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.

Development of the clinical reasoning competency scale for nurses

BACKGROUND

Clinical reasoning is emphasized as an important component of nursing education, since nurses' lack of clinical reasoning leads to incorrect clinical decision-making. Therefore, a tool for measuring clinical reasoning competency needs to be developed.

METHODS

This methodological study was conducted to develop the Clinical Reasoning Competency Scale (CRCS) and examine its psychometric properties. The attributes and preliminary items of the CRCS were developed based on a systematic literature review and in-depth interviews. The validity and reliability of the scale were evaluated among nurses.

RESULTS

The exploratory factor analysis was conducted for the construct validation. The total explained variance of the CRCS was 52.62%. The CRCS consists of 8 items for plan setting, 11 items for intervention strategy regulation, and 3 items for self-instruction. The Cronbach's α of the CRCS was 0.92. Criterion validity was verified with the Nurse Clinical Reasoning Competence (NCRC). The correlation between the total NCRC and CRCS scores was 0.78, all of which were significant correlations.

CONCLUSION

The CRCS is expected to provide raw scientific and empirical data for various intervention programs to develop and improve nurses' clinical reasoning competency.

Meta-Analysis of Flipped Learning Effects in Nursing Education

Background: This study is a meta-analysis confirming the effect size of clinical competence, critical thinking ability, self-directedness, and learning satisfaction, the outcome variables of flipped learning applied to nursing education. Methods: We selected 18 related studies that analyzed data using CMA (Comprehensive Meta-Analysis 2.2). Results: The effect size of the entire study was Hedges’ g = 0.68 (95% CI = 0.43~0.92). The heterogeneity of the overall effect size was I² = 90.7% (Q = 246.67, p < 0.001); critical thinking ability had an effect size of Hedges’ g = 0.87, learning satisfaction of Hedges’ g = 0.79, clinical competence of Hedges’ g = 0.53, and self-directedness of Hedges’ g = 0.37. The differences were statistically significant. Conclusion: Flipped learning can effectively improve nursing students’ clinical competence, critical thinking ability, self-direction, and learning satisfaction.

[Simulation-based education program on postpartum hemorrhage for nursing students]

Purpose

This study was conducted to develop a simulation-based postpartum care education program for women with postpartum hemorrhage and to verify the effects of the program on postpartum care.

Methods

This program was developed according to the ADDIE model of instructional system design, which consists of analysis, design, development, implementation, and evaluation phases. This quasi-experimental study used a non-equivalent control group pre- and post-test design, and data were collected from April 23 to May 4, 2015. To verify the effects of the program, 33 nursing students in the experimental group participated in a simulation program, whereas 31 students in the control group were given a case study.

Results

The experimental group had statistically significantly higher scores for clinical performance (t=-4.80, p<.001), clinical judgment (t=-4.14, p<.001), and learning satisfaction (t=-10.45, p<.001) than the control group.

Conclusion

The results of this study indicate that the simulation-based postpartum care education program for women with postpartum hemorrhage was effective for developing students' competency, implying that a similar program should be integrated into the clinical training component of the maternal nursing curriculum.

A Review for Concept Clarification of Critical Thinking, Clinical Reasoning, and Clinical Judgment in Nursing Education

Purpose: This article is a comprehensive review for concept clarification of critical thinking, clinical reasoning, and clinical judgment, which still lack a consensus and are of mixed use. Methods: Norris's method of concept clarification was used to review concepts that have no clear definition or conceptualization yet. Results: This review summarized literature from various disciplines, classified each concept based on similarities and differences, and provided hypothetic conceptual schema. Conclusion: Clinical reasoning and clinical judgment are clinical situation specific concepts, while critical thinking is a concept applied in general situations. Critical thinking is a broader concept and serves as a foundation for clinical reasoning and clinical judgment. Clinical reasoning precedes clinical judgment. Clinical judgement implies the end point or conclusion of clinical reasoning. Each of critical thinking, clinical reasoning, and clinical judgment is a cognitive and affective process not a psychomotor process. The concept of clinical competency involves action taken after the cognitive processes of clinical reasoning and clinical judgment.

Preliminary study of outcome-based clinical practicum for undergraduate nursing students

AIM

A growing trend in South Korean nursing education is toward outcome-based education. In response, there is now a greater emphasis on achieving the learning outcomes that are outlined in the curricula of outcome-based education. This study aimed to describe the effectiveness of outcome-based clinical practicum for nursing students.

METHODS

In this preliminary longitudinal study, 62 third-year nursing students were enrolled from a university in Seoul, Korea. Three parameters of proficiency were measured three times in the students for 1 year including: achievement of expected learning outcomes, nurses' core competence, and critical thinking. For the data analysis, a descriptive analysis and repeated-measures ANOVA were used with the IBM SPSS v. 23.0 software program.

RESULTS

Completing the outcome-based clinical practicum was associated with a significantly enhanced achievement of expected learning outcomes, nurses' core competency, and critical thinking. All of the six expected learning outcomes significantly improved across the pre-, mid-, and postpracticum time points.

CONCLUSIONS

The outcome-based clinical practicum improved the achievement of the expected learning outcomes, nurses' core competency, and critical thinking of the nursing students. Further study is recommended to investigate students' and educators' qualitative experiences of outcome-based clinical practicum.