Standardized language systems for the design of high-fidelity simulation scenarios: A Delphi study

PURPOSE

This study aimed to identify which of the standardised Nursing Interventions Classification (NIC) activities should be used in the design of clinical cases with high fidelity simulation for educational preparation of undergraduate nursing students in non-technical skills.

DESIGN AND METHODS

A three-round Delphi study was carried out: the first round with taxonomy experts, the second round with academic and clinical lecturers with limited experience in the simulation-based learning methodology, and the third round with academic and clinical lecturers having at least two years of simulation experience. The NIC interventions were grouped into two levels of competence in accordance with the undergraduate nursing degree curriculum (1st- and 2nd-year students, the "novice" level; 3rd- and 4th-year students, the "advanced" level). The NIC allows the description of nurse student competencies in multiple clinical scenarios and throughout various contexts: theory, clinical practice and simulation.

FINDINGS

The experts identified 163 interventions in 8 areas as relevant and feasible, selecting 42 for the "novice" students, in Nursing Fundamentals (13) and Adult Nursing Care 1 (29), and 97 for the "advanced" students: Maternity Care and Child Health Nursing (18), Mental Health (13), Nursing Care of Older People (12), Community Health Nursing (20) and Adult Nursing Care 2 (34). In addition, 24 interventions were identified as cross-cutting, with training to be provided across all four years of the degree.

CONCLUSION

A total of 163 interventions of the NIC list were selected by experts as being both relevant and feasible to nursing undergraduate education. This creates the favourable framework to design high-fidelity scenarios for the training of non-technical skills according to the competences required and in line with the health care reality. Therefore, enabling an optimal combination of theoretical education by academic lecturers with practical training by clinical lecturers and staff nurses.

High-fidelity simulation increases pharmacy resident perceived competence during medical emergencies

INTRODUCTION

Our objective was to assess postgraduate year one (PGY1) pharmacy resident perceived competence during medical emergencies before and after implementation of a longitudinal simulation training curriculum.

METHODS

At the University of California San Francisco (UCSF) Medical Center, PGY1 pharmacy residents serve as primary code team responders for code blue, code sepsis, and code stroke, among other medical emergencies. In 2015, the UCSF Residency Training Program implemented a longitudinal simulation curriculum for PGY1 pharmacy residents. Throughout the residency year, residents participated in four simulation lab sessions that addressed various medical emergencies. To assess the impact that the simulation curriculum had on resident perceived competence during medical emergencies, a 19-question survey (13 clinical questions and six control questions) was distributed to the residents at the end of the residency year. Resident responses from the 2015 to 2016 and 2016 to 2017 surveys were compared to a control residency class from 2014 to 2015 who did not undergo the simulation curriculum.

RESULTS

Simulation-trained PGY1 pharmacy residents reported significantly greater perceived competence in five of the twelve medical emergency scenarios (acute coronary syndromes, symptomatic bradycardia, supraventricular tachycardia, ventricular tachycardia, and cardiac arrest) as compared to non-simulation-trained controls. In addition, the PGY1 pharmacy residents felt that their performance as a clinical pharmacist would significantly improve as a result of the simulation curriculum.

CONCLUSIONS

Incorporation of a longitudinal simulation curriculum into PGY1 pharmacy resident training can positively impact resident self-reported competence when performing essential pharmacist functions during medical emergencies.

High-fidelity simulation and nursing students' anxiety and self-confidence: A systematic review

BACKGROUND

As a complementary teaching pedagogy, high-fidelity simulation remains as an effective form of simulation modality. Empirical evidence has additionally shown high-fidelity simulation (HFS) to be an effective contributor to students' learning outcomes.

PURPOSE

This paper critically appraised existing scientific articles that covered the influence of utilizing HFS on the effects of nursing students' anxiety and self-confidence during undergraduate nursing education.

METHODS

This was a systematic review of scientific articles conducted from 2007 to 2017 on the topic of the influence of using HFS on students' self-confidence and anxiety. The literature of six electronic databases (Proquest, SCOPUS, MEDLINE, PubMed Central, CINAHL, and PsychINFO) was reviewed.

RESULTS

Following the literature search, 35 articles were selected. This review provides updated evidence on the efficacy of HFS in reducing anxiety and enhancing self-confidence among nursing students when performing nursing duties or managing patients. Moreover, this review highlights the need for more research that examines the impact of HFS on students' anxiety.

CONCLUSION

As this form of simulation is found to be effective in the enhancement of nursing student self-confidence and the reduction of their anxiety when caring for patients and/or employing nursing skills, the inclusion of simulation-based activities in all clinical nursing courses is vital.

High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students

BACKGROUND

Simulation has become integral to the training of both undergraduate medical students and medical professionals. Due to the increasing degree of realism and range of features, the latest mannequins are referred to as high-fidelity simulators. Whether increased realism leads to a general improvement in trainees' outcomes is currently controversial and there are few data on the effects of these simulators on participants' personal confidence and self-assessment.

METHODS

One-hundred-and-thirty-five fourth-year medical students were randomly allocated to participate in either a high- or a low-fidelity simulated Advanced Life Support training session. Theoretical knowledge and self-assessment pre- and post-tests were completed. Students' performance in simulated scenarios was recorded and rated by experts.

RESULTS

Participants in both groups showed a significant improvement in theoretical knowledge in the post-test as compared to the pre-test, without significant intergroup differences. Performance, as assessed by video analysis, was comparable between groups, but, unexpectedly, the low-fidelity group had significantly better results in several sub-items. Irrespective of the findings, participants of the high-fidelity group considered themselves to be advantaged, solely based on their group allocation, compared with those in the low-fidelity group, at both pre- and post-self-assessments. Self-rated confidence regarding their individual performance was also significantly overrated.

CONCLUSION

The use of high-fidelity simulation led to equal or even worse performance and growth in knowledge as compared to low-fidelity simulation, while also inducing undesirable effects such as overconfidence. Hence, in this study, it was not beneficial compared to low-fidelity, but rather proved to be an adverse learning tool.

Using high fidelity simulation to increase nursing students' clinical postpartum and newborn assessment proficiency: A mixed-methods research study

OBJECTIVE

The objective of this study was to explore the benefits of using High Fidelity Simulators (HFS) to teach maternal postpartum and newborn assessment skills to student nurses before they interacted with actual hospital patients.

DESIGN

This descriptive, observational study employed a mixed-method design using a Qualtrics online survey instrument.

SETTING

The study was set at a Midwestern university.

PARTICIPANTS

The study used a convenience sample of third-year BSN nursing students (n = 132).

METHODS

After participating in an HFS experience and completing a maternity clinical rotation, students took an online Qualtrics survey evaluating the benefits and drawbacks of the HFS experience.

RESULTS

Students valued the HFS experience at an average score of 3.82 on a Likert Scale of 1-5. Open-ended questions identified three themes: psychomotor learning leading to skill acquisition, affective learning, and simulation restructuring to provide more time, better instructor preparation, and smaller groups.

CONCLUSION

This study's data supports the use of HFS to enhance nursing care and education, with special attention given to instructional consistency. Practicing new assessment skills in a non-threatening, safe environment gives students expertise and confidence while promoting the development of critical thinking skills.

Improving Nursing Confidence and Consistency in Assessment of Opioid Withdrawal: Efficacy of Simulation and Debriefing

The purpose of the current study was to determine if the amount of confidence in completing the Clinical Opiate Withdrawal Scale (COWS) varied among participants and whether consistency in scoring outcomes to patients occurred with COWS assessment among groups assigned to simulation and debriefing conditions. Sixty nursing staff were randomized into three groups: (a) scenario; (b) scenario and simulation; and (c) scenario, simulation, and debriefing. Staff were administered a questionnaire to assess their confidence before (i.e., pretreatment) and after (i.e., posttreatment) the simulation exercise and at 30-day follow up. The COWS assessment tool was completed by nursing staff during treatment and follow-up sessions. Significant improvements in confidence were found in all three treatment conditions. Highest consistency in scoring outcomes of the COWS to patients was found with the scenario, simulation, and debriefing condition. All participants reported having increased confidence completing the COWS. The amount of confidence among groups was not significant. Although nursing confidence did not differ among groups, increased scoring outcome reliability was found in groups using simulation and debriefing. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 27-35.].