High-fidelity simulation and nursing students' anxiety and self-confidence: A systematic review

The effectiveness of simulation-based learning (SBL) on students' knowledge and skills in nursing programs: a systematic review

BACKGROUND

Simulation-Based Learning (SBL) serves as a valuable pedagogical approach in nursing education, encompassing varying levels of fidelity. While previous reviews have highlighted the potential effectiveness of SBL in enhancing nursing students' competencies, a gap persists in the evidence-base addressing the long-term retention of these competencies. This systematic review aimed to evaluate the impact of SBL on nursing students' knowledge and skill acquisition and retention.

METHOD

A comprehensive search of electronic databases, including CINAHL, PubMed, Embase, Scopus, and Eric, was conducted from 2017 to 2023 to identify relevant studies. The Joanna Briggs critical appraisal tools were used to assess the methodological quality of the included studies. A total of 33 studies (15 RCTs and 18 quasi-experimental) met the inclusion criteria and were included in the review. A descriptive narrative synthesis method was used to extract relevant data.

RESULTS

The cumulative sample size of participants across the included studies was 3,670. Most of the studies focused on the impact of SBL on life-saving skills like cardiopulmonary resuscitation (CPR) or other life-support skills. The remaining studies examined the impact of SBL on critical care skills or clinical decision-making skills. The analysis highlighted consistent and significant improvements in knowledge and skills. However, the evidence base had several limitations, including the heterogeneity of study designs, risk of bias, and lack of long-term follow-up.

CONCLUSION

This systematic review supports the use of SBL as a potent teaching strategy within nursing education and highlights the importance of the ongoing evaluation and refinement of this approach. While current evidence indicates enhancing knowledge and skill acquisition, limited studies evaluated the retention beyond five months, constraining generalisable claims regarding durability. Further research is essential to build on the current evidence and address gaps in knowledge related to the retention, optimal design, implementation, and evaluation of SBL interventions in nursing education.

The effect of simulation-based learning on nursing students' clinical decision-making skills: Systematic review and meta-analysis

BACKGROUND

Simulation-based education methods improve nursing students' clinical decision-making skills. It allows students to experience situations they may not encounter in a real clinical environment.

OBJECTIVES

The aim of this systematic review was to better understand the effectiveness of simulation-based education on clinical decision-making skills in undergraduate nursing students.

DESIGN

Meta-analysis of randomized controlled trials and quasi-experimental studies.

DATA SOURCES

The review included fourteen studies obtained by scanning the PubMed, EBSCO (Medline, CINAHL), OVID, Web of Science, and Cochrane databases.

REVIEW METHODS

Three authors independently screened the literature, extracted data, and assessed the quality of the included studies. The methodological quality of the studies was assessed with the Critical Appraisal Checklists for experimental and quasi-experimental studies developed by the Joanna Briggs Institute. Standardized mean difference with 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were performed with Review Manager 5.4 software.

RESULTS

In this study, 1614 records were reached as a result of the first screening. After examining the titles and removing duplicate articles and other articles that did not meet the research criteria according to the abstracts, 48 articles were included in the full-text analysis. Three researchers read the studies (n = 48) eligible for evaluation, and 14 (n = 14) studies suitable for full-text review met all of the listed inclusion criteria and were included in the meta-analysis.

CONCLUSION

The analysis revealed that simulation-based educational practices appeared to improve undergraduate nursing students' clinical decision-making skills.

Responding to In-hospital Cardiac Arrests During Times of System-wide Strain: A Code Refresher Training

BACKGROUND

Pandemic conditions of system-wide strain are associated with increased rates of in-hospital cardiac arrest (IHCA). During normal times, medical-surgical nurses may forget cardiopulmonary resuscitation (CPR) skills as soon as 3 months after training, leaving them unprepared and anxious about managing cardiac arrests. During pandemic surges, heightened anxiety can also impact concentration and confidence.

METHOD

Clinicians offered a 45-minute mock code training refresher for medical-surgical nurses to improve confidence performing CPR while adhering to pandemic-related safety procedures. In this pre-post clinical education project, nurses' confidence was measured with the Nursing Anxiety and Self-Confidence with Clinical Decision Making© Scale.

RESULTS

Although the results were not statistically significant, participants verbally reported increased confidence to initiate resuscitation, collaborate with team members, and use personal protective equipment during the posttraining debrief.

CONCLUSION

A high percentage of RNs do not have adequate confidence and/or competence in performing CPR, particularly during times of system-wide strain, and this brief, inexpensive refresher training warrants further study. [J Contin Educ Nurs. 2024;55(9):442-448.].

Acquisition of Behavioral Skills after Manikin-Based Simulation of Neonatal Resuscitation by Fellows in Neonatology

OBJECTIVE

Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation.

STUDY DESIGN

From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation.

RESULTS

Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance.

CONCLUSION

An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training.

KEY POINTS

· Simulation training should improve technical and behavioral skills of providers. · Behavioral skills improve after a first cycle of training, but not after a repeat cycle. · Anxiety modulates trainees' behavioral performance.

Impact of Nursing Clinical Elective Courses on New Graduate Nurses' Clinical Practice: A Mixed-Methods Descriptive Study

BACKGROUND

Clinical elective courses provide additional specialty knowledge for prelicensure nursing students; however, it is unknown how these courses impact nurses' clinical practice after graduation.

PURPOSE

To describe how clinical nursing electives impact graduates' clinical practice.

METHODS

A mixed-methods descriptive design was used. Students who graduated from a prelicensure nursing program were sent an electronic survey and participated in qualitative interviews.

RESULTS

Thirty-three graduates completed the survey, with 9 participating in interviews. Sixteen graduates worked in the clinical practice areas that were the same, or related to, the clinical elective they took. Many graduates felt that taking the elective course improved their confidence in the clinical setting and provided increased knowledge that put them at an advantage over their peers.

CONCLUSION

Clinical electives may offer a means to meet health care system needs by preparing a more confident, knowledgeable new graduate in specialty areas in which nurses are needed most.

Nursing Students' Attitudes Toward Technology: Multicenter Cross-Sectional Study

BACKGROUND

The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students' attitudes toward technology could be investigated to assess their needs regarding this proficiency.

OBJECTIVE

This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes.

METHODS

Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences.

RESULTS

In total, 646 students answered the questionnaire-342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students' technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=-0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=-0.196; ρSwedish=-0.262; ρPolish=-0.133) and with the perceived skill in using computer devices (P<.001; ρall=-0.209; ρSwedish=-0.347; ρPolish=-0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=-0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively).

CONCLUSIONS

This study highlights nursing students' techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care's increasing reliance on technology, integrating health technology-related topics into education is crucial for future professionals to address health care challenges effectively.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14643.

Perspectives of Nursing Students on Hybrid Simulation-Based Learning Clinical Experience: A Text-Mining Analysis

Given the past limitations on clinical practice training during the COVID-19 pandemic, a hybrid format program was developed, combining a time-lapse unfolding case study and high-fidelity simulation. This study assesses the effectiveness of a new form of clinical training from the perspective of student nurses. A questionnaire was administered to 159 second-year nursing students enrolled in the "Basic Nursing Practice II" course. Text mining was performed using quantitative text analysis for the following items: (1) aspects that were learned more deeply, (2) benefits, and (3) difficulties encountered with the new practice format. The new clinical practice format enhanced participants' learning related to the daily changes required in nursing care and improved their nursing competency through simulated patient interactions. However, the participants faced difficulties dealing with patients accompanied by secular changes. Moreover, they found remote group work challenging. These findings can be applied to the development of new educational strategies.

Approaches for boosting self-confidence of clinical nursing students: A systematic review and meta-analysis

Background

Self-confidence is a key element in successfully promoting achievement strivings among the healthcare workforce. Targeted interventions can strengthen this characteristic in nursing students, thus improving the quality of hospital services.

Objectives

We evaluated the effect of educational interventions on boosting self-confidence in nursing students using systematic review and meta-analysis.

Methods

A comprehensive search was used to screen the related studies in Scopus, PubMed, Embase, Web of Science, and PsycINFO. Peer-reviewed literature in English until June 2023 was reviewed. Inclusion criteria were controlled trials, either non-randomized studies of intervention (NRSI) or randomized (RCTs). Studies were assessed for methodological quality by the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and the Cochrane "Risk of Bias" tool for RCTs (RoB 2.0) and quality assessment tool for before-after (pre-post) studies with no control group. The main outcome was the self-confidence score of nursing students because of educational methods or intervention/s. Using the inverse variance weights method, a pooled standardized mean difference (SMD) estimate with a corresponding 95% confidence interval (CI) was determined. Random-effects meta-analysis was used to assess conceptual heterogeneity using Stata.

Results

Twenty-two studies were selected involving 1758 participants and 940 cases of nursing students in the intervention group on boosting self-confidence (Fourteen Randomized controlled trials, Five Quasi-experimental, and three Before-After studies). The post-intervention self-confidence results in the nursing student's intervention group were significantly greater (SMD) (SMD for Controlled experimental design = 0.51; 95% CI = 0.14-0.89), (SMD for Quasi-experimental = 0.04; 95% CI = -0.33-0.41), (SMD for Before-After (Pre-Post) = 2.74; 95% CI = 1.85-3.63). The random-effect meta-analysis of 22 interventional studies determined that educational interventions are significantly associated with the improving self-confidence of nursing students. The intervention showed a moderate impact on the research units, according to Cohen's d results. Also, the results of simulation learning intervention (SMD = 0.42; 95% CI = 0.03-0.81) showed a significant relationship between intervention and outcome in studies.

Conclusions

Analysis of our findings revealed the successful impact of most interventional approaches in boosting self-confidence, especially in the long term. It can be concluded that self-confidence is a multifactorial concept that can be improved by using targeted combination intervention strategies.

Benefits of simulation for ultrasound-guided midline placement training: MC-in-Sim pilot study

INTRODUCTION

Ultrasound-guided placement of Midlines catheters (MCs) is a standard procedure with many benefits for patients. Even if there are some guidelines worldwide, this invasive technique is still taught at the patient's bed and relies on mentoring in many care centers. The performance of this care by novice practitioners raises ethical and quality of care issues mainly because of its risk of complications. This study aimed to propose and assess a simulation-based learning method for the placement of MCs in novice practitioners.

METHODS

A single-center prospective observational study was conducted with anesthesia residents who had no prior experience of Midline placement. Two workshops were planned. The first one consisted of a theoretical training and a simulated practical phase. The second workshop included an assessment of theoretical memorization, a practical exercise and adherence to the training program.

RESULTS

The median score of the theoretical memorization was 14.6 (interquartile range [IQR]: 13.5-15.8). The MCs placement time was significantly higher (Med: 12.23 min; IQR: 12.21-12.80) for novice practitioners who did not successfully complete solo MCs placement in simulation versus novice practitioners who successfully completed solo MCs placement in simulation 6.66 min (IQR: 5.92-8.93) (p = 0.002). The number of attempts was significantly higher (p = 0.034) for the novice practitioners who did not successfully complete solo MCs placement in simulation with 67% having performed three punctures, against 0% for the novice practitioners who successfully completed solo MCs placement in simulation. All novice practitioners found this training model efficient for learning how to place MCs and considered it allows for reproducibility in care situations.

CONCLUSION

This ultrasound-guided MCs training on simulation is an agile and fast alternative to traditional bedside training for anesthesia novice practitioners.

Comparing the effect of assessment-simulation-animation-based against traditional education on nursing students' anxiety and self-efficacy in maternity clinical practicum

BACKGROUND

The clinical practicum is the practical course that causes the most anxiety in nursing undergraduates. Although high-fidelity simulation education has been demonstrated to boost nursing students' self-efficacy and decrease anxiety in patient care, it is also associated with excessive psychological stress. Assessment-simulation-animation-based (ASA-based) education has been developed to solve the drawbacks of simulation-based education while preserving positive learning outcomes.

OBJECTIVES

To compare the effects of ASA-based education and traditional education in reducing anxiety and improving self-efficacy of junior nursing students in their maternity clinical practicum.

DESIGN

This study used a two-group pre-post quasi-experimental design. The comparison group was studied first followed by the experimental group.

SETTINGS

Department of Nursing and affiliated medical center at a medical university in southern Taiwan.

PARTICIPANTS

We enrolled 114 junior nursing students from two different class years.

METHODS

A convenience sample of junior nursing students was used in this study, with 55 in the experimental group and 59 in the comparison group. The intervention included online ASA-based education videos with pamphlets and was conducted three days a week for five weeks encompassing the maternity nursing clinical practicum. We developed and applied the Clinical Situation Anxiety Scale (CS-AS) and Clinical Situation Self-Efficacy Scale (CS-SES) before and after the intervention. Qualitative feedback was assessed after the intervention. Data were collected from both the comparison and experimental groups during the fall and spring terms of both the 2019-2020 and 2020-2021 academic years.

RESULTS

Compared with the comparison group, the total CS-AS and CS-SES scores significantly improved from before to after the intervention in the experimental group. The students responded to the intervention by demonstrating clinical consistency, knowing what to do and how to do it and more confidently practicing health education.

CONCLUSION

Our results suggest that ASA-based education with videos and pamphlets contributed to reducing anxiety and increasing self-efficacy in nursing students during their maternity clinical practicum.

Effects of simulation-based education module on delirium care in undergraduate nursing students: A quasi-experimental study

AIM

To examine the effects of a delirium education module on undergraduate nursing students' knowledge of and perceived confidence and competence in delirium care.

BACKGROUND

Delirium is common in intensive care units (ICUs) and leads to poor clinical outcomes. The under recognition of delirium is a major problem in ICU medicine. Nurses, as first-line health care providers, can address this by recognizing patients who are experiencing delirium. Since undergraduate nursing students will be the future ICU nurses, it is important to deliver the knowledge regarding delirium care. However, education about assessing delirium in ICUs among undergraduate nursing students is lacking.

DESIGN

Quasi-experimental study.

METHODS

A total of 74 undergraduate students were divided into an intervention group (n=34) and a comparison group (n=40). A 2-hour simulation-based delirium education module integrated into a critical care curriculum was delivered to the intervention group only. The classroom-based intervention was administered at a medical university in northern Taiwan. Study outcomes were measured using a structured survey including (1) a 16-item delirium care knowledge quiz, (2) confidence in delirium care scale and (3) competence in delirium care scale. The survey was distributed to students before and after the module in December 2020. The Mann-Whitney U test, chi-square test and Fisher's exact test were adopted to test the differences of all variables between groups. A generalized estimating equation model was used to investigate the adjusted treatment effects.

RESULTS

The participants had a median age of 22 years and 81% were female. The delirium education module yielded greater knowledge (B = 3.04, 95% confidence interval = 2.20-3.88), confidence (B = 4.20, 95% confidence interval = 2.67-5.73) and competence (B = 4.82, 95% confidence interval = 3.33-6.30) in delirium care when the treatment and control groups were compared.

CONCLUSIONS

For undergraduate nursing students, simulation-based education module is effective in improving the knowledge of and confidence and competence in delirium care. It is recommended that this be included in critical care nursing curricula.

Health-related behaviors and symptoms of anxiety and depression in Spanish nursing students: an observational study

Background

Symptoms of anxiety and depression are prevalent among young adults and are a significant public health issue. College students are at a higher risk of experiencing poor mental health than other young people due to several factors, including moving away from home, financial pressures, heavy workload, poor time management skills, competitivity, new processes of socialization and insufficient coping mechanisms, among others. In addition, nursing students' mental and physical health may also be affected by unhealthy lifestyle habits and health-related behaviors.

Aim

To determine the prevalence of symptoms of depression and anxiety, and the association between these symptoms and health-related behaviors, in a population of Spanish student nurses.

Methods

Cross-sectional study on a sample of 339 nursing students. We used the Hospital Anxiety and Depression Scale, the International Physical Activity Questionnaire-Short form, the Spanish Healthy Eating Index and an "ad hoc" questionnaire for sociodemographic variables. The association between psychological symptoms and health-related behaviors was analyzed through binary logistic regression models.

Results

The prevalence of symptoms of depression and anxiety was 3.8% and 24.5%, respectively. Negative health-related behaviors were frequent, namely tobacco and alcohol consumption, suboptimal physical activity and diet. Moderate physical activity was associated with a lower probability of experiencing depressive symptoms. Symptoms of anxiety were related to a low level of physical activity, an unhealthy diet and alcohol consumption ≥2 times a week.

Conclusion

Student nurses could benefit from the implementation of both physical and mental health promotion initiatives.

Virtual reality and critical care education in nursing: A cross-sectional study

BACKGROUND

The nursing care of a critically ill patient in the intensive care unit requires specific training. Virtual reality can facilitate the nursing assessment of critically ill patients.

OBJECTIVE

To evaluate the utility of virtual reality as a tool for teaching nursing assessment of critically ill patients.

DESIGN

This is a cross-sectional study.

SETTING

University of the Balearic Islands (Spain) during the 2022 academic year.

PARTICIPANTS

Third-year nursing students.

METHODS

A specific environment was designed for virtual reality immersion using a BNEXT head-mounted display. Data were collected using three questionnaires: perception of self-efficacy regarding skill-acquisition in the nursing care process; immersivity; utility and tool satisfaction.

RESULTS

A total of 111 undergraduated nursing students responded, 86.8 % of whom had no previous intensive care units experience. They rated the virtual reality experience positively for learning the nursing care process, emphasising the need for skin and mucosal hygiene, patient mobilisation and family care, as well as an understanding of the therapeutic technology required. A total of 67.6 % felt as though they were physically present. They reported a high degree of acceptance and satisfaction.

CONCLUSIONS

Virtual reality has facilitated the exposure of students to an unfamiliar environment such as the intensive care units, proving to be useful, satisfying, and motivating in teaching the nursing care process.

The effect of simulation-based advanced cardiac life support training on nursing students' self-efficacy, attitudes, and anxiety in Palestine: a quasi-experimental study

BACKGROUND

Cardiac Arrest (CA) is one of the leading causes of death, either inside or outside hospitals. Recently, the use of creative teaching strategies, such as simulation, has gained popularity in Cardio Pulmonary Resuscitation (CPR) instruction. This study aimed to assess the effect of High-Fidelity Simulation (HFS) training on nursing students' self-efficacy, attitude, and anxiety in the context of Advanced Cardiac Life Support (ACLS).

METHODOLOGY

The study design is quasi-experimental employing a pre-test and post-test approach during April and May 2023. A convenient sample of 60 undergraduate nursing students in a 4-year class from a nursing college at the Arab American University/ Palestine (AAUP) participated in this study. The data were analyzed using a paired sample t-test in SPSS program version 26. Three data collection tools were used pre- and post-intervention; the Resuscitation Self-Efficacy Scale (RSES), The Attitudinal instrument, and the State Anxiety Inventory (SAI).

RESULTS

The total number of nursing students was 60, out of them (56.7%) were female, while the mean age was (22.2) years. Improvements were seen in all four domains of self-efficacy following HFS training: recognition, debriefing, recording, responding and rescuing, and reporting. (t (59) = 26.80, p < 0.001, confidence interval [29.32, 34.05]). After receiving HFS training on ACLS, the post-intervention for the same group attitude scores significantly increased from 32.83 (SD = 15.35) to 54.58 (SD = 8.540) for emotion, from 6.72 (SD = 2.44) to 10.40 (SD = 1.40) for behavior, and from 7.03 (SD = 2.03) to 10.33 (SD = 1.42) for cognitive. The anxiety level decreased post-simulation from 3.53 (SD = 0.3) to 2.14 (SD = 0.65), which was found to be statistically significant (t(59) = 16.68, p < 0.001, 95% CI [1.22 to 1.55]). Female students (M = 73.18), students who observed a real resuscitation (M = 71.16), and who were satisfied with their nursing major (M = 72.17) had significantly higher self-efficacy scores post-simulation.

CONCLUSION

The HFS can be recommended as an effective training strategy among nursing students. The ACLS training-based HFS was effective in improving the students' self-efficacy and attitudes and decreasing their anxiety.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis

AIM

To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation.

REVIEW METHODS

This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods.

RESULTS

Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence.

CONCLUSIONS

Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions.

RELEVANCE TO CLINICAL PRACTICE

These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Workshop for Basic Gynaecological Examinations: Improving Medical Student Learning through Clinical Simulation

INTRODUCTION

This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical-practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations.

MATERIALS AND METHODS

This was a quasi-experimental pre-post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Marañón Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020-2021 and 2021-2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives.

RESULTS

Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020-2021 academic year and 80.6% of students in the 2021-2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical-practical knowledge (improvement mean = 1.38 and 1.21 in 2020-2021 and 2021-2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points.

CONCLUSIONS

Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.

Mock trial as a simulation strategy allowing undergraduate nursing students to experience evidence-based practice: A scoping-review

OBJECTIVE

The purpose of this scoping review was to determine the underlying design of simulations that help undergraduate nursing students acquire evidence-based practice (EBP) experiences.

METHOD

The JBI methodology was used for this review. The inclusion criteria were studies conducted in academic, clinical, or virtual settings that examined simulation programs designed to facilitate the acquisition of EBP by undergraduate nursing students. A comprehensive search was performed on Jan 3, 2022, using the Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), and the Excerpta Medica database (EMBASE). Grey literature was not included. Publication year was limited to 2020 and later. There was no language restriction. Data were extracted using a tool developed by the reviewers and based on the National League for Nursing Jeffries Simulation Theory.

RESULT

A total of 12,931 articles were found, and after duplicate articles and articles deemed ineligible based on the title and abstract (12,914 articles), 17 published papers were examined. The full texts of these studies were reviewed for eligibility, and one study was selected for the present scoping review. The selected study examined a mock trial designed to allow undergraduate nursing students to experience the ethical decision-making based on a diversity of evidence. The program reported in the study consisted of a prebriefing-simulation (mock)-debriefing structure with verified positive effects on EBP education.

CONCLUSION

A mock trial is a useful educational strategy for allowing undergraduate nursing students to experience EBP, but a creative method should be found that can modify the mock trial for practical operation as the designing the program demands high levels of human and material resources.

REGISTRATION

OSF Registries, https://osf.io/gdtyu, We updated OSF registry data for documenting important protocol amendments.

A protocol for a scoping review of the use of mental simulation and full-scale simulation in practising healthcare decision-making skills of undergraduate nursing students

AIM

This scoping review aims to explore the effect of FSS and mental simulation on the decision-making skills of nursing students.

BACKGROUND

Full-scale simulation (FSS) has been the most used simulation modality in nursing education due to its applicability to enhance both technical and non-technical skills. However, FSS can be excessively costly and other factors such as technophobia and lack of trained staff and support make FSS less accessible, especially for nursing education. Therefore, a novel mental simulation that is interactive and supported by visual elements can be a substitute for FSS, at least for some of the skills, such as clinical decision-making. Reviews comparing the effectiveness of FSS and mental simulation on decision-making skills in nursing students are lacking. Further knowledge on the effectiveness of these two modalities on decision-making skills for nursing students is needed to inform the nursing education curriculum and to decide between the two modalities.

DESIGN

This protocol adheres to the guidelines outlined in the PRISMA extension for scoping reviews (PRISMA-scr) checklist.

METHOD

The methodological framework for scoping reviews will be followed for this scoping review. Scopus, EBSCOhost the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE and for the grey literature ERIC and BASE will be searched for related studies. The search will be limited to January 2008 and April 2023 (up-to-date) and English. A detailed search strategy was developed with an experienced research information manager and this strategy will be adapted to each database. A single screening will be performed by an author who will screen all abstracts and titles and full-text publications. After the study selection step of the framework, the data from the included studies will be charted using a data extraction form. The data will be synthesised by comparing the effect of FSS and mental simulation on decision-making skills.

CONCLUSION

A synopsis of the publication on FSS and mental simulation on nurse students' decision-making skills will be useful for stakeholders when choosing between two modalities to deliver decision-making skills to nursing students and also help to inform the nursing education and simulation practice.

SCOPING REVIEW REGISTRATION

Protocols.io (doi: 10.17504/protocols.io.e6nvw57y7vmk/v1).

Constructing a Mixed Simulation With 360° Virtual Reality and a High-Fidelity Simulator: Usability and Feasibility Assessment

Virtual reality technology has been adopted to overcome barriers of conventional simulation. This study was conducted to determine the impact of mixed simulation (a 360° virtual reality and a high-fidelity simulator) on learning how to provide nursing care for patients with arrhythmia. A total of 49 students were randomly assigned to intervention (n = 25) and control (n = 23) groups. They were given four arrhythmia cases with a 360° virtual reality system first followed by a manikin-based simulation. The mixed simulation group showed greater improvement in knowledge, higher decision-making competency in "knowing and acting" ( P = .025) and "seeking information from instructors" ( P = .049), and lower anxiety in "using resources to gather information" ( P = .031). Study participants achieved a good level of empathy (3.28 ± 0.72) and liked the program (4.56 ± 0.60). They were satisfied with the program (4.48 ± 0.65). These findings provide new insight into learning through blending of new technology. When the 360° virtual reality was used with existing manikin-based simulation, they effectively reinforced one another. The 360° virtual reality can be an effective strategy to ensure active participation to gain a comprehensive understanding of and empathy for patients.

Psychological distress in nursing students: relationship with screen time, diet and physical activity

OBJECTIVE

to determine the prevalence of anxiety and depression symptoms, as well as their association with screen time, diet and physical activity, in a cohort comprised by nursing students.

METHOD

a descriptive and cross-sectional study conducted with a sample of 648 Nursing students. The instruments used were the Hospital Anxiety and Depression Scale, the short version of the International Physical Activity Questionnaire and the Spanish Healthy Eating Index (Índice de Alimentación Saludable Español, IASE). Different multiple linear regression models were performed to analyze the association between anxiety/depression symptoms and screen time, diet and physical activity.

RESULTS

the prevalence values for anxiety and depression symptoms were 24.1% and 3.7%, respectively. Prolonged screen times (>6 hours a day), low levels of physical activity and inadequate diet were independently and significantly associated with deeper psychological symptoms.

CONCLUSION

Nursing students' mental health might benefit from the implementation of initiatives promoting healthy lifestyles.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study

INTRODUCTION

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®".

OBJECTIVES

To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course.

METHODS

A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively.

RESULTS

Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®.

CONCLUSIONS

TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

Magnitude of general anxiety disorder among nursing students and its associated factors

Background

University training in nursing together with other student variables can increase the risk of anxiety in students. It is important to assess the student's level of anxiety, which can have repercussions on their training and mental health. There are several validated tools such as the generalized anxiety disorder scale (GAD-7).

Objective

To know which factors are associated with the appearance of anxiety and which protect against it in university nursing students.

Method

A cross-sectional descriptive study was carried out in which 170 university nursing students from University of Jaén participated. A bivariate and multivariate analysis was performed, calculating odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals (CIs) to determine which factors were associated with a higher score on the GAD-7 questionnaire, and therefore with the presence of anxiety.

Results

In total, 66.5% (113) of the students have suffered an anxiety crisis on some occasion and 48.8% (83) of the students did not carry out activities of any kind to control anxiety and stress. Practicing religious and spiritual beliefs increased the probability of having anxiety compared to those who did not have religious beliefs (aOR = 3.92; 95% CI = 1.09, 14.08), as well as having previously suffered an anxiety crisis (aOR = 5.13; 95% CI = 2.39, 11.04). Protective factors against anxiety appear to be second-year students (aOR = 0.33; 95% CI = 0.16, 0.72) and being deeply satisfied with the teaching staff (aOR = 0.03; 95% CI = 0.01, 0.79).

Discussion/Implications for practice

Knowing the factors that are associated with the appearance of anxiety is necessary to facilitate early detection and care in nursing university students.

Is Virtual Patient Simulation Superior to Human Patient Simulation: A Randomized Controlled Study

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

The Effect of Simulation on Newly Licensed Nurses' Confidence in Initiating Cardiopulmonary Resuscitation: A Narrative Review

Hospitalized patients experiencing cardiac arrest are more likely to receive resuscitative interventions such as cardiopulmonary resuscitation (CPR), advanced cardiac life support, and defibrillation, than patients who experience a cardiac arrest outside the hospital setting. Annually, there are nearly 290,000 inpatient cardiac arrests each year in the United States. These cardiac arrests are associated with a mean survival rate of only 25%. Increasing nurses' feelings of confidence in initiating CPR may lead to faster reaction times, shorter hospital stays, and improved patient outcomes. A narrative review of literature about the effectiveness of simulations on newly licensed nurses' perceived confidence in initiating CPR confidence levels yielded 16 articles.

Effectiveness of the SBAR-Based training program in self-efficacy and clinical decision-making of undergraduate anesthesiology nursing students: a quasi-experimental study

BACKGROUND

Structured Situation, Background, Assessment, and Recommendation (SBAR) training technique have been widely utilized in clinical and educational settings. Therefore, the current study investigated the effectiveness of an SBAR-based educational program in students' self-efficacy and clinical decision-making skills.

METHODS

This quasi-experimental study was conducted using a pretest and posttest design and a control group at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. A total of 70 three- and fourth-year students were recruited for the study using the census method. The students were randomly assigned to the intervention and control groups. The intervention group participated in an SBAR-based educational course consisting of eight sessions held in 4 weeks. Differences in the levels of self-efficacy and clinical decision-making skills before and after participation in the SBAR course were assessed and compared. Data were analyzed using descriptive tests, the Mann-Whiney U test, paired and independent t-tests, and the Wilcoxon test.

RESULTS

The intervention group demonstrated significantly higher levels of self-efficacy with a mean score of 140.66 ± 22.43 (P < 0.001) and clinical decision-making with a mean score of 75.31 ± 7.72 (P < 0.001); while in the control group, the mean score of self-efficacy and clinical decision-making skills was 85.34 ± 18.15 and 65.51 ± 4.49, respectively. Moreover, the Mann-Whitney U test showed that the levels of students' clinical decision-making skills were promoted to the next level after the intervention (P < 0.001); it means the distribution of the level of intuitive-interpretive skill was upgraded from 0 to 22.9%.

CONCLUSION

The SBAR-based training programs can promote the self-efficacy and clinical decision-making skills of anesthesiology nursing students. Considering the weakness of the anesthesiology nursing curriculum at the undergraduate level in Iran, it can be expected that the SBAR-based training course should be included as an educational intervention in the curriculum of anesthesiology nursing students.

The effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AIM

This study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students.

BACKGROUND

Clinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students' satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training.

DESIGN

The study was designed as a pragmatic randomized controlled trial.

SETTING

This study was conducted at a university in Turkey.

PARTICIPANTS

A total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44).

METHODS

The intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022.

RESULTS

This study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05).

CONCLUSION

The findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students' stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study

AIM

To evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students' generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants' satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module.

BACKGROUND

Following the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated.

DESIGN

A mixed methods study incorporating quasi-experimental and qualitative components.

METHODS

We recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants' post-intervention satisfaction, experiences and opinions.

RESULTS

Post-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings.

CONCLUSIONS

This study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students' learning outcomes. Further studies should include a control group, evaluate students' knowledge and skills, and retention of knowledge to confirm the true impact of such training.

[Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students]

PURPOSE

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students.

METHODS

A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test.

RESULTS

The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning.

CONCLUSION

The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

Experiences of simulation-based learning among undergraduate nursing students: A systematic review and meta-synthesis

OBJECTIVES

We aimed to examine the experiences of simulation-based learning (SBL) among undergraduate nursing students.

DESIGN

We conducted a systematic review and meta-synthesis on the experiences among undergraduate nursing studies who received SBL.

DATA SOURCES

We searched through six databases namely PubMed, CINAHL, Scopus, Web of Science, Embase, ProQuest, for qualitative studies published from January 2011 to January 2022.

REVIEW METHODS

A meta-synthesis was conducted according to the three-stage framework outlined by Thomas and Harden (2008). Critical appraisal was performed using the Critical Appraisal Skills Program (CASP) checklist. A standardised data extraction form was developed with reference from JBI Qualitative Assessment and Review Instrument Data Extraction Tools for Qualitative Research (JBI-QARI) checklist for data extraction.

RESULTS

Fifteen studies were included, and four themes emerged from the synthesis: (1) acquiring knowledge and skills through SBL; (2) positive experiences of using high-fidelity simulation (HFS) and virtual reality simulation (VRS) methods; (3) challenges encountered while using SBL methods and (4) drawing parallels between simulation and real clinical settings.

CONCLUSION

SBL allowed undergraduate nursing students to gain knowledge, acquire skills and have a positive SBL experiences. However, the provision of innovative strategies and resources for nursing students to overcome SBL-based challenges are still needed.

Effect of High-Fidelity Simulation on Self-Satisfaction and Self-Confidence Among Nursing Students

Introduction

Newly graduating nurses should be able to enter clinical practice as safe, accurate, competent, and compassionate professionals in health care settings that necessitate them to be learners who can easily get familiar with a broad diversity of clinical practice settings.

Purposes

The purpose of this study was to evaluate the effect of high-fidelity simulation experiences on self-satisfaction and self-confidence among the pediatric nursing students.

Methods

A quasi-experimental design, post-test, was carried out through the recruitment of a convenience sample of 150 nursing students from Arab American University. The students were randomly assigned to the study (n  =  75) or control (n  =  75) groups. Data were collected using learner satisfaction and self-confidence scales.

Results

The results of the post-test revealed that there was a significant difference between both groups in self-satisfaction (t (148)  =  11.14, P < .001) and self-confidence (t (148)  =  13.04, P < .001). The mean score of self-satisfaction for the study group (22.45  ±  2.27) was higher than control group (16.80  ±  3.76). Also, the study group' mean self-confidence score (35.72  ±  3.49) was higher than the control group (27.28  ±  4.39).

Conclusion

High-fidelity simulation was confirmed to be an helpful tool to keep an effective and safe learning method for pediatric nursing students, thus increasing their satisfaction and confidence.

Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study

AIM

To determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations.

BACKGROUND

Clinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance.

DESIGN

A quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21).

METHODS

Before conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing.

RESULTS

Physiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed.

CONCLUSIONS

The clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.

A Description of Breast Models Used to Teach Clinical Skills

Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.

Mapping the research hotspots and theme trends of simulation in nursing education: A bibliometric analysis from 2005 to 2019

BACKGROUND

Simulation-based nursing training has been used incorporated into nursing education for decades, however, there is limited information related to simulation research hotspots and theme trends over time.

OBJECTIVES

To investigate the research hotspots and theme trends of simulation in nursing education through bibliometric analysis.

METHODS

Relevant articles on simulation in nursing education published between 2005 and 2019 were retrieved from PubMed. The Bibliographic Item Co-occurrence Matrix Builder (BICOMB) was used to extract and quantitatively analyze the Medical Subject Headings (MeSH) terms and subheadings. The biclustering analysis was conducted using gCluto1.0 to identify the research hotspots. A strategic diagram was employed to reveal the development trend of the theme.

RESULTS

A total of 4102 publications were retrieved from PubMed showing an overall increasing trend. Based on the results, the United States was the most productive country (2868,55.7 %), the journal Nurse Education Today journal was the top journal concerning this field, and Cooper SJ and Holtschneider ME were authors with the highest number of publications on this topic. Quantitative and co-word biclustering analyses were used in this study. The research hotspots in recent 5 years were focused on: (1) interprofessional simulation in patient-care teams; (2) patient simulation in psychiatric nursing education; (3) virtual reality simulation (VRS) in midwifery and nursing education; (4) simulation in critical care nurses' continuing education/training, and (5) simulation in pediatric resuscitation education. The strategic diagram showed that the VRS in midwifery and nursing education might have a significant potential to become an emerging hotspot soon.

CONCLUSION

The research literature production of simulation in nursing education was increasing over the past 15 years. Through co-word biclustering analysis, five research hotspots were identified. Among them, simulation in psychiatric education and critical care continuing education had a central priority that researchers should pay further attention to, and VRS could be the major trend for future study. Furthermore, this study described the overall range of research interests and provided ideas for innovative and efficient research projects.

Use of simulation to improve nursing students' medication administration competence: a mixed-method study

Background

Medication administration errors are among the most important adverse events in healthcare systems. To minimise the risk of this occurring, nursing training programmes should emphasise the overriding priority of patient safety. In this respect, simulation can be a valuable resource in teaching procedures, for patient safety in general and safe medication administration in particular. In this study, we evaluate the use of a simulation-based activity for students to acquire skills in safe medication administration, and consider the students’ perceptions of this activity.

Methods

Second-year nursing students enrolled in the subject of pharmacology at a Spanish university during the academic year 2018–2019 were invited to participate in this mixed-method study. Their acquisition of professional competencies via a simulation exercise was evaluated according to the ‘six rights’. Before the simulation, each student completed a researcher-developed online questionnaire. The simulation was evaluated by the students’ tutor, using a checklist. A descriptive analysis was made of the data obtained from the questionnaire and during the simulation. At the end of the semester, the students' opinions were recorded in the questionnaire, in response to an open question. A content analysis was made of the responses to the open question.

Results

The simulation exercise was performed by 179 students, of whom 73 had previously completed the questionnaire. Analysis showed that, in comparison with the pre-simulation questionnaire results, compliance with the six rights improved in all dimensions except data documentation: right patient (from 64.4% to 83.3%); right medication (from 60.3% to 95.8%); right dose (from 60.3% to 100%); right route (from 54.8% to 95.8%); right time (from 24.7% to 70.8%); the right documentation result fell from 54.8% to 45.8%. The students expressed their satisfaction with the simulation method, affirming that it brought them closer to the reality of health care.

Conclusions

Simulation is a useful tool for the acquisition of skills in medication administration. The students were satisfied with the simulation capacity to bridge the gap between theory and practice. Moreover, simulation represents an added teaching resource in the nursing degree curriculum and is expected to enhance patient safety.

The impact of small-group virtual patient simulator training on perceptions of individual learning process and curricular integration: a multicentre cohort study of nursing and medical students

BACKGROUND

The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students.

METHODS

We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience.

RESULTS

Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students.

CONCLUSIONS

In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.

Dose-Response Relationship between High-Fidelity Simulation and Intensive Care Nursing Students' Learning Outcomes: An Italian Multimethod Study

Background: The best application modality of high-fidelity simulation in graduate critical care nursing courses is still rarely investigated in nursing research. This is an important issue since advanced nursing skills are necessary to effectively respond to critically ill patients' care needs. The aim of the study was to examine the influence of a modified teaching model based on multiple exposures to high-fidelity simulations on both the learning outcomes and the perceptions of graduate students enrolled in a critical care nursing course. Methods: A multimethod study involving a sample of graduate critical care nursing students was conducted. A theoretical teaching model focused on multiple exposures to high-fidelity simulations is currently applied as a teaching method in an Italian critical care nursing course. According to the Kirkpatrick model for evaluating training programs, the performance, self-efficacy, and self-confidence in managing critically ill patients were considered learning outcomes, while satisfaction with learning and students' lived experiences during the experimental phases were considered students' perceptions. Results: Multiple exposures to high-fidelity simulations significantly improved performance, self-efficacy, and self-confidence in managing virtual critically ill patients' care needs. The satisfaction level was high, while lived experiences of participants were positive and allowed for better explanation of quantitative results of this study. Conclusions: Multiple exposures to high-fidelity simulations can be considered a valuable teaching method that can improve the learning outcomes of graduate nurses enrolled in an intensive care course.

Relationship between psychological characteristics, personality traits, and training on performance in a neonatal resuscitation scenario: A machine learning based analysis

BACKGROUND

In life-threatening emergency events, prompt decision-making and accurate reactions are essential for saving a human's life. Some of these skills can be improved by regular simulation trainings. However, besides these factors, individual characteristics may play a significant role in the patients' outcome after a resuscitation event. This study aimed to differentiate personality characteristics of team members who take responsibility for their actions, contextualizing the effect of training on resuscitation performance.

METHODS

Six hundred and two third-year medical students were asked to answer psychological and personality questionnaires. Fifty-five of them performed in a neonatal simulation resuscitation scenario. To assess participants' performances in the NLS scenario, we used a scenario-based designed NLS checklist. A machine learning design was utilized to better understand the interaction of psychological characteristics and training. The first model aimed to understand how to differentiate between people who take responsibility for their actions vs. those who do not. In a second model, the goal was to understand the relevance of training by contextualizing the effect of training to other important psychological and personality characteristics like locus of control, anxiety, emotion regulation, openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.

RESULTS

No statistically significant differences were found for psychological characteristics between the training group and the no training group. However, as expected, differences were noted in favor of the training group for performance and within gender for psychological characteristics. When correcting for all these information in a model, anxiety and gender were the most important factors associated with taking responsibility for an action, while training was the only relevant factor in explaining performance during a neonatal resuscitation scenario.

CONCLUSION

Training had a significantly stronger effect on performance in medical students in a neonatal resuscitation scenario than individual characteristics such as demographics, personality, and trait anxiety.

Nursing educators' collaboration and professional development: a cross-sectional study

OBJECTIVES

Teacher cooperation can be described as the collaboration of teachers in the form of exchange, synchronisation, and co-construction. The aim of this study was to determine if attitudes towards teacher collaboration, teacher self-efficacy, and perceptions of a safe team climate were related to teacher collaboration activities, as well as if these collaboration activities fostered professional development.

METHODS

An explorative study using an online questionnaire was conducted. A total of 202 (n=202) nursing educators participated. Scales measuring teacher collaboration, professional development, teacher self-efficacy, and safe team climate were used. Data analysis included explorative and confirmatory factor analysis, correlation analysis, and structural equation modelling.

RESULTS

The results showed a positive relation between teacher self-efficacy, perceptions of a safe team climate, and attitudes towards teacher collaboration with collaboration activities.

CONCLUSIONS

The results underline the importance of offering collaborative settings and opportunities for educators to reflect on their experiences during teacher training.

A Systematic Review and Narrative Synthesis of the Effectiveness of Peer- versus Faculty-led Simulation for Clinical Skills Acquisition in Undergraduate Student Nurses. MSc Project Findings

Background:

Clinical skills learning is an integral part of undergraduate nursing programmes in United Kingdom nurse education. Faculty staff teach some elements of clinical skills, and some are taught by clinicians in practice. International evidence indicates that some students feel overly anxious when taught by faculty members but less so with their peers, meaning that peer-led clinical skills teaching and learning might reduce anxiety and facilitate the acquisition and retention of skills education.

Objective:

The objective of this systematic review was to explore the research relating to undergraduate student nurses’ acquisition of skills within the simulation setting, particularly the associations between peer-led and lecturer-led learning.

Methods:

A systematic review of the literature was used to find all available evidence. A search of nine healthcare databases using Boolean and MeSH search terms including ‘Peer-to-peer’, ‘Clinical Skill*’, ‘Simulat*’, and ‘Student Nurs*’ was undertaken. Due to the heterogeneity of the research found, statistical meta-analysis was not possible, and so a narrative synthesis based on thematic analysis was conducted, which involved three-person research team critically appraising nine articles for inclusion in the review.

Results:

Articles were located from worldwide sources.

Three main themes in the findings were: psychological factors, motor skills, and educational issues. The use of peers can help to increase students’ motor skills, improved the psychological impact of skills and learning, and offered students a chance to be active participants in their education.

Conclusion:

Having explored the literature, we conclude that peer-to-peer teaching and learning could have a place in undergraduate nursing education; however, it is not clear if student nurses’ skills acquisition is more effective if mediated by peer- or lecturer-led teaching. Further research is required in this area to quantify and compare outcomes.

Enablers of the successful implementation of simulation exercises: a qualitative study among nurse teachers in undergraduate nursing education

BACKGROUND

Simulation exercises are increasingly being used as a teaching method in the field of undergraduate nursing education. Thus, the present study sought to identify, describe and discuss enablers of the successful implementation of simulation exercises in undergraduate nursing education.

METHODS

This study had a qualitative descriptive design and involved individual interviews conducted between November and December 2018 with six nurse teachers from three different university campuses in Norway. The transcribed interviews were analysed by means of a qualitative thematic analysis.

RESULTS

The majority of the interviewees wanted to offer more simulation exercises as part of their respective undergraduate nursing education programmes. Moreover, creating a safe environment, facilitating student-centred learning and promoting reflection were all identified by the interviewees as enablers of the successful implementation of simulation exercises.

CONCLUSIONS

The findings of this study indicate that nurse teachers consider simulation to be a valuable teaching method for improving students' learning outcomes. In addition, the findings could guide the future implementation of simulation exercises in undergraduate nursing education.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04063319 . Protocol ID: 52110 Nursing Students' Recognition of and Response to Deteriorating Patients.

Simulation design for improvement of undergraduate nursing students' experience of evidence-based practice: A scoping-review protocol

Simulation may be an effective educational strategy for undergraduate nursing students to experience evidence-based practice. The aim of this scoping review is to explore such simulations to discover the design characteristics that best achieve this goal. In this review, we will consider studies in which the focus was on evidence-based practice-related simulation programs for undergraduate students in academic, clinical, or virtual settings. We will also focus on the active learning strategies applied in such simulation programs. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology. Studies will be searched in Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), and the Excerpta Medica database (EMBASE). Sources of unpublished studies/gray literature will not be included in this scoping review. Data extraction will be undertaken by using a data-extraction tool developed by the reviewers, based on the National League for Nursing Jeffries Simulation Theory. Via a narrative summary and tabulated results, we will describe how the simulation programs were designed or implemented in an undergraduate curriculum.