The affective component of learning in simulation-based education - facilitators' strategies to establish psychological safety and accommodate nursing students' emotions

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.

Peer Collaborative Clinical Decision Making in Nursing Simulation: A Theoretical Framework

BACKGROUND

Collaboration and decision making among nursing students are essential competencies in nursing education. However, how students collaborate and make decisions in simulation is a complex phenomenon and not well understood. This study aimed to develop a framework that describes peer collaborative clinical decision making (PCCDM) among nursing students in simulation.

METHOD

Charmaz's constructivist grounded theory method was used. The sample included 32 participants (16 dyads) from two nursing programs.

RESULTS

The PCCDM framework described three interrelated functional domains (cognition, behavior, and emotion) experienced through three interrelated processes (awareness, communication, and regulation), alternating between individual and collaborative spaces and changing across time according to the simulation's acuity levels.

CONCLUSION

The PCCDM framework provides a model that reflects how these processes unfold over time in simulations, which can be applied in nursing simulation, classroom, and clinical settings that require students to make collaborative decisions. [J Nurs Educ. 2024;63(7):435-443.].

Teaching and Learning About the Transgender Population: Student Reflections

BACKGROUND

Decreasing the disparities in health care for transgender people requires nursing to expand its knowledge base about the population. There is limited research and information about curricula integration inclusive of this population, yet much is written about the gap in nursing knowledge and education. There may be insufficient opportunities to expose students to the population as patients; therefore, creative education strategies are necessary.

METHOD

An innovative multimodal education process was implemented in an urban university setting to expose undergraduate nursing students to the population. Lecture, video, live testimonial, and panel discussion were used. Class reflections and survey data revealed three qualitative narrative reflections.

RESULTS

Students reported awareness of how to improve their interactions with this population, appreciation for the experience, and meaningfulness of the experience.

CONCLUSION

The experience brought students closer to understanding the need in providing equitable and appropriate care. Multiple modes of teaching were successful in the affective learning domain. More research in ways to enhance nursing education is necessary. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Factors Affecting Nursing Students' Reflective Thinking During Simulation Debriefing

BACKGROUND

Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear.

PURPOSE

This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students.

METHODS

This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking.

RESULTS

Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students.

CONCLUSIONS

Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing.

Developing a competency framework for training with simulations in healthcare: a qualitative study

BACKGROUND

Simulation is a technique used to create an experience without going through the real event. Competency-based medical education focuses on outcomes and ensures professionals have the necessary knowledge, skills, and attitudes. The purpose of this study was to develop a set of competencies for the instructors providing basic and advanced levels of simulation-based training in healthcare.

METHODS

We conducted a qualitative study in three steps, with each next step building on and influenced by the previous one. First, we conducted a literature review, then a consensus development panel, and finally a three-step Delphi process. The participants were experts in the fields of healthcare, education, and simulations.

RESULTS

The six main competencies identified for the instructor providing simulation-based training at the basic level in healthcare include knowledge of simulation training, education/training development, education/training performance, human factors, ethics in simulation, and assessment. An instructor providing simulation-based training at an advanced level in healthcare should also possess the following five competencies: policies and procedures, organisation and coordination, research, quality improvement, and crisis management.

CONCLUSION

The identified competencies can serve as a valuable resource for simulation educators and organisations involved in simulation education, to plan curriculum and implement a continuous train-the-trainers programme.

Exploring the impact of emotionalized learning experiences on the affective domain: A comprehensive analysis

The central aim of this research endeavor was to delve into the profound influence of affective learning experiences on the cognitive and psychomotor domains. Concurrently, the study sought to discern the effects of these experiences on students' academic accomplishments within the three domains. This differentiation was predicated upon the interplay between pedagogical resources and the multifaceted dimensions of cognitive, affective, and social contexts for learning. Over the course of four consecutive semesters, data were meticulously collected from a cohort of 140 undergraduates enrolled at a private-sector university. The experimental cohorts 1, 2 and 3, comprising 35, 46, and 31 students, respectively, were instructed through distinct methodologies - namely, activity learning, reflective learning, and collaborative learning. In parallel, the control group, composed of 28 students, received instruction via the discussion method. The findings eloquently established a robust and affirmative linear correlation between affective experiences and achievements within the cognitive and psychomotor domains. This correlation notably underscored the far-reaching influence of the affective domain upon its cognitive and psychomotor counterparts. Furthermore, the variable of emotional context for learning emerged as a conspicuously noteworthy determinant of students' achievements across all three domains. In contrast, the remaining independent variables - namely, pedagogical resources, cognitive learning context, and social learning context - did not exhibit a substantial contribution. However, it was observed that the amalgamation of all four independent variables yielded a statistically significant relationship with achievements within the cognitive, affective, and psychomotor domains. This underscored the imperative nature of accounting for all pertinent factors when formulating instructional approaches that yield optimal outcomes.

Realistic simulation case scenario as a vertical integration teaching tool for medical students: A mixed methods study

Realistic simulation-based learning has recently become an integral part of medical education and can provide several advantages if applied effectively. This study aimed to develop and validate a realistic simulation case scenario (RSCS) as a novel teaching tool for preclinical medical students. Furthermore, we aimed to evaluate student perception of this tool as a teaching strategy, as well as to acquire an in-depth understanding of student perspectives. We employed the mixed methods approach to explore how clinical reasoning develops through a validated RSCS. This study, which included 50 third-year medical students, was conducted at the College of Medicine, Dar Al Uloom University, KSA between November 2021 and February 2022. Most of the participants (94%) were satisfied with the RSCS method and 92% of the participants reported RSCS as more effective in terms of achieving learning objectives. Many advantages of RSCS have been reported, including the provision of realistic knowledge relating to critical care management, encouraging student participation in the learning process, and enhancing interpersonal and problem-solving skills. In conclusion, RSCS is an effective and dynamic teaching approach that aids in knowledge consolidation with a significant impact on the emotions and cognitive abilities of students.

Twelve tips for the pre-brief to promote psychological safety in simulation-based education

It is recognised that simulation-based education can be stressful, and this can impact negatively on learning. A fundamental aspect of facilitating simulation is creating a safe educational environment. Edmondson's seminal work on creating psychological safety among interpersonal teams has been embraced by the healthcare simulation community. Psychological safety is an underpinning philosophy for creating simulation experiences in which learners can develop within a stimulating and challenging yet supportive social atmosphere. Through careful design and thoughtful delivery, the introductory phase of simulation, the pre-briefing, can effectively prepare learners for simulation, reduce learner anxiety, and promote psychological safety, to enhance learning experiences. These twelve tips provide guidance for conducting a pre-brief and promoting a psychologically safe environment for simulation-based education.

Endeavouring interplay: a grounded theory study of how nurse educators' work with simulation-based learning

BACKGROUND

Simulation-based learning is frequently used as a teaching and learning strategy in nursing and other health professions educations, and educators have a key role as facilitators. This facilitator role provides them with a particularly relevant perspective to help us understand and theorize around the essence of simulation-based learning, and how it is approached. This study aims to explore nurse educators' experiences and strategies in simulation-based learning.

METHOD

Data were collected in 2018-2021 using in-depth interviews with eight nurse educators. Transcripts were analysed through constant comparison using Classical Grounded Theory approach.

RESULT

The participants' main concern was how to Maximize students' learning-space in simulation. To resolve this, four strategies were identified: legitimizing simulation, self-development, preparing students, and tailoring simulation. Legitimisation, and self-development were found to be important prerequisites for developing the learning space and were therefore defined as the background or context of the theory. Nurse students were the focus of the two remaining categories, preparing students and tailoring simulation, and are thus defined as being in the foreground of the theory. The dynamics of these four strategies were captured in the Grounded theory of Endeavouring interplay.

CONCLUSION

The theory of Endeavouring interplay illustrates the complexity educators are encountering when aiming to optimize simulation as a learning space for nurse students. The strategies used are adapted to the organisational climate, available resources and context, and include striving to legitimize simulation, pursue self-development in the role as facilitator, help students prepare for simulation-based learning, and tailor the simulation to both contextual factors and individual student needs.

Medications for opioid use disorder: An interactive educational program developed for the nurse practitioner curriculum

ABSTRACT

Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths.

Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions

Background

High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators’ guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator’s role during simulated scenarios.

Methods

A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation.

Results

One main category, “Alternating between active and passive facilitation,” emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students’ understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator’s presence in the simulation room during the simulated scenarios influenced students’ emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed.

Conclusions

The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-022-00233-0.