Underground nursing students' experiences in a face-to-face, hybrid, and online escape room model: a comparative analysis in Serbian context

Educational escape rooms (EERs) are gamified teaching and learning tools increasingly used in nursing education. This study aims to compare undergraduate nursing students' gameful experiences (GEs) across three EER models: face-to-face, hybrid, and online. A cross-sectional study was conducted with 136 first-year students in a Serbian undergraduate nursing programme. All models EERs had the same narrative, which included several topics from the Fundamentals of Nursing course. Face-to-face and hybrid EERs were implemented in faculty skills laboratories, while the online model used the Zoom® platform. Face-to-face EERs were conducted in 2021/2022. and hybrid and online in the 2022/2023 school year. Immediately after the EER activity, the Gameful Experience Scale (GAMEX) assessed students' GE across six dimensions (Enjoyment, Absorption, Creative Thinking, Activation, Absence of Negative Effects and Dominance). All students solved the puzzles in the allotted time and 'escaped from the room.' Median escape time from face-to-face EER was 39.2 (IQR = 2.1), from online 37.4 (IQR = 4.1), and hybrid 37.2 (IQR = 3.5) minutes. By comparing GE students in three EER models, significant differences were found in five dimensions of the GAMEX scale. Students in face-to-face EER enjoyed significantly more (p < 0.001) and thought more creatively (p < 0.001), while the GE of online model students indicated significantly higher levels of activation (p < 0.001), dominance (p < 0.001), and negative effect (p < 0.001). In the face-to-face and hybrid models, students' GE were more moderate in these dimensions. All EER models can generate positive emotions with moderate negative effects, aligning with the goals of EERs as educational games. Further research is needed to identify the most effective EER model for different areas of nursing education.

Reliability and validity of simulation-based Electrocardiogram assessment rubrics for cardiac life support skills among medical students using generalizability theory

Simulation-based learning (SBL) is effective for EKG interpretation training in the advanced cardiac life support (ACLS) context, enhancing motivation, confidence, and learning outcomes. However, research on the psychometrics of assessment rubrics for ACLS skills among pre-clinical students is limited. This study investigates the validity and reliability of assessment rubrics for ACLS skills, including EKG interpretation, scenario and pharmacological management, and teamwork. An SBL course that integrates basic EKG interpretation into ACLS Stations was conducted at Phramongkutklao College of Medicine, utilizing high-fidelity mannequins to simulate realistic scenarios, enrolling 96 medical students. The course consisted of five independent stations, and each student was assessed once by two raters using ten-item assessment rubrics. The rubrics included three domains: (1) EKG and ACLS algorithm skills, (2) management and mechanisms of action, and (3) affective domains. Validity evidence on the content was gathered, and construct validity was confirmed with confirmatory factor analysis (CFA). Inter-rater and internal consistency reliability were calculated. Generalizability theory was utilized to analyse the data. Three expert reviews yielded an item-objective congruence index of 0.67-1.00, with iterative validation through alpha and beta tests. The CFA demonstrated a good fit, but two questions with loading factors below 0.30 were removed, resulting in an eight-item assessment form. An inter-rater correlation of 0.70 (p < 0.001) and a Cronbach's alpha of 0.76 was demonstrated. To achieve a Phi-coefficient ≥0.80, three raters and at least 10 items are required in a p×i×r crossed design. With eight items, r:(p×i) nested design reliability was 0.69, 0.79, and 0.83 for one, two, and three raters, respectively. While a single rater with 10 items achieved a Phi-coefficient of 0.74. The rubrics for assessing ACLS skills among pre-clinical students demonstrated acceptable validity and reliability. A condensed eight-item rubric with acceptable reliability is proposed as a practical tool for optimizing assessment in future evaluations relevant to the pre-clinical context.

Development and validation of the QASSH scale: a tool for assessing the quality of simulation scenarios in healthcare education

Simulation-based education has become essential for pre- and post-graduate training of healthcare professionals. However, there is no tool to help simulation educators or program managers in assessing the educational quality of simulation scenario scripts for team-based immersive simulation (IS), simulated participants (SP) and procedural simulation (PS). To that end, we developed the Quality Assessment of Simulation Scenario in Healthcare (QASSH) tool. This study aims at providing validity evidence for QASSH. We set up a francophone group of experts within the French-speaking Society for Simulation in Healthcare (SoFraSimS) network and designed this scale based on recently published best practices and our long experience in conceiving simulation scenarios. We tested it by submitting three scenarios of high, borderline and low quality for assessment to a group of experts, a third of which were involved in its development. Analysis of reliability and validity of the QASSH was done using the Standards for educational and psychological testing. Generalizability theory (GT) was used to assess the internal structure and reliability of the tool. The absolute reliability coefficients (G coefficients) calculated through GT were: 0.97 (IS), 0.96 (SP), and 0.98 (PS). G-facet analyses showed that no removal of a single item of QASSH significantly increased the G coefficient above 0.01 for any of the three variants. Cronbach's alpha coefficients were 0.94 (IS), 0.94 (SP) and 0.97 (PS). Estimating the impact of the number of raters on reliability (i.e. D-studies) showed that two raters were enough to achieve a G coefficient above 0.85. The G study shows a high generalizability coefficient (≥0.90), which demonstrates high reliability. The response process evidence for validity provides evidence that no error was associated with using the instrument and its reliability was high with two raters. The QASSH is a tool to assess the quality of healthcare simulation scenarios and will be helpful to instructors wishing to build effective IS, PS and SPs scenarios.

Influencing factors and learning outcomes in virtual simulation learning experiences: A structural equation modeling

BACKGROUND

Virtual simulations have demonstrated positive cognitive, psychomotor, and affective learning outcomes. However, research exploring the causal relationship between these learning outcomes and the factors influencing them among nursing students remains limited.

AIM

This study aims to explore causal relationships between the learning outcomes and various factors associated with virtual simulation learning experiences, including the learning process, control and active learning, cognitive benefits, and reflective thinking among nursing students in a virtual learning environment.

DESIGN

A cross-sectional design was used for this study.

SETTINGS

The study was conducted among Korean nursing students in a virtual learning environment.

PARTICIPANTS

A convenience sample of 208 Korean nursing students participated in the study.

METHODS

Participants completed a structured, self-administered questionnaire designed to assess simulation fidelity, learning process, control and active learning, cognitive benefits, reflective thinking, and learning outcomes. Structural equation modeling was used to evaluate the hypothesized model and its fit.

RESULTS

Simulation fidelity was a significant predictor of the learning process (β = 0.96, p < .001), control and active learning (β = 0.94, p < .001), cognitive benefits (β = 0.97, p < .001), and reflective thinking (β = 0.94, p < .001). However, only the learning process (β = 0.48, p < .05) and reflective thinking (β = 0.29, p = .02) significantly predicted learning outcomes, while control and active learning and cognitive benefits did not.

CONCLUSIONS

Nurse educators should design and implement pedagogical strategies that enhance the learning outcomes of nursing students by prioritizing the learning process and reflective thinking within virtual simulation learning experiences.

Evaluating the impact of an educational intervention with cognitive rehearsal training on preparing pre-registration nursing students to respond to workplace incivility

BACKGROUND

Workplace incivility can cause distress to nursing students and adversely affect team cohesiveness which can then negatively affect the quality of patient care. Preparing students to foster healthy work environments and deal with acts of incivility that threaten teamwork and patient safety becomes increasingly important as nursing students progress through their academic careers.

OBJECTIVES

This study aimed to assess the impact of structured education based on cognitive rehearsal response training on pre-registration nursing students' self-efficacy perceptions in dealing with workplace incivility.

DESIGN

A single-group pre - and post - intervention study design.

SETTINGS & PARTICIPANTS

A consecutive sample of 91 third-year pre-registration Bachelor of Nursing students across three campuses of a single university participated in the study between August and October 2022.

METHODS

A concurrent nested mixed method design comprising a structured educational intervention and a 'before and after' survey (open-ended and closed-ended questions) was conducted to evaluate the efficacy of the intervention on nursing students' perceived self-efficacy in handling workplace incivility. The quantitative component was supplemented by qualitative insights from free-text comments on the quality and effectiveness of, and satisfaction with the educational intervention.

RESULTS

Participants reported an increase in perceived self-efficacy of 4.8 (SD = 4.5) points, 95 % CI [3.8, 5.8], during the post-intervention phase compared to the pre-intervention stage. This difference was statistically significant, t (90) = 10.2, p < .001, and large, d = 0.84. Additionally, the overall effectiveness of the educational intervention was rated highly, with a mean score of 8.51 and SD of 1.71. Qualitative content analysis revealed five categories: knowledge is power, the cue card method, simple and clear, role-playing realism, and the road to improvement and change. Qualitative content analysis revealed five categories: knowledge is power, the cue card method, simple and clear explanation, role-playing realism, and the road to improvement and change.

CONCLUSION

Cognitive rehearsal response training significantly enhanced nursing students' perceived self-efficacy in handling workplace incivility. Larger-scale randomised controlled trials are warranted in order to validate these findings and support broader scale implementation.

Immersive insights: A qualitative systematic review and thematic synthesis of views, experiences, health and wellbeing of students and educators using virtual reality in nursing and midwifery education

BACKGROUND AND OBJECTIVES

As healthcare evolves with technology, the demand for a more skilled nursing and midwifery workforce has increased, making traditional learning alone insufficient. This has driven the adoption of virtual reality (VR) based simulation learning. While VR's effectiveness has been reviewed, student and educator experiences and well-being remain underexplored. This review examined the perspectives of nursing and midwifery students and educators using immersive VR, and its impact on health and well-being.

METHODS

A qualitative systematic review was conducted searching across seven databases, CINAHL, Embase, Education Resources Information Centre, MEDLINE, PsycINFO, Scopus, and Web of Science Core Collection, from January 2001 to March 2024. Qualitative evidence on midwifery and nursing students and educators using immersive VR, including head-mounted displays, were included. An adapted Critical Appraisal Skills Programme tool was used to assess study quality. Themes were developed using thematic synthesis.

FINDINGS

Forty-five studies from 14 countries were synthesised. VR topics covered skills, competencies, knowledge acquisition, and professional values. Seven analytical themes emerged: impact on health and well-being, constraints to VR use, unique selling points of VR, enhanced productivity in teaching and learning, perceptions of realism in VR, professional development and attitude shifts, and future considerations for VR use.

CONCLUSION

While VR provides significant benefits in nursing and midwifery education, its full integration is hindered by practical challenges, and concerns about health and well-being. Effective adoption requires dedicated educator support, student collaboration in content development, clear guidelines, increased institutional investment, and balanced use alongside traditional simulations. Future research should investigate learner and educator perspectives longitudinally to maximise VR's educational potential.

The impact of feedback elements in serious games on nursing learning outcomes: A systematic review and meta-analysis

OBJECTIVE

This study evaluates the impact of different feedback elements in serious games (SGs) on nursing education outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

6546 English-language studies published between 2000 and 2023 were retrieved from seven electronic databases.

REVIEW METHODS

This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane Risk of Bias tool was used for quality assessment. Meta-analysis and subgroup analysis were conducted using RevMan 5.4, and the certainty of evidence for each outcome was assessed using the GRADE approach.

RESULTS

Eight studies were included in the meta-analysis. Findings showed that, compared to traditional learning methods, outcome feedback had a moderate effect size on knowledge (SMD = 0.51, 95 % CI [0.09, 0.92]), while comparative feedback had a small, non-significant effect size (SMD = 0.38, 95 % CI [-0.36, 1.12]). Immediate feedback had a large effect size on skills (SMD = 0.87, 95 % CI [0.61, 1.14]), and outcome feedback had a moderate effect size (SMD = 0.50, 95 % CI [0.21, 0.79]). Serious games with feedback had a large effect size on motivation (SMD = 1.31, 95 % CI [0.45, 2.17]). For confidence, outcome feedback had a moderately large effect size (SMD = 0.64, 95 % CI [-0.22, 1.51]), and comparative feedback had a small effect size (SMD = 0.24, 95 % CI [-0.44, 0.91]), but neither reached statistical significance. GRADE assessment showed high certainty for immediate feedback on skills, moderate certainty for outcome feedback on knowledge and skills, and very low certainty for comparative feedback on knowledge. Evidence certainty for motivation and confidence was low or very low.

CONCLUSION

Serious games incorporating feedback elements can enhance nursing students' motivation. Immediate feedback significantly improves nursing skills, while outcome feedback improves knowledge acquisition. However, further research is needed to validate these findings due to the limited number of studies and high heterogeneity.

Enhancing metacognition and nursing competency in undergraduate students utilizing multi-user virtual environment simulations: A multi-site multi-group comparative study

BACKGROUND

Simulation-based education is pivotal in nursing as it provides safe environments for clinical practice to enhance competencies. While traditional simulation enhances knowledge, critical thinking, confidence, and metacognition, it is encumbered by limitations like high cost and spatial constraints. In comparison, virtual simulations, such as multi-user virtual environment simulations, offer immersive and interactive experiences that can help overcome many of these limitations.

AIM

We aimed to evaluate the effects of multi-user virtual environment simulations on nursing students' metacognition and competency and examine the impact of varying simulation exposures in a multi-site context.

DESIGN

A multi-site multi-group comparative design was used to assess the effectiveness of multi-user virtual environment simulations.

SETTING

The study was conducted across five universities in South Korea.

PARTICIPANTS

A total of 518 undergraduate nursing students from ten groups at five universities participated in the study.

METHODS

Participants engaged in child and community health nursing simulations within virtual environments, including settings like hospitals, public health centers, and residential homes. The scenarios were constructed using expert-validated templates to prompt student actions. Metacognition and nursing competency were measured using pretest and posttest questionnaires, with statistical analysis employed to assess the degree of variations.

RESULTS

Significant improvements in metacognition and nursing competency were observed, especially among students with lower initial skill levels. Exposure to three or more scenarios led to significant gains in metacognition and competency. Students in high-cluster groups demonstrated changes in metacognition through the integration of simulation and clinical practicum approaches.

CONCLUSIONS

Multi-user virtual environment simulations effectively enhance nursing students' metacognition and competency, providing a cost-effective, immersive, and interactive alternative to traditional simulations. High-quality scenarios and real-time peer feedback are critical for maximizing educational outcomes. Future research should optimize the quantity and quality of scenarios and integrating multi-user virtual environment simulations with clinical practicum to further advance nursing education.

Large-group simulation as a remote learning method in interprofessional health care education - a mixed methods study

BACKGROUND

Remote learning is expected to become more common in interprofessional health care education. Therefore, evidence-based knowledge about remote-learning methods is consistently needed to implement them more widely. Interprofessional large-group simulation is a suitable method for interprofessional education, but the knowledge on its remote implementation is scarce.

AIM

To describe the participants' experiences of the remotely implemented interprofessional large-group simulation and produce knowledge for further development.

DESIGN

A convergent mixed methods study design was used.

SETTINGS

A remotely implemented interprofessional large-group simulation in health care education was carried out in 2023.

PARTICIPANTS

Finnish interprofessional health care students and professionals from organizations at various educational levels and professional organizations (N = 810).

METHODS

Data were collected via an online questionnaire from remote interprofessional large-group simulation participants (n = 263). Descriptive and multivariate methods as well as inductive content analysis were used in the data analysis.

RESULTS

It emerged that the remotely implemented interprofessional large-group simulation was a suitable learning method for interprofessional collaboration competencies. According to the participants, the immersive structure of the large-group simulation promoted learning. The structure consisted of diverse pedagogical solutions, real-time and inspiring learning discussions, and user-oriented technical implementation in the large-group simulation. Professionals found the simulation a more activating learning method than students did.

CONCLUSIONS

The remotely implemented interprofessional large-group simulation proved to be a useful remote-learning method. Its immersive pedagogical implementation enabled the achievement of learning goals, but giving instructions for remote participation in advance proved important. Purposefully chosen technological solutions helped create a realistic, interactive, and psychologically pleasant learning environment. However, technological solutions to activate participants in remote learning need to be further developed.

Nurses' learning about professional interpersonal communication: Findings from an integrative review

BACKGROUND

Effective communication, a cognitive and social skill, is pivotal in quality care delivery. It is important to explore how nurses learn about communication during their program of study, and more importantly the substance of what they have learnt regarding communicating with patients. This is of value given the changing context of health care, society and contemporary nursing.

AIM

To explore learning and teaching practices of professional, interpersonal communication and the associated outcomes for student learning during pre-registration education.

DESIGN

Integrative review.

DATA SOURCES

Four databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Proquest and Scopus, were searched January 2000 through to December 2020. A subsequent rapid review of literature 2020 to 2023 was guided by Dobbin's method.

REVIEW METHOD

Whittemore and Knafl's framework guided this review. It included 1. problem identification, 2. literature search, 3. data evaluation, 4. data analysis, and 5.

PRESENTATION

The PRISMA protocol informed screening of literature. The quality of included articles was assessed using the Mixed Method Appraisal Tool (MMAT).

RESULTS

Of the initial eligible 46 articles critiqued, 26 remained; A rapid review found one further article. Twenty-seven articles were included in the final analysis. We derived a comprehensive understanding of curricula that included conceptual approaches, teaching techniques, student outcomes, and novel innovations. Conceptional approaches described self-efficacy based on Bandura's social learning theory. Teaching techniques to advance social and active learning though varied, were dominantly active experiential learning. Student outcomes were forthcoming across all described modes of learning and teaching that involved good education practices that actively engaged learners. Finally, we specifically identified novel practices that included immersion, repetition of deliberate practice, scaffolding and coaching. The specific unique contribution of these practices was the capacity to acknowledge and embrace existing innate student capacities.

CONCLUSION

Current literature advocates students learning of professional communication is forthcoming from appropriately designed courses. Research and evaluation of student learning remains rudimentary. The contribution of factors such as students' life skills and innate communication ability to their learning of professional interpersonal communication is largely absent. Further research is needed regarding the best focus for learning and teaching of professional interpersonal communication.

Nursing and Emergency Medical Technician Students' Perspectives on Mass Casualty Simulation Training: A Phenomenological Study

The purpose of this study was to explore the lived experiences of senior undergraduate nursing students and emergency medical technician students participating in a large-scale mass casualty incident simulation. This study used a qualitative, interpretive phenomenological research design. Participants included senior undergraduate responders (N = 385), with 250 nursing students and 135 emergency medical technician students, who attended a simulated mass casualty incident at a private university in the western United States. Data were collected from 2021 through 2024 via written reflective essay responses to open-ended prompts. Data were analyzed using Patricia Benner's method for interpretive phenomenology in nursing in conjunction with Heideggerian hermeneutics. Our findings suggest that mass casualty simulation training helps improve student responders' capacity to make accurate medical and logistical decisions under pressure, collaborate effectively as an interdisciplinary team, and remain professional in stressful situations. The implications for healthcare professions are that medical emergency simulation training can enhance technical skills, instill a more robust dedication to healthcare professions, and confidently assist in future emergencies.

The efficacy of virtual-reality teaching and learning method in enhancing interprofessional knowledge, clinical skill performance, and self-confidence in nursing education: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the efficacy of virtual reality in enhancing nursing students' knowledge, clinical skill performance, and self-confidence.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

Six databases-CINAHL, Cochrane Library, Embase, MEDLINE, PubMed, and Web of Science-were comprehensively searched for randomized controlled trials, published from database inception to May 3, 2024, which investigated virtual reality in nursing education.

REVIEW METHODS

Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to examine five domains of potential bias in the trials. Random effects models were applied in the meta-analysis and assessment of heterogeneity.

RESULTS

Nine studies with a total of 660 nursing students were included in the final analysis. Virtual-reality teaching and learning appeared to improve students' knowledge (pooled standardized mean difference [SMD] = 0.24; 95 % confidence interval [CI] = 0.01-0.46; p = 0.04) and self-confidence (pooled SMD = 0.40; 95 % CI = 0.16-0.64; p < 0.001). Egger's regression test of each pooled result indicated that publication bias had only a minor influence on the pooled analysis.

CONCLUSION

Virtual-reality learning was effective in increasing nursing students' knowledge and self-confidence in nursing learning. The incorporation of virtual reality into the teaching and learning process in nursing education is a promising strategy to enhance nursing students' competencies. Future research is necessary to improve virtual reality-based learning methods, as well as to determine their long-term implications for nursing education.

The PRIMROSE Project: What is 'physiological birth'? A quantitative approach to the perceptions of the Australian population

BACKGROUND

The definition of 'physiological birth' by the World Health Organization in 1997 may need to be revisited to better align with current practices in labour and birth in the Australian context, and to better understand the perspectives of women and their care providers. This study explored if obstetric doctors, midwives, doulas, women, and support people (with experience in labour and birth in the last 12 months) recognise physiological birth differently, which interventions they consider congruent with physiological birth, and terms that should be included in a consensus statement of 'physiological birth'.

METHODS

A self-administered, anonymous, 68-field questionnaire was developed and shared online via social media platforms (Facebook, X, and LinkedIn). The questionnaire included Visual Analogue Scales, multi-choice, Likert scale, and open-text items. Data were collected between August - November 2023.

RESULTS

733 participants interacted with the survey. Medical intervention such as vaginal examination to assess labour progress, was considered congruent with physiological birth, whereas continuous cardiotocography and artificial rupture of membranes were considered to be 'non-physiological'. Doulas associated physiological birth with being 'intervention-free' more strongly than any other group. Obstetrics doctors viewed birth as inherently risky. Respondents indicated that the psychological experience of birth, and terms such as 'spontaneous onset', 'no/minimal intervention' and 'spontaneous delivery/birth' should be included in a consensus statement of 'physiological birth'.

CONCLUSION

There are multiple understandings of the term 'physiological birth', implying that the term lacks clarity. There are disparities in how care providers and women view intervention in birth; suggesting a consensus statement of 'physiological birth' is appropriate for the Australian context.

Comparison of the effects of medication error encouragement training and low-fidelity simulation on the medication safety competence and knowledge of nursing students: A quasi-experimental study

INTRODUCTION

Medication safety is a key indicator of healthcare quality and an essential component of patient safety. Medication errors threaten medication safety, causing harm to patients and leading to psychological and financial consequences for both patients and healthcare providers. There has been a significant increase in medication errors among nursing students. Among the main causes of medication errors are insufficient education, which leads to a lack of knowledge and competency in safe medication administration. Medication error encouragement training and low-fidelity simulation are among the new educational methods in the field of safe medication administration training. This study aimed to compare the effects of two methods-medication error encouragement training and low-fidelity simulation-on the knowledge and competency of medication safety among nursing students.

METHODS

This study is a quasi-experimental, two blinded, two-group design conducted in 2023. Sixty-four third-year nursing students were selected through convenience sampling and randomly assigned to control and intervention groups. The students' medication safety knowledge was assessed through self-report, and their medication safety competence was evaluated using a scenario as a pretest. Subsequently, one group underwent medication error encouragement training, while the other group experienced low-fidelity simulation. Afterward, the participants' medication safety competence was assessed post-intervention using a different scenario from the pretest, with their performance observed and their medication safety knowledge score self-reported. Data collection was done through the Medication Safety Critical Element Checklist and Medication Safety Knowledge Assessment. Data analysis was performed using SPSS version 16, with a significance level set at 0.05.

RESULTS

The independent sample t-test revealed no significant difference between the knowledge and medication safety competence scores of the two groups before the intervention (P > 0.05). The paired sample t-test indicated a significant increase in the scores of knowledge and medication safety competence for both groups after the intervention (P < 0.05). Additionally, the MANCOVA test demonstrated a significant increase in the medication safety competence score for the medication error encouragement training group compared to the low-fidelity simulation group after the intervention (P < 0.05). However, no significant difference was found in the medication safety knowledge scores between the two groups after the intervention (P > 0.05).

CONCLUSION

The study results indicate that both medication error encouragement training and low-fidelity simulation play a significant role in enhancing the knowledge and medication safety competence of nursing students. Therefore, it is recommended that nursing educators incorporate these two methods in medication safety training.

Participatory simulation training design: The MAMA interprofessional team-training program for obstetric care of pregnant individuals living with HIV in Tanzania

INTRODUCTION

Stigma towards women living with HIV (WLHIV) during childbirth can lead to suboptimal care and clinical outcomes. In this paper we describe the design of MAMA, a simulation team-training curriculum for labor and delivery (L&D) providers to reduce HIV stigma, provide more respectful maternity care (RMC), and improve clinical empathy.

METHODS

In order to adapt the PRONTO model of simulation training, we integrated and applied the ADAPT-ITT framework for systematic adaptation of evidence-based interventions (EBI) and participatory design principles to create a responsive and innovative program. This process ensured we met local needs through continuous and iterative input from stakeholders, enabling those who would benefit from the intervention to drive its creation.

RESULTS

The final intervention is a 2.5 days workshop, followed by a 2-hour in-situ refresher in the providers' clinical setting. The training centers simulation scenarios, teamwork and communication activities, and interactive lessons on principles of RMC, HIV stigma, prevention of mother-to-child transmission, implicit bias, teamwork, clinical empathy, and coping with burnout.

CONCLUSION

The ADAPT-ITT model, augmented by participatory design strategies, provides a systematic yet flexible process to adapt and contextualize EBIs. The use of these complementary approaches resulted in a locally grounded intervention to build provider confidence and skills caring for WLHIV giving birth and to improve RMC in facilities in Tanzania.

TRIAL REGISTRATION

NCT03600142.

Bibliometric analysis of high-fidelity simulation training in nursing

BACKGROUND

While advances have been made in the field of high-fidelity realistic simulation in nursing, bibliometric studies in this field are limited.

OBJECTIVES

The objectives were: (1) to examine the number of articles published in the field of nursing on high-fidelity realistic simulation with a time frame from 2009 to 2023; (2) to identify the scientific journals that publish the most on high-fidelity simulation in nursing; (3) to analyze the authorship of scientific publications on high-fidelity simulation in nursing.

DESIGN

This is a bibliometric study of high-fidelity simulation in nursing.

METHODS

The search was carried out in the Web of Science database, using the controlled vocabulary available in the MESH Terms, "High-Fidelity Simulation Training". To compose the final sample, the following inclusion criteria were taken into account: original article, available in its entirety, involving the training of nursing professionals. Exclusion criteria applied were: review studies, not focusing solely on the training of nursing professionals.

RESULTS

A total of 191 manuscripts were obtained. For the selection stage, the EndNote software was used to exclude duplicate studies; sequentially, the studies were exported to the Rayyan software for selection by reading the title and abstract, for subsequent analysis of the studies by the inclusion and exclusion criteria, a total of 72 studies were obtained for analysis. The number of studies on training nursing staff has shown an upward curve over the years. The journals that published the most on the subject over the years were Nurse Education Today (n = 10), Clinical Simulation in Nursing (n = 7) and Healthcare (n = 5). The authors who published the most on the subject were: Arrogante, O (n = 11), Jimenez-Rodriguez, D (n = 6), Carrion-Garcia, L. (n = 3).

CONCLUSION

The concentration of scientific productions on high-fidelity realistic simulation, by author affiliation, has been in Europe and the United States of America, with an increase in publications over the last decade.

A systematic review and sequential explanatory synthesis: Artificial intelligence in healthcare education, a case of nursing

AIM

This review aims to explore the impact of artificial intelligence (AI) on knowledge acquisition, skills development, and attitudes among nursing students.

BACKGROUND

AI offers hopeful opportunities to enhance learning experiences and prepare future healthcare professionals.

METHODS

This was a sequential explanatory mixed-method systematic review. This review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive electronic database was searched to identify relevant studies. Eligibility criteria were studies examining the impacts of AI interventions on nursing students' knowledge, skills, or attitudes. The methodological quality of the studies was assessed using the mixed-method appraisal tool.

RESULTS

Nine research articles were included in the review. These studies utilized both quantitative and qualitative methodologies to examine the impact of AI on nursing students. Quantitative studies found positive relations between AI interventions and knowledge acquisition, skills development, and attitudes toward AI among nursing students. Qualitative findings revealed the positive outcomes of AI in fostering learning engagement, self-efficacy, and confidence.

CONCLUSIONS

AI shows potential for supporting knowledge acquisition, skills development, and fostering positive attitudes among nursing students.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

AI-driven interventions enhance nursing education by improving clinical decision-making, confidence, and knowledge acquisition. By integrating AI, nurse educators can develop more interactive, personalized, and impactful learning environments that may help students with the complexities of contemporary healthcare. Policies, standardized guidelines, and faculty development programs may be developed that can promote ethical AI integration, equitable access, and faculty training. These changes can be considered essential to maximize AI's benefits.

An Extracorporeal Membrane Oxygenation (ECMO) Simulation-Based Experience Among Postgraduate Critical Care Nursing Students During the COVID-19 Pandemic: A Qualitative Study

During the COVID-19 pandemic, extracorporeal membrane oxygenation (ECMO) was used for respiratory distress. This study sought to describe the nurses' perspectives on the process of ECMO training through a simulation-based experience (SBE). Eleven nurses who undertook postgraduate studies in critical care using simulation were recruited. A qualitative descriptive study. Purposive sampling was applied, and data were collected through semi-structured interviews. An inductive analysis was used. The credibility, transferability, confirmability, and dependability strategies were used for rigor. Three themes were identified: (a) Simulation: a bridge between practice and educational content, simulation serves as a link between acquired knowledge and its integration with clinical practice; (b) Patient-ECMO machine interaction, simulation enables the integration of ECMO management within nursing care, as an extension of the care of the individual; (c) Critical situations in simulation, the management of vascular pressures is identified as the greatest challenge faced by nurses during simulation. SBEs enable critical care nurses to be trained in the management of highly complex technological devices such as ECMO.

Everyday Clinical Ethics: Essential Skills and Educational Case Scenarios

Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated with everyday clinical ethics and to identify educational case scenarios to illustrate everyday clinical ethics. Individual, semi-structured interviews were conducted with a convenience sample of bioethicists. Bioethicists were asked: (1) What are the essential skills required for everyday clinical ethics? And (2) What are potential educational case scenarios to illustrate and teach everyday clinical ethics? Participant interviews were analyzed using qualitative content analysis. Twenty-five (25) bioethicists completed interviews (64% female; mean 14.76 years bioethics experience; 80% white). Five categories of general skills and three categories of ethics-specific skills essential for everyday clinical ethics were identified. General skills included: (1) Awareness of Core Values and Self-Reflective Capacity; (2) Perspective-Taking and Empathic Presence; (3) Communication and Relational Skills; (4) Cultural Humility and Respect; and (5) Organizational Understanding and Know-How. Ethics-specific skills included: (1) Ethical Awareness; (2) Ethical Knowledge and Literacy; and (3) Ethical Analysis and Interaction. Collectively, these skills comprise a Toolbox of Everyday Clinical Ethics Skills. Educational case scenarios were identified to promote everyday ethics. Bioethicists identified skills essential to everyday clinical ethics. Educational case scenarios were identified for the purpose of promoting proficiency in this domain. Future research could explore the impact of integrating educational case scenarios on clinicians' ethical competencies.

The Physician Is on Campus: Improving Communication and Collaboration Between Future Nurses and Physicians Through Simulation

ABSTRACT

The purpose of this project was to determine if physician participation in simulation affects students' perceptions of nurse/physician communication and collaboration. Fifty-five students participated in six groups. Three groups had a physician present and involved during their eight-hour pediatric simulation; the others continued with current practice, which involved phone contact with an individual posing as a physician. There was a statistically significant difference in two items on the Nurse Attitudes About Communicating and Collaborating With Physicians tool when pre- and post-simulation means were compared. Findings are consistent with previous research, indicating simulation-based learning can improve students' perceptions of nurse-physician collaboration.

Experiences of immersive virtual reality in healthcare clinical training for nursing and allied health students: A mixed studies systematic review

BACKGROUND

Immersive virtual reality (IVR) is increasingly used in education as an alternative to traditional pedagogy. Although promising learning outcomes have been reported using immersive virtual reality, the users' experience has not been fully explored.

OBJECTIVE

To consolidate evidence on immersive virtual reality experiences in healthcare clinical training for undergraduate nursing and allied health students.

REVIEW METHODS

A mixed-studies systematic review. Quantitative and qualitative studies involving nursing or allied health students were selected, researching head-mounted gear through experience outcomes. Both published and unpublished studies in the English language from 2013 to 2024 were included. Methodological quality was assessed using the mixed methods appraisal tool. Thematic analysis was used for qualitative findings and narrative analysis was used for quantitative findings. Convergent data synthesis approaches were used to integrate both results.

RESULTS

A total of 93 studies were selected, encompassing 11 RCTs, 34 Quasi-experimental, 15 quantitative, 12 qualitative, and 21 mixed-method studies. The results showed that immersive virtual reality augmented learning experiences. The widespread positive response to using IVR in healthcare education exemplifies its promising potential. Three integrated themes were identified: (1) the versatility of IVR, (2) heuristic learning, and (3) the inappropriacy of IVR.

CONCLUSIONS

IVR can enhance clinical and educative efficiency in the learning experiences of nursing and allied health students. Future research should aim to idealise feasibility by addressing discomfort or motion sickness caused by VR systems and finding alternative cost-saving mediums.

Development of a Virtual Pediatric Holistic Comfort Care Clinic

BACKGROUND

Guided by the tenets of Kolcaba's holistic comfort theory, we developed, implemented, and evaluated a simulated online pediatric advanced practice health center. The Pediatric Comfy Care Clinic (PCCC) was created to enhance person-centered diagnostic reasoning and holistic advanced management skills for family nurse practitioner students.

METHODS

Our interprofessional team used a standardized approach to online design and development while integrating essential holistic comfort theory concepts for student engagement and assessment of learning. We explored outcomes of pre- and postclinic quizzes and student reflection data using mixed methods.

RESULTS

Significant differences ( P  < .001) were noted in all postpractice quizzes in each affiliated PCCC module with variable student outcomes on graded clinic encounters. Important student perspectives on teaching and learning in the virtual clinic were noted.

CONCLUSION

A comfort theory-driven, simulated, and digitally enhanced virtual clinic is feasible and valuable with important implications for holistic advanced practice.

Development of Clinical Judgment in Prelicensure Nursing Students Through Simulation: A Longitudinal Study

BACKGROUND

There is a lack of longitudinal studies measuring student progression in clinical judgment. Previous studies measured gains in clinical judgment after 1 intervention or over 1 semester.

PURPOSE

This study evaluated the development and progression of clinical judgment in simulation throughout a prelicensure bachelor of science in nursing (BSN) program using the Lasater Clinical Judgment Rubric (LCJR).

METHODS

This retrospective longitudinal study evaluated clinical judgment using the LCJR over 4 semesters, with a sample of 53 prelicensure nursing students. Each student had 18 simulation scores recorded during the study. A linear mixed model was employed to compare LCJR average scores from the beginning to the end of the program and across each semester.

RESULTS

Eighteen simulations were reviewed among 4 nursing courses. LCJR scores increased progressively from the first to the fourth semester.

CONCLUSIONS

Students showed progression of clinical judgment throughout a BSN curriculum using the LCJR as an assessment tool.

An interprofessional cognitive aid to optimise extubation planning for patients with acute spinal cord injury

BACKGROUND

Early management of patients in the intensive care unit after acute spinal cord injury is challenging, particularly for patients with cervical injury and tetraplegia who have high rates of pneumonia and extubation failure.

OBJECTIVES

The primary objective was to evaluate the usability of a new interprofessional cognitive aid to optimise extubation planning for patients with acute tetraplegia. Secondary objectives were to (i) observe and compare clinician behaviour during high-fidelity simulation scenarios and (ii) compare clinician self-ratings of confidence before and after introduction to the cognitive aid.

METHODS

Dual methods design. Twenty-six intensive care clinicians (doctors, nurses, and physiotherapists) completed two cervical spinal cord-injured patient simulation scenarios in a random order. Between their two scenarios, participants were orientated to the new cognitive aid. Simulations were audiovisually recorded and scored by a blinded observer using a standardised checklist. Pre and post simulation questionnaires and semistructured interviews were completed.

RESULTS

The cognitive aid had good usability across all three disciplines (mean score on the System Usability Scale was 74.4). After introduction to the cognitive aid, clinicians had higher confidence with completing an independent respiratory assessment (p < 0.01) and objective outcome measures required for extubation (p < 0.01) and to discuss their objective findings and ongoing management with the multidisciplinary team (p = 0.04). Significantly more factors related to pneumonia (p < 0.001) and extubation readiness (p < 0.01) were identified, and significantly more time was taken to complete the second simulation (p = 0.03). The simulation scenarios were described as realistic, and the cognitive aid was positively perceived.

CONCLUSIONS

The interprofessional cognitive aid had good usability and enhanced intensive care clinicians' assessment, confidence, and communication about the extubation readiness of patients with acute cervical spinal cord injury.

Palliative nurses' empathic tendencies, quality of life, individualized care perceptions

Background: Palliative care is an important part of health services. The individualized care perceptions are is critical for supporting individuality during care and providing quality nursing care. Individualized care not only has, as well as having foundation of the philosophy of nursing but also, is also related to the nurses' empathic tendencies and professional quality of life of nurses.Aim: This study was conducted to examine the relationships between the empathic tendencies, professional quality of life, and individualized care perceptions of palliative care nurses.Research design: This is a cross-sectional study.Participants and research context: The study was conducted with 141 nurses working in palliative care between December 2023 and February 2024. The data of the study were collected using a "Participant Information Form," the "Emphatic Tendency Scale (ETS)," the "Professional Quality of Life Scale (ProQOL R-IV)," and the "Individualized Care Scale-Nurse Version A (ICS-Nurse-A)."Ethical considerations: Ethics committee approval was obtained to conduct the study. Individuals who agreed to participate in the study were informed of the purpose of the study, and their written consent was obtained.Findings: The participants had moderate levels of empathic tendencies, compassion satisfaction, and burnout, while their compassion fatigue and individualized care perceptions were high. There was a positive correlation between empathic tendencies and individualized care perceptions (p < .01). Empathic tendency and compassion satisfaction were significant positive predictors of the individualized care perceptions of the participants and respectively explained 13% and 20% of the total variance in their individualized care perceptions. On the other hand, burnout was a significant negative predictor of their individualized care perceptions and explained 5% of the total variance in their individualized care perceptions.Conclusions: High levels of empathic tendencies and compassion satisfaction had positive effects on the individualized care perceptions of palliative care nurses, whereas high levels of burnout had a negative effect on the same variable.

How I Do It: Teaching and Applying Qualitative Methods to Improve Surgical Simulation Design and Implementation

OBJECTIVE

To propose a simulation-based learning curriculum for trainees to comprehend and apply qualitative methodology.

DESIGN

After learning theoretical principles of qualitative methodology through assigned readings and meetings with an expert, a surgical simulation fellow practiced applying grounded theory principles to evaluate a piloted simulation curriculum teaching surgery residents de-escalation communication skills. The simulation consisted of a "just-in-time" de-escalation training, 2 simulated patient (SP) encounters, and 2 learner debrief sessions. All components were video recorded, then transcribed. The first authors performed first and second level coding yielding thematic data.

SETTING

Single academic institution PARTICIPANTS: One surgical simulation fellow.

RESULTS

About 3 themes emerged describing key aspects of the pilot simulation. The first, Escalation Spirals and SP case portrayal, consisted of the SP assuming the role of an agitated patient, as trained, with escalating and de-escalating emotions based on learner interactions. The second theme, Safety Codes, identified critical safety issues in the simulation. Lastly, Rule Confusion included the learner not understanding simulation logistics. These themes informed the team of what to keep and change for the next simulation pilot of the de-escalation curriculum.

CONCLUSIONS

Teaching qualitative methods in a practice-based learning format is feasible and has simultaneous potential to improve educational content and safety simulation-based curricula.

Integrating Complex Pain Concepts Into Prelicensure Nursing Education: An Unfolding Case Study to Enhance Clinical Reasoning and Competency

BACKGROUND

Unfolding case studies are an active learning strategy that help students integrate knowledge with practical experience, enhancing clinical judgment and easing their transition into professional practice.

PROBLEM

Chronic pain, a complex health issue, is often inadequately addressed in nursing curricula, leaving prelicensure nursing students unprepared to manage pain effectively in clinical practice, contributing to the academic-practice gap.

APPROACH

Using an evidence matrix, faculty interviews, and syllabi analysis across 4 programs, gaps in chronic pain concepts were identified. A 4-term unfolding case study was developed to address these gaps, aligned with the American Association of College of Nursing Essentials and following a patient from acute to chronic pain transition.

CONCLUSIONS

By incorporating evidence-based, active learning strategies like an unfolding case study for a complex concept such as chronic pain management scaffolded across a curriculum, nurse educators can better prepare future nurses for practice.

Essential Primary Health Care Skills: Virtual Simulations for Nurse Practitioner Education

BACKGROUND

Practice-based learning is essential in nurse practitioner (NP) education to ensure public safety and prepare students for independent practice. However, lack of clinical placement opportunities results in variability in clinical experience, necessitating educational innovation.

PURPOSE

To evaluate the usability, engagement, and impact of the Essential Skills for Nurse Practitioners virtual simulations (VS).

METHODS

Four VS covering concussion management, Medical Assistance in Dying (MAiD), memory concerns in older adults, and prescribing medical cannabis were evaluated across 3 Canadian universities using self-assessment competency rubrics and the Classroom Instructional Support Perception (CRiSP) scale.

RESULTS

Competencies improved significantly across all VS, with highest improvement in concussion management. CRiSP results indicated high usability and engagement with all VS, underscoring their effectiveness.

CONCLUSIONS

Findings indicate VS can enhance students' readiness to manage complex clinical situations and help address clinical placement shortages.

Public Health Simulation-Infused Program (PHSIP) for Nursing Education

INTRODUCTION

Recent health crises, like COVID-19, have increased the need for nurses with public health competencies, but students lack knowledge and are unconvinced of the importance of the field.

METHODS

Pre-licensure nursing students (n = 341) engaged with a public health simulation-infused program (PHSIP) that scaffolded throughout the curriculum. Public health knowledge was tested pre- and post-simulation-based education (SBE), and the simulation effectiveness tool-modified (SET-M) was used to evaluate Learners' perception of the SBE experience.

RESULTS

Learners' overall mean SET-M scores were 47.1/57 (83%), ranging from 49.5 to 54 out of 57. Post-test knowledge scores were found to be significantly higher than pre-test (p < 0.001), with an average overall mean knowledge score of 70% (±0.25) and an effect size of 0.82.

DISCUSSION

Scaffolding public health SBEs across the curriculum allowed continuous exposure to public health content. Lessons learned include the need to chunk pre-SBE training to prevent cognitive overload, and the time and resources needed to create a PHSIP.

CONCLUSION

Nursing educators should embrace the PHSIP curriculum to provide an opportunity for students to gain an appreciation for the field and gain the knowledge, skills, and resources needed to care for the public's health.

A Scoping Review of the Experiences of Internationally Educated Nurses Working With Older Adults in High-Income Countries

AIM

To comprehensively review the experiences and support needs of internationally educated nurses in healthcare settings for older people, identify current supportive interventions for internationally educated nurses in gerontological nursing practice and determine research gaps in the existing literature on their experiences and support needs. The review includes all types of nurses, except those focusing solely on undergraduate nurses who have yet to practise and nursing assistants.

METHODS

A scoping review by a Canadian review group followed the methodological framework outlined by Arksey and O'Malley (2005) and later refined by Levac, Colquhoun, and O'Brien (2010). Articles of any publication date were included. A two-stage screening process was conducted independently to determine eligibility. Data extraction was performed using a piloted charting form. We also conducted a consultative exercise with Canadian nurses. Thematic and descriptive analyses were employed to analyse the extracted data.

DATA SOURCES

Seven databases (PubMed, PsycINFO, PsychArticles, CINAHL, Scopus, Web of Science and EThOS) were systematically searched on April 27, 2024. Grey literature was searched using Google search engines, OpenGrey, ProQuest Sociological Abstracts and ProQuest ERIC, Healthcare Management Information Consortium, Open Grey repository, Proceedings First, Canada Health and Council for Allied Health Professions Research, and through expert consultation.

RESULTS

The scoping review identified 11 articles from Canada, Germany, Ireland, the Netherlands, New Zealand, Norway and the United Kingdom, highlighting positive experiences and challenges internationally educated nurses face in healthcare settings for older people. Nurses were primarily registered nurses. Challenges included workplace interpersonal issues, language barriers and organisational constraints, while positive experiences included being valued by older adults and colleagues.

CONCLUSION

The findings highlight the need for supportive interventions like mentorship, cultural competency training and organisation-led initiatives to improve internationally educated nurses' integration and retention in geriatric care, enhancing care quality for older persons.

IMPLICATIONS FOR PRACTICE

Enhancing mentorship programs, cultural competency training, and organization-led support initiatives can improve the integration, retention, and overall well-being of internationally educated nurses in geriatric care, ultimately enhancing the quality of care for older adults.

TRIAL REGISTRATION

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Promoting Intraprofessional Collaboration and Critical Thinking With Escape Rooms: An Example of a Clinical Skills Class

IMPORTANCE

Although gamification is recognized for enhancing motivation and learning outcomes, there is a need for specific evidence on how innovative methods, such as educational escape rooms, affect learning experiences and teamwork.

OBJECTIVE

This study examined the effectiveness of using the educational escape room as an innovative approach for occupational therapy (OT) and occupational therapy assistant (OTA) students.

DESIGN

One-group, preexperimental, pre- and poststudy.

SETTING

A simulation laboratory at a university.

PARTICIPANTS

Seventy-six OT and 38 OTA students enrolled in clinical skills classes were randomly assigned to teams of OT and OTA students.

INTERVENTION

An escape room incorporating associated topics covered in the clinical skills course. Students worked collaboratively and applied their combined knowledge and critical thinking skills to solve 10 puzzles to escape in 1 hr.

OUTCOMES AND MEASURES

The Readiness for Interprofessional Learning Scale, Self-Assessment Scale for Active Learning and Critical Thinking, and a researcher-developed knowledge assessment were administered 2 wk before and immediately after the escape room experience to evaluate the students' intraprofessional collaboration, activity learning, critical thinking skills, and knowledge levels.

RESULTS

Students' readiness for teamwork, activity learning, and critical thinking skills increased after participating in the escape room experience. Students' knowledge levels also improved, with a moderate effect size. These results suggest the possible benefits of educational escape rooms.

CONCLUSIONS AND RELEVANCE

Escape rooms are an increasingly popular, innovative teaching modality in health care education. This study validated that escape rooms promote students' learning outcomes and intraprofessional teamwork. Plain-Language Summary: This study assessed the effectiveness of using an escape room as a teaching tool in a clinical skills class for occupational therapy (OT) and occupational therapy assistant (OTA) students. The findings revealed significant improvements in the students' teamwork, active learning, critical thinking skills, and knowledge levels after the escape room experience. These results suggest that incorporating escape rooms into OT education can enhance learning outcomes and should be further explored in future studies with more rigorous experimental designs. This innovative approach benefits students' academic development and can affect OT practice. Fostering collaboration and critical thinking better prepares students to provide comprehensive and effective care to their future clients. This study contributes to the growing body of research that supports active learning pedagogies in OT education, highlighting the importance of engaging and experiential learning methods in preparing students for real-world practice.

Integration of Rapid Cycle Deliberate Practice Into Prelicensure Nursing Curricula: Preparing Nursing Students for Cardiac Arrest Care

BACKGROUND

Nursing students are not consistently trained on how to care for patients experiencing sudden cardiac arrest. In rapid cycle deliberate practice (RCDP), learners perform a simulation with micro-debriefs interjected by the instructor.

PROBLEM

RCDP has been used to train health care students on how to respond during a sudden cardiac arrest, but its application to prelicensure nursing students is underreported.

APPROACH

A curricular innovation was implemented based on RCDP and Vygotsky's Zone of Proximal Development (ZPD) to educate prelicensure nursing students on how to care for patients experiencing sudden cardiac arrest. The outcome of the curricular innovation was evaluated via assessment of students' perceptions following participation in the curriculum innovation.

OUTCOMES

Eighty-four prelicensure nursing students completed the curricular innovation survey, with most student perceptions favorable.

CONCLUSION

Evaluation supports the integration of this curricular innovation into nursing curricula for sudden cardiac arrest training.

Simulation-Based Learning About Care of People With Disabilities: An Integrative Review

BACKGROUND

An estimated 44.1 million US citizens are living with disabilities. People with disabilities are at higher risk for health problems, affecting their overall quality of life and care experience. Simulation-based learning (SBL) enables students to apply cognitive, affective, and psychomotor competencies through simulated experiential activities in realistic environments. Research is limited on the integration of disability into SBL nursing education.

AIM

To appraise and synthesize extant literature on the integration of disability in SBL in prelicensure nursing programs.

METHODS

This review identified and synthesized 18 research articles describing the implementation of disability SBL in prelicensure nursing programs.

RESULTS

Four themes were identified substantiating the importance of integrating disability into SBL: knowledge and understanding, communication confidence, empathy, and enlightened attitudes.

CONCLUSIONS

Disability SBL strategies are integral to achieving learning outcomes related to patient-centered care. Large well-designed studies are needed to measure its effectiveness.

Effects of Virtual Reality Versus Narrative Case Study on Empathy and Ageist Attitudes in Prelicensure Nursing Students

AIM

This study examined the effects of a virtual reality (VR) experience on empathy and attitudes toward older adults in prelicensure nursing students.

BACKGROUND

With an aging global population and concerns about age bias in health care and its role in health disparities, nurse educators must develop educational strategies that improve empathy and decrease bias.

METHOD

A sample of 61 second-degree, prelicensure nursing students participated in a quasi-experimental, comparison group study. The intervention group participated in a VR experience; the comparison group completed a narrative case study.

RESULTS

A mixed analysis of variance showed that both groups significantly improved from pretest to posttest for both empathy and attitudes, and there were no differences between the groups.

CONCLUSION

The observed findings suggest that both the narrative case study and VR were effective at improving empathy and attitudes.

Teaching for Learning in Mind: An Evidence-Based Model

AIM

The aim was to advance the development of a conceptual model derived from findings of a research study that articulated how nurse educators translate and transfer nursing knowledge into experiential teaching strategies.

BACKGROUND

Brain science teaching and learning is successful because the learning encounter is focused on guiding learners on how to use content. Educator preparation grounded in neuroscience strategies facilitates a shift from teaching in mind to learning in mind.

METHOD

Conceptual model development included blending evidence from research and principles from educational theory, resulting in the Nurse Educator Teaching for Learning in Mind model.

RESULTS

Preparing educators to teach requires a clear understanding of coming to the learning space with learning in mind. Creation of a safe learning space included communication, shared vulnerability, transparency, and intentionality.

CONCLUSION

This evidence-based conceptual model offers direction for next steps in operationalizing best educational practices in nurse educator preparation and development.

Beyond the Case Study: Laboratory Activities to Complement Integumentary Education

OBJECTIVE

To present a full scope of detailed and engaging laboratory activities recommended by physical therapist clinicians and educators from across the US to assist health professions faculty to develop new or improve current integumentary/wound management (IWM) instruction.

METHODS

A three-round Delphi survey was conducted to update IWM curriculum recommendations for entry-level doctor of physical therapy education. First-round participants provided ideas for laboratory activities. Activity responses were discussed, edited for redundancy, and clarified. Missing information (eg, estimated cost and time required) was added to increase usability.

RESULTS

A total of 139 laboratory activities were recommended by survey participants. Many of the suggestions included inexpensive and readily available, do-it-yourself wound models requiring food or other moulage techniques. These simulations are elucidated to facilitate translation of ideas into classroom and community laboratory activities to promote student learning.

CONCLUSIONS

The literature supports that most entry-level healthcare profession programs report limited IWM education, emphasizing the need for effective and efficient use of IWM contact hours. Developing engaging and meaningful hands-on laboratory activities is vital to increasing student knowledge and skill in this area of clinical practice.

Evaluation of acquisition and retention of non-technical skills of residents submitted to interprofessional simulation-based training in pediatric cardiopulmonary resuscitation

OBJECTIVE

The purpose of the study was to evaluate the acquisition and retention of non-technical skills by pediatric residents who participated in an interprofessional simulated pediatric cardiopulmonary resuscitation scenario through simulation-based training.

METHOD

This prospective cohort study was conducted at a simulation center of a Pediatric Hospital. Ninety-six residents of pediatrics and nursing were divided into 16 interprofessional teams and participated in a cardiopulmonary resuscitation simulated scenario followed by a debriefing session. It was conducted twice on the same day and repeated after a period of time that ranged from 107 to 161 days. Groups were evaluated for the acquisition and retention of non-technical skills and global non-technical performance through a valid and reliable tool for measuring teamwork in medical emergencies.

RESULTS

Participants demonstrated an improvement in leadership, teamwork, task management, and overall performance of the team after the first intervention. However, when evaluated during the second intervention, retention of leadership and teamwork were noted, but not for task management and overall performance.

CONCLUSION

Learning non-technical skills is complex and requires training, ideally with short periodicity, since it demands frequent practice for its acquisition and retention. The present research showed that non-technical skills can be acquired through simulation-based training. However, it was noted that the retention of these skills is more complex, requiring repeated simulations over a longer period of time. Therefore, further research on the learning curve, time to acquisition, and retention of non-technical skills trained with simulation-based education is warranted.

Scoping Review of Gamification in Rehabilitation Care of Adults With Chronic Illnesses

BACKGROUND

Gamification uses game-based mechanics, aesthetics, and game thinking to engage people, motivate action, promote learning, and solve problems. However, gaps remain in understanding and implementing gamification in rehabilitation care, necessitating further exploration and clarification of the best evidence for application of gamification.

OBJECTIVE

To conduct a scoping review of the use of gamification in rehabilitation care for adults with chronic illnesses, summarizing the scope, forms, elements, guiding theories, effectiveness, and ease of use of gamification.

METHODS

Eight databases in English or Chinese were searched from January 1, 2011 to May 20, 2024 following the standard scoping review framework.

RESULTS

A total of 24 papers were included. Gamification was applied in the rehabilitation of endocrine, skeletal, circulatory, neurological, and cerebrovascular diseases, primarily using virtual reality and three-dimensional forms. Eight gamification elements were most commonly utilized. Positive outcomes included enhanced rehabilitation knowledge, improved attitudes, better physical function, and increased self-care ability. Most patients found gamified rehabilitation care engaging and easy to use.

DISCUSSION

The application of gamification in adult chronic disease rehabilitation care shows great promise. However, the lack of theory-driven or longitudinal data in some studies highlights the need for more randomized controlled and longitudinal research to explore the effectiveness of gamified intervention.

Effects of an Avatar-Based Simulation on Family Nurse Practitioner Students' Self-Evaluated Suicide Prevention Knowledge and Confidence

ABSTRACT

Family nurse practitioners (FNPs) are often gatekeepers and can recognize the warning signs of suicidality yet may lack adequate education or self-confidence in identifying people in crisis. The purpose of this research was to evaluate the effectiveness of an online suicide prevention simulation with 53 FNP students. Pre/post responses were found to be statistically significant across all preparedness and attitudinal items following the Kognito© training ( p < .001). Online, avatar-based suicide prevention training with FNP students may be effective in improving participants' perceived preparedness and self-confidence with patients at risk for suicidality.

Extended reality technologies in adult basic life support education: A scoping review

Aim

In recent years, virtual and augmented reality (VR/AR) technologies have gained increasing attention as innovative tools for education, including in the field of adult Basic Life Support (BLS). While existing reviews on this topic primarily focus on comparing VR/AR with other educational approaches, our research aimed to identify the VR/AR hardware and software applications assessed in published studies and their alignment with learning objectives in adult BLS education.

Methods

We conducted a scoping literature review using the Population, Exposure, and Outcome (PEO) framework to analyse publications from 2018 to 2024. The review focused on the impact of VR/AR (exposure) on affective, behavioral, and cognitive learning outcomes (outcome) in adult BLS education among laypersons, healthcare professionals, pre-licensure students, and duty-to-respond laypersons (population).

Results

From 1,282 database records and 54 alternative sources, 31 articles were selected for comprehensive analysis. Many of the studies (11/31; 36%) targeted pre-licensure students, such as nursing students, and laypersons (9/31; 20%), primarily high school students. Only one study focused on duty-to-respond laypersons (1/31; 3%). VR studies (24/31; 77%) were more common than AR studies (6/31; 19%), featuring a broad spectrum of ten VR headsets compared to just two types of AR headsets. Among the assessed software applications, twenty-one commercial programs were examined-sixteen designed for VR and five for AR. Most studies investigated affective outcomes (25/31; 81%), while behavioural outcomes were also commonly examined (22/31; 71%). In contrast, cognitive outcomes were explored in fewer studies (9/31; 29%).

Conclusion

Our review identified several challenges in existing studies, including variability in software and hardware, diverse learning outcomes, and accessibility issues with extended reality (XR) technology. To maximize its effectiveness, XR should be aligned with specific learning objectives rather than adopted for its novelty. Prioritizing educational efficacy ensures that XR enhances learning by addressing precise gaps, ultimately improving the understanding and retention of resuscitation skills among both laypersons and healthcare professionals.

Construction and Validation of a Simulation Scenario for Teaching Family-Focused Care in Pediatric Oncology

Clinical simulation can be a promising teaching strategy to help nurses develop behaviors that improve family care actions, promoting safe and high-quality care. The objective of this study was to build, validate, and test a simulation scenario in pediatric oncology family-focused care (FFC) following an initial diagnosis of cancer. It is a six-step methodological study based on the philosophy of Family-Centered Care (FCC), with a user-centered design. The evaluators established a Content Validity Index (CVI) > 0.8 for validation. Pilot testing included the Simulation Design Scale. The data were analyzed by descriptive statistics. A total of 35 experts participated in this study. All 19 items in the scenario were validated and considered relevant, in a single round, with the item-level CVI ranging between 0.8 and 1 and a scale-level CVI of 0.92. The high-fidelity developed and validated clinical simulation scenario is a consistent tool for the education of advanced practice nurses.

Outcomes of Children With Tracheostomy Before and After Implementing Caregiver Simulation-Based Tracheostomy Education

OBJECTIVE

Tracheostomy-related emergencies (TRE) such as decannulation, cannula obstruction, and hemorrhage contribute significantly to mortality, emergency department (ED) visits, and hospitalizations. High-fidelity simulation-based training (SBT) for family caregivers can improve their competence in TRE management. The aims of the study were to compare the frequency of ED visits, readmissions, and mortality in children with tracheostomy based on caregiver completion of SBT.

STUDY DESIGN

Retrospective study.

SETTING

Single-center academic children's hospital.

METHODS

Children who underwent tracheostomy from 2014 to 2020 were studied, with cohorts based on caregiver completion of SBT. Patients were followed for 1 year following hospital discharge after tracheostomy. The frequency and reasons for ED visits, readmissions, and mortality were evaluated.

RESULTS

Among the 158 patients who met inclusion criteria, the caregivers of 83 (53%) patients completed SBT. Overall mortality was significantly lower (P < .001) among patients whose caregivers completed SBT (2%) compared to patients whose caregivers did not complete SBT (17%). There was no significant difference in mortality due to tracheostomy-related causes based on caregiver completion of SBT (P > .99). There were no significant differences in the total ED visits (P = .44) and readmissions (P = .11), or tracheostomy-related ED visits (P = .61) and readmissions (P = .45) based on caregiver completion of SBT.

CONCLUSION

Overall mortality was significantly lower among patients whose caregivers completed SBT. The frequency of ED visits, readmissions, and mortality due to tracheostomy-related causes did not differ between the groups. Although high-fidelity SBT may augment caregiver competence in TRE management, further study is needed to determine if SBT can measurably impact tracheostomy-related outcomes.

Experiences of final-year nursing students on simulation: a qualitative study

Simulation is employed to facilitate instructional experiences in patient safety and nursing education for students. Through simulation, students endeavor to adapt to various scenarios and address associated challenges. The aim of the study was to examine final-year nursing students' experiences with scenario-based simulation. The Reporting Criteria for Consolidated Standards and Colaizzi's seven-step phenomenological data analysis method were employed. A qualitative study was conducted using a phenomenological research design. Content analysis conducted within the scope of simulation application yielded two main themes: 'Emotions, thoughts', and 'Challenges' related to simulation. It was ascertained that students underwent a spectrum of emotional and cognitive responses towards the simulation, encompassing both affirmative (enjoyable, realistic, educational, confidence-boosting) and adverse (stressful) dimensions. Concurrently, challenges related to treatment were noted, including the calculation of medication dosages for pediatric patients, the delivery of medication education to patients afflicted with dementia, and managing medication refusal exhibited by patients with bipolar disorder.The simulation with standardized patients administered to final-year nursing students prior to graduation can raise awareness of students' theoretical and practical deficiencies in clinical practice.

Analysis of high-fidelity simulation effects and their connection with educational practices in early nursing education

BACKGROUND

Literature confirms the tangible educational benefits of participating in high-fidelity simulation exercises. However, the final assessment of such sessions is always a combination of the teacher's actions, the project, the technical infrastructure, and the student. The aim of this study was to evaluate and conduct a comparative analysis of high-fidelity simulation sessions regarding applied educational practices, satisfaction levels, and self-confidence among nursing students at a university located in a major academic center in southern Poland.

METHODS

This cross-sectional study was conducted in May and June during the 2021/2022, 2022/2023, and 2023/2024 academic years on a group of 422 first-year undergraduate nursing students. Data from 412 students who participated in high-fidelity simulation sessions were analyzed. The study employed a custom questionnaire, the Educational Practice Questionnaire (EPQ), and the Student Satisfaction and Self-Confidence in Learning Scale (SSCL). The study used Spearman's correlation coefficient, Kruskal-Wallis test, Dunn's post-hoc analysis and multivariate linear regression. A significance level of p < 0.05 was adopted.

RESULTS

The students rated the attractiveness of the sessions, the development of competencies, and the conducted debriefing relatively highly (average score above 4). Statistically significant differences were found between academic years in the assessment of social competencies acquired (p = 0.008) and the evaluation of debriefing elements as a summary method (p = 0.009). Students indicated that collaboration (M = 4.81; SD = 0.44) was present in the proposed educational method and considered it the most valuable aspect (M = 4.59; SD = 0.66). A positive correlation (r > 0) was noted between the development of knowledge (r = 0.389, p < 0.001), practical skills (r = 0.44, p < 0.001), and social skills (r = 0.401, p < 0.001) and satisfaction. There was also a positive correlation (r > 0) between the applied techniques during simulation and the level of self-confidence in the learning process (p < 0.05). The applied multiple regression models identified the aspects of the sessions that had a direct and unimpeded impact on nursing students' sense of satisfaction and self-confidence. These aspects included, among others, active learning and diverse learning methods.

CONCLUSIONS

This study confirmed the justification for organizing high-fidelity simulation sessions for nursing students due to the overall benefits for the student (in terms of satisfaction and increased self-confidence), the institution (student satisfaction with the university's educational offerings), and the profession (high perception of increased nursing competencies).

Immersive Virtual Reality Versus Mannequin-based Simulation Training for Trauma Resuscitation: A Randomized Controlled Noninferiority Trial

INTRODUCTION

Despite its high potential, the effect of immersive virtual reality simulation (VRS) in trauma resuscitation training has not been studied. The aim of this study was to test the hypothesis that VRS is non-inferior to mannequin-based simulation (MBS) in trauma resuscitation training.

METHODS

In a single-center, randomized controlled noninferiority trial, we compared individual training with an immersive virtual reality Trauma Simulator to live MBS training in a facilitated group. The primary outcome was the Trauma Score (ranging from 55 to 177) during the MBS assessment. The secondary outcomes were the Trauma Score VRS assessment, System Usability Scale (SUS) (ranging from 0 to 100), and Simulation Sickness Questionnaire (SSQ) (ranging from 0 to 235.62).

RESULTS

A total of 38 participants were enrolled in the study. The mean Trauma Score in MBS assessment was 163.2 (SD 7.9) for the control group and 163.1 (SD 13.8) for the intervention group; the difference of means 0.1 (95% confidence interval: -7.3, 7.5; P = .977). The mean Trauma Score in VRS assessment was 134.2 (SD 24.4) for control group and 158.4 (SD 17.6) for intervention group; the difference of means 24.2 (95% confidence interval: 10.1, 38.3; P = .001). The mean SUS of Trauma Simulator was 74.4 (SD 10.5). The median SSQ Total Severity score was 3.7 (IQR 0-18.7).

CONCLUSIONS

This study showed that VRS led to noninferior effects on trauma resuscitation skills to MBS. Trauma Simulator had good usability, was well received by the participants, and had minimal adverse effects.

Improving Tanzanian student nurse-midwives' knowledge, skills and attitude in postpartum hemorrhage prevention through simulation-based education: a pre-post quasi experimental study

BACKGROUND

Postpartum hemorrhage is a leading cause of maternal deaths in Tanzania, highlighting the critical need for effective training for student nurse-midwives in ordinary diploma programs. The study aimed to determine the changes in knowledge, skills, self-confidence, and satisfaction in preventing and managing postpartum hemorrhage among student nurse-midwives after the simulation-based education method is being used.

METHODS

A pre-post quasi-experimental study design without a control group was conducted to assess the impact of simulation-based education on student nurse-midwives' knowledge, skills, self-confidence, and satisfaction regarding the prevention and management of postpartum hemorrhage at one college of health and allied sciences in the northern Tanzania. A total of 55 student nurse-midwives were included. Data were collected using structured self-administered questionnaires related to knowledge, skill check, self-confidence, and satisfaction. Descriptive statistics, bivariate analysis using T-tests and Chi-square tests, as well as multiple regression models, were employed to analyze the data. A p-value of less than 0.05 was used to assess statistically significant differences in the adjusted mean (Beta Coefficient) between the post-intervention and pre-intervention periods.

RESULTS

The results indicated that student nurse-midwives experienced a significant improvement in knowledge and skills after simulation-based education method (p < 0.001). Additionally, the multiple regression analysis revealed that knowledge scores were notably higher at endline of the study compared to the baseline, with an effect size of (AβC = 11.7; 95% CI: 11.0-12.5) and 13.9(12.7-15.1) respectively. Furthermore, students reported high level of self-confidence and satisfaction regarding their abilities in preventing and managing postpartum hemorrhage after simulation, as assessed using the unadjusted Bloom technique.

CONCLUSION

The results revealed that simulation-based education was an effective pedagogical method for improving student nurse-midwives knowledge, skills, self-confidence, and satisfaction in the prevention and management of postpartum hemorrhage.

Human factors and systems simulation methods to optimize peri-operative EHR design and implementation

The increase in adoption of Electronic Health records (EHR) in healthcare can be overwhelming to users and pose hidden safety threats and inefficiencies if the system is not well aligned with workflows. This quality improvement study, facilitated from September 2023-April 2024, aimed to proactively test a new EHR using systems focused simulation and Human factors methods, prior to go-live, in a peri-operative children's hospital setting to improve safety, efficiency and usability of the EHR. The project was conducted at a large, academic, quaternary care children's hospital undergoing a transition from one EHR to another. Two cycles of usability testing followed by in situ simulations focused on testing the new EHR with interprofessional peri-operative team members prior to go live. Usability testing, using relevant clinical workflows, was completed over zoom using the EHR "testing" environment with individual care providers across multiple peri-operative roles. In situ simulations were facilitated in the actual peri-operative and Otolaryngology clinic spaces with full interprofessional teams. Qualitative data was collected and summarized through debriefing and recordings of the sessions. Human factors and patient safety principles were integrated throughout the recommendations. A total of 475 recommendations were made to improve the safety, efficiency, usability, and optimization of the EHR. The outcomes included a range of usability and system issues including latent safety threats and their impact on safe and quality patient care. There was a plethora of usability improvements, including some critical issues that were uncovered and mitigated prior to the go live date.

Cybersickness and discomfort from head-mounted displays delivering fully immersive virtual reality: A systematic review

AIM

To synthesize existing knowledge on the phenomenon of cybersickness and discomfort associated with the use of HMDs in delivering fully immersive VR experiences within educational contexts.

BACKGROUND

Virtual reality (VR) plays an increasingly important role in education; however, head-mounted displays (HMDs) may trigger cybersickness and discomfort.

DESIGN

A systematic review (PROSPERO: CRD42024583656) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

The PubMed, CINAHL, Cochrane Library and Scopus databases were searched to identify primary studies in English or Italian, published from 2013 to 2024.

RESULTS

Twenty-five studies were included. Ad hoc questionnaires followed by the Simulator Sickness Questionnaire and the Motion Sickness Assessment Questionnaire were mainly used to detect cybersickness. In 12 studies, inconsistent or very low scores of cybersickness were reported. Oculomotor disturbances were the most frequently documented negative effects, followed by disorientation. Discomfort was assessed in eight studies, mainly with ad hoc questionnaires, with five of them reporting inconsistent or minimal discomfort.

CONCLUSIONS

Students and professionals should be informed about the possibility of some adverse effects, especially if they undertake daily activities after the educational sessions (e.g. oculomotor issues and driving).

Exploring the Development of Early Career Nurses: Insights 4 Years After Graduation

AIM

To explore how Early Career Nurses perceive their preparedness for nursing practice, the teaching and learning experiences, and the role of professional experience placements on their professional development.

DESIGN

A qualitative study using a hermeneutic phenomenological approach.

METHOD

The study involved 25 Early Career Nurses who participated in follow-up interviews 4 years post-graduation in Australia between 2022 and 2024. Data were collected through semi-structured interviews and analysed using Thematic Analysis.

RESULTS

Three key themes emerged: gaps in preparedness, the power of being embedded and too many balls to juggle. Participants indicated a mixed sense of preparedness with significant gaps in clinical skills. They emphasised the critical role of professional experience placements and mentorship to bridge the gap between theoretical knowledge and practical application. Placements and mentorship opportunities were considered essential to develop confidence and competence for effective nursing practice.

CONCLUSION

The study highlights the necessity for nursing curricula to address significant gaps in clinical skills, particularly in surgical and emergency nursing. By incorporating more simulation-based learning, interprofessional education and robust mentorship programmes, nursing education can better prepare graduates for the realities of clinical practice. These enhancements will help ease the transition from academic training to clinical practice, reducing reality shock and fostering a more confident, competent and resilient nursing workforce.

IMPLICATIONS FOR THE PROFESSION

Nursing education must integrate more simulation-based learning and interprofessional education opportunities, which are crucial for bridging the gap between theoretical knowledge and practical application, ensuring that graduates are adequately prepared for the demands of clinical practice. Additionally, professional experience placements and mentorship should be prioritised to develop the confidence and competence for effective nursing practice.

REPORTING METHOD

This study adheres to the Consolidated criteria for reporting qualitative research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.