Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis

Post-simulation debriefing as a stepping stone to self-reflection and increased awareness - a qualitative study

BACKGROUND

The voice of the students should be engaged in simulation curriculum development. Involving the students in the development of debriefing strategies might result in a deeper understanding of learning. However, few studies have investigated the students' perspectives on debriefing strategies. The aim of the study was to explore nursing students' perspectives on the post-simulation debriefing.

METHODS

An explorative, descriptive design with a qualitative approach was used. Data were collected in December 2017 and May 2018 through focus group interviews with undergraduate nursing students in Norway immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing degree. Data were analysed using systematic text condensation.

RESULTS

Thirty-two nursing students participated in the study. The data analysis identified two main categories. The category 'Facilitator as a catalyst for reflection' illustrated the facilitator's multifaceted and vital role in initiating and guiding the students' reflection process in the debriefing. The category 'A process towards increased awareness' encompasses the students' guided process of acquiring new insight into their professional development, and how they put parts together to see the wholeness in what was simulated.

CONCLUSIONS

This study provides knowledge to facilitators regarding nursing students' perspectives on facilitating reflection and learning during debriefing discussions. The facilitator's multifaceted role in guiding the students' reflections and their process of acquiring new insight into their professional development were identified as critical to learning during debriefing.

The efficacy of high-fidelity simulation on knowledge and performance in undergraduate nursing students: An umbrella review of systematic reviews and meta-analysis

OBJECTIVES

This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students.

DESIGN

Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results.

DATA SOURCES

Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies.

REVIEW METHODS

The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias.

RESULTS

Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported.

CONCLUSIONS

The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.

Student nurses' utilisation of self-directed simulation learning at a University in Gauteng

BACKGROUND

 Self-directed simulation learning (SSL) is a globally accepted teaching and learning strategy wherein student nurses take the initiative in diagnosing their learning needs, formulate learning goals, identify resources for learning, and implement relevant strategies in response to their learning needs. This autonomous learning strategy will assist student nurses in taking ownership of their learning. Consequently, student nurses exit the training programme to become lifelong learners, safe and competent professional nurses.

OBJECTIVES

 This study aimed to explore and describe the experiences of student nurses' utilisation of SSL at a University in Gauteng and to make recommendation(s) to enhance the use of SSL.

METHOD

 A qualitative, exploratory, descriptive, and contextual research design was used to uncover the student nurses' experiences with the use of SSL at a University. Nineteen participants were purposively sampled. Data collection was conducted through focus group interviews. Tesch's method of data analysis was used to analyse, organise and interpret data.

RESULTS

 Theme: student nurses experience time constraints, which hinder their utilisation of SSL. Subthemes: (1) a compacted academic timetable, and (2) limited access to the clinical simulation laboratory for self-directed learning.

CONCLUSION

 Time constraints hinder the utilisation of SSL, and this challenge threatens the acquisition of clinical skills and knowledge during the training of student nurses.Contribution: Evidence-based recommendations to enhance the utilisation of SSL at a University.

Reliability of the Mental Health Nurse Competency Assessment Tool (ECOEnfSM): A pilot study

AIM

To evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice.

METHOD

A pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient).

RESULTS

The Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (P < .01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (P < .01). All UCs showed a good to excellent consistency (r > 0.80). The "Home Visits" assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it.

CONCLUSION

The ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

Enriching nursing knowledge and practice in Jordanian government hospitals through basic life support simulation training: A randomized controlled trial

Background

Healthcare providers must possess the necessary knowledge and skills to perform effective cardiopulmonary resuscitation (CPR). In the event of cardiopulmonary arrest, basic life support (BLS) is the initial step in the life-saving process before the advanced CPR team arrives. BLS simulation training using manikins has become an essential teaching methodology in nursing education, enhancing newly employed nurses' knowledge and skills and empowering them to provide adequate resuscitation.

Objective

This study aimed to evaluate the potential effect of BLS simulation training on knowledge and practice scores among newly employed nurses in Jordanian government hospitals.

Methods

A total of 102 newly employed nurses were randomly assigned to two groups: the control group (n = 51) received standard training, and the experimental group (n = 51) received one full day of BLS simulation training. The training program used the American Heart Association (AHA)-BLS-2020 guidelines and integrated theoretical models such as Miller's Pyramid and Kolb's Cycle. Both groups were homogeneous in inclusion characteristics and pretest results. Knowledge and practice scores were assessed using 23 multiple-choice questions (MCQs). Data were analyzed using one-way repeated measures ANOVA.

Results

The results indicated significant differences in knowledge scores, F(2, 182) = 58.514, p <0.001, and practice scores, F(2, 182) = 20.134, p <0.001, between the control and experimental groups at all measurement times: pretest, posttest 1, and posttest 2. Moreover, Cohen's d reflected the effectiveness of BLS simulation training as an educational module, showing a large effect (Cohen's d = 1.568) on participants' knowledge levels and a medium effect (Cohen's d = 0.749) on participants' practice levels.

Conclusion

The study concludes that BLS simulation training using the AHA-BLS-2020 guidelines and integrating theoretical models such as Miller's Pyramid and Kolb's Cycle significantly improves knowledge and practice scores among newly employed nurses, proving highly effective in enhancing their competencies in performing CPR. Implementing BLS simulation training in nursing education programs can significantly elevate the proficiency of newly employed nurses, ultimately improving patient outcomes during cardiopulmonary arrest situations. This training approach should be integrated into standard nursing curricula to ensure nurses are well-prepared for real-life emergencies.

Trial Registry Number

NCT06001879.

The effects of simulation-based education on undergraduate nursing students' competences: a multicenter randomized controlled trial

BACKGROUND

Education in nursing has noticed a positive effect of simulation-based education. There are many studies available on the effects of simulation-based education, but most of those involve a single institution, nonrandomized controlled trials, small sample sizes and subjective evaluations of the effects. The purpose of this multicenter randomized controlled trial was to evaluate the effects of high-fidelity simulation, computer-based simulation, high-fidelity simulation combined with computer-based simulation, and case study on undergraduate nursing students.

METHODS

A total of 270 nursing students were recruited from five universities in China. Participants were randomly divided into four groups at each institution: the high-fidelity simulation group, the computer-based simulation group, the high-fidelity simulation combined with computer-based simulation group, and the case study group. Finally, 239 participants completed the intervention and evaluation, with 58, 67, 57, and 57 participants in each group. The data were collected at three stages: before the intervention, immediately after the intervention, and three months after the intervention.

RESULTS

The demographic data and baseline evaluation indices did not significantly differ among the four groups. A statistically significant difference was not observed between the four methods for improving knowledge, interprofessional collaboration, critical thinking, caring, or interest in learning. While skill improvement differed significantly among the different groups after the intervention (p = 0.020), after three months, no difference was observed (p = 0.139). The improvement in skill in the computer-based simulation group was significantly lower at the end of the intervention than that in the high-fidelity simulation group (p = 0.048) or the high-fidelity simulation combined with computer-based simulation group (p = 0.020).

CONCLUSIONS

Nursing students benefit equally from four methods in cultivating their knowledge, interprofessional collaboration, critical thinking, caring, and interest in learning both immediately and over time. High-fidelity simulation and high-fidelity simulation combined with computer-based simulation improve skill more effectively than computer-based simulation in the short term. Nursing educators can select the most suitable teaching method to achieve the intended learning outcomes depending on the specific circumstances.

TRIAL REGISTRATION

This clinical trial was registered at the Chinese Clinical Trial Registry (clinical trial number: ChiCTR2400084880, date of the registration: 27/05/2024).

Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence

BACKGROUND

The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses.

OBJECTIVES

This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL.

METHODS

The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days.

RESULTS

From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01).

CONCLUSIONS

We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.

Teaching nursing students: As an umbrella review of the effectiveness of using high-fidelity simulation

AIM

To conduct an umbrella review of the effectiveness of using high-fidelity simulation in nursing student teaching, thereby supporting continuous improvement in teaching practitioners' implementation of high-fidelity simulation intervention strategies.

BACKGROUND

Several systematic reviews have investigated the effectiveness of high-fidelity simulation in nursing student teaching in recent years. However, conclusions vary and a systematic assessment is lacking.

DESIGN

This review encompasses an umbrella review.

METHODS

A search of PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted to retrieve data on an umbrella review of high-fidelity simulation effectiveness in nursing student teaching from database inception to November 2023. The quality of the included systematic reviews was independently assessed by two reviewers using the AMSTAR 2 and PRISMA scales. Outcome indicators from the included systematic reviews were graded using the GRADE system.

RESULTS

Twelve systematic reviews focusing on high-fidelity simulation effectiveness in nursing student teaching were included. Notably, all 12 systematic reviews exhibited very-low methodological quality, with 9 exhibiting some degree of reporting deficiencies, 2 exhibiting severe information deficiencies and 1 reporting relatively complete information. A total of 22 outcome indicators and 53 pieces of evidence were included. The results revealed 15 pieces of low-quality evidence and 38 pieces of very-low-quality evidence. Mounting evidence suggests that high-fidelity simulation teaching effectively enhances nursing students' theoretical performance, practical skills and various clinical comprehensive abilities, highlighting a positive teaching effect. However, further validation through high-quality, large-sample studies is warranted.

CONCLUSION

The overall evidence quality of the current systematic reviews evaluating high-fidelity simulation effectiveness in nursing student teaching is low. Additionally, the methodological quality and the degree of reporting standardization require further improvement. Therefore, high-quality, large-sample randomized controlled trials are essential for further substantiating high-fidelity simulation effectiveness in nursing student teaching.

Outcomes of scenario-based simulation courses in nursing education: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the effects of scenario-based simulation courses on nursing students' professional knowledge, clinical practice skills, and self-confidence in learning.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

A literature search of six databases including CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science was performed on 28 February 2023.

REVIEW METHODS

The methodological quality of the studies included was assessed using RoB 2. A random-effects model was used for pooling effect size. The heterogeneity of each pooled analysis was quantified with I2. Egger's regression test was performed to assess publication bias in each pooled analysis.

RESULTS

Sixteen trials conducted between 2011 and 2022 were included in the final analysis. Scenario-based simulation courses significantly improved nursing students' professional knowledge (pooled SMD 0.66; 95 % CI 0.33-0.98; p < 0.001), clinical practice skills (pooled SMD 1.45; 95 % CI 0.96-1.94; p < 0.001), and self-confidence in learning (pooled SMD 0.37; 95 % CI 0.12-0.63; p < 0.001). Substantial heterogeneity was observed in the pooled analyses of professional knowledge and clinical practice skills.

CONCLUSION

Scenario-based simulation courses appeared to be beneficial for increasing nursing students' professional knowledge, clinical practice abilities, and self-confidence in learning. Therefore, simulation-based learning should be regarded as an essential component of the nursing curriculum as it improves nursing students' skills and prepares them for real-world practice.

Assessing satisfaction in simulation among nursing students: psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale

BACKGROUND

The Satisfaction with Simulation Experience scale is a 5-point Likert scale that measures students' satisfaction in medium and high-fidelity simulation scenarios. This study aims at investigating the psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale.

METHODS

A multi-centre cross-sectional study was conducted. The scale was administered to a sample of 266 undergraduate nursing students from two Italian universities after attending a medium- and high-fidelity simulation session in November 2022 and March 2023. Cronbach's alpha coefficient and item-total correlation were sorted out to assess internal consistency and reliability. The test-retest method was used as a measure of scale stability over time as well as the confirmatory factor analysis to verify construct validity.

RESULTS

The Cronbach's alpha value was 0.94 for the overall scale, indicating excellent reliability, and it was 0.84 or higher for each subscales, indicating good reliability. A large correlation coefficient of 0.60 or higher was found between each item and its subscale and between each item and the overall scale score. A medium test-retest correlation coefficient was found for most items (r > 0.30). The confirmatory factor analysis confirmed the factorial structure found in the original study.

CONCLUSIONS

Satisfaction is an important teaching and learning quality indicator along with the achievement of learning outcomes in simulation. The Satisfaction with Simulation Experience - Italian Version scale showed good reliability and validity; therefore, it could be a useful tool to assess simulation impact in Italian nursing students. The extensive utilization of the Satisfaction with Simulation Experience scale, along with its various validated versions, could facilitate assessing satisfaction in simulation across diverse contexts and enable comparisons of findings across studies in different countries.

Vaccination Training for Pharmacy Undergraduates as a Compulsory Part of the Curriculum?-A Multicentric Observation

In order to increase vaccination rates, the Government of Germany introduced vaccination against influenza and COVID-19 into the regular care administered by pharmacists. However, vaccination training is yet not integrated into the German pharmacy curriculum. Therefore, the Institute for Clinical Pharmacy and Pharmacotherapy in Duesseldorf had developed an innovative vaccination course using high-fidelity simulation for students. To investigate the acceptance further, the course was carried out at three different German universities (Bonn, Duesseldorf, Greifswald). Students were asked to give their self-assessment before and after and satisfaction only after the training course. Responses from 33 participants from the University of Bonn, 42 from the University of Duesseldorf and 49 from the University of Greifswald were analyzed. Every participant at the respective universities showed a significant increase in their self-assessment and indicated a high level of satisfaction with the course. The results also did not differ significantly between the respective universities. Consequently, the results lead to the hypothesis that the satisfaction of pharmacy students with this kind of training using high-fidelity simulation is very high and attractive, and can be recommended for other German universities. The integration of such vaccination training into the German pharmacy curriculum might be a future step.

Physical Realism of Simulation Training for Health Care in Low- and Middle-Income Countries-A Systematic Review

ABSTRACT

This systematic review was conducted, according to PRISMA standards, to examine the impact of the level of physical realism of simulation training on clinical, educational, and procedural outcomes in low- and middle-income countries (LMICs) as defined by the World Bank. A search from January 1, 2011 to January 24, 2023 identified 2311 studies that met the inclusion criteria including 9 randomized (n = 627) and 2 case-controlled studies (n = 159). Due to the high risk of bias and inconsistency, the certainty of evidence was very low, and heterogeneity prevented any metaanalysis. We observed limited evidence for desirable effects in participant satisfaction and confidence, but no significant difference in skills acquisition and performance in the clinical practice environment. When considering the equivocal evidence and cost implications, we recommend the use of lower physical realism simulation training in LMIC settings. It is important to standardize outcomes and conduct more studies in lower income settings.

Undergraduate Nursing Students' Attitude and Perception Toward High-Fidelity Simulation-Based Education in a Middle Eastern Country

Introduction

Rapid use of technologically driven simulation environment in teaching-learning has caused mixed feelings among students. High-fidelity simulation-based education is superior in cultivating the knowledge, skills, caring, learning interest, and collaboration among nursing students. However, the nursing students' attitudes and perceptions toward high-fidelity simulation-based education are unexplored.

Objectives

The present study aims to explore the attitude and perception of undergraduate nursing students toward high-fidelity simulation-based education.

Methods

Cross-sectional survey research design was adopted. We used self-administered Education Practices Questionnaire (student version) and Attitude Scale toward Simulation-Based Education to collect the data. A total of 109 nursing students were recruited.

Results

Nursing student's attitude shows (mean = 68.26); perception on educational practices of high-fidelity simulation-based education demonstrates (M = 39.33 ± 7.87) and the importance of high-fidelity simulation-based education shows (M = 37.73 ± 7.45). However, no significant difference observed between the male and female student's attitude (t = -0.286 [0.78]) and perception (t [107] = 0.960 [0.34]). Similarly, no significant difference was observed among the different levels of students p > .005 on perception and attitude toward high-fidelity simulation-based education.

Conclusion

The study proposed to have high-fidelity simulation-based education as an integral part of teaching in clinical training of students at all levels of nursing program.

The effectiveness of simulation-based education combined with peer-assisted learning on clinical performance of first-year medical residents: a case-control study

BACKGROUND

Simulation-based education and peer-assisted learning (PAL) are both known as useful educational methods. Previous research has reported that combining these two methods are effective for training medical residents in short-term evaluation. This study was aimed to evaluate the middle- to long-term effects of simulation-based education combined with PAL on the performance of medical residents during emergency department duties.

METHODS

This study was designed as a case-control study and conducted over three years at Okayama University Hospital in Japan. Postgraduate-year-one medical residents were assigned to three groups: a simulation group that received simulation-based education, a lecture group that received traditional lecture-based education, and a control group that received no such prior trainings. Prior training in emergency department duties using PAL was performed as an educational intervention for the simulation and lecture groups during the clinical orientation period. The residents' medical knowledge was assessed by written examinations before and after the orientation. The performance of residents during their emergency department duties was assessed by self-evaluation questionnaires and objective-assessment checklists, following up with the residents for three months after the orientation period and collecting data on their 1st, 2nd, and 3rd emergency department duties. All the datasets collected were statistically analyzed and compared by their mean values among the three groups.

RESULTS

A total of 75 residents were included in the comparative study: 27 in the simulation group, 24 in the lecture group, and 24 in the control group. The simulation and lecture groups obtained significantly higher written examination scores than the control group. From the self-evaluation questionnaires, the simulation group reported significantly higher satisfaction in their prior training than the lecture group. No significant differences were found in the emergency department performance of the residents among the three groups. However, when evaluating the improvement rate of performance over time, all three groups showed improvement in the subjective evaluation, and only the simulation and lecture groups showed improvement in the objective evaluation.

CONCLUSION

Simulation-based education combined with PAL is effective in improving the knowledge and satisfaction of medical residents, suggesting the possibility of improving work performance during their emergency department duties.

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.

To Clap or Not to Clap: Relevance of "Applause" in Simulation-Based Learning Sessions

INTRODUCTION

Applause is a common behavior during simulation case learning sessions. Some simulation facilitators believe that this should not be allowed, arguing that it can mislead students when they make mistakes during simulation. This study was conducted to explore the opinions of students about spontaneous applause (initiated by the participants), as a habitual behavior in the simulation sessions, in the undergraduate and postgraduate nursing degrees.

METHODS

A qualitative research study was conducted based on the content analysis of 7 focus groups composed of simulation students (N = 101, both undergraduate and graduate students). The participants were asked to conduct a debate about the following question: What is your opinion about the spontaneous applause given to participants by their peers at the completion of the scenario as they go to the debriefing, and why? An inductive method of content analysis was used to interpret the data.

RESULTS

The majority considered applause as a sign of support; one student disapproved of the practice. For most participants, receiving spontaneous applause from their peers after finishing the simulation represented a spontaneous example of moral support that reduced the participants' stress.

CONCLUSIONS

Applause within the context of clinical simulation is a motivational act, which should not be repressed by the facilitator, as long as it is a spontaneous and genuine act by the participants once the simulation experience ends.

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.

Benefits of an Integrated Nurse Residency Program in the Neonatal Intensive Care Unit: A Review of the Literature

BACKGROUND

The neonatal intensive care unit is a specialized unit where nurses, physicians, and other providers take care of the smallest patients in healthcare. Because neonatal intensive care units are highly specialized, many nursing students graduate from undergraduate programs with little experience or knowledge related to the care of neonatal patients.

RESULTS

Nursing residency programs with hands-on simulation training have been shown to provide significant benefits to new and novice nurses as they enter the workforce, particularly in areas where the patient population requires highly specialized treatment. The myriad of benefits provided by nurse residency programs and simulation training exercises have been shown to result in improved nurse retention, job satisfaction, nursing skill, and patient outcomes.

CONCLUSION

Because of the proven benefits, integrated nurse residency programs and simulation training should be the standard for training new and novice nurses in the neonatal intensive care unit environment.

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.

Development and Assessment of Innovative High-Fidelity Simulation Vaccination Course Integrating Emergency Cases for Pharmacy Undergraduates-A Randomized Controlled Study

Recently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. In order to adapt the pharmacy curriculum for clinical practice, an innovative, vaccination training course using a high-fidelity simulator (HFS) was developed, implementing clinical scenarios to manage adverse events. In a randomized controlled trial using a pre and post design with pharmacy undergraduates, the intervention group interacted with an HFS, while the control group was trained with low-fidelity injection pads. Before and after the respective training, each participant went through an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire and knowledge quiz. Both training methods showed a significant increase in skills, but there was also a significant greater increase in the intervention group when compared to the control group, particularly with respect to the vaccination process. Furthermore, every individual in the intervention group improved from the pre- to post-training OSCEs. Therefore, HFS has been proven to be an appropriate tool to train pharmacy students for the purposes of vaccine administration and to prepare for future challenges. Particularly, recognizing and managing adverse reactions can be addressed in a very effective way.

The future of cancer nursing in Europe: Addressing professional issues in education, research, policy and practice

Cancer nursing has evolved to meet the demands of rising cancer incidence, newer and more complex treatment options, and the emergence of specialist roles supporting patients from pre-diagnosis, through treatment, survivorship and end of life care. Nurses are involved in direct and in-direct care of people at risk of, and living with and after cancer in diverse contexts. As a result, nurses are positioned to have a significant influence on the processes and outcomes of cancer care, through education, research, policy, practice and leadership. However, nursing and cancer care face challenges, arising from workforce shortages, under-investment in services and under-representation in decision-making. This paper discusses the evolution of cancer nursing across education, policy, research, profession and practice, and sets an agenda for innovation and disruption across these domains to ensure sustainability of cancer care services and care for people living with and after cancer. We argue for the continued advancement of cancer nursing with critical focus on identifying and addressing inequities in role recognition and access to specialist cancer nursing education throughout Europe. Partnership, exchange of learning, and co-design will be central to progressing education, evidence and policy to support future growth in the cancer nursing workforce and embed cancer nurses in research and policy setting at local, national and international levels.

Implementation of a Multimodal Interdisciplinary Massive Transfusion Protocol Educational Bundle Improves Knowledge and Self-Efficacy

PURPOSE

Critical events in the operative setting require rapid management to prevent adverse outcomes. This article describes a multimodal educational bundle that was designed and implemented to improve readiness to respond to crises involving significant blood loss. Intended outcomes of this project were to increase knowledge and self-efficacy of anesthesia providers and perioperative staff members related to the use of the massive transfusion protocol (MTP).

DESIGN

This is a quality improvement (QI) project.

METHODS

A two-part educational bundle consisted of pre-education and low-fidelity simulation (LFS) via computer-based training (CBT) modules followed by hands-on skills sessions. Anesthesia providers, registered nurses, and technicians in the operative suite completed the educational intervention. Knowledge and self-efficacy were measured pre-and-post intervention.

FINDINGS

After completing the educational bundle, the aggregated mean score on a knowledge test increased by 5.65%. Self-efficacy related to role-specific responsibilities and confidence regarding the team's ability to carry out the MTP significantly increased for all participants (n = 62).

CONCLUSIONS

This project serves as an example of how a multimodal educational bundle can improve knowledge, confidence, and readiness to respond to critical events. This model demonstrates how pre-education and LFS enable crisis management training to be readily accessible for an entire interdisciplinary team.

The effect of breast self-examination training on nursing students by using hybrid-based simulation on knowledge, skills, and ability to correctly evaluate pathological findings: Randomized Controlled Study

AIM

To investigate the effectiveness of hybrid simulation-based training and classical-based training with the Miller pyramids' ability to evaluate students' knowledge, skills and pathologies in breast self-examination.

BACKGROUND

Breast cancer incidence is becoming more common among women in developed and developing countries. Nurses should be capable of evaluating breast self-examination knowledge, abilities and pathologies.

METHOD

A randomized full experimental design was used. Two groups were formed: a hybrid simulation-based training group (n = 36) and a classical-based training group (n = 36)-students in the hybrid simulation-based group trained on a standardized patient with a wearable breast attachment. The classical-based training group received training on the breast model. The laboratory performance of the students was evaluated one week after the training. Their performance on the standardized patient was evaluated against the checklist in the clinical setting one week after the laboratory. Before and after the training, each student's knowledge of basic and Application steps was evaluated. Students completed the self-description form regarding the clinical process after the clinical performance. All participants received 60 min of theoretical and 60 min of demonstration training. While the students in the hybrid simulation-based training group completed the 55-minute simulation training, the students in the Classic-based training group practised on the desktop breast model for 10 min. The hybrid simulation-based training group received 175 min of total training time, whereas the classical-based training group received 130 min.

RESULTS

Compared with classical-based training, teaching BSE with hybrid simulation-based training raised students' total knowledge score, application step score, skill score and pathological evaluation score (p < 0.05). Students who trained using hybrid simulation-based training experienced low levels of anxiety but increased levels of excitement and motivation (p < 0.05). The education and counselling scores of students who received hybrid simulation -based simulation training were higher than those who received classical-based training (p < 0.05). There was no statistically significant difference between the groups' BSE mean pre-test basic knowledge scores (p = 0.186). BSE mean application steps knowledge scores difference (pre-test-post-test) of the groups was found to be statistically significant (p < 0.001) CONCLUSION: The ability to accurately evaluate breast self-examination on knowledge, skills and pathological findings of students in the hybrid simulation-based training group was higher than in the classical-based training group. Besides, the students' perceived communication, education and counselling efficiency in the hybrid simulation-based training group were higher compared with the classical-based training group.

Quantifying the benefits of Australian emergency services training

There is greater competition for funding within the public sector and, combined with the increasing scope of high-risk hazards that emergency services personnel are responsible for is placing greater economic pressure on emergency services worldwide. With this pressure comes additional requirements to justify expenditure and effort across operational and corporate contexts, including the training of career and volunteer personnel to the necessary level of contemporary multi-hazard expertise. Within this context, Australasian fire and emergency services must submit formalised cases for funding through state or Commonwealth treasury departments, in most cases competing with other government departments for limited funding. These are usually assessed based on public and political value and benefit. The investment in new, high-fidelity practical and simulated training environments, let alone a new training academy or college, is expensive and has the potential to be one of the largest capital projects emergency services can undertake. Justifying the cost of new training environments is complex due to the difficulty of translating the technicalities of specialised emergency response into corporate language and because of the lack of data and literature on which to draw guidance. This paper bridges this knowledge gap by building on existing models and research to propose an Emergency Services Training Financial Rationalisation Model (EST-FRM) for the funding of emergency services academies in Australia. The model has potential application wherever financial rationalisation of emergency services facilities is required.

Dosage Form Modification, a Simulation Activity between Nursing and Pharmacy Students

Background: The aim of this exploratory pilot study was to evaluate student perceptions of a simulation activity involving undergraduate nursing and pharmacy students. The key question was "how do nursing and pharmacy students respond in an immersive collaborative simulation activity which involves medication dosage form modification?" Methods: One hundred nursing students participated in a simulated exercise where patients required medications for which there were barriers to administration. Fourteen pharmacy students were also present in the simulated health environment, observing the work of the nursing students and being available to provide advice regarding medication administration to the nursing students. A mixed methods approach was employed for this exploratory pilot study, where both nursing and pharmacy students were invited to complete a survey regarding the experience at the end of the simulation exercise and pharmacy students completed a reflection. Both surveys and reflections were analyzed. Results: Survey results indicated very high satisfaction regarding the exercise for both pharmacy and nursing students. Analysis of pharmacy student reflections also indicated apprehension regarding their preparedness to contribute to the exercise, enjoyment in participation, their understanding of the value of collaboration between the two groups of students, and also recognition of their need to be more prepared for such situations. Conclusion: This study assessed student perceptions and did not formally evaluate learning outcomes. The interprofessional immersive simulated learning opportunity was viewed as valuable by both nursing and pharmacy students. The immersive simulation provided teaching staff with the opportunity to develop a new approach for the teaching of dosage form modification to both nursing and pharmacy students in an interprofessional setting.

Creation and validation of a high-fidelity simulation scenario for suicide postvention

OBJECTIVE

to create and validate a high-fidelity simulation scenario about the initial support to suicide bereaved people.

METHOD

a methodological research study to create and validate a simulation scenario about postvention. Its creation was based on scientific recommendations, the validation process was carried out by experts, based on an instrument developed by the authors; the data were statistically analyzed using the Content Validity Index and Gwet concordance coefficient.

RESULTS

the scenario was created to provide initial support to suicide bereaved people in the Primary Health Care context. As learning objectives, welcoming, health care and organization monitoring were proposed according to technical-scientific recommendations. The scenario was validated by 10 specialists in the themes of postvention (5 judges) and high-fidelity simulation (5 judges). The scenario items met the acceptance and reliability criteria (Content Validity Index = 0.80) and satisfactory concordance (Gwet coefficient = 0.640).

CONCLUSION

the study presented in full a scenario on postvention with innovative potential that can be used free of charge in clinical simulation development during training of different categories of health professionals, to act in support of suicide bereaved people.

High-fidelity simulation duration and learning outcomes among undergraduate nursing students: A systematic review and meta-analysis

OBJECTIVES

To explore the effects of different lengths of the three key steps (prebriefing, simulation, and debriefing) of high-fidelity simulation (HFS) on the knowledge and skills of undergraduate nursing students.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

A systematic search was conducted for Chinese and English publications from the Web of Science, PubMed, Embase, Cochrane, and two Chinese databases (Wanfang and CNKI) up to November 24, 2021.

REVIEW METHODS

Two independent raters screened the retrieved studies and extracted data based on a coding protocol from the studies that met the inclusion criteria. Data were synthesized using meta-analytic procedures based on a random-effect model and computing effect sizes by standard mean differences (SMD) with a 95% confidence interval (CI).

RESULTS

Forty-four studies were included, and 23 studies were analyzed. High-fidelity simulation (HFS) with debriefing of 10 min or less (SMD = 1.18), simulation of 15-20 min (SMD = 1.43), and debriefing of 11-30 min (SMD = 1.19) showed larger effect sizes for knowledge, while HFS with debriefing of >10 min (SMD = 0.91), simulation of 15 min or less (SMD = 0.89), and over 30 min of debriefing cultivation (SMD = 0.84) showed larger effect sizes for skill.

CONCLUSIONS

During the prebriefing, simulation, and debriefing, shorter sessions are more effective for improving knowledge in BSN students, whereas longer sessions are most effective for improving skills in BSN students. Nurse educators can schedule HFS to meet the expectations of learning outcomes based on the actual situation.

Assessing the Financial Sustainability of High-Fidelity and Virtual Reality Simulation for Nursing Education: A Retrospective Case Analysis

To stimulate classroom discussion and collaboration amid the COVID-19 pandemic, increasingly creative pedological methods for nursing education are necessary. Traditionally, high-fidelity simulation has been the standard for nursing education, but the use of virtual reality simulation is increasing. One of the major evaluative measures of simulation clinical training is the cost associated with each modality. In this retrospective case analysis, budget impact analysis methods were employed to compare high-fidelity simulation with virtual reality simulation. The components of each simulation pedagogy were compared in categorized cost buckets. Overall, virtual reality simulation education was determined to require 22% less time than high-fidelity simulation education. The cost associated with the virtual reality simulation was found to be 40% less expensive than the high-fidelity simulation. Our results demonstrate that virtual reality simulation is a financially advantageous, resource conscious pedagogical option for nursing education.

Health Sciences Students’ Attitude, Perception, and Experience of Using Educational Simulation in Saudi Arabia: A Cross-Sectional Study

Background: Simulation-based education (SBE) provides a safe, effective, and stimulating environment for training medical and healthcare students. This is especially valuable for skills that cannot be practiced on real patients due to ethical and practical reasons. We aimed to assess medical students’ attitude, perception, and experience of simulation-based medical education in Saudi Arabia. Method: A validated cross-sectional survey, using the KidSIM scale, was conducted to measure the level of perception and experience of students from different health sciences specialties toward integrating simulation as an educational tool. Participants responded to questions investigated the importance of simulation, opportunities for Inter-Professional Education (IPE), communication, roles and responsibilities, and situation awareness. Only students with previous experience of SBE were considered for participation. Result: This survey was completed by 246 participants, of whom 165 (67%) were male students and 228 (93%) were aged between the range of 18–30 years old. Of the respondents, 104 (67%) were respiratory care students, 90 (37%) were anesthesia technology students, and 45 (18%) were nursing students. Most of the participants had previous experience in IPE simulation activities (84%), and more than half of the students (54%) had a grade point average (GPA) ranging between 5.00 and 4.50. Overall, students had positive attitudes toward and beliefs about SBE, with a mean score of 129.76 ± 14.27, on the KidSIM scale, out of 150. Students’ GPA was significantly associated with a better perception to the relevance of simulation (p = 0.005), communication (p = 0.003), roles and responsibilities (p = 0.04), and situation awareness (p = 0.009). GPA is merely the sole predictor for positive attitude toward simulation with coefficient Beta value of 4.285 (p = 0.001). There were no significant correlations between other students’ characteristic variables (gender, specialty, study year, experience in IPE, and prior critical care experience). Conclusion: We found that health sciences students’ perception of SBE in Saudi Arabia is generally positive, and students’ performance is a significant determinant of the positive perception.

From Centralized to Decentralized Model of Simulation-Based Education: Curricular Integration of Take-Home Simulators in Nursing Education

In a centralized model of simulation-based education (Ce-SBE), students practice skills in simulation laboratories, while in a decentralized model (De-SBE), they practice skills outside of these laboratories. The cost of “take-home” simulators is a barrier that can be overcome with additive manufacturing (AM). Our objective was to develop and evaluate the quality of education when year one nursing students practiced clinical skills from home following normal curricular activities but in the De-SBE format. A group of expert educators, designers, and researchers followed a two-cycle, iterative design-to-cost approach to develop three simulators: wound care and urethral catheterization (male and female). The total cost of manufacturing all three simulators was USD 5,000. These were sent to all year one nursing students who followed an online curriculum. Twenty-nine students completed the survey, which indicated that the simulators supported the students’ learning needs, and several changes were requested to improve the educational value. The results indicate that substituting traditional simulators with AM-simulators provided an acceptable alternative for nursing students to learn wound care and urethral catheterization off-campus in De-SBE. The feedback also provided suggestions to improve each of the simulators to make the experience more authentic.

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.

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

OBJECTIVES

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

DESIGN

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

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda

BACKGROUND

Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide.

OBJECTIVE

This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education.

METHODS

We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework.

RESULTS

We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations).

CONCLUSIONS

We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

Integrating simulation training during clinical practice in nursing homes: an experimental study of nursing students' knowledge acquisition, self-efficacy and learning needs

BACKGROUND

Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students' clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students' knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment.

DESIGN

The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison.

METHODS

First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students' outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests.

RESULTS

Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges' g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen's d from 0.3 to 1.0).

CONCLUSION

Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.

Effects of Manikin Fidelity on Simulation-Based Nursing Education: A Systematic Review and Meta-Analysis

BACKGROUND

Few studies have examined whether higher-fidelity manikins are superior to lower-fidelity manikins in nursing simulation-based education.

METHOD

A database search initially yielded 2,656 studies written in English or Korean. Duplicates and irrelevant studies were excluded. Ancestry searches generated 3 additional studies, and 15 studies met the criteria.

RESULTS

Higher-fidelity manikins were more effective than lower-fidelity manikins in improving skill performance/clinical competence and perception of nursing students and nurses. In terms of learners' knowledge, satisfaction, and self-confidence, both higher- and lower-fidelity manikins were similarly effective for nursing students.

CONCLUSION

This article provides evidence that higher-fidelity manikins do not always ensure a superior educational effect compared with lower-fidelity manikins. [J Nurs Educ. 2022;61(2):67-72.].

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.

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.

Use of Computer-Based Scenarios for Clinical Teaching: Impact on Nursing Students' Decision-Making Skills

Computer-based learning has numerous advantages. It gives students the chance to accommodate and solve problems independently, it can increase motivation during the learning process, and it offers students direct feedback. Students will also receive an authentic learning experience, increasing their level of knowledge retention. It can assist nursing educators in improving learning outcomes.

AIM

This study aimed to investigate and evaluate the impact of computer-based scenarios on undergraduate nursing students' decision-making skills.

SAMPLE

There was a total sample of 112 nursing students who were enrolled in a critical care nursing course at the College of Applied Medical Sciences in Saudi Arabia. These students were divided into two groups.

METHODS

The two groups were taught the same topic for one week. Two case scenarios were given to each group during the clinical rotation. The study group used the computer-based case scenario, and the control group used the paper-based case scenario. The two groups were compared regarding their decision-making skills. The student's feedback about the computer-based case scenarios was also investigated.

RESULTS

The study group scored significantly higher in their decision-making skills when compared to the control group. In addition, the study group reported that they highly agreed that their general learning and specific nursing abilities improved after using computer-based case scenarios.

Online-synchronized clinical simulation: an efficient teaching-learning option for the COVID-19 pandemic time and: beyond

Face-to-face clinical simulation has been a powerful methodology for teaching, learning, and research, and has positioned itself in health science education. However, due to the COVID-19 pandemic, social distancing has forced universities to abandon simulation centers and make use of alternatives that allow the continuation of educational programs safely for students and teachers through virtual environments such as distance simulation. In Latin America, before the pandemic, the use of non-presential simulation was very limited and anecdotal. This article has three main objectives: to establish the efficacy of online-synchronized clinical simulation in the learning and performance of medical students on the management of patients with COVID-19 in simulation centers of three Latin American countries, to determine the quality of the online debriefing from the students' perspective, and to deepen the understanding of how learning is generated with this methodology.

Integration of Extended Reality and a High-Fidelity Simulator in Team-Based Simulations for Emergency Scenarios

Wearable devices such as smart glasses are considered promising assistive tools for information exchange in healthcare settings. We aimed to evaluate the usability and feasibility of smart glasses for team-based simulations constructed using a high-fidelity simulator. Two scenarios of patients with arrhythmia were developed to establish a procedure for interprofessional interactions via smart glasses using 15-h simulation training. Three to four participants formed a team and played the roles of remote supporter or bed-side trainee with smart glasses. Usability, attitudes towards the interprofessional health care team and learning satisfaction were assessed. Using a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree), 31 participants reported that the smart glasses were easy to use (3.61 ± 0.95), that they felt confident during use (3.90 ± 0.87), and that that responded positively to long-term use (3.26 ± 0.89) and low levels of physical discomfort (1.96 ± 1.06). The learning satisfaction was high (4.65 ± 0.55), and most (84%) participants found the experience favorable. Key challenges included an unstable internet connection, poor resolution and display, and physical discomfort while using the smart glasses with accessories. We determined the feasibility and acceptability of smart glasses for interprofessional interactions within a team-based simulation. Participants responded favorably toward a smart glass-based simulation learning environment that would be applicable in clinical settings.

The lived experiences of intensive care nursing students exposed to a new model of high-fidelity simulation training: a phenomenological study

BACKGROUND

In postgraduate intensive care nursing courses, high-fidelity simulation is useful to prepare students to guarantee safe and quality care of critically ill patients. Surprisingly, this issue has not attracted sufficient attention in the literature, and it is not clear whether the linear application of the traditional high-fidelity simulation method based on prebriefing, the simulation session and debriefing, can serve as empirical reference in postgraduate students' education. The aim of this study was to investigate the lived experiences of postgraduate students receiving multiple exposures to an innovative high-fidelity simulation design based on Kolb's Experiential Learning Theory.

METHODS

A phenomenological study was conducted at an Italian University involving a purposive sample of 15 nursing students attending the postgraduate intensive care course. Audio-recorded face-to-face in-depth interviews were held by a researcher in a dedicated room complemented with non-verbal communication outlined in the field notes. Thematic analysis was used to analyse the transcribed data.

RESULTS

Three themes and ten categories were derived from the data analysis. The themes included pragmatic learning experience, the emotional path, and confidence.

CONCLUSIONS

Multiple exposure to high-fidelity simulation was lived as a pragmatic learning experience enhancing the students' ability to apply theory into practice. This novel approach also contributed to the transition from negative to positive feelings and improved students' confidence about technical and non-technical skills when caring for a critically ill patient.

Motivation: bringing up the rear in nursing education. Motivational elements in simulation. The participants' perspective

BACKGROUND

Motivation is a fundamental element of human behavior and learning. We believe that this aspect has not been sufficiently addressed in the field of simulation-based learning in nursing.

PURPOSE

The aim of this study was to explore the views and perspectives of students involved in simulation-based learning related to their process of motivation. Also, to identify the motivational elements they perceived, as well as the aspects that could reduce their motivation in the simulation sessions.

METHODS

A qualitative study was conducted based on content analysis from 7 focus groups composed of simulation students (n = 101).

RESULTS

The study obtained 26 subcategories, 10 categories, and 2 emerging themes (in total, 17 motivational elements and 7 demotivational elements).

CONCLUSION

The motivational elements were related with the non-directive/imposing style of the facilitator, the adequate structure and planning of the sessions, the possibility of transferring what was learned to the real world, and especially the atmosphere created in the simulation session. The main demotivational elements were directed simulation, an uncomfortable environment, and the planning and structure of the sessions (with an excessive theoretical content or with stringent evaluations).

Effects of a Complex Case Study and High-Fidelity Simulation on Mechanical Ventilation on Knowledge and Clinical Judgment of Undergraduate Nursing Students

BACKGROUND

Improving nursing students' knowledge and clinical judgment related to mechanical ventilation (MV) is paramount, considering the heightened need for MV due to the current COVID-19 (coronavirus disease 2019) pandemic. High-fidelity simulation (HFS) provides students with real-life clinical experiences that they would rarely confront in clinical training, especially complex case scenarios (such as a patient needing MV).

PURPOSE

This study assessed students' clinical knowledge and judgment after including HFS involving MV in an undergraduate nursing program.

METHODS

This was a quasi-experimental design with a convenience sample of 151 nursing students using the Lasater Clinical Judgment Rubric.

RESULTS

There were significant differences between the intervention and control groups in knowledge (t = 20.42; P = .001) and total clinical judgment scores (t = 19.55; P < .001) post-HFS.

CONCLUSIONS

Including a complex case study using MV and HFS significantly improved students' clinical decision-making, clinical knowledge, and self-confidence and enhanced their critical thinking, noticing, interpreting, reflecting, and responding capabilities.

A pilot study to understand faculty and student needs for undergraduate medical education simulation sequencing in the United Arab Emirates

This article was migrated. The article was marked as recommended. Introduction: The use of simulation-based education in undergraduate medical education has many advantages. Purposeful planning of the sequence of simulation sessions within the curriculum is necessary for complex simulation exercises. This requires pre-session completion of prerequisite knowledge. Methods: Two surveys were conducted. An electronic survey was sent to faculty involved in simulation at UAE medical schools (n=29). The faculty survey addressed the simulation sessions planning process, sequencing of simulation topics, and institutional simulation team structure. The second survey was administered via paper to final year medical students from Dubai Medical College (DMC) who received simulation sessions (n=22). The survey addressed completion of prerequisite knowledge, receipt of the session objectives, and psychological safety and overall session ratings. Quantitative data were analyzed descriptively. Responses to open ended questions were analyzed thematically. Results: The faculty response rate was (21/29: 72.4%). Only (7/21: 33.3%) faculty members indicated there was prior planning to ensure proper sequencing within the curriculum. Only (3/21: 14.2%) indicated that simulation topics were chosen based on curriculum gaps. A small percentage (3/21: 14.2%) reported working with other faculty and an instructional designer. Qualitative themes included barriers to planning, structural considerations, and factors for successful simulation integration. The student response rate was 100%. Only (4/22:18.2%) of students completed the required pre-session prerequisite knowledge. Most students (18/22: 81.8%) received the session objectives prior to the simulation session. Qualitative themes included lack of completion of pre-requisite knowledge prior to the session, absence of learning objectives, and technical issues. Conclusion: This study highlights the gap in adequate sequencing of complex simulation scenarios within the curriculum. This is mainly due to the lack of completion of the required prerequisite knowledge prior to the session. Such complex integration requires adequate planning and collaboration of the simulation team with key stakeholders including faculty, the curriculum committee, and instructional designers.

Efficacy of Simulation Using NLN/Jeffries Nursing Education Simulation Framework on Satisfaction and Self-Confidence of Undergraduate Nursing Students in a Middle-Eastern Country

Introduction

Utilizing simulation in nursing education is increasingly becoming a popular teaching pedagogy. Simulation provides opportunity to the nursing students to practice the clinical skills through various real life like situational experiences. Simulation improves the clinical decision making skills of the nursing students.

Objective

A descriptive, cross sectional, correlational study was conducted to evaluate the efficacy of simulation using NLN/Jeffries Nursing Education Simulation Framework on satisfaction and self-confidence of Undergraduate nursing students.

Methods

370 undergraduate nursing students participated in the study. Educational practices, Simulation design, Student satisfaction and Self-confidence questionnaires were used.

Results

Majority of the nursing students perceived agreement on various domains of student satisfaction, self-confidence, educational practices and simulation design used in the curriculum. The students were self-confident to care for similar patients in the clinical area and satisfied with this instructional method. Satisfaction and self-confidence were correlated with educational practices and simulation design.

Conclusion

Developing simulations using NLN/Jeffries Nursing Education Simulation framework will provide meaningful, engaging, and pedagogically sound experiences for the students. Pre-briefing and de-briefing are meaningful strategies to enhance the learning of students.