Enhancing Graduate Nurses’ Health Assessment Knowledge and Skills Using Low-fidelity Adult Human Simulation:

Reduction of Central-line-Associated Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit through Simulation Education

Introduction

Critically ill neonates and those with complex medical conditions frequently require the use of central venous lines. Unfortunately, central line-associated bloodstream infections (CLABSIs) result in significant morbidity and mortality, and the cost and increased length of stay burden the healthcare system. Previous studies have demonstrated that standardized care bundles can decrease CLABSI rates, but achieving sustained improvement has proven difficult.

Methods

All patients admitted to the Neonatal Intensive Care Unit between 2014 and 2020 who had a CVL were included in this study. First, we recorded all CLABSI events and total CVL days according to defined criteria. Then, in late 2016, we instituted simulation-based nursing training for CVL care.

Results

Job Instruction Sheets were initially introduced to Neonatal Intensive Care Unit nursing staff simultaneously with one-on-one teaching sessions between instructors and bedside nurses. Intermittent performance audits and re-education for identified deficiencies did not improve the CLABSI rate per 1000 line days. After instituting simulation-based CVL training in 2016, there was a decreased rate of CLABSI events per 1000 line days sustained over time (x = 0.692).

Conclusions

Standardized care bundles and Hospital-acquired Condition interactor audits were insufficient to reduce the CLABSI rate. However, combining care bundles and education with simulation-based training significantly decreased CLABSI rates. One-on-one intensive training and continued ongoing monitoring were critical to producing a sustained reduction. This experience demonstrates that supervised, interactive education combined with simulation can significantly impact patient outcomes.

High-fidelity simulation in undergraduate nursing education: A meta-analysis

OBJECTIVES

To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education.

DESIGN

A meta-analysis of randomized controlled trials and quasi-experiment.

DATA SOURCES

Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021.

REVIEW METHODS

The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I².

RESULTS

Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown.

CONCLUSIONS

High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

A conceptual framework for simulation in healthcare education - The need

This study used a social constructivist approach to explore the literature in relation to the acknowledgment and application of models and frameworks in simulation based learning and teaching activities in health care education. This paper addresses the data collection phases in the research design in developing a Conceptual Framework for Simulation in Healthcare Education.

BACKGROUND

Two literature review activities occurred in the study. The first literature review explored the challenges in the literature for further research in relation to the educational factors that have an impact upon simulation as a learning and teaching modality. This part of the research process was to identify the publications that address simulation as a learning and teaching modality and uncover evidence to justify the study. The literature revealed that there were limited publications in relation to simulation as a learning and teaching modality that was underpinned by a conceptual framework.

DESIGN

The study research design employed Evaluation Research to conduct a further intensive review of the literature as part of phase one of data collection. The second part of phase one of data collection was the surveying of randomly selected simulation education centres around the world to ascertain their employment of a conceptual framework in the application of simulation as a learning and teaching modality. Phase two was the genesis of the conceptual framework and Phase three was the evaluation of the draft framework using a modified Delphi Technique by randomly selected simulation experts.

RESULTS

The intensive literature review highlighted that authors acknowledged education-based theories but this did not extend to the application of a conceptual framework to simulation as a learning and teaching modality. The survey provided the evidence to support the development of a Conceptual Framework for Simulation in Healthcare Education for the conceptualisation, design, development and delivery of simulation teaching and learning activities in health care education. The simulation experts provided valuable data and commentary in the final formation of the conceptual framework.

CONCLUSION

Based on the outcomes of the literature review, questionnaire and modified Delphi Technique the need for the development, and subsequent structure and utility of the Conceptual Framework for Simulation in Healthcare Education was verified.

Transition experiences of newly graduated Filipino nurses in a resource-scarce rural health care setting: A qualitative study

PROBLEM

Without a doubt, the transition to a professional nursing role is a challenging and stressful experience for many new nurses, regardless of where they are employed; yet, no study has been conducted to comprehend in detail the transition experiences of newly graduated nurses employed in a resource-scarce rural health care setting.

PURPOSE

This study describes the transition experiences of newly graduated Filipino nurses during their initial clinical placement process.

METHODS

A qualitative phenomenological approach using structured interviews with 15 newly graduated Filipino nurses were used along with the Coliazzi's methodological framework for data analysis.

FINDINGS

Four distinct themes emerged from the content analysis, as follows: experiencing transition shock, feeling pressured, learning excitement, and needing support.

CONCLUSIONS

Similar to the findings of other international studies, newly graduated Filipino nurses described their transition experiences as a stressful and challenging journey. Both academic and nursing administration team members can play key roles in facilitating a smooth transition and the integration of new nurses into the nursing workforce through the employment of evidence-based educational and structured organizational strategies.

Preparing Physiotherapy Students for Clinical Placement: Student Perceptions of Low-Cost Peer Simulation. A Mixed-Methods Study

INTRODUCTION

Simulation is increasingly used in health care education, yet the organizational and financial costs can be prohibitive. This study aimed to investigate whether peer simulation is perceived by third-year undergraduate physiotherapy students as valuable for clinical placement preparation.

METHODS

Third-year undergraduate physiotherapy students participated in a 9-week peer simulation program, using each other as patients, and were invited to complete two surveys evaluating perceptions of the program. The program consisted of weekly patient interactions during which students were required to assess and treat a "patient" under strict simulation guidelines and in accordance with stated learning objectives. Items rated included self-perceived skills, confidence, time management, and clinical placement readiness and included collection of qualitative responses. Surveys were released at commencement and completion of the simulation program.

RESULTS

Of 79 third-year students, 63% completed survey 1 and 66% completed survey 2. Students had high expectations of the program and these were consistently met. Peer simulation rated highly for all items, including identifying knowledge and skill deficits, and improving confidence, clinical reasoning, time management, and communication. Simulation was considered safe, supportive, engaging, and valuable for clinical placement preparation. Students identified some lack of authenticity when working with peers.

CONCLUSIONS

Peer simulation was perceived by students as valuable in preparing them for clinical placement, despite a perceived lack of realism. These findings support the use of peer simulation as an alternative to the use of more formalized standardized patients in an undergraduate physiotherapy program. Further investigation is required to establish a detailed cost analysis of the program and to determine the amount of realism required to optimize the benefits of this promising educational strategy.

Integrating simulation based learning into nursing education programs: Hybrid simulation

BACKGROUND

Hybrid simulation can be developed with mannequins of any fidelity and tabletop simulators with a standardized patient to create a complex, high-level learning activity.

OBJECTIVE

The aim of this study is to analyze the effects of a hybrid simulation technique used with nursing students in a scenario about the emergency setting.

METHODS

This one-group pre-test post-test model quasi-experimental study was carried out with 39 students in Ankara, Turkey, from October 2014 to July 2015.

RESULTS

Nearly all participants reported that the simulation improved their critical thinking, decision-making skills, and self-confidence before the clinical activity and that they felt as though they were real nurses during the activity (94.7%, 97.3%, 84.2%, and 92.1%, respectively).

CONCLUSION

The results of this study support the integration of hybrid simulation experiences throughout the nursing curriculum, as evidenced by positive responses from students through the simulation evaluation questionnaire.

Integrating Gerontology and Community Concepts Through Simulation

This article describes an innovative simulation experience for nursing students. Faculty from a community health nursing course and a course in gerontology worked together to provide a comprehensive simulation experience that combined low-fidelity and high-fidelity experiences that provided an integrated learning experience and gave faculty with an opportunity to collaborate to improve outcomes. Student and faculty feedback was overwhelmingly positive. Future plans include incorporating a third didactic course, Leadership and Management, and working with other disciplines to demonstrate interprofessional collaboration.

Assessment of a learning intervention in palliative care based on clinical simulations for nursing students

BACKGROUND

Major deficiencies exist in undergraduate nursing education for Palliative Care. Opportunities to care for dying patients are often unavailable to students in traditional clinical settings. Palliative care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality palliative/end of life care. It is valuable to explore the student nurses' beliefs, feelings and satisfaction regarding the impact that simulation clinic applied to palliative care has and how it influenced their overall experience of caring for a dying patient and the patient's family. This study aimed to evaluate a learning intervention in palliative care using a low-fidelity clinical simulation for undergraduate nursing students from a Spanish university, based on the analytics of their expectations and learning objectives.

METHOD

Sixty-eight students participated in this mixed descriptive design study, they participated in a palliative care simulation scenario and completed three questionnaires which assess the knowledge and expectations before the simulation and the subsequent satisfaction with the performance and learning received.

RESULTS

The intervention in question met students' learning expectations, singling out social abilities as important tools in palliative care training, and the students were satisfied with the presented case studies.

CONCLUSIONS

Our results suggest that low-fidelity clinical simulation intervention training in palliative care is an appropriate and low-cost tool for acquiring competitive skills. Learning in the simulation scenarios provides a mechanism for students to improve student communication skills.

Piloting the feasibility of head-mounted video technology to augment student feedback during simulated clinical decision-making: An observational design pilot study

BACKGROUND

Clinical decision-making is a complex activity that is critical to patient safety. Simulation, augmented by feedback, affords learners the opportunity to learn critical clinical decision-making skills. More detailed feedback following simulation exercises has the potential to further enhance student learning, particularly in relation to developing improved clinical decision-making skills.

OBJECTIVE

To investigate the feasibility of head-mounted video camera recordings, to augment feedback, following acute patient deterioration simulations.

DESIGN

Pilot study using an observational design.

METHODS

Ten final-year nursing students participated in three simulation exercises, each focussed on detection and management of patient deterioration. Two observers collected behavioural data using an adapted version of Gaba's Clinical Simulation Tool, to provide verbal feedback to each participant, following each simulation exercise. Participants wore a head-mounted video camera during the second simulation exercise only. Video recordings were replayed to participants to augment feedback, following the second simulation exercise. Data were collected on: participant performance (observed and perceived); participant perceptions of feedback methods; and head-mounted video camera recording feasibility and capability for detailed audio-visual feedback.

RESULTS

Management of patient deterioration improved for six participants (60%). Increased perceptions of confidence (70%) and competence (80%), were reported by the majority of participants. Few participants (20%) agreed that the video recording specifically enhanced their learning. The visual field of the head-mounted video camera was not always synchronised with the participant's field of vision, thus affecting the usefulness of some recordings.

CONCLUSION

The usefulness of the video recordings, to enhance verbal feedback to participants on detection and management of simulated patient deterioration, was inconclusive. Modification of the video camera glasses, to improve visual-field synchronisation with participants' actual visual field, is recommended to further explore this technology for enhancing student performance.

Beginning and advanced students' perceptions of the use of low- and high-fidelity mannequins in nursing simulation

BACKGROUND

There is little research evidence that demonstrates the difference between the use of low- and high-fidelity mannequins in assisting students to acquire their skills when students are at different points in their nursing education experience.

OBJECTIVES

Our study examined differences between the use of low- and high-fidelity mannequins on student outcomes with both beginner and advanced students.

DESIGN

A quasi-experimental investigation.

SETTINGS

Participants performed two simulations, one simulation using a low-fidelity mannequin and the other simulation using a high-fidelity mannequin.

PARTICIPANTS

First and fourth semester pre-licensure students from a Bachelor of Science in Nursing program and an accelerated nursing entry program participated in this study.

METHODS

A Students' Satisfaction and Self-confidence Scale and Simulation Design Scale were used to obtain data. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 17.0. The results obtained from scales were compared using Wilcoxon sign test and Mann-Whitney U test. A p value of <0.05 was considered statistically significant.

RESULTS

The student satisfaction score of the students in the low-fidelity mannequin group was 3.62±1.01, while that of the students in the high-fidelity mannequin group was 4.67±0.44'dir (p=0.01). The total score of the simulation design scale in the low-fidelity mannequin group was 4.15±0.63, while it was 4.73±0.33 in the high-fidelity mannequin group (p=0.01).

CONCLUSIONS

Students' perceptions of simulation experiences using high-fidelity mannequins were found to be higher in contrast to their perceptions of experiences using low-fidelity mannequins.

A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse

BACKGROUND

The transition from student to newly qualified nurse can be stressful for many newly qualified nurses who feel inadequately prepared. A variety of support strategies to improve the transition process have been reported across the international literature but the effectiveness of such strategies is unknown.

OBJECTIVES/AIM

To determine the effectiveness of the main strategies used to support newly qualified nurses during the transition into the clinical workplace and, where identified, evaluate the impact of these on individual and organisational outcomes.

DESIGN

Systematic review.

DATA SOURCES

A search of electronic databases to identify published studies (CINAHL, MEDLINE, British Nursing Index, Cochrane Library, EMBASE, PsychLit, PsychINFO, PsychARTICLES, Web Of Science, EBM Reviews, BioMed, TRIP, ERIC, SCOPUS (January 2000-April 2011) was conducted. Relevant journals were hand-searched and reference lists from retrieved studies were reviewed to identify any further studies. The search was restricted to English language papers. The key words used were words that described new graduate nurses and support strategies (e.g. internship, residency, orientation programmes).

REVIEW METHODS

The inclusion criteria were quantitative studies that investigated the effectiveness of support strategies for newly qualified graduate nurses. Studies that involved students in their final year of graduate study were excluded (for example extern programmes). Extraction of data was undertaken independently by two reviewers. A further two reviewers assessed the methodological quality against agreed criteria.

RESULTS

A total of 8199 studies were identified from the database search and 30 met the inclusion criteria for the review. The evidence suggests that transition interventions/strategies do lead to improvements in confidence and competence, job satisfaction, critical thinking and reductions in stress and anxiety for the newly qualified nurse.

CONCLUSIONS

This systematic review demonstrates the beneficial effects of transitional support strategies for newly qualified nurses from the perspective of the new nurse and their employer. The overall impact of support strategies appears positive, irrespective of the type of support provided. This may suggest that it is the organisations' focus on new graduate nurses that is important, rather than simply leaving them to acclimatise to their new role themselves. Future research should involve well designed randomised controlled trials with larger sample sizes, using more objective and reliable outcome measures.

Effectiveness of patient simulation in nursing education: meta-analysis

BACKGROUND

The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms.

OBJECTIVE

To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis.

METHODS

This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis.

RESULTS

We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity.

CONCLUSIONS

These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods.

The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse

EXECUTIVE SUMMARY

Background: The transition period from student to newly qualified nurse where nurses are adjusting to their new role and consolidating their knowledge and skills can be stressful. It is a time when many newly qualified nurses are left feeling inadequately prepared. A variety of strategies to ease the transition process have been reported, which aim to increase confidence, competence, sense of belonging of new graduates, improve recruitment and retention and reduce turnover costs.

OBJECTIVES

To synthesise the best available evidence on the effectiveness of support strategies and interventions aimed for newly qualified nurses.

METHODS

A comprehensive search was undertaken on major electronic databases to identify both published and unpublished studies from 2000 to the present date. Reference lists of retrieved papers were searched and authors contacted. Only quantitative studies published in English language were considered.Methodological quality and data extraction: Two reviewers independently assessed methodological quality and extracted data from the included studies. A third reviewer resolved any disagreements through discussion.

DATA SYNTHESIS

The review did not identify comparable Randomised Controlled Trials (RCTs), and as such meta-analysis of the data was not appropriate. The data extracted from the included studies were synthesized into a narrative summary.

RESULTS

Thirty three studies were included in the review: RCT (1), Quasi-experimental (3) and observational/descriptive studies (29). Countries of origin were: USA (25), Australia (4), England (2), New Zealand (1) and Thailand (1). Studies were categorised according to the type of programme or support strategy provided: nurse internship/residency programmes (14) and graduate nurse orientation programmes (7), preceptorship (4), simulation (3) and mentoring (2), final year nursing students transition programs (2) and externship (1).Outcomes were categorised as being important to the employer (recruitment, retention, turnover rates, competence, confidence and costs), or to the new graduate (stress and anxiety reduction, job satisfaction, knowledge/skills acquisition, critical thinking and interpersonal skills, confidence and professional nursing behaviours).

CONCLUSIONS

The range of outcomes reported across the studies made it difficult to report firm conclusions. A general increase in level of confidence was noted, along with reduction in stress and anxiety. Some success in relation to increases in knowledge, critical thinking and levels of job satisfaction were reported. A number of studies reported a V shaped pattern (initial high levels, dipping at 6 months and then reverting to baseline levels) for autonomy, job satisfaction, and professional transition. Research relating to improvements in retention and reduction in turnover was generally poor.

IMPLICATIONS FOR PRACTICE

The overall impact of intervention programmes appears positive, irrespective of the intervention. This may suggest that it is the organisation's focus on new graduate nurses with support from colleagues that is important. .Mentors/preceptors need to be adequately prepared for the role.

IMPLICATIONS FOR FUTURE RESEARCH

Future research should build on the strengths and limitations of the current studies. A lack of experimental studies means there is commonly little control over other variables that might influence the outcome. There is a need for larger studies using more objective and reliable measures.

A comprehensive systematic review of the use of simulation in the continuing education and training of qualified medical, nursing and midwifery staff

BACKGROUND

Simulation can be defined as a person, device or set of conditions made to resemble a real life situation. It is used in many high-risk industries particularly when reality is dangerous, critical events are rare and errors are costly in human and/or financial terms. The use of simulation in the UK is now considered an essential component of education programmes designed for healthcare practitioners. However the use of simulation in undergraduate education has been studied in depth but little is known about its use in postgraduate education.

OBJECTIVE

The aim of this systematic review was to establish: where and in which context is simulation an effective educational medium in post qualifying/continuing education; what is the benefit to learners of using simulation in respect of their knowledge, skills and confidence and what are the implications for future research in this area?

INCLUSION CRITERIA

This review looked for both quantitative and qualitative evidence in the form of primary research.The review focused on post qualification medical, nursing and midwifery staff undertaking educational development programmes utilising simulation. Types of interventions: the intervention explored in this review is simulation in the form of the re-creation of a patient centred scenario / event in a realistic context. The review explicitly excluded simulation designed to specifically to improve motor skills in isolation from context, such as part task trainers.

TYPES OF OUTCOME MEASURES

The outcome measures to be explored in this review were: demonstration of the application of knowledge to the simulated clinical situation; demonstrable improvement in knowledge of the environment and equipment; demonstration of risk assessment; safe working practice in relation to the clinical environment; recognition of own limitations and knowing when to call for help; effective communication; team working and leadership skills; evidence from learners in relation to the educational experience; evidence of increased learner confidence following simulated practice; evidence of improved patient outcome being assessed in relation to training SEARCH STRATEGY: The search strategy aimed to find both published and unpublished English language studies from 1998-2009. Databases systematically searched included: Medline, CINAHL, EMBASE, ERIC and the Dissertation Abstracts International Proceedings.

METHODOLOGICAL QUALITY

Papers were assessed for methodological quality independently by two of the review team. Critical appraisal of methodological quality of papers was undertaken using the Joanna Briggs Institute modules, Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Qualitative Assessment and Review Instrument (JBI-QARI). Differences in judgment were resolved through discussion between the two reviewers of their differences and through the inclusion of a third reviewer if necessary in order to reach consensus. A fifth member of the team independently reviewed all included and excluded studies as a quality control mechanism.

DATA COLLECTION

The process of data extraction was undertaken independently by two reviewers using the JBI data extraction tools.

DATA SYNTHESIS

A statistical meta-analysis of the data was not possible due to the variation in outcome measures used in the papers. The findings are therefore presented descriptively using the specified outcome measures as a reporting framework.

RESULTS

The initial search identified 1522 papers. Thirty eight papers were considered to have met the inclusion criteria and were subsequently critically appraised for methodological quality. Thirty papers were considered to be of appropriate quality for inclusion in the review. These were predominantly experimental pre post test studies but they covered a wide range of healthcare workers and situations.

CONCLUSION

There is considerable evidence that suggests that simulation based educational programmes are consistently effective in improving the performance of doctors, nurses and midwives in educational contexts particularly in teamwork and communication. There is also evidence that practitioners value simulation as a learning and teaching strategy. There is however very little evidence to support the assumption that improvements in performance are translated into "real life" clinical settings and ultimately outcomes for service users.

IMPLICATIONS FOR PRACTICE

Although the evidence base provided by this review is relatively weak in terms of educational practice it would seem to have high face validity. The evidence has added coherence when seen in the context of educational theory and those planning educational programmes for healthcare practitioners should be cognizant of the potential benefits offered by simulation as part of a blended approach to learning.

IMPLICATIONS FOR RESEARCH

This review has identified a clear need to establish causative links between simulation based educational programmes and improvements in healthcare practice, by using experimental designs where simulation is compared with other educational interventions.