Examining Knowledge, Skill, Stress, Satisfaction, and Self-Confidence Levels of Nursing Students in Three Different Simulation Modalities

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

OBJECTIVE

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

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

Enhancing Surgical Nursing Student Performance: Comparative Study of Simulation-Based Learning and Problem-Based Learning

Background

Surgical nursing is a high-risk, high-pressure, and complex field. Nurses need extensive knowledge, skills, and abilities. Problem-Based Learning (PBL) and Simulation-Based Learning (SBL) are effective student-centered methods. Which method is better for surgical nurse training? More research is needed to determine the best approach for undergraduate surgical nurse education.

Purpose

To compare the impact of PBL and SBL on undergraduate nursing students' performance and improve learning outcomes in surgical nursing education.

Methods

We used a pretest/post-test design with 318 nursing undergraduates randomly assigned to two groups. Participants completed three progressive scenarios focused on surgical nursing cases. Experts blindly reviewed video recordings using the 70-item Korean Nurses' Core Competence Scale (KNCCS) to assess performance. The 13-item Satisfaction and Self-confidence in learning Scale (SSS) measured learning confidence and satisfaction. SBL participants also completed the 16-item Educational Practices in Simulation Scale (EPSS) and 20-item Simulation Design Scale (SDS).

Results

The study found significant positive effects on both groups, with noticeable improvements in post-test, retention, and follow-up test results (P < 0.001). The SBL group showed higher competency levels in nurses (P < 0.001). The Cohen's d and effect size (r) for various skills were as follows: clinical performance (0.84767 and 6.39023), critical thinking (0.31017 and 0.15325), professional attitude (0.85868 and 0.39452), and communication skills (1.55149 and 0.61294). The satisfaction and self-confidence of nurses were higher in the SBL group (4.53±0.596; 4.47±0.611) compared to the PBL group (4.32±0.689; 4.25±0.632) in all dimensions of SSS (all P < 0.05). The SBL group also scored high in simulation design and EPSS. However, improvements are needed in fidelity, objectives, information, and students' expectations.

Conclusion

SBL and PBL improve nurses' core competence, satisfaction, and self-confidence. SBL is superior. This study promotes student-centered education, enhancing surgical nursing professionals' quality and ensuring future patient safety.

Nursing students satisfaction and self-confidence with standardized patient palliative care simulation focusing on difficult conversations

OBJECTIVES

Lack of experience communicating with patients and families at the end of life are key concerns for nursing students. Palliative care simulation using standardized patients (SPs) focusing on difficult conversations may lead to increased self-confidence in providing palliative and end-of-life care in clinical practice. There is currently a paucity of research on SP palliative care simulations in undergraduate nursing education. The objective of this research was to assess 3rd year undergraduate nursing students' levels of satisfaction and self-confidence with palliative and end-of-life care simulations focusing on difficult conversations, as measured by the Student Satisfaction and Self-Confidence in Learning Scale (SSSCLS) and the Simulation Design Scale (SDS).

METHODS

A descriptive post-intervention study. Four palliative care simulation days, consisting of 2 clinical scenarios, were conducted over 4 weeks. The first simulation was an outpatient palliative care clinic scenario, and the second was an inpatient hospital scenario. Nursing students enrolled in a 3rd year nursing palliative care elective (n = 51) at an Australian university were invited to participate. Students who attended simulation days were eligible to participate (n = 31). Immediately post-simulation, students were invited to complete the SSSCLS and the SDS. Fifty-seven surveys were completed (simulation 1, n = 28; simulation 2, n = 29). The data were analyzed using descriptive statistics.

RESULTS

Results showed that students had high levels of self-confidence in developing palliative care and communication skills after both simulation experiences and high levels of satisfaction with the SP simulations.

SIGNIFICANCE OF RESULTS

The lack of published literature on palliative care and end-of-life SP simulation highlights the need to collect further evidence to support this as an innovative approach to teaching palliative care. SP palliative care simulation focusing on difficult conversations assists in developing students' communication skills and improves satisfaction and self-confidence with palliative and end-of-life care.

Can High-Fidelity Patient Simulation Be Used for Skill Development in Junior Undergraduate Students: A Quasi-Experimental Study

High-fidelity patient simulation (HFPS) is widely used in professional training to enhance students' competence in clinical management. A guideline for HFPS provides a systematic approach to direct students to learning during the simulation process. Problem-solving (PS) and clinical reasoning (CR) skills are essential to developing students' professional competence in safe and effective care. These two skills should be initiated in the early training. A structured guideline was developed for HFPS. This study aimed to investigate the effects of the structured HFPS guideline on the development of PS and CR skills in junior nursing students. The students were required to go through four sessions, pre-briefing, simulation design, facilitation, and debriefing, for the HFPS; the study utilized the Problem-Solving Inventory (PSI) and the Nurses' Clinical Reasoning Scale (NCRS) to measure PS and CR abilities before and after HFPS. Bivariate analysis, a one-sample t-test, and an independent t-test were performed to evaluate the performance of the PS and CR skills during the two study periods. A total of 189 students were recruited, with 92 in the intervention group and 97 in the control group. The research assistant was responsible for student recruitment through email invitations and allocating the students into the control group or the intervention group. A Wilcoxon analysis was performed and revealed significant differences in PS and CR between the two groups (p < 0.001). The analytic results showed that the PSI, particularly in domains of Problem-Solving Confidence (PSC) (p < 0.001) and overall PS (p < 0.001), and the CR (p < 0.001) had significant improvement after HFPS, particularly in the intervention group. The study concluded that the structured HFPS guideline significantly improved the students' problem-solving and clinical reasoning abilities. Nurse educators play an important role in providing explicit learning instructions in a simulation guideline that directs and guides students to learn at each stage of HFPS. The students can be directed to be engaged in their learning through HFPS to enhance their competence in knowledge and skill development (PS and CR) for their personal and professional development.

A Modified Guideline for High-Fidelity Patient Simulation to Improve Student Satisfaction and Self-Confidence in Learning: A Mixed Study

The coronaviral pandemic has led to a shift in traditional teaching methods to more innovative approaches, such as high-fidelity patient simulation (HFPS), which can improve students' clinical judgment and decision making for quality patient care. A modified guideline was introduced to enhance students' satisfaction and self-confidence in learning through HFPS. The study involved 189 baccalaureate nursing students, with 92 in the intervention group and 97 in the control group. The intervention group received the modified HFPS guideline, while the control group received standard treatment with basic instruction. After the HFPS debriefing session, students provided narrative feedback on their learning experiences. The quantitative results showed that students in the intervention group reported a significant improvement in satisfaction and self-confidence in learning compared to the control group. The modified HFPS guideline provided clear guidance for students to learn and apply knowledge and skills more effectively, leading to increased engagement during interactive simulation sessions. The results suggest that the HFPS guideline should be added to the curriculum to enhance students' satisfaction and self-confidence in learning, even for junior students. After the pandemic, innovative teaching methods, such as HFPS, can be necessary and beneficial for healthcare professional training.

The development and study of the effectiveness of a novel uterine contraction learning aid: A two-phase research study

BACKGROUND

Nursing students lack clinical experience in assessing intrapartum uterine activity, rating their ability and level of understanding as low or fair despite receiving theoretical instruction prior to attending clinical placements. Teaching model/aids may facilitate learning, however, purchasing additional models could prove expensive within many organisations. Limited exposure to skills rehearsal in school may contribute to student anxiety, stress, and perceived low self-efficacy when in clinical practice.

OBJECTIVES

To develop and assess the effectiveness of a novel Uterine Contraction Learning Aid as a training tool to expand the knowledge, attitude, and practice of nursing students.

METHODS

A two-phase study conducted at The Institute of Nursing in Thailand. Phase I was underpinned by research and development. After first being considered for its quality, by five experts comprising an obstetrician, two midwives and two nursing instructors, the novel Uterine Contraction Learning Aid was assessed by 30 fourth-year nursing students with experience in assessing uterine contractions for its educational suitability. Phase II - Sixty year-three nursing students were assigned via matched-pairs to either an experimental or control group to evaluate the effectiveness of the Uterine Contraction Learning Aid, completing three questionnaires underpinned by the knowledge, attitude, and practice concept.

RESULTS

Phase I- Descriptive statistics applied to survey responses indicate participants rated the quality of the Uterine Contraction Learning Aid highly in every aspect of learning skills, and perceptions of confidence. The overall production was rated at a good level. Phase II - An independent sample t-test was used to compare knowledge, attitude, and practice values in assessing uterine contractions between control and experimental groups. Participants in the experiment group had significantly higher scores in knowledge and practice when assessing uterine contractions compared to the control group (t = 4.768, p < 0.000 vs. t = 3.630, p < 0.001, respectively). There was no statistically significant difference in attitudes in relation to assessing uterine contractions between the two groups (t = 0.188, p = 0.852).

CONCLUSIONS

The novel Uterine Contraction Learning Aid can be used effectively to prepare nursing students prior to practicing with women undergoing intrapartum care.

In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study

AIM

To evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations.

BACKGROUND

The amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence.

DESIGN

This was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators.

METHODS

A total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment.

RESULTS

Nursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group.

CONCLUSIONS

In-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.

Nursing Students' Scenario Performance: Game Metrics in a Simulation Game

AIM

The purpose of this study was to examine nursing students' scenario performance in a simulation game by utilizing game metrics.

BACKGROUND

A significant advantage of simulation games is that they can store large amounts of data. Although game metrics enable the objective evaluation and analysis of performance, their use in the evaluation of students' performance is limited.

METHOD

Nursing students (N = 376) played a simulation game at home for 1 week. The resulting data consisted of game metrics stored in the game: number of playthroughs, mean scores, and mean playing times.

RESULTS

The total number of playthroughs was 1,923. Statistically significant differences were found between different scenarios regarding the mean score (p < .0001). Mean playing time was significantly associated with the mean score (p < .05).

CONCLUSION

Game metrics demonstrate nursing students' scenario performance in clinical reasoning skills in different scenarios in a simulation game.

The Relationship Between Perceived Quality of Care and the Patient Safety Culture of Turkish Nurses

BACKGROUND

Evaluating nurses' perceived quality of care and safety culture is an essential part of the nursing practice and critical to improving the quality of nursing care.

PURPOSE

This study aimed to examine the relationship between perceived quality of care and Turkish nurses' patient safety culture.

METHODS

This was a descriptive cross-sectional study. The data were collected from a foundation university hospital in Istanbul. The sample consisted of 116 nurses, and data were collected using the Caring Behaviors Inventory-24 and Patient Safety Culture Scale. The nurses were asked to complete the questionnaires.

RESULTS

The mean age of participating nurses was 25.95 ( SD = 6.72) years. The mean duration of professional experience of the participants was 6.37 ( SD = 6.05) years. Most (72.4%) of the participants were women who had graduated from vocational high schools (52.6%) and were working in the neonatal intensive care unit (37.9%). The highest mean subdimension score on the Caring Behaviors Inventory-24 was 5.78 ( SD = 0.43) for the knowledge and skills subdimension. The highest mean subdimension score on the Patient Safety Culture Scale was 3.55 ( SD = 0.48) for the unexpected event and error reporting subdimension. Statistically significant correlations were found between Caring Behaviors Inventory-24 and Patient Safety Culture Scale scores ( r = .553, p < .01), with the lowest correlation found between the employee behavior and knowledge and skills dimensions ( r = .305, p = .001). The highest statistically significant correlation coefficients that were found were between the Patient Safety Culture Scale total scores and the connectedness dimension of the Caring Behaviors Inventory-24 ( r = .58, p < .001).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Nurses perceive patient care positively and have a positive perception of safety culture. Evaluating the perceived quality of care and patient safety culture perceptions will help prevent adverse events related to patient care and improve the quality of care.

Objective and Subjective Stress Parameters in Response to High and Low-Fidelity Simulation Activities

Nursing graduates are required to have both excellent theoretical and practical skills that should be used during stressful emergency interventions. Since the received knowledge should be practiced to gain skills and trained to achieve competences, simulation exercises can be beneficial to even reduce the stress that each individual may face during emergency management of patients. A total of 146 first-year nursing students participated in the study, including 124 women and 22 men aged between 19 and 50 years, with a mean age of 32 years. The objective method estimated psychophysiological parameters (serum cortisol). Objective and subjective methods were used. The subjective method assessed stress experienced by students based on the standardized Stress Appraisal Questionnaire Version B for dispositional assessment. The study was conducted in the Monoprofile Medical Simulation Centre at the University of Economics and Innovation in Lublin, Poland and was approved by the University Research Ethics Committee. Both participants under and over 25 years of age showed increased levels of stress after low and high-fidelity simulations, with statistically significantly higher stress levels found for the low fidelity method. Low-fidelity simulation methods generated a greater increase in cortisol levels, indicating a higher stress level than the high-fidelity methods. The analysis of the scores obtained in the Stress Appraisal Questionnaire (KOS-B) showed that higher cortisol levels after the low-fidelity simulation reduced the subjective perception of a threat, while higher cortisol levels before the high-fidelity simulation promoted higher intellectual activity among the students. Levels of stress in the education of nursing students using low and high-fidelity methods can limit the sense of threat and activate professional task performance. The use of low and high-fidelity simulation does not generate destructive stress levels.

Effects of high-fidelity simulation teaching on nursing students' knowledge, professional skills and clinical ability: A meta-analysis and systematic review

OBJECTIVE

This meta-analysis was designed to systematically determine the effect of high-fidelity simulation teaching on nursing students' knowledge level, professional skill level and clinical ability.

BACKGROUND

High-fidelity simulation is an increasingly popular pedagogical approach in nursing education. It provides students with opportunity to practice in a variety of simulations before entering clinical practice through a variety of real-life situational experiences and many institutions and educators have embraced this method for enhancing access to clinical skills. However, evidence for the effectiveness of the method in nursing teaching remains scarce.

DESIGN

A meta-analysis and systematic review.

METHODS

The following Chinese and English databases were searched for relevant articles: PubMed, Embase, Cochrane library, Web of Science, CNKI (China National Knowledge Infrastructure) and Wangfang. The search encompassed the establishment of these databases up until November 2021. Two reviewers separately entered the data into Review Manager Software 5.3.

RESULTS

A total of 15 studies were included in this study. High-fidelity simulation significantly increased nursing students' knowledge acquisition (SMD = 1. 37, 94％CI:0. 73-2. 00，P ＜0. 0001), enhanced nursing students'professional skills (SMD = 0. 90, 95％CI:0. 36-1. 44，P = 0. 0001). In terms of clinical practice ability outcomes, high-fidelity simulation significantly improved the levels of critical thinking ability (SMD = 0. 58, 95％CI:0. 09-1. 07，P ＜0. 00001), Clinical judgement ability (SMD = 1. 34, 95％CI:0. 38-2. 31，P＝0. 006) and communication skills (SMD = 2. 62, 95％CI:1. 84-3. 40，P ＜0. 001) of nursing students.

CONCLUSIONS

We found that high-fidelity simulation have strong educational effects in nursing education, helping nursing students to increase knowledge acquisition, enhance professional skills and cultivate their clinical practice ability (critical thinking ability, communication skills and clinical judgement ability). These findings can provide guidance for nursing educators, indicating that the use of High-fidelity simulation teaching represents an effective solution for transitioning students from the learning environment to clinical practice.

Nursing Students’ Satisfaction and Self-Confidence Levels After Their Simulation Experience

Background

Nursing students should be well prepared before going to clinical setting as they provide direct care to patient. Simulation gives the learners the opportunity to be active learners who practice, train, and give a reflection on a specific experience.

Objective

To obtain an understanding of the human patient simulation experience and nursing students’ perceptions of satisfaction and self-confidence.

Method

Cross-sectional, descriptive design was undertaken. Using purposive sampling, 273 nursing students were enrolled in basic adult nursing courses at levels four and five at female nursing college at King Saud University, Riyadh, Saudi Arabia. A questionnaire was used to measure the demographic characteristics, simulation design characteristics, and simulation educational practice context. Student Satisfaction and Self-confidence in Learning Scale was used to measure students’ satisfaction and self-confidence. Bivariate analyses were utilized where needed and multiple linear regression analysis was performed to find the relationship between variables.

Results

The current study revealed overall, nursing students were satisfied and self-confident after their human patient simulation experience. A relationship was observed between demographic characteristics, simulation design characteristics, and simulation educational practice context with students’ satisfaction and self-confidence.

Conclusion

Simulation is an effective teaching strategy that prepares nursing students for real clinical practice. Findings provided policymakers with information on nursing students’ current levels of satisfaction and self-confidence that can lead to developing future policies.

VIRTUAL SIMULATION FOR LAST-YEAR NURSING GRADUATE STUDENTS IN TIMES OF COVID-19: A QUASI-EXPERIMENTAL STUDY

Background

The COVID-19 pandemic has made it necessary to adapt university health-education. Virtual simulation has been proposed to be a suitable tool.

Methods

A quasi-experimental study was conducted on nursing students in the final year. The virtual simulation platform vSim® was used. Improvements in knowledge, skills during simulation, satisfaction and selfconfidence obtained through the training provided were analyzed, as well as satisfaction with the platform.

Results

Prepost training knowledge improved. Skill acquisition improved between the first and last attempts in all cases. The levels of selfconfidence and satisfaction with the training and the platform used were high.

Conclusions

The vSim® was a useful solution during the pandemic. Knowledge improved and high selfconfidence was obtained.

Stress level experienced by participants in realistic simulation: a systematic review

OBJECTIVES

to identify the available evidence regarding stress levels experienced by participants in education based on a realistic simulation.

METHODS

systematic review that included randomized clinic trials on electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Latin-American and Caribbean Literature in Health Sciences, LIVIVO, PubMed, Scopus, and Web of Science. The additional search was performed on Google Scholar and OpenGrey. All searches occurred on September 24, 2020. The methodologic quality of the results was evaluated by the Cochrane Collaboration Risk of Bias Tool.

RESULTS

eighteen studies were included, which evaluated the participants' stress using physiologic, self-reported measures, or the combination of both. Stress as experienced in a high level in simulated scenarios.

CONCLUSIONS

evidence of the study included in this systematic review suggest that stress is experienced in a high level in simulated scenarios.

Contemporary Integrative Review in Simulation-Based Learning in Nursing

Background: In general, simulation-based learning (SBL) has been a part of nursing education in the past two decades, though nursing educators are facing difficulties in evaluating its effectiveness in theory and practice. The aim of this review was to synthesize the research findings regarding the effects of SBL among nursing students from published scientific articles. Methods: This integrative review focused on articles published in English between 2016 and 2020, identified by using electronic databases such as Cochrane Library, PubMed, Medline (Ovid), SCOPUS, RISS, and Korea Med. Results: Fifteen articles were selected by a step-by-step process. Data were synthesized and effects of SBL methods were derived under four themes: ‘Knows A Self Com_p’ such as knowledge and skills; Attitude; Self (learning, efficacy, determination, competency, confidence, utilization, satisfaction, assessment); and Com(n) (competency, communication, and confidence) and P (perceptions and performance). Conclusion: The review results showed that SBL is the best method for teaching clinical practice. Article-focused simulations with simulators were more effective than classroom teaching, depending on the context, topic, and method. The overall results showed that SBL is a positive, safe and effective method for nursing students in clinical and simulation room settings to improve the skills and practice of client care.