Perceptions and needs for a community nursing virtual simulation system for Chinese nursing students during the COVID-19 pandemic: A qualitative study

Background

Virtual simulation systems are being increasingly used in the field of nursing education. However, these systems are mostly designed based on the perspective of developers, and the needs of the end users are often neglected. The purpose of this study was to explore the perceptions and needs of Chinese undergraduate nursing students for the development of a community nursing virtual simulation system.

Methods

This was a descriptive qualitative study enrolling 12 undergraduate nursing students at a University in China. Data were collected through semi-structured interviews. The content analysis method was used for data analysis.

Result

Three themes and 15 sub-themes were extracted from this study: (1) Positive perceptions regarding virtual systems: a) Provides space for trials and errors, b) Not limited by time and space, c) Provides auxiliary tools; (2) Design and use requirements: a) Performance needs, b) Contents design needs, c) Appearance design needs, d) Support Needs; (3) Competency enhancement needs: a) Community nursing practice ability, b) Critical thinking ability, c) Independent thinking ability, d) Ability to deal with emergencies, e)Teamwork skills, f) Self-efficacy, g) Resilience, h)Interpersonal communication skills.

Conclusion

Designers and engineers should consider students' needs, aim to improve students' abilities, improve the diversity, the scientific and rigor of content, and enhance user immersion and interest. The system should be programmed to provide real-time feedback, timely technical and professional support, in order to optimize use experience of nursing students.

The Lived Experiences of Saudi Nursing Students in Digital Clinical Experience: A Phenomenological Study

Background Novel digital methods of simulation are gaining popularity in nursing education in light of the limited access to clinical placement and expensive high-fidelity simulation technologies. Aim The aim of this study is to explore the lived experiences of Saudi nursing students in digital clinical experiences (DCEs). Methods A qualitative phenomenological research design, grounded in Husserlian phenomenology, was employed. Purposive sampling was utilized to select 21 participants actively involved in DCEs. In-depth interviews were conducted to collect rich, narrative data. Results The thematic analysis has yielded four themes, namely, "comfort and safety", "critical thinking and problem solving", "appraisal of knowledge", and "transition to practice." Conclusions The findings contribute to ongoing discussions about leveraging technology in nursing education, emphasizing the need for educators and policymakers to integrate digital tools that enhance the learning experiences of nursing students.

Virtual Reality Simulation Applications in Pre-Licensure Psychiatric Nursing Curricula: An Integrative Review

The integrative review's objective is to determine the effectiveness of incorporating virtual reality (VR) simulation teaching methods in pre-licensure psychiatric nursing curricula. While the demand for skilled nurses has increased, the COVID-19 pandemic exacerbated nursing educational resource shortages and reduced the number of qualified applicants accepted into nursing schools. Psychiatric assessment and communication skills are difficult to obtain. VR simulation may present an effective solution to enhancing nursing students' psychiatric education. The integrative review was the study design. Tailored search terms were applied to the following databases: PubMed, PsycINFO, ERIC, and CINAHL Plus with Full Text. The databases were searched by title and abstract during the period January 1, 2011, through October 14, 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to search strategies and results. The selected articles were evaluated using the Johns Hopkins research evidence appraisal tool. Eleven studies met the inclusion criteria for the integrative review. Study results were categorized into two main themes: (a) pedagogical approach and (b) usability. Three sub-themes emerged: (a) knowledge, (b) attitudes, and (c) skills. VR was found to be effective in increasing nursing students' knowledge; improving communication and decision-making skills; and impacting attitudes toward patients living with mental illness. VR was found to be the same as or superior to traditional and other simulation methods in teaching psychiatric nursing education to pre-licensure students. While convenient, virtual reality use involves managing technical difficulties and considering safety. VR simulation is an effective pedagogical approach for psychiatric nursing curricula and offers a potentially cost-effective alternative to traditional learning and other simulation methods.

Identifying best practices for virtual nursing clinical education: A scoping review

BACKGROUND

COVID-19 forced nurse educators across the world to rapidly shift clinical experiences from face-to-face to the virtual world without identification of best practices to guide this transition.

PURPOSE

The purpose of this review was to identify best practices in virtual clinical experiences for undergraduate and graduate nursing students using the Community of Inquiry model as a framework.

METHOD

A scoping review was conducted using the Joanna Briggs Institute Scoping Review process. Ten databases were searched systematically for literature related to virtual nursing student clinical experiences. The 36 articles retained for review were appraised using evidence-based rapid critical appraisal tools.

RESULTS

The literature suggests virtual clinical experiences may positively impact clinical reasoning and judgement; knowledge gain, retention, and application; affective learning; communication and teamwork; competence; engagement; confidence; and satisfaction. However, increased anxiety, frustration with technology and access, difficulty asking questions, and increased cost were reported. Additional considerations included appropriate faculty training, student support, and accreditation and board certification requirements. Standards related to virtual clinical experiences and simulation for advanced practice registered nurses needs further study.

CONCLUSION

Virtual clinical experiences resulted in positive student learning outcomes. Through the provision of quality virtual clinical experiences, nurse educators have the potential to maximize student learning and professional growth.

The Use of Metaverse in Nursing Education: An Umbrella Review

BACKGROUND

Given the wide range of metaverse technologies, there is a need to synthesize evidence of metaverse pedagogy used effectively for nursing education.

PURPOSE

This umbrella review synthesized systematic reviews on the use of metaverse in nursing education.

METHODS

A search was performed in MEDLINE, EMBASE, CINAHL, Web of Science, and Education Full Text. This umbrella review was conducted with reference to the Joanna Briggs Institute (JBI) Reviewer's Manual and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The JBI Critical Appraisal Checklist for Systematic Review was used to assess the quality of studies.

RESULTS

The final review comprised 15 articles published between 2013 and 2021, most of which indicate that metaverse interventions support increased knowledge, self-confidence, engagement, satisfaction, and performance in nursing students. Several articles in this review presented mixed findings related to certain learning outcomes.

CONCLUSION

This umbrella review supports the viability and effectiveness of metaverse in nursing education.

Use and Effectiveness of Virtual Simulations in Nursing Student Education: An Umbrella Review

Computer-based virtual simulation in nursing is a rapidly developing field. A summary of current research could benefit nursing faculty who are incorporating this pedagogy into online teaching due to social distancing requirements. This umbrella review aimed to explore the use and effectiveness of virtual simulations in prelicensure nursing education. Our umbrella review approach was informed by The Johanna Briggs Institute guidelines. The 18 included reviews captured the experiences of over 7600 nursing students who engaged with five different virtual (screen-based) simulation modalities. Results indicated that virtual simulations can be effective in developing nursing students' knowledge and psychomotor and psychosocial skills, for example, in medication administration and communication. There was no study that showed a conclusive benefit of virtual simulations for developing clinical reasoning. Students enjoyed virtual simulations, claiming they were accessible, fun, and engaging ways to learn. Many benefits of virtual simulations and some technological challenges were identified in a mapped model. In the future, more rigorous and experimental studies are needed to confirm effects on learning outcomes. Nursing curriculum designers need to define the place and purposes of the pedagogy to ensure that knowledge and skills learned during virtual simulations can be applied to real-world, patient-centered care.

Global Trends and Hot-Spots in Research on Virtual Simulation in Nursing: A Bibliometric Analysis From 1999 to 2021

Background

Virtual simulation has been widely used in nursing education and nursing training. This study aims to characterize the publications in terms of countries, institutions, journals, authors, collaboration relationships, and analyze the trends of virtual simulation in nursing research.

Methods

Publications regarding virtual simulation in nursing were retrieved from Web of Science core collection. Microsoft Excel 2010, VOSviewer were used to characterize the contributions of the authors, journals, institutions, and countries. The trends, hot-spots and knowledge network were analyzed by Citespace and VOSviewer.

Results

We identified 677 papers between 1999 and 2021. The number of publications grew slowly until 2019, after that, it got a sharp increase in 2020 and 2021. The USA, Canada and Australia were three key contributors to this field. Centennial College and University of San Paulo, University of Ottawa and Ryerson University were top major institutions with a larger number of publications. Verkuyl M was the most productive and highest cited author. Clinical Simulation in Nursing, Nurse Education Today, Journal of Nursing Education were the three productive journals. The foundational themes of virtual simulation research in nursing are “virtual learning during COVID-19, clinical nursing care, education in nurse practitioners, education technology”.

Conclusion

Virtual simulation in nursing field has attracted considerable attention during COVID-19 pandemic. The research hotspot is gradually shifting from clinical nursing care to studies of nursing education using different virtual simulation technologies

Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature

BACKGROUND

There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students.

OBJECTIVE

The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants' learning experience in medical, midwifery, and nursing preclinical university education.

METHODS

A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020.

RESULTS

Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine.

CONCLUSIONS

Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education.

Virtual pedagogical strategies and HESI student outcomes in response to COVID-19

BACKGROUND

To maintain curricular integrity in response to COVID-19, nurse educators are increasingly required to transition from traditional (face-to-face) to virtual pedagogy.

OBJECTIVES

The purpose of this analysis was to compare the HESI scores based on a traditional pedagogy with the HESI scores following implementation of virtual pedagogy during Spring 2020.

METHODS

Student (n = 115; 81% female; mean age = 25.71 years) HESI scores were compared after each eight-week session using the Mann Whitney U test, permutation test and Wilcoxon rank test. Logistic regression was used to identify students achieving at least 850. Chi-square test was used to determine the relationship between pedagogy and students meeting 850 HESI scores. Fall 2019 Exit HESI scores were also compared with Spring 2020 Exit HESI scores.

RESULTS

Students from diverse backgrounds (53.9% White; 27.8% Hispanic; 10.4% Asian; 5.2% Black; 1% Unknown) increased (p = 0.022) M_HESI scores following virtual pedagogy in Fundamentals, although no difference was found in Maternity (p = 0.311), Psychiatric (p = 0.129) or Medical Surgical Nursing (p = 0.692). Wilcoxon rank test revealed significant differences in M_HESI scores in same cohort of students between traditional (Psychiatric) and virtual strategies (Medical-Surgical) (p < 0.01); and traditional (Medical-Surgical) and virtual (Psychiatric) strategies (p = 0.023). White students' M_HESI scores were higher than Asian students', as revealed by Logistic regression with no differences based on gender. Spring 2020 and Fall 2019 Exit HESI scores were comparable (p = 0.499). Chi-square analysis revealed no relationship between pedagogy and achieving at least 850 on HESI (χ² = 0.027, p = 0.871).

CONCLUSIONS

Based on the exit HESI scores, virtual pedagogy was as effective as traditional pedagogy for maintaining student competency in a community college associate degree nursing program. Future analyses of the effectiveness of virtual pedagogy in meeting curricular outcomes is warranted, regardless of exit degree option.

Using Debriefing for Meaningful Learning With Screen-Based Simulation

BACKGROUND

COVID-19 has led to increased use of screen-based simulation. However, the importance of including a robust debriefing as a component of these simulations is often neglected.

PROBLEM

Failing to include debriefing with screen-based simulation could negatively impact student learning outcomes.

APPROACH

Debriefing, including recollection, discussion to reveal understanding, feedback and reflection, is a process of helping learners make sense of learned content and knowledge as it is applied to the patient care experience. Debriefing for Meaningful Learning (DML) is an evidence-based method derived from theory, which can be easily incorporated into screen-based simulation to augment the clinical learning experience.

CONCLUSION

By guiding learners to consistently engage in DML, clinical decisions and actions taken during virtual simulations can be uncovered, discussed, challenged, corrected, and explored. Including a synchronous, structured debriefing like DML ensures that screen-based simulation results in meaningful learning in addition to performance feedback to foster safe and quality patient care.

Gamification in Nursing Education: An Integrative Literature Review

The objective of this literature review and evaluation project was to determine what evidence exists on the use of interactive digital learning and gamification for adult learners in nursing, for the purpose of guiding a redesign of our organization's online clinical education courses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in the literature search, with the critical analysis and leveling of evidence. After determining the search terms, four electronic databases (PubMed, CINAHL, ERIC, and Cochrane) were searched with the guidance of a medical librarian. Eight reviewers participated, and an evidence-based practice specialist served as auditor. Twenty-three articles were included in the review, which revealed overall support for the gamification process with specific findings about optimizing the process. The review further suggested that interactive digital learning in the form of games, gamification, or scenario-based learning has a positive effect on learner engagement and satisfaction; however, none of the studies were able to quantify objective data about knowledge retention. Further research is needed to test different modalities that improve both learner engagement and knowledge retention. [J Contin Educ Nurs. 2020;51(11):509-515.].

Enhancing Nursing Education Through Affordable and Realistic Holographic Mixed Reality: The Virtual Standardized Patient for Clinical Simulation

Nurses serve a valuable role in the healthcare industry. Nurses are trained with the skills and knowledge to thrive in a fast-paced, evolving environment. In order to meet the complex and diverse needs of patients, nurses must be able to assess and prioritize care to produce safe and high-quality outcomes. Simulation is an established method of educating nursing students and preparing nurses to respond appropriately to situations they are likely to encounter in practice. Traditional nursing simulation devices are prohibitively expensive for many nursing education institutions. The development of augmented, mixed, and virtual reality simulation delivery offers a new platform for simulation, known as immersive simulation. Immersive simulation can virtually place nursing students in situations that are difficult to arrange in actual clinical practicums or that occur rarely but for which nurses need to be prepared. Additionally, the hardware required to deliver immersive simulation is much cheaper than that of traditional nursing simulation devices. This chapter describes the virtual standardized patient application delivered via mixed reality immersive simulation. This chapter also discusses the research initiative currently underway to assess student perceptions to this modality of health training simulation.

A Framework for Web-Based Interprofessional Education for Midwifery and Medical Students

Scheduling interprofessional team-based activities for health sciences students who are geographically dispersed, with divergent and often competing schedules, can be challenging. The use of Web-based technologies such as 3-dimensional (3D) virtual learning environments in interprofessional education is a relatively new phenomenon, which offers promise in helping students come together in online teams when face-to-face encounters are not possible. The purpose of this article is to present the experience of a nurse-midwifery education program in a Southeastern US university in delivering Web-based interprofessional education for nurse-midwifery and third-year medical students utilizing the Virtual Community Clinic Learning Environment (VCCLE). The VCCLE is a 3D, Web-based, asynchronous, immersive clinic environment into which students enter to meet and interact with instructor-controlled virtual patient and virtual preceptor avatars and then move through a classic diagnostic sequence in arriving at a plan of care for women throughout the lifespan. By participating in the problem-based management of virtual patients within the VCCLE, students learn both clinical competencies and competencies for interprofessional collaborative practice, as described by the Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Interprofessional education for personalized medicine through technology-based learning

The delivery of personalized medicine utilizing genetic and genomic technologies is anticipated to involve many medical specialties. Interprofessional education will be key to the delivery of personalized medicine in order to reduce disjointed or uncoordinated clinical care, and optimize effective communication to promote patient understanding and engagement regarding the use of or need for these services. While several health professional organizations have endorsed and/or developed core competencies for genetics and genomics, the lack of interprofessional guidelines and training may hamper the delivery of coordinated personalized medicine. In this perspective, we consider the potential for interprofessional education and training using technology-based approaches, such as virtual simulation and gaming, compared with traditional educational approaches.

Using a virtual patient in an advanced assessment course

BACKGROUND

A virtual patient, Digital Clinical Experience (DCE), was incorporated into an advanced assessment course.

METHOD

Students conducted systems-based physical examinations on the DCE, documenting findings using a standard history format and physical examination skills checklists. Faculty reviewed transcripts generated from the students' history and physical examination to evaluate the logical order and progression of the examination.

RESULTS

The nine DCE modules were included as half of the 2-hour weekly laboratory requirement and counted as 17.5% of the course grade. Faculty customized specific components of individual modules, including instructions to students and model documentation, to align with course objectives and faculty preferences. DCE use permitted faculty to provide structured student practice and evaluate essential advanced assessment skills that have not been previously assessed for individual students due to excessive time and cost.

CONCLUSION

The potential impact of integrating a virtual patient on students' history taking and physical examination skills in their clinical courses should be explored.

Virtual education: is it effective for preparing nurses for a hospital move?

OBJECTIVE

The objective of this study was to compare the effectiveness of using a virtual environment (VE) versus traditional paper floor plans (FPs) to prepare nurses for wayfinding in a new hospital building.

BACKGROUND

This study was designed to control for variables such as task complexity and individual ability that have been missed in other media comparison studies.

METHODS

Thirty nurses were assigned to the VE or FP condition using a randomized block experimental design. Subjects were blocked by alternate ranks on spatial/navigational ability and computer attitude/experience and randomly assigned to conditions. Nurses received instruction with either a VE or FP condition. Wayfinding tasks were then completed with trained observers at the new hospital under construction.

RESULTS

The investigators found no significant differences between the wayfinding performance or postintervention confidence levels of subjects. Instruction using both media improved wayfinding and navigation skills. Qualitative findings suggest that interactions of the instructional style, media, and learner influence information retention and transfer.

CONCLUSIONS

Although the virtual media did not prove to be more effective than FPs, it was equally effective for learning wayfinding and navigation skills in a new hospital. Nursing leaders may want to consider use of 3-dimensional VEs as an early method to provide repetitive practice for learning how to navigate a new large-scale space.