Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis

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.

Factors influencing critical thinking in simulation-based maternal-child nursing education among undergraduate nursing students: a mixed methods study

BACKGROUND

Critical thinking constitutes a multifaceted and dynamic process to make appropriate decisions and solve problems. In simulation-based learning, critical thinking can be influenced by personal factors, facilitators, and design.

OBJECTIVE

This study was conducted to investigate the experiences and factors associated with critical thinking in simulation-based maternal-child nursing education.

METHODS

This study utilized an explanatory sequential mixed-methods approach. In the quantitative phase, convenience sampling was employed to select 400 undergraduate nursing students who met the following inclusion criteria: no history of repeating the maternal-child nursing and midwifery practicum course and class attendance of at least 80% of the total instructional hours. Following the completion of quantitative data collection, purposive sampling was used to recruit 80 students who had participated in and completed the initial survey to participate in focus group discussions.

RESULTS

Half of the nursing students had moderate scores of critical thinking on maternal-child nursing simulation. The regression analysis revealed that perception of professional identity, a personal factor, was statistically significantly associated with a high level of critical thinking (Beta = 0.207, t = 4.607, p = 0.000). Additionally, the attitude toward simulation (Beta = 0.139, t = 2.731, p = 0.007) and perceived stress (Beta = -0.103, t = -2.269, p = 0.024) were statistically significantly associated with critical thinking level. In the simulation design, the support aspect toward simulation design (Beta = 0.265, t = 2.943, p = 0.003) and the problem-solving aspect toward simulation importance (Beta = 0.239, t = 2.288, p = 0.023) were statistically significantly associated with a high level of critical thinking. The multiple linear regression model accounted for 35% of the variance in critical thinking with maternal-child nursing simulated learning. Qualitative data revealed the following themes: (1) a well-planned approach enables me to optimize my learning; (2) allow me to make mistakes, but please don't leave me with failure; and (3) emulating practice shapes my growth as a nursing professional.

CONCLUSIONS

The personal factor and simulation design factors were important for increasing critical thinking level. Promoting effective learning strategies, such as the use of simulated experiences, is useful in enhancing midwifery and nursing students' competencies.

Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study

BACKGROUND

In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness.

OBJECTIVE

This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education.

METHODS

We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method.

RESULTS

A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals' education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions' digital education be defined and standardized?

CONCLUSIONS

This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education.

Intrinsic Factors and Psychological Safety Among Nursing Students During Simulation-Based Learning-A Correlational Design

INTRODUCTION

Well-designed simulation-based learning (SBL) experiences enhance students' self-confidence, self-efficacy, clinical judgment, and psychomotor skill development. An emerging concept in SBL research is psychological safety. There is currently no research on factors influencing psychological safety specifically related to the SBL environment, nor is there any literature found to determine whether intrinsic student characteristic, such as self-compassion and resilience, contributes to SBL learning outcomes. The aim of this study is to determine whether there is a relationship between nursing students' intrinsic characteristics (self-compassion, resilience, and anxiety sensitivity) and their psychological safety.

METHODS

Bivariate correlation was used to examine associations among sociodemographic variables and outcome variables. Multiple regression was used to determine the predictive nature of the sociodemographic variables. Assumptions for variables in multiple regression models were tested (normal distribution, heteroscedasticity, multicollinearity). All data were analyzed in SPSS, Version 28. The P value of significance was set at 0.05 for all analyses.

RESULTS

Most of the 118 participants were non-Hispanic (89%), White (65%), and females (95%). Results of the demographic bivariate analysis revealed no significant differences among this diverse group or semester in the curriculum for psychological safety. The multiple regression found self-compassion (β = 29, P = 0.004), anxiety sensitivity (β = -0.16, P = 0.049), and resilience (β = 0.26, P = 0.004) predict psychological safety.

CONCLUSIONS

The importance of creating a psychologically safe learning environment has been recognized as essential to best practices. Our findings suggest that an understanding of student characteristics that impact their perception of psychological safety will allow educators to develop strategies to better support learners in the simulation environment.

Virtual reality and standardized patient simulation programs in chemotherapy education for breast cancer: A comparative analysis of nursing students' knowledge, cognitive load, satisfaction and confidence

AIM

To compare the effectiveness of the Virtual Reality (VR) Simulation Program and the Standardized Patient (SP) Simulation Program in chemotherapy education for breast cancer patients among undergraduate nursing students, focusing on knowledge, cognitive load, satisfaction and self-confidence levels.

BACKGROUND

Effective chemotherapy education is critical for nursing students to develop the competencies to manage treatment side effects and support patient adherence, especially in breast cancer care. Simulation-based learning methods, such as the VR Simulation Program and the SP Simulation Program, offer innovative approaches to enhance nursing education; however, their comparative effectiveness remains uncertain.

METHODS

This two-group quasi-experimental study was conducted with 107 first-year nursing students at a university in Turkey. Participants were randomly assigned to the VR Simulation Program (n = 54) or the SP Simulation Program (n = 53). Data were collected using a semi-structured questionnaire, Chemotherapy Knowledge Assessment Test, Cognitive Load Scale and Student Satisfaction and Self-Confidence in Learning Scale. Data analysis was conducted using t-tests.

RESULTS

Both the VR Simulation Program (t = -4.30, p < 0.001) and the SP Simulation Program (t = -7.48, p < 0.001) significantly improved students' knowledge. However, the SP Simulation Program group scored higher in knowledge (t = -2.891, p = 0.005), cognitive load (t = -2.891, p = 0.005), satisfaction (t = -3.176, p = 0.002) and self-confidence (t = -2.971, p = 0.004).

CONCLUSIONS

Despite imposing a higher cognitive load, the SP Simulation Program was more effective than the VR Simulation Program in enhancing nursing students' knowledge, satisfaction and self-confidence in chemotherapy education. These findings highlight the need for carefully planned educational strategies to manage cognitive demands and optimize learning outcomes in nursing education.

[Construction of a methodology for clinical evaluation of medical devices using simulation tools and illustration through three studies]

INTRODUCTION

European regulations have recently moved towards more stringent requirements for demonstrating the safety and performance of medical devices (MDs).

OBJECTIVE

To apply an innovative testing method using medical simulation to the evaluation of three medical devices at different stages of their life cycle.

METHOD

The methodology for evaluating DMs using simulation is based on seven stages: definition of the context, training, construction of a scenario to test the DM, validation of the scenario, realization of the scenario, evaluation of the scenario by the players and validation and exploitation of the results.

RESULTS

Our evaluation methodology enabled us to assess three DMs at different stages of their development: a respiratory protection device at the initial stage (prototype definition), a respiratory protection mask (prototype optimization) and bottle adapters (post-marketing).

CONCLUSION

Simulation is a valuable tool for evaluating DM. The proposed methodology enables it to be used and adapted to different contexts. It responds to the specificities of clinical evaluation of this class of products, and helps to better anticipate certain risks.

Prevalence and associations of neurodevelopmental and mental health disorders with academic and well-being challenges among nursing and midwifery students: A cross-sectional study

INTRODUCTION

This study highlights the significant stress faced by nursing and midwifery students stemming from the rigorous requirements of their curriculum, which includes both demanding theoretical and practical elements. This study aims to identify the causes and manifestations of learning environment stress among midwifery and nursing students.

METHODS

A cross-sectional study in Lithuania, Poland and Latvia was employed to evaluate students' learning challenges and neurodiversity using 40 different questions assessed on a Likert scale. Data were gathered through online surveys in February-April 2024, distributed to nursing and midwifery students from three international institutions.

RESULTS

The findings reveal significant correlations (p<0.05) between anxiety and stress levels in students with neurodiversity, underscoring the critical impact of stress on the mental health and well-being of nursing students. These results demonstrate significant associations (ρ=0.2; p<0.05) with shifts in life meaning, health issues, emotional and cognitive challenges, and mobbing.

CONCLUSIONS

Anxiety and stress are significantly related to the presence of neurodisability among students, highlighting the necessity for targeted mental health interventions to address these critical issues.

Using expert-modeling videos in telesimulations to teach pediatric and neonatal nursing

to assess the perception of self-efficacy, self-confidence, and satisfaction of undergraduate nursing students during the use of expert-modeling videos as a learning strategy in the period of social distancing.

this was a descriptive study with undergraduates studying disciplines of caring for hospitalized newborns and children at a higher education nursing institution in the interior of the state of São Paulo, Brazil. Activities were organized in three moments, in real time: prebriefing, expert-modeling videos and debriefing. The expert-modeling videos replaced the clinical simulation scenario during the social distancing required by the COVID-19 pandemic, for the development of telesimulation. Specific validated scales were used to analyze students' self-confidence, self-efficacy and satisfaction. Content analysis assessed the advantages and disadvantages of using expert-modeling videos.

thirty-nine undergraduates took part in the study. High levels of self-confidence, self-efficacy and satisfaction were found among the participants. The advantages of expert-modeling videos were organized into the following categories: Convenience, Security and continuity of studies and Efficient teaching method, and the disadvantages into Problems with technology, Distractions, Lack of personal contact and Mental fatigue.

telesimulation activities were consolidated as strategies that enabled learning in times of emergency online teaching due to the realness of telesimulation, the development of skills in caring for children and newborns and the link between theory and practice.

Exploring eye-tracking data as an indicator of situational awareness in nursing students during a cardiorespiratory arrest simulation

AIM

To examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels.

BACKGROUND

Eye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction.

DESIGN

A comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels.

METHODS

Thirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale.

RESULTS

The first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0.640, p = 0.010).

CONCLUSION

Eye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction.

Interventions for psychiatric disorders among university students: An umbrella review of systematic reviews and meta-analyses

Background

Mental disorders are considered to be the main reason for the increase of the disease burden. College students seem to be more vulnerable to the adverse effects of stress, which makes them more at risk of suffering from mental disorders. This umbrella review aimed to evaluate the credibility of published evidence regarding the effects of interventions on mental disorders among university students.

Methods

To identify systematic reviews and meta-analyses investigating the effects of interventions on mental disorders in the university student population, extensive searches were carried out in databases including PubMed, Embase, and the Cochrane Database, spanning from inception to July 21, 2023. Subsequently, a thorough reanalysis of crucial parameters such as summary effect estimates, 95 % confidence intervals, heterogeneity I2 statistic, 95 % prediction intervals, small-study effects, and excess significance bias was performed for each meta-analysis found.

Results

Nineteen articles involving 74 meta-analyses were included. Our grading of the current evidence showed that interventions based on exercise, Cognitive-behavioural Intervention (CBI), mindfulness-based interventions (MBI), and other interventions like mood and anxiety interventions (MAI) were effective whereas exercise intervention had the highest effect size for both depression and anxiety among university students. However, the credibility of the evidence was weak for most studies. Besides, suggestive evidence was observed for the positive effects of CBI on sleep disturbance(SMD: -0.603, 95 % CI: -0.916, -0.290; P-random effects<0.01) and MAI on anxiety (Hedges'g = -0.198, 95 % CI: -0.302, -0.094; P-random effects<0.01).

Conclusion

Based on our findings, it appears that exercise interventions, CBI, and MAI have the potential to alleviate symptoms related to mental disorders. Despite the overall weak credibility of the evidence and the strength of the associations, these interventions offer a promising avenue for further exploration and research in the future. More high-quality randomized controlled trials should be taken into account to verify the effects of these interventions on various mental disorders.

Learning outcomes and cost-utility analysis of hybrid patient and mannequin-based simulation

INTRODUCTION

There is no clear evidence on the relationship between nursing student learning outcomes and the type of simulator used or its cost-effectiveness.

OBJECTIVES

Compare nursing student learning outcomes using either the hybrid patient or mannequin and the cost-utility of both simulators.

METHOD

A randomised experimental study with an experimental group (hybrid patient = 99) and a control group (mannequin = 97). A training intervention was carried out for polytrauma patients.

RESULTS

Statistically significant differences were found between the simulator used and the performance results for tourniquet (hybrid 5.37 ± 1.33, mannequin 4.95 ± 1.09; p = .008) and spinal board (hybrid 6.18 ± 2.02, mannequin 6.97 ± 20.2; p = .001) application. The cost-utility ratio was estimated to be 3.29 for the hybrid patient and 1.92 for the mannequin.

CONCLUSION

The use of a hybrid patient or mannequin has not been shown to be a determinant of performance outcomes or student perceptions in training interventions in polytrauma patient care. However, as the cost per participant with a mannequin is almost twice as high, the hybrid patient has a better cost-utility ratio.