International overview of high-level simulation education initiatives in relation to critical care

Twelve tips for developing and implementing an effective critical care simulation programme

Simulation training in healthcare settings has become a valuable training tool. It provides an ideal formative assessment for interdisciplinary teaching. It provides a high fidelity and highly immersive environment where healthcare staff and students can practice developing their skills in a safe and controlled manner. Simulation training allows staff to practice skills that better prepare them for clinical emergencies, therefore possibly optimising clinical care. While the benefits of simulation education are well understood, establishing a programme for use by critical care staff is complex. Complexities include the highly specialised scenarios that are not typically encountered in non-critical care areas, as well as the need for advanced monitoring equipment, ventilation equipment etc. These 12 tips are intended to assist healthcare educators in navigating the complexities in the establishment of a critical care simulation programme, providing advice on selecting target audiences, learning outcomes, creating a critical care simulation environment and recommendations on evaluation and development of the programme.

Development and validation of assessment instruments for cervical collar and spinal board placement in simulated environments for nursing students in the care of polytrauma patients

BACKGROUND

Multiple trauma injuries are the leading cause of death and disability in people under the age of 45 and require prompt and specialised care. However, medical and nursing education programmes do not always include specific training in emergency pre-hospital care, resulting in a lack of basic practical skills in trauma management.

OBJECTIVE

To develop and validate two instruments for assessing nursing students' competence in cervical collar and spinal board application in simulated pre-hospital emergency scenarios.

METHOD

This is an instrumental study that involves the development of two assessment instruments and the evaluation of their psychometric properties in a sample of 392 nursing students. Content validity was assessed using expert judgement, by calculating the content validity ratio (CVR) for each item and the scale level content validity index average (S-CVI/Ave) for the instruments. Exploratory factor analysis using the MINRES extraction method and Promax rotation was performed to analyse the performance of the items and structure of the rubrics. Internal consistency was analysed using the Omega coefficient and inter-rater agreement was assessed using Cohen's Kappa coefficient.

RESULTS

Initially, two rubrics were obtained: one with six items for cervical collar placement (S-CVI/Ave = 0.86) and one with nine items for spinal board placement (S-CVI/Ave = 0.81). Both had a single-factor structure, with all items having factor loadings greater than 0.34 for the cervical collar rubric and 0.56 for the spinal board rubric, except for item 2 of the cervical collar rubric (λ = 0.24), which was subsequently removed. The final cervical collar rubric (five items) had an overall internal consistency of 0.84 and the spinal board rubric had an overall internal consistency of 0.90, calculated using the Omega statistic. The weighted Kappa coefficient for each item ranged from acceptable (0.32) to substantial (0.79). These results show that we have successfully developed two sufficiently valid instruments to assess the immobilisation competencies proposed in the objective of the study.

CONCLUSION

Whilst further research is needed to fully establish their psychometric properties, these instruments offer a valuable starting point for evaluating nursing students' competence in cervical collar and spinal board application in simulated pre-hospital scenarios.

Korean Nursing Students' Experiences of Virtual Simulation Programs Replacing In-Person Mental Health Nursing Practicum during the COVID-19 Pandemic

This qualitative study explored the experiences of nursing students whose clinical practice in mental health nursing had been substituted with virtual simulation programs due to the COVID-19 pandemic. The participants were ten nursing students who had undergone a virtual simulation program-centered practice, replacing the traditional clinical practice in mental health nursing and previous clinical practice in mental health nursing. The data were collected through in-depth individual interviews from January to February 2021. Following Braun and Clarke's method, the thematic analysis identified five themes and ten sub-themes. The five themes included the following: (1) lack of vibrancy in the actual clinical setting, (2) limited direct and indirect practical experience, (3) performing diverse roles in a virtual setting, (4) learner-directed practicum, and (5) sense of relief due to a safe virtual practicum environment. The participants recognized the limitations of the practice, particularly regarding communication with patients with mental disorders in the virtual simulation program. However, their perception of nursing underwent a positive change through the indirect clinical practice experience. Accordingly, it is necessary to develop a platform for the mental health nursing practicum that can easily interact with clients and to establish a hybrid practice that combines the clinical practice and virtual simulation practice.

3D-Printing-Based Fluoroscopic Coronary Angiography Simulator Improves Learning Capability Among Cardiology Trainees

Aim

One of the essential competencies of cardiology trainees is the ability to perform coronary angiography with good projection.

Purpose

This study is a research and development study aimed at testing the effectiveness of 3D-printing-based fluoroscopic coronary angiography simulator as a learning medium for diagnostic coronary angiogram.

Methods

Thirty-four cardiology trainees randomly were divided into two groups. Both groups took a pretest before the intervention. The first group (group A) studied using conventional learning media and underwent the first post-test. Afterward, they switched to a 3D-printing-based fluoroscopic coronary angiography simulator and underwent a second post-test. The second group (group B) studied using a 3D-printing-based fluoroscopic coronary angiography simulator, underwent the first post-test, switched to the conventional learning media, and underwent a second post-test.

Results

The delta between the post-test I and the pretest of group B was 8.53, higher than the delta between the post-test I and the pretest of group A (5.21) with a significant difference (p = 0.003). In group A, the delta between post-test II and pretest was 9.65, higher than the delta between post-test I and pretest (5.21) with a significant difference (p < 0.001).

Conclusion

3D-printing-based fluoroscopic coronary angiography simulator is effective as a learning medium for coronary angiogram diagnostics.

Simulation-based education: deceiving learners with good intent

The level of performance of every clinician and of the overall multiprofessional team relies on the skills and expertise they have individually and collectively acquired through education, training, self-directed learning, and reflection. Simulation-based education (SBE) is playing an increasingly important role in that respect, and it is sometimes said that it is an art to facilitate. Many explanations can justify this assertion. Although there is generally an emphasis on making everything as realistic or "high-fidelity" as possible, it is often futile and this is where the art of simulation comes into play with an element of modulation of realism linked to the intended learning objectives. The atmosphere created by the educators; how the learners are made to engage and interact; how physical, technical, and contextual elements are simulated or represented; and what type of technology is used need to be appropriately adapted to contribute to the immersiveness of any SBE activity. Although it inevitably carries a negative connotation, some form of "deception" is more commonly used than one may think for the benefit of learners during SBE. High levels of realism are sometimes achieved by making learners believe something works or reacts as would be expected in real life, whereas it is achieved in a totally different manner. Learners do not need to know, see, or understand these "tricks of the trade", shortcuts, or artistic or technological aspects, and this can be considered a form of benevolent deception. Similarly, information may be withheld to recreate a realistic situation and push learners to demonstrate specific learning outcomes, but it needs to be practised with caution and be justifiable. These forms of "positive" deception are part of most SBE activities and are used to help learners bridge the reality gap so they can suspend disbelief more easily, exercise critical thinking, and treat the simulation more realistically without damaging the trust they place in their educators. This article will discuss how aspects of SBE activities are often manipulated, modified, or hidden from learners to facilitate the learning experience and present a simulation fidelity model encompassing the environmental, patient, semantical, and phenomenal dimensions.

A Review of Human Circulatory System Simulation: Bridging the Gap between Engineering and Medicine

(1) Background: Simulation-based training (SBT) is the practice of using hands-on training to immerse learners in a risk-free and high-fidelity environment. SBT is used in various fields due to its risk-free benefits from a safety and an economic perspective. In addition, SBT provides immersive training unmatched by traditional teaching the interactive visualization needed in particular scenarios. Medical SBT is a prevalent practice as it allows for a platform for learners to learn in a risk-free and cost-effective environment, especially in critical care, as mistakes could easily cause fatalities. An essential category of care is human circulatory system care (HCSC), which includes essential-to-simulate complications such as cardiac arrest. (2) Methods: In this paper, a deeper look onto existing human circulatory system medical SBT is presented to assess and highlight the important features that should be present with a focus on extracorporeal membrane oxygenation cannulation (ECMO) simulators and cardiac catheterization. (3) Results: A list of features is also suggested for an ideal simulator to bridge the gap between medical studies and simulator engineering, followed by a case study of an ECMO SBT system design. (4) Conclusions: a collection and discussion of existing work for HCSC SBT are portrayed as a guide for researchers and practitioners to compare existing SBT and recreating them effectively.

Management of the deteriorating adult patient: does simulation-based education improve patient safety?

Failure to recognise the deteriorating patient can cause severe harm and is related to preventable death. Human factors are often identified as contributing factors. Simulation-based education is used to develop clinicians' human factors skills. This article discusses the evidence concerning the efficacy of simulation-based education for improving the recognition and management of the acutely deteriorating adult patient, and the limitations of simulation-based education. Findings demonstrated simulation-based education was the most effective educational method identified for training staff in recognising unwell patients. The evidence demonstrating the impact of simulation-based education on patient outcomes was equivocal. The quality of the evidence was low grade regarding the efficacy of simulation-based education on human factors. Further research is required to confirm the efficacy of simulation-based education for human factors and patient outcomes.

Clinical simulation in nursing education in intensive therapy: an integrative review

OBJECTIVE

to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care.

METHOD

an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017.

RESULTS

29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years.

CONCLUSION

variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.

Research Priorities of Clinical Nurses and Midwives in the Eastern Mediterranean Region: a Mixed Methods Study

Effective use of resources in healthcare research is essential in meeting the United Nation's Sustainable Development Goal (SDG) 3 to achieve universal health coverage, increase retention of healthcare workers, and strengthen the capacity of all countries to reduce risk and manage global health risks; the World Health Organization (WHO) also identifies nursing research as an important piece of the framework for improving global healthcare. Determining research priorities to reduce redundancy and ensure a solid evidence base for practice is especially critical in resource-limited countries or those facing healthcare crises such as those in the Middle East. To identify regional research priorities for nursing, focus group discussions composed of hospital-based nurses were conducted in Egypt, Oman, and Saudi Arabia. Forty-eight percent of research priorities were nearly the same as those identified as critical by regional nursing leadership in a previous study, demonstrating consistency between clinician- and administrator-identified research priorities, and suggesting healthcare administrators are well attuned to the research needs of clinicians. Both groups identified critical gaps in population and community health research. Across countries, research priorities identified were related to nursing workforce, health systems research, and quality of care, representing critical issues needing investigation to build a solid evidence base for nursing practice.

Patients with chronic conditions: simulate to educate?

Simulation in healthcare in an way to train professionals but it is not yet use commonly to train patient or their caregivers. Recently, it has been suggested to extend simulations to patients with chronic conditions. Simulations could help patients and caregivers to acquire psychosocial and self-management skills. This approach proved to be effective for the training of healthcare professionals, but its transferability to patients needs to be evaluated. Already, several questions arise. However, by considering simulations as pretexts for debriefing, they enable patients and professionals to assess a concrete situation, implying voluntary and reflexive learning processes. Thus, video recording should be assessed for its role in patient metacognition, defined as knowing about knowing. A taxonomy for simulations dedicated to patients, like that already developed for healthcare professionals, should be considered. Although practical constraints must be identified and addressed, they should not be the primary issue guiding research. The transferability of simulation as an educational technique from professionals to patients and caregivers should be investigated essentially in order to provide a significant benefit to patients.

Using Generalizability Theory to Inform Optimal Design for a Nursing Performance Assessment

The promotion of competency of nurses and other health-care professionals is a goal shared by many stakeholders. In nursing, observation-based assessments are often better suited than paper-and-pencil tests for assessing many clinical abilities. Unfortunately, few instruments for simulation-based assessment of competency have been published that have undergone stringent reliability and validity evaluation. Reliability analyses typically involve some measure of rater agreement, but other sources of measurement error that affect reliability should also be considered. The purpose of this study is three-fold. First, using extant data collected from 18 nurses evaluated on 3 Scenarios by 3 Raters, we utilize generalizability (G) theory to examine the psychometric characteristics of the Nursing Performance Profile, a simulation-based instrument for assessing nursing competency. Results corroborated findings of previous studies of simulation-based assessments showing that obtaining desired score reliability requires substantially greater numbers of scenarios and/or raters. Second, we provide an illustrative exemplar of how G theory can be used to understand the relative magnitudes of sources of error variance-such as scenarios, raters, and items-and their interactions. Finally, we offer general recommendations for the design and psychometric study of simulation-based assessments in health-care contexts.

Does simulation enhance nurses' ability to assess deteriorating patients?

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care.

Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region

PURPOSE

As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region.

DESIGN

A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016.

METHODS

Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau.

FINDINGS

Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections.

CONCLUSIONS

Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives.

CLINICAL RELEVANCE

Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.

Satisfaction and gains perceived by nursing students with medium and high-fidelity simulation: A randomized controlled trial

BACKGROUND

The use of simulation to reproduce the experience of health care settings and its use as a strategy in the teaching of nurses has grown at an unprecedented rate. There is little scientific evidence to examine the differences in satisfaction and gains perceived by the students with the use of medium and high fidelity.

OBJECTIVES

To analyse and benchmark gains and satisfaction perceived by nursing students, according to their participation in medium- and high-fidelity simulated practice.

DESIGN

Randomized control trial post-test only design with control group.

SETTING AND PARTICIPANTS

Students of the 4th year of the Bachelor's Degree in Nursing who performed medium and high-fidelity simulated practice in a Simulation Centre environment.

METHODS

A satisfaction scale and a scale of perceived gains from the simulation were applied to the students who underwent simulated practice in a medium-fidelity environment (control group) and high-fidelity environment (experimental group). Statistical analysis was performed and a significance level of p<0.05 was established.

RESULTS

Of the 85 students who participated in the study, the majority were female (92.94%), with an average age of 21.89years (SD=2.81years). Satisfaction is statistically significant in the realism dimension and overall satisfaction. In the gains perceived with the simulation there is a statistically significant difference in the dimension recognition/decision.

CONCLUSION

Students are very satisfied with the realism of high-fidelity simulated practice and consider that this helps them more with recognition and decision compared with the medium-fidelity simulation.