through universities, and they receive funds through VATAT, an education-related entity. The integration of basic science and clinical education, development of earlier, more hands-on clinical experiences, and increased ambulatory and community-based medical education will demand new funding and operating partnerships between the universities and the health care delivery system. Additional financing policies will be needed to ensure the appropriate infrastructure and support for both educators and learners. If Israel develops collaborations between various government agencies such as the Ministries of Education, Health, and Finance, the universities, hospitals, and the sick funds (HMOs), it should be able to address successfully the challenges of the 21st century for the health professions and meet its population's needs.

Implementing high-fidelity simulations with large groups of nursing students

Nurse educators are increasing the use of simulation as a teaching strategy. Simulations are conducted typically with a small group of students. This article describes the process for implementing 6 high-fidelity simulations with a large group of undergraduate nursing students. The goal was to evaluate if student knowledge increased on postsimulation quiz scores when only a few individuals actively participated in the simulation while the other students observed.