Using Nonfaculty Registered Nurses to Facilitate High-Fidelity Human Patient Simulation Activities

Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review

OBJECTIVE

This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education.

BACKGROUND

In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education.

DESIGN

An integrative review adapted a systematic approach.

DATA SOURCE

Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied.

INCLUSION CRITERIA

The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education.

REVIEW METHODS

Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted.

RESULTS

Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator."

CONCLUSION

Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers.

A Systematic Review of the Literature Related to the NLN/Jeffries Simulation Framework

AIM

The purpose of this manuscript it to disseminate findings from a systematic review of the literature related to the NLN/Jeffries Simulation Framework.

BACKGROUND

This review was initiated by the National League for Nursing to illuminate what is currently known about best simulation practices, research to support these practices, and priorities for future research. It is part of a larger project aimed at further developing the NLN/Jeffries Simulation Framework.

METHOD

Searches using CINAHL, the journal Simulation in Healthcare, and reference lists from key documents yielded 1,533 relevant publications for the period January 2000 to September 2014.

RESULTS

The final review of the literature includes 153 studies. Three themes, along with key issues, gaps, and best practices supported by the literature, were identified.

CONCLUSION

This systematic review provides empirical support for the major components of the NLN/Jeffries Simulation Framework and contributes to its further development.

Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload

INTRODUCTION

Using simulation to teach and assess learners represents a powerful approach to training, but one that comes with hidden costs in terms of faculty time, even if programs adopt existing curricula. Some simulators are built to be used independently by learners, but much of the surgical simulation curricula developed for cognitive and psychomotor tasks requires active faculty involvement and low learner-to-faculty teaching ratios to ensure sufficient practice with feedback. The authors hypothesize that the added teaching demands related to simulation have resulted in a significant financial burden to surgery training programs. To date, the effect of simulation-based training on faculty workload has not been estimated objectively and reported in the literature.

METHODS

To test their hypothesis, the authors analyzed data from 2 sources: (1) changes over time (2006-2014) in formal teaching hours and estimated faculty costs at the University of Minnesota, General Surgery Department and (2) a 2014 online survey of general surgery program directors on their use of simulation for teaching and assessment and their perceptions of workload effects.

RESULTS

At the University of Minnesota, the total number of hours spent by department faculty in resident and student simulation events increased from 81 in annual year 2006 to 365 in annual year 2013. Estimated full-time equivalent faculty costs rose by 350% during the same period. Program directors (n = 48) of Association of Program Directors in Surgery reported either a slight (60%) or a significant (33%) increase in faculty workload with the advent of simulation, and moderate difficulty in finding enough instructors to meet this increase. Calling upon leadership for support, using diverse instructor types, and relying on "the dedicated few" represent the most common strategies.

CONCLUSION

To avoid faculty burnout and successfully sustain faculty investment in simulation-based training over time, programs need to be creative in building, sustaining, and managing the instructor workforce.

Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses

BACKGROUND

In 2006, the National League for Nursing published three measures related to novice nurses' beliefs about self-confidence, scenario design, and educational practices associated with simulation. Despite the extensive use of these measures, little is known about their reliability and validity.

METHODS

The psychometric properties of the Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire were studied among a sample of 2200 surveys completed by novice nurses from a liberal arts university in the southern United States. Psychometric tests included item analysis, confirmatory and exploratory factor analyses in randomly-split subsamples, concordant and discordant validity, and internal consistency.

RESULTS

All three measures have sufficient reliability and validity to be used in education research. There is room for improvement in content validity with the Student Satisfaction and Self-Confidence in Learning and Simulation Design Scale.

CONCLUSION

This work provides robust evidence to ensure that judgments made about self-confidence after simulation, simulation design and educational practices are valid and reliable.

Characteristics of effective simulated clinical experience instructors: interviews with undergraduate nursing students

Effective clinical nursing instructors are essential for maximizing nursing students' educational experience. Due to a shortage of clinical placement sites and advancements in technology, nursing students are increasingly learning clinical judgment and decision making in the simulated clinical experience (SCE) with human patient simulators. In this environment, SCE instructors help students acquire knowledge and skills in decision making in a controlled, risk-free, hospital-like clinical environment. Using informal student interviews, this study examined nursing student perceptions of the characteristics of an effective instructor in the simulated clinical experience. To capture information about the characteristics of effective SCE instructors, interviews were conducted with students (N = 8) from two universities in Northern California. All participants had experience working with human patient simulators in the simulation laboratory. Students identified six themes for SCE instructors: Personality, Teaching Ability, Evaluation, Nursing Competence, Interpersonal Relationships, and Realism. Further research on the similarities and differences of this new educational environment is recommended.

Equivalence testing of traditional and simulated clinical experiences: undergraduate nursing students' knowledge acquisition

Although simulated clinical experience is being used increasingly in nursing education, vital evidence related to knowledge acquisition associated with simulated clinical experience does not exist. This intervention study used a 2×2 crossover design and equivalence testing to explore the effects of simulated clinical experiences on undergraduate students' (n = 74) knowledge acquisition in a fundamentals of nursing course. Following random assignment, students participated in laboratory-based simulated clinical experiences with high-fidelity human patient simulators and traditional clinical experiences and completed knowledge pretests and posttests. Analysis identified significant knowledge gain associated with both simulated and traditional clinical experiences, with the groups' knowledge scores being statistically significantly equivalent. A priori equivalence bounds around the difference between the groups were set at ± 5 points. Simulated clinical experience was found to be as effective as traditional clinical experience in promoting students' knowledge acquisition.