Context Matters: Factors Affecting Implementation of Simulation Training in Nursing and Midwifery Schools in North America, Africa and Asia

Utilization of simulation in undergraduate clinical nursing skills training: A cross-sectional study in China

AIM

This study seeks to explore the challenges and experiences of nurse educators in adopting simulation in undergraduate clinical skills training in China.

BACKGROUND

Despite global recognition in nursing education, simulation's role in Chinese nursing schools' clinical skills training is largely uncharted.

DESIGN

A cross-sectional study.

METHODS

An online questionnaire was developed and disseminated among nurse educators. It garnered responses from 123 participants representing 50 undergraduate colleges across China.

RESULTS

Of the respondents, 59 (47.9 %) reported using simulation as a teaching method in clinical skills training. However, a mere five (8.5 %) were acquainted with and applied the Healthcare Simulation Standards of Best Practice in their simulation processes. The earliest adoption of simulation occurred in 1998, with the latest instance in 2019. Role-playing (91.5 %) and task trainers (86.4 %) were the predominant simulation modalities. Most participants exhibited a deficiency in skills necessary for managing simulation activities, including structured pre-briefing, facilitation and handling technological debriefing issues. A mere seven (11.9 %) of the teachers utilized valid and reliable instruments to assess simulation experiences.

CONCLUSIONS

The use of simulation in undergraduate clinical nursing skills training in China is not only infrequent but also lacks adherence to a best practice framework. Four significant challenges were identified for nurse faculty using simulation: (1) the design of standardized scenarios; (2) encouraging active student participation in simulation and debriefing; (3) the prolongation of simulation due to technical issues; and (4) the constraint of limited class time allowing only a few students to engage in simulation.

Radiography student perceptions of a simulated clinical placement to enhance clinical placement capacity: A descriptive qualitative study

INTRODUCTION

Post-pandemic workforce demands in Wales have resulted in an increase in radiography students, causing an imbalance between student numbers and clinical placement learning opportunities. Simulation-based education (SBE) has been effectively implemented in several healthcare professions to replace clinical placement hours and enhance learning equity. This study aimed to address the limited scope of literature surrounding this approach within diagnostic radiography education in Wales, by exploring student perceptions of a Simulated Clinical Placement (SCP) package in one university radiography degree programme, to establish its acceptability as a replacement of clinical hours.

METHODS

A qualitative descriptive design was selected to explore the value and factors influencing student perceptions of SCP. A focus group of eight students was formed to collect data, which was audio recorded, transcribed, coded and thematically analysed.

RESULTS

Four themes were identified; preconceptions and prior experiences, SCP provision, learning conducive to confidently meeting professional standards, and role in clinical placement capacity. Student preconceptions and prior experiences were initially negative but evolved into enjoyment throughout package delivery. SCP provision influenced learning experiences, with all students reporting SCP enhanced confidence and skills supporting them in meeting required professional registration expectations. Students further reported most learning still occurred in clinical departments, and this was preferable to the SCP.

CONCLUSION

Overall, despite the SCP package being supportive to clinical learning, it was deemed insufficient to replace clinical placement hours, and should be a supplement, not a substitute. Additionally, simulation packages should only be adopted for accommodating already increased student numbers, not as a means of increasing cohort size.

IMPLICATIONS FOR PRACTICE

Clinical placements and simulation activities will progressively cohabitate, however with limited research and guidance, further exploration is required to establish the extent of this relationship for capacity management.

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).

A competency framework for simulation facilitation in low-resource settings: a modified Delphi study

BACKGROUND

Skilled facilitators are essential to drive effective simulation training in healthcare. Competency-based frameworks support the development of facilitation skills but, to our knowledge, there are no frameworks that specifically address context-sensitive priorities developed with practitioners working in low-resource settings.

METHODS

We aimed to develop a core competency framework for healthcare simulation facilitation in low-resource settings using a modified Delphi process. We drew on the domain expertise of members of the Vital Anaesthesia Simulation Training Community of Practice, with the study guided by a four-member steering group experienced in the conduct of simulation in low-resource settings. In survey round 1, participants (n = 54) were presented with an initial competency set derived from a previous qualitative study and co-created a set of 57 competencies for effective simulation facilitation in low-resource settings. In survey round 2, participants (n = 52) ranked competencies by relevance into three performance categories: techniques; artistry; and values. In survey round 3, participants (n = 50) ranked competencies on their importance. The steering group collated results and presented a draft core competency framework. In survey round 4, participants (n = 50) voted with 98% agreement that this framework represented the most relevant and important competencies for effective facilitation of simulation sessions in low-resource settings.

RESULTS

The final 32-item framework encompasses core competencies found in existing standards and includes important new concepts such as demonstration of cultural sensitivity; humility; ability to recognise and respond to potential language barriers; facilitation team collaboration; awareness of logistics; and contingency planning.

DISCUSSION

This competency-based framework highlights specific practices required for effective simulation facilitation in low-resource settings. Further work is required to refine and validate this tool to train simulation facilitators to deliver effective training to improve patient safety.

Assessing Healthcare Simulation Facilitation: A Scoping Review of Available Tools, Validity Evidence, and Context Suitability for Faculty Development in Low-Resource Settings

SUMMARY STATEMENT

Assessment tools support simulation facilitation skill development by guiding practice, structuring feedback, and promoting reflective learning among educators. This scoping review followed a systematic process to identify facilitation assessment tools used in postlicensure healthcare simulation. Secondary objectives included mapping of the validity evidence to support their use and a critical appraisal of their suitability for simulation faculty development in low-resource settings. Database searching, gray literature searching, and stakeholder engagement identified 11,568 sources for screening, of which 72 met criteria for full text review. Thirty sources met inclusion; 16 unique tools were identified. Tools exclusively originated from simulation practice in high-resource settings and predominantly focused on debriefing. Many tools have limited validity evidence supporting their use. In particular, the validity evidence supporting the extrapolation and implications of assessment is lacking. No current tool has high context suitability for use in low-resource settings.

The Use of Simulation in Communication Sciences and Disorders: A Follow-Up Survey

PURPOSE

This study investigates changes in the prevalence and practice of simulation in communication sciences and disorders (CSD) education. It is a follow-up to a 2015 survey on the same topic. Given the changes in program certification standards and the impact of the COVID-19 pandemic on clinical education programs across the United States, re-examination of simulation in CSD is warranted.

METHOD

An online questionnaire was developed to survey university programs accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association. University program directors and clinical directors received recruitment e-mails using QuestionPro, an online survey platform. The recruitment e-mail contained the purpose of the study and a link to the online questionnaire along with instructions to forward the survey to the appropriate designee. The consent form was then embedded in the questionnaire.

RESULTS

The results of this survey indicated changes in patterns and the use of simulation in clinical education for CSD. Results indicated an overall increase in the use of simulations, specifically in computer-based simulations. Distance simulation as a hybrid technology proved a major addition to clinical education programs during the COVID-19 pandemic. External and internal factors affecting the use of simulations in CSD were identified.

CONCLUSIONS

The use of simulation to supplement clinical education in CSD has evolved in recent years. These changes are likely due in part to changes in certification standards in the profession, an increase in awareness and training, and reliance on distance simulation during the COVID-19 pandemic.

"It would be nice to have more than basic support": A learning needs assessment survey of midwifery faculty in low- and middle-income countries of the Asia Pacific region

BACKGROUND

The provision of high-quality midwifery education relies on well-prepared educators. Faculty members need professional development and support to deliver quality midwifery education.

AIM

To identify development needs of midwifery faculty in low- and middle-income countries of the Asia Pacific region, to inform program content and the development of guidelines for faculty development programs.

METHODS

An online learning needs assessment survey was conducted with midwifery faculty from low- and middle-income countries in the Asia Pacific Region. Quantitative survey data were analysed using descriptive statistics. Textual data were condensed using a general inductive approach to summarise responses and establish links between research aim and findings.

FINDINGS

One hundred and thirty-one faculty completed the survey and a high need for development in all aspects of faculty practice was identified. Development in research and publication was the top priority for faculty. Followed closely by leadership and management development, and then more traditional activities of teaching and curriculum development. Preferred mode of program delivery was a blended learning approach.

DISCUSSION

Historically, programs of faculty development have primarily focussed on learning and teaching methods and educational development. Yet contemporary faculty members are expected to function in roles including scholarly activities of research and publication, institutional leadership and management, and program design and implementation. Unfortunately, programs of development are rarely based on identified need and fail to consider the expanded role expectation of contemporary faculty practice.

CONCLUSION

Future midwifery faculty development programs should address the identified need for development in all expected faculty roles.

Simulation-Based Education as a Solution to Challenges Encountered with Clinical Teaching in Nursing and Midwifery Education in Malawi: A Qualitative Study

Nursing and midwifery education in Malawi entails theoretical learning and clinical practice, essential for developing competent professionals. However, challenges such as staff shortages and limited resources hinder effective clinical teaching. Simulation-based education (SBE) offers a promising solution. This study aims to explore how SBE can enhance clinical teaching in Malawian nursing and midwifery education. Data were collected through in-depth interviews with lecturers, clinical instructors, and focus group discussion (FGD) with the final-year students. Thematic analysis revealed several key findings: SBE serves as a valuable gap-filler in clinical education, addressing complex needs while offering diverse learning opportunities. It also provides a platform for enhanced supervision and assessment strategies. The results indicate that SBE enables students to master various clinical skills without direct patient contact, reducing congestion at clinical sites while ensuring credit acquisition. Moreover, it proves effective as both a supervision and assessment tool for evaluating students' clinical performance. In conclusion, the study advocates for the integration of SBE into Malawian nursing and midwifery education to alleviate the challenges associated with traditional clinical teaching. By leveraging SBE, institutions can mitigate overcrowding at clinical sites and provide students with diverse learning experiences. However, successful implementation requires adequate infrastructure, resources, and skilled lecturers. Ultimately, SBE holds the potential to significantly enhance the quality and outcomes of nursing and midwifery education in Malawi.

Cocreation With Prelicensure Nursing Students of a Simulated Practice Placement

BACKGROUND

Cocreation is a collaborative process that uses problem-based learning to construct new initiatives. It has many known benefits associated with innovation in the development of programs, such as by creating simulations based on firsthand experiences.

METHODS

Thirty second-year prelicensure nursing students cocreated simulations and associated lesson plans for a simulated practice placement. They followed a 4-step process described in the article.

RESULTS

Cocreation combines lecturers' and students' unique skills and knowledge, creating programs based on the unique firsthand experiences of stakeholders. As the students take control of their own workloads, facilitators need to be adaptable in the support they provide, depending on the needs of the students.

CONCLUSION

The staged process provided a structure for the students to produce their simulations and lesson plans. The cocreation of the simulated practice placement provided an innovative educational model that supported student development and produced lessons and simulations based on stakeholder need.

Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review

BACKGROUND

The shortage of nursing and healthcare clinical placements has prompted the investigation of ways to supplement authentic learning. Mobile mixed reality has become increasingly available, however, the affordances and design principles for the facilitation of critical thinking are yet to be explored.

OBJECTIVE

To examine how mobile mixed reality facilitates critical thinking in nursing and healthcare higher education.

DESIGN

Systematic review.

REVIEW METHODS

A search in seven databases (MEDLINE, PsychINFO, AMED, ERIC, Scopus, Cochrane, and Web of Science) was conducted with 3488 titles and abstracts screened. The quality of the included studies was evaluated using the Mixed Methods Assessment Tool (MMAT).

RESULTS

A total of 12 studies with 1108 participants were included. The breadth of healthcare disciplines was limited to five disciplines that utilised bespoke scenarios on head-mounted displays. Most scenarios were emergency or critical response, with limited time for pre-brief, debrief, or overall user time. Only two studies directly measured critical thinking, with others including indirect reference to diagnoses, interpretation, analysis, or evaluation of healthcare scenarios. Affordances and design principles for the future development of mobile mixed reality for critical thinking in nursing and healthcare higher education are identified.

CONCLUSIONS

While some pedagogical affordances of mobile mixed reality can be identified in a narrow number of healthcare disciplines, there remain to be limited valid measures of critical thinking used to quantify effectiveness. Future studies would benefit from considering scenarios beyond emergency and critical responses, including longitudinal studies that reflect the development of critical thinking over time, and exploration of co-designed scenarios with and by nursing and healthcare students.

Blueprint for community emergency department pediatric simulation

Background

Gaps in quality of pediatric emergency care have been noted in community emergency departments (CEDs), where >85% of children receive care. In situ simulation provides opportunities for hands-on experiences and can help close these gaps. We aimed to develop, implement, and evaluate an innovative, replicable, and scalable pediatric in situ simulation-based CED curriculum, under the leadership of a local colleague, through collaborative approach with a regional academic medical center (AMC).

Methods

Kern's model was used as follows: problem identification and general needs assessment-pediatric readiness assessment and discussions with CED physician and nursing leadership; targeted needs assessment-review of recent pediatric transfer cases; goals and objectives-enhance pediatric knowledge and skills of interprofessional teams and detect latent safety threats; educational strategies-codeveloped by CED and AMC, included prelearning using podcasts and videos, simulation and facilitated debriefing, resource sharing after simulations; implementation-3-h simulation sessions facilitated in person by the CED team and remotely by AMC (leadership required participation and paid staff); and evaluation and feedback-retrospective pre-post survey, Simulation Effectiveness Tool-Modified (SET-M), Net Promoter Score (NPS), and review/feedback meetings.

Results

Based on needs assessment, the selected cases included newborn resuscitation, seizure, asthma, and tetrahydrocannabinol ingestion causing altered mental sensorium in a child. Twenty-four 3-h simulation sessions were conducted over 1 year. A total of 168 participants completed the sessions, while 75 participants (54.7% nurses, 22.7% physicians, and others) completed feedback surveys. Seventy-six percent of participants reported completing presimulation education material. Participants reported improved skills at appropriately evaluating a critically ill newborn and critically ill infant/toddler and improved teamwork during the care of a pediatric patient. The majority agreed that simulation was effective in teaching pediatric resuscitation. The NPS was 84% (excellent).

Conclusions

A locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.