Impact of classroom-based MASK-ED™ (KRS simulation) on physiotherapy student clinical performance: a randomized cluster trial

BACKGROUND

In physiotherapy there is a growing body of literature exploring the benefits simulation could have in the university-setting, prior to the commencement of work-integrated learning. MASK-ED™ simulation is one form of simulation that could be beneficial for student learning and improve performance in the clinical setting. MASK-ED™ simulation involves an educator donning a silicone mask and portraying a patient role that has been specifically developed to meet learning objectives.

OBJECTIVE

To evaluate the effectiveness of MASK-ED™ simulation compared to role-play with peers for training pre-clinical physiotherapy students.

METHODS

A single-centre, single-blind, cluster randomized trial with concealed allocation, between group post-measures, and intention-to-treat analysis was conducted at an Australian university between February 2018 - January 2021. Participants were 144 physiotherapy students, cluster randomized by tutorial groups (exp n = 70, con n = 74), undertaking their neurological curricula. The experimental group was exposed to MASK-ED™ simulation in five out of a potential thirty-two tutorials (16%) whilst the control continued with role-play with peers. The primary outcome measure was Assessment of Physiotherapy Practice scores from the students' rehabilitation work-integrated learning clinical placement. These were compared between the experimental and control groups using Mann-Whitney U tests. Secondary outcome measures include practical and written examination scores. These were compared between groups via independent t-tests. Participant satisfaction surveys were also administered to the experimental group.

RESULTS

One hundred thirty-two participants' (exp n = 62, con n = 72) results were analyzed. There were no significant differences between the experimental and control groups for Assessment of Physiotherapy Practice scores (p = 0.699-0.995). There were no significant differences found between the groups, across the secondary outcome measures. Participants found MASK-ED™ simulation was somewhat helpful for preparing them for clinical practice, however felt that a group setting was not as effective as a one-on-one encounter would have been.

CONCLUSIONS

MASK-ED™ simulation was no more effective than role-play with peers in preparing physiotherapy students for work-integrated learning. The influence of the design of simulation on effective learning and the number of classroom-based simulation encounters required to impact clinical performance requires further investigation.

The Effect of Simulation-Enhanced Orientation on Graduate Nurses: An Integrative Review

The purpose of this review is to examine the state of science of simulation-enhanced orientation and its effect on graduate nurses (GNs).

BACKGROUND

GNs are essential to the alleviation of staffing deficits, mitigation of patient safety events, and provision of clinically adept care. Successful transition from academia to clinical practice is often influenced by factors that compromise retention, increase attrition, and impair professional development.

METHOD

The method used was an integrative literature review.

RESULTS

There is a paucity of research in the literature regarding the effect of simulation-enhanced orientation on clinical competency, confidence outcomes, and other benchmarks of professional development that may influence retention or attrition.

CONCLUSION

This integrative review confirmed the paucity of research of qualitative and quantitative outcomes of simulation-enhanced orientation on GNs. Stakeholders of organizational and educational institutions may find this review valuable, as it highlights the necessity for additional research. [J Contin Educ Nurs. 2021;52(3):150-156.].

The Nature of Nursing Competency in Simulation of Adult Medical-Surgical Nursing: Exploratory Factor Analysis

BACKGROUND AND PURPOSE

Educators, employers, and regulatory agencies face substantive challenges in evaluating nursing competency. Evidence on what competency is and how to measure it can mitigate the challenges.

METHODS

Participants (N = 67) completed three high-fidelity simulation tests. Each video-recorded test was scored by three raters using a 41-item instrument. Exploratory factor analysis was used to define the latent structure of the instrument.

RESULTS

A five-factor solution accounted for 56% of the variance, minimized negative loadings, and minimized the number of cross-loadings. The factors were minimally correlated (each r < .30).

CONCLUSIONS

The factors, Vigilant Action, Role Nuances, Precision, Procedural Skills, and Risk Reduction, represent integrated dimensions of competency that can be linked to specific tasks underlying safe practice.

A scoping review of safety management during clinical placements of undergraduate nursing students

BACKGROUND

The abundant knowledge on nursing students' competencies in clinical safety, and the multiple approaches adopted make it difficult to obtain an overview of the current status of this question.

PURPOSE

To review the literature on undergraduate nursing students' safety competencies during their clinical placements.

METHOD

A scoping review was carried out. Searches were executed in PubMed, CINAHL, WOS, MEDES, and websites of relevant organizations. The framework proposed by the Joanna Briggs Institute was adopted.

FINDINGS

A total of 43 studies were selected for the final sample. The review identified four major topics: the presence of adverse events in clinical placements, the acquisition of competencies in clinical safety, student experiences regarding clinical safety, and pedagogical approaches for clinical safety.

DISCUSSION

Nursing students encounter adverse events and clinical safety incidents throughout their clinical training. Faculties should assign the highest priority to this question, due to its importance in the creation of a culture of safety.

The State of Knowledge Regarding the Use of Simulation in Pre-Licensure Nursing Education: A Mixed Methods Systematic Review

This project is a mixed-methods systematic review on the use of simulation in pre-licensure nursing. This research question guided this review: What is the best evidence available upon which to base decisions regarding the use of simulation experiences with pre-licensure nursing students? Searches of CINAHL Plus with Full Text, MEDLINE, and ERIC were performed to identify relevant literature. These searches yielded 1220 articles. After duplicates were removed and titles and abstracts were reviewed for relevance to the inclusion criteria, the remaining 852 articles were independently assessed for quality by pairs of researchers. Forty-seven articles were retained. Findings were grouped into research using high-, medium-, and low-fidelity simulations and a group where researchers included several or all types of simulation. The conclusion is that insufficient quality research exists to guide educators in making evidence-based decisions regarding simulation. More rigorous and multi-site research is needed.

Examining the Relationships Between Clinical Judgment, Simulation Performance, and Clinical Performance

Simulation-based learning experiences are designed to prepare the student for clinical practice; however, there is little documentation of a relationship between simulation performance and performance in the clinical setting. When essential aspects of a clinical situation are replicated in simulation, students should readily understand and manage similar situations in clinical practice. This study examined the relationships between clinical nursing judgment development, simulation performance, and clinical performance.

The value of simulation-based learning in pre-licensure nurse education: A state-of-the-art review and meta-analysis

Simulation modalities are numerous in nursing education, with a need to reveal their range and impact. We reviewed current evidence for effectiveness of medium to high fidelity simulation as an education mode in pre-licensure/pre-registration nurse education. A state-of-the-art review and meta-analyses was conducted based on a systematic search of publications in English between 2010 and 2015. Of 72 included studies, 43 were quantitative primary studies (mainly quasi-experimental designs), 13 were qualitative studies and 16 were reviews of literature. Forty of 43 primary studies reported benefits to student learning, and student satisfaction was high. Simulation programs provided multi-modal ways of learning. A meta-analysis (8 studies, n = 652 participants) identified that simulation programs significantly improved clinical knowledge from baseline. The weighted mean increase was 5.0 points (CI: 3.25-6.82) on a knowledge measure. Other objectively rated measures (eg, trained observers with checklists) were few. Reported subjective measures such as confidence and satisfaction when used alone have a strong potential for results bias. Studies presented valid empirical evidence, but larger studies are required. Simulation programs in pre-licensure nursing curricula demonstrate innovation and excellence. The programs should be shared across the discipline to facilitate development of multimodal learning for both pre-licensure and postgraduate nurses.

Piloting Augmented Reality Technology to Enhance Realism in Clinical Simulation

We describe a pilot study that incorporated an innovative hybrid simulation designed to increase the perception of realism in a high-fidelity simulation. Prelicensure students (N = 12) cared for a manikin in a simulation lab scenario wearing Google Glass, a wearable head device that projected video into the students' field of vision. Students reported that the simulation gave them confidence that they were developing skills and knowledge to perform necessary tasks in a clinical setting and that they met the learning objectives of the simulation. The video combined visual images and cues seen in a real patient and created a sense of realism the manikin alone could not provide.

Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review

OBJECTIVE

To conduct a systematic review to appraise and review evidence on the impact of simulation-based education for undergraduate/pre-licensure nursing students, using existing reviews of literature.

DESIGN

An umbrella review (review of reviews).

DATA SOURCES

Cumulative Index of Nursing and Allied Health Literature (CINAHLPlus), PubMed, and Google Scholar.

STUDY SELECTION

Reviews of literature conducted between 2010 and 2015 regarding simulation-based education for pre-licensure nursing students.

DATA EXTRACTION

The Joanna Briggs Institute methodology for conduct of an umbrella review was used to inform the review process.

RESULTS OF DATA SYNTHESIS

Twenty-five systematic reviews of literature were included, of which 14 were recent (2013-2015). Most described the level of evidence of component studies as a mix of experimental and quasi-experimental designs. The reviews measured around 14 different main outcome variables, thus limiting the number of primary studies that each individual review could pool to appraise. Many reviews agreed on the key learning outcome of knowledge acquisition, although no overall quantitative effect was derived. Three of four high-quality reviews found that simulation supported psychomotor development; a fourth found too few high quality studies to make a statistical comparison. Simulation statistically improved self-efficacy in pretest-posttest studies, and in experimental designs self-efficacy was superior to that of other teaching methods; lower level research designs limiting further comparison. The reviews commonly reported strong student satisfaction with simulation education and some reported improved confidence and/or critical thinking.

CONCLUSION

This umbrella review took a global view of 25 reviews of simulation research in nursing education, comprising over 700 primary studies. To discern overall outcomes across reviews, statistical comparison of quantitative results (effect size) must be the key comparator. Simulation-based education contributes to students' learning in a number of ways when integrated into pre-licensure nursing curricula. Overall, use of a constellation of instruments and a lack of high quality study designs mean that there are still some gaps in evidence of effects that need to be addressed.

Virtual Patients in Health Professions Education

The field of health professions continues to struggle with the impact of increasing practitioner and educator shortages. Health professions education is also faced with the issues of limited clinical placements and an increasing demand for online education. To address these issues, health professions educators have increasingly turned to simulations to provide experiential learning in safe, controlled environments. One of the newest simulation technology innovations to emerge is that of virtual patient simulations. This chapter reviews the context in which virtual patients have emerged, the range of virtual patient technologies available, and the ways in which health professions educators currently use virtual patient simulations.

Supervising nursing students in a technology-driven medication administration process in a hospital setting: a systematic review protocol

The objective of this review is to identify, describe and synthesize the experiences of nurse supervisors and the factors that influence the supervision of pre-graduate nursing students in undertaking technology-driven medication administration in hospital settings.The current review seeks to answer the following questions.

Exploring Student and Faculty Perceptions of Clinical Simulation: A Q-Sort Study

BACKGROUND

Simulation learning has become a widely accepted and valuable methodology within nursing education. This study assessed whether student and faculty perceptions regarding simulation learning have changed since curricular integration of simulation activities within an undergraduate nursing program.

METHOD

Q-methodology was used to identify unique and similar perspectives of 12 faculty and 21 students. Participants completed a brief demographic questionnaire and sorted statements related to beliefs about simulation-based learning.

RESULTS

Faculty perceptions were captured within one viewpoint-positive enthusiasts. Three student viewpoints were identified: challenge seekers, realistic embracers, and support seekers. Both students and faculty believed that simulation improved critical thinking.

CONCLUSION

The findings suggest that faculty should be aware of the range of student perceptions and tailor their teaching approaches accordingly to maximize student learning.

Nursing education research in Finland--A review of doctoral dissertations

OBJECTIVES

The aim of this literature review was to describe the focus of nursing education research in Finnish doctoral dissertations in the field of nursing and caring sciences between the years 1979-2014. In addition, the characteristics (methods, study informants and reporting of validity, reliability, and research ethics) of the dissertations were described.

METHODS AND DATA

A literature review was carried out. Altogether 51 Finnish doctoral dissertations of nursing and caring sciences focusing on nursing education research were included in the final analysis. The dissertations were published in 1990-2014. The data were analyzed by content analysis both deductively and inductively.

RESULTS

Finnish nursing education research was focused on four main areas: structural factors in nursing education, nurse teacherhood, teaching activities, and learning and learning outcomes in nursing education. The most central focus was learning in nursing education whereas nurse teacherhood and structural factors in nursing education were studied the least. Students were the predominant study informant group while nurse staff including nurse mentors were next and nurse educators only the third. Surveys and interviews were the most common data collection methods. In the findings there were a lot of similarities with international nursing education research.

CONCLUSIONS

Finnish nursing education research has been relatively student-centered yet studies focusing on the education of other nursing-based professions are rare. Future research about nurse teacherhood, curricula and structural factors in nursing education is recommended also. In addition, nursing education research should focus on the central phenomena of nursing education and working life. All in all, more nursing education research is needed. Nursing education dissertations cover only 12.3% of all the dissertations of nursing and caring sciences in Finland.

Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review

OBJECTIVE

This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education.

BACKGROUND

In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education.

DESIGN

An integrative review adapted a systematic approach.

DATA SOURCE

Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied.

INCLUSION CRITERIA

The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education.

REVIEW METHODS

Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted.

RESULTS

Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator."

CONCLUSION

Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers.

Walking the bridge: Nursing students' learning in clinical skill laboratories

Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified - walking the bridge - in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.

Advancing renal education: hybrid simulation, using simulated patients to enhance realism in haemodialysis education

BACKGROUND

Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction.

METHOD

This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes.

CONCLUSION

Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring.