Learning Confidence Research Articles

Promotion of learner autonomy within the framework of a flipped EFL instructional model: perception and perspectives

This study investigated the effects of the flipped classroom model on EFL learner autonomy in a content-based instructional context. The participants involved were students enrolled in two linguistics classes, divided into an experimental group (n = 64) which received a flipped classroom (FC) instruction and a control group (n = 60) taught in a non-flipped classroom. In the FC, various functions were embedded in a Moodle course management system (CMS), including video lectures, online quizzes, resources and e-journals. The comparison between the pre- and post-questionnaire on perceived learner autonomy showed no difference between the groups prior to instruction; however, significant statistical differences were found between the groups following instruction, especially in the constructs of learner autonomous strategy, learner behavior and learner confidence. The examination of e-journals revealed that learner autonomy had been improved in terms of strategy use, behavior, interaction with the materials, the use of social resources and self-management of learning. The CMS log analysis showed significant correlations between online learning activities and perceived learner autonomy. Furthermore, the data collected from the pre- and post-questionnaires, e-journal and interviews were analysed and interpreted to explain the fostered learner autonomy from psychological, technical, sociocultural and political–critical perspectives.

The Role of Achievement Goals and Self-regulated Learning Behaviors in Clinical Reasoning

Achievement goals are motivational antecedents which play an important role in students’ self-regulated learning (SRL). Achievement goals are also found to have an influence on students’ learning outcomes. However, how achievement goals and SRL jointly affect learning performance is still an underexplored area of research, especially in computer-supported learning environments. This research added new evidence on the relationship between achievement goals, SRL behaviors and students’ performance outcomes in a task of students diagnosing virtual patients in BioWorld, a technology-rich environment to help medical students practice their clinical reasoning skills. Multidimensional data (e.g. trace data, self-reports) were collected from 50 participants. Findings from this research demonstrated that performance avoidance goals positively predicted the SRL behavior of link evidence. Performance and mastery approach goals had a marginal negative effect on the SRL behavior of link evidence. Among the SRL behaviors traced, order lab test and check evidence positively predicted students’ efficacy, while link evidence negatively predicted their efficacy. The SRL behavior of check evidence positively predicted students’ confidence in making a correct diagnosis. Furthermore, performance approach goals negatively predicted the diagnostic confidence of learners. The instructional implications and the broader impacts for future research are discussed.

Feedback from L1 users – a potential facilitator of L2 use

ABSTRACTIn bilingual settings, the communication between majority and minority language speakers usually takes place in the majority language. This paper examines whether majority language speakers, who receive positive feedback from minority language speakers when accommodating to them, use the minority language more frequently for authentic purposes. We propose positive feedback from L1 users as a potential facilitator of L2 use. We report the development and the properties of the scale we utilised to assess L1 user feedback (L1FB). We embedded L1FB into the socio-contextual model of L2 communication and tested four hypotheses regarding the effect of L1FB on L2 use among majority language speaking high school students in bilingual Finland. All the hypotheses were supported by the data. Most importantly, L1FB significantly moderated the effect of L2 confidence on L2 use. L2 confidence had a larger effect on L2 use among those who received positive feedback. In the absence of positive L1FB, however, confident L2 learners used their L2 as little as their more anxious and less competent peers did. We discuss the relevance of L1FB with regard to authentic L2 use in general and the promotion of lesser used languages, in particular.

Integrating the Bleeding Control Basic course into medical school curriculum

BackgroundThe American College of Surgeons has pioneered hemorrhage control through its lifesaving bleeding control (BCon) basics course. A gap exists in teaching these skills to medical students. We sought to integrate BCon into the medical school curriculum. MethodsBCon programs taught to entering Year 1 medical students in Academic Years 2017–2018. Post-course surveys assessed effectiveness of teaching and learner confidence in performing skills. Refreshers in Year 2 and Year 3 of study were implemented to reinforce skills. ResultsPost-course surveys (n = 348) showed that 98% of students felt that they were effectively taught how to stop bleeding and 92% felt comfortable using these skills. ConclusionThe BCon program is feasible to implement in medical school. It is easily integrated into pre-existing curricula in addition to other life support skills taught to medical students. SummaryBleeding control is increasingly a topic of national concern with mass casualty incidents. We used a peer training model to teach BCon techniques to all our medical students on entry into medical school and these skills were refreshed longitudinally in the next two years. Combining BCon training with other basic life support skills training is feasible and medical students find this training effective.

ФОРМУВАННЯ «Я – КОНЦЕПЦІЇ» ДИТИНИ В УМОВАХ ІНФОРМАЛЬНОЇ ОСВІТИ (КРОС-КУЛЬТУРНИЙ АСПЕКТ)

The following scientists were engaged in research on the dynamics of the self-concept in childhood – Huitt W., James W., Rogers С., Robert B. Burns. They believe that the development of self-concept is a process of gaining knowledge about yourself, awareness of yourself as an active subject of life. The child gradually builds a cognitive theory about who he is and what he is capable of, and uses it in adapting his behavior. At school age, self-esteem also depends on self-confidence in learning. Children who have good academic performance usually have high self-esteem, while children with low academic performance have correspondingly low self-esteem. But it should be noted that self-esteem is strongly socially determined. So we decided to investigate the influence of cultural factors on the development of children's self-concept in the conditions of informal education. The study involved 25 Ukrainian and 18 Vietnamese students (this is their total number in this educational program). The children ranged in age from 7 to 12 years. We used the following methods - “Self-assessment of Dembo-Rubinstein” Kuhn – McPartland test “Who am I?” and projective image “I’m on English language courses”. Classes at courses in Ukraine took place in small groups, 4-8 people in each, and in Vietnam as well. In addition to learning the English language courses, all students attending secondary schools in their cities. Significant differences were identified according to the Mana-Whitney criterion (at the level of 0.05) according to the competency scales (“Ability to draw” and “Ability to speak English”) and on the “Level of happiness” scale. Indicators of individual characteristics, such as “Beauty”, “Mind”, “Kindness” do not have significant differences. It is likely that the greater personal involvement of Ukrainian children in informal education and the subjective importance of the skills acquired during the study in sections has a positive effect on the childrens’ assessment of their skills. Despite the fact that the Ukrainian children positively evaluate their skills, they are generally lower rate their individual characteristics and level of happiness.

Development and Implementation of a Three-dimensional Printed Knee Joint Simulation Model Using the Consolidated Framework for Implementation Research: Addressing Local Simulation Needs.

BackgroundKnee joint injections and aspirations are essential procedures for medical students, residents, and primary care physicians to master. Simulation-based training has been shown to improve learner confidence and performance scores in knee joint injections. Current knee joint simulators are expensive, ranging from hundreds to thousands of dollars. Using three-dimensional (3D) printing and gel layering technology, we designed and manufactured an inexpensive simulator. The aim of this implementation study was to gather the opinions of local simulation specialists and administrators regarding the simulator's curricular implementation.MethodsUsing the Consolidated Framework for Implementation Research (CFIR), we developed a 31-item implementation survey. It was administered to local simulation specialists and administrators. The purpose of the survey was to identify the aspects of the simulator that they deemed important to the implementation process, as well as obtain their qualitative feedback about the design.ResultsIn total, three participants completed the survey. There were 16 survey items that were rated as very important, including local manufacturing, appropriate planning, internal development, evidence-based development, and reasonable costs. Another nine items were deemed important, including the adaptability of the product and ability to test the product. The simulation specialists also expressed some concerns they had with the design of the simulator and made suggestions about how we could address these concerns.ConclusionsLocal development and manufacturing, coupled with appropriate pre-implementation planning and efficacy evidence, were selected as factors that would potentially contribute to the success of the implementation of the simulator in the local curriculum.

Regular in situ simulation improves participants' confidence in technical and non-technical skills required for managing a medical emergency

To assess whether an embedded hospital-wide in situ simulation programme improves the confidence of learners in managing medical emergencies across different disciplines, specialties and grades. Wide multidisciplinary in situ simulation (ISS) programme has been implemented at the Homerton Hospital

Iatrogenic Critical Care Procedure Complication Boot Camp: A Simulation-based Pilot Study.

Traditional medical education strategies teach learners how to correctly perform procedures while neglecting to provide formal training on iatrogenic error management. Error management training (EMT) requires active exploration as well as explicit encouragement for learners to make and learn from errors during training. Simulation provides an excellent methodology to execute a curriculum on iatrogenic procedural complication management. We hypothesize that a standardized simulation-based EMT curriculum will improve learner's confidence, cognitive knowledge, and performance in iatrogenic injury management. This was a pilot, prospective, observational study performed in a simulation center using a curriculum developed to educate resident physicians on iatrogenic procedural complication management. Pre- and postintervention assessments included confidence surveys, cognitive questionnaires, and critical action checklists for six simulated procedure complications. Assessment data were analyzed using medians and interquartile ranges (IQRs), and the paired change scores were tested for median equality to zero via Wilcoxon signed rank tests with p<0.05 considered statistically significant. Eighteen residents participated in the study curriculum. The median (IQR) confidence increased significantly by a summed score of 12.5 (8.75-17.25; p<0.001). Similarly, the median (IQR) knowledge significantly increased by 6 (3-8) points from the pre- to postintervention assessment (p<0.001). For each of the simulation cases, the number of critical actions performed increased significantly (p<0.001 to p=0.002). We demonstrated significant improvement in the confidence, clinical knowledge, and performance of critical actions after the completion of this curriculum. This pilot study provides evidence that a structured EMT curriculum is an effective method to teach management of iatrogenic injuries.

Embedding employability within higher education for the profession of policing

Purpose The purpose of this paper is to evaluate the impact of an employability module, the College of Policing Certificate in Knowledge of Policing (CKP), on students’ career aspirations, their confidence and wish to join the police along with the appropriateness of the module. This will inform the implementation of employability as part of the College of Policing-managed Police Education Qualifications Framework (PEQF). Design/methodology/approach A three-year longitudinal research study used mixed methods across four points in time to evaluate the impact on students studying the employability module. Findings The research suggests that the employability-focussed CKP was useful as an introduction to policing, it developed interest in the police and enhanced the confidence of learners applying to join. Lessons learnt from the CKP should be considered during the implementation of the PEQF. Research limitations/implications The ability to generalise findings across different groups is limited as other influences may impact on a learner’s confidence and employability. However, the implications for the PEQF curriculum are worthy of consideration. Practical implications As the police service moves towards standardised higher educational provision and evolution of policing as a profession, lessons can be learnt from the CKP with regards to the future employability of graduates. Originality/value Enhancing the employability evidence base, focussing on policing, the research identified aspects which may impact on graduates completing a degree mapped to the PEQF. The research is therefore of value to higher education and the professional body for policing.

Interprofessional Healthcare Student Training in the Care of Sexual Assault Patients Utilizing Standardized Patient Methodology.

The medical assessment of sexual assault (SA) is challenging because SA patients are often hesitant to disclose their medical needs, which puts them at further physical and psychological risk, and because of provider unease in conducting SA examinations. This challenge is compounded by a lack of provider training. The study goals were to develop an interprofessional simulation event that would foster SA interview skills, foster effective communication with SA patients, and increase learner confidence in assessing SA patients. Participants were senior-year school of medicine (n = 165) and advanced practice registered nursing (n = 30) students (N = 195) who were enrolled in a mandatory Military Sexual Assault Assessment and Treatment course, along with data provided by trained standardized patients (SPs, n = 16) who participated in the simulation event and in assessments of learners. Measures included the Sexual Assault Interview Skills Checklist, the Essential Elements of Communication, and the Confidence in SA Assessment scale. Data were analyzed using analysis of variance and t tests at the P < 0.05 threshold. Postsimulation Sexual Assault Interview Skills Checklist and Essential Elements of Communication scores demonstrated an acceptable level of competence according to both students and SPs. Confidence in SA assessment rose significantly from presimulation to postsimulation. Before simulation, medical students were significantly lower than nursing students, but the simulation event closed the confidence in SA assessment gap. This interprofessional simulation event resulted in SA interview competence, communication skills competence, and improved confidence scores. Combined, these findings support the efficacy of simulation to train emerging healthcare providers to properly assess SA.

Satisfaction and Confidence in Using Clinical Simulation Models among Undergraduate Nursing Students in a Public University in Malaysia: A Cross-sectional Study

Clinical simulation models have long been employed to teach clinical skills. The usage promotes satisfaction and confidence in learning among nursing students to learn the clinical skills. The study aimed to investigate the undergraduate nursing students’ satisfaction and self-confidence in learning using the clinical simulation models. It also determined the relationship between student satisfaction with self-confidence in learning. This quantitative cross-sectional survey employed Student Satisfaction and Self-Confidence in Learning Scale from the National League for Nursing. The 118 samples were recruited using the stratified sampling method among all years of undergraduate nursing students in a Public University in Malaysia. Descriptive statistics was used to describe the samples and scores of Student Satisfaction and Self-Confidence in Learning. Spearmen correlation was employed to test the relationship between Student Satisfaction with Self-Confidence in Learning and significant level was determined at p less than.05. Hundred and eighteen respondents with the age ranged from 20 to 25 years (M = 21.73, SD = 1.19) were females (91%) and nine (8%) were males. The overall satisfaction was more than 3.5 (M = 3.89, SD = 0.54). The overall self-confidence was also high (M = 4.01, SD = 0.68). The Spearman correlation result showed that the two variables were weakly correlated, r (116) = 0.485, p =.000. The findings showed that undergraduate nursing student in this study conveyed a high satisfaction and self-confidence in learning using the clinical simulation models despite a weak correlation between the two variables (p <.05). It is crucial that the simulations be continuously used with the hope of improving their clinical practice. The result of this study is relevant in supporting the used of simulation models in nursing education. It is recommended that future studies to include qualitative method to provide rich data on nursing student's experiences.

A case study on the implementation of the Educational Prosperity model for the schooling of low-income populations in Canada

The framework of Educational Prosperity (EP) assesses progression towards sustainable development; it does so by adopting an equity-based “life-course” approach focused on the early and cumulative nature of children’s success to guide the effective deployment of resources to support teaching and learning. Confident Learners’ instruction and assessment tools embed EP and concentrate on children’s progress on the “pathway to literacy success.” Reading acquisition depends upon code-related skills and language skills. Teachers shift their role, from teaching a grade-based curriculum to teaching the specific skills that children need to improve their literacy skills; they receive ongoing professional development from a literacy lead and from the broad school and social community.

Synergy in Learning, Teachers and Student Support Assistants Working Together to Promote Learner Metacognition in Post-Compulsory Education

Observations of teaching found Student Support Assistants (SSAs) were frequently ineffectively utilised in supporting learners’ progress, with working partnerships between teachers and SSAs tenuous. This relates to previous research (Sharples et al, 2015a, 2015b; Sanders, 2017a, 2017b) which also indicated that learning support was often ineffectually used in class sessions. Learning support frequently focused on task completion rather than encouraging learner autonomy. Our project promoted effective partnerships between teachers, SSAs and learners through implementing strategies to develop learners’ self-assessment and thinking skills, effectively encouraging and deepening their learning. A team of 16 teachers and SSAs from different subject areas held initial meetings to establish working relationships and agree stages for the project. The team was introduced to the action research approach, enabling them to become more research literate. This collaborative project used systematic practitioner research to critically examine the current situation and make changes based on the evidence which arose. It brought together practitioners from various levels within the setting, giving each member a space in which to express their opinions, take action and engage with the activities which arose. Initial background research considered the key findings from the Education Endowment Fund (EEF) Report (Sharples et al, 2015a). These were used to consider and challenge our practice and plan the research. Following extensive discussion, the team developed a Working Practice Guide and designed resources to support student learning. Time was additionally available for staff to plan strategies together prior to their implementation in sessions. These activities, including concept diagrams, learner review tickets and use of thinking prompts, enhanced learners’ self-assessment during lessons with the teachers and SSAs. It provided the opportunity for learners to discuss and resolve areas of difficulty. The effectiveness of the strategies implemented in class were additionally reflected upon by staff and learners. Regular meetings enabled evaluation of the strategies and future planning. Using the strategies, combined with meeting regularly, promoted teacher, SSA, and learner confidence with SSAs becoming enablers of learning and partners in the learning process.

The interplay between learner beliefs and foreign language anxiety: insights from the Turkish EFL context

ABSTRACT Foreign language learning in classroom settings has long been found to be associated with anxiety. Though it is known that sources of foreign language anxiety are varied, whether anxiety is related to learners’ inherent beliefs about language learning is understudied. To this end, the present study examines the possible relationship between learner beliefs and language anxiety in the under-researched Turkish EFL context. A population of university-level Turkish EFL learners (n = 153) completed the Beliefs about Language Learning Inventory (BALLI) and the Foreign Language Classroom Anxiety scale (FLCAS). The underlying constructs in both instruments were explored using an Exploratory Factor Analysis (EFA). A series of Pearson Product-Moment Correlation Coefficient (PPMCC) tests were performed on the factor scores from both instruments. The findings revealed that fear of ambiguity was positively linked to classroom performance anxiety and negative feelings towards English. In addition, the more confident learners feel themselves using English, the more desire they seem to have to interact with native speakers. Overall, positive beliefs about language learning may be helpful in reducing anxiety and boosting confidence in language learning. These findings not only enhance our understanding of the complex psychology of language learning but also have important implications for instructed EFL/ESL settings.

Effect of Simulation on Maternity Nursing Students' Perception, Satisfaction and Self-Confidence

Aim: The current study aimed to assess the effect of simulation on maternity nursing students, perception, satisfaction and self-confidence. Setting: The study was conducted at maternity skills laboratory, Faculty of Nursing, Benha University. Design: A descriptive study was utilized. Sampling: A convenient sampleof 151 students. Tools: Three tools were used to collect data, structured interviewing questionnaire, simulation design scale, student satisfaction and self-confidence in learning. Results: 53.6% and 46.3%of the students had moderate level of perception and satisfaction regarding simulation activities, 49% of the students had high level of self-confidence in learning regarding simulation activities. There was statistically significant positive correlation between total perception, satisfaction and self-confidence score (p=0.000). Conclusion: Students had moderate level of perception and satisfactionin learning regarding simulation activities and had high level of self-confidence in learning regarding simulation activities. Recommendation: Students should be provided by variety of simulation-based education on maternity nursing skills to increase level of perception, satisfaction and self-confidence.

An English-language Multimedia Teaching Model Based on Krashen’s Theory

Traditional English teaching practice often centers on the teacher and implements the teaching mode of “exemplifying by the teacher-answering by students-evaluating by the teacher”. This inflexible teaching mode fails to fully exert student’s subjective function; at the same time, due to the lack of necessary guidance and help from teachers, students are more likely to suffer from learning burnout and low self-confidence. With this regard, an English multimedia teaching mode was proposed in this study based on Krashen’s “Language Input Theory”. The theory is characterized by emphasizing the analysis of English language learning from the perspectives of “acquisition” and “learning”, advocating “understanding” of knowledge and using student-centered teaching methods. In this study, Krashen’s theory was combined with interactive learning methods and multimedia information technology to form an English teaching mode focused on “teacher-student”, “student-student” and “student-computer” interactions and build an “in class- after class” and “online-offline” English learning environment. This mode was practically applied in the teaching of “College English” at Hohai University in Jiangsu Province, China. The results show that the English multimedia teaching mode based on Krashen’s theory is more effective than the traditional teaching mode in improving students’ interest and self-confidence in learning.

Design of a Digital Art Teaching Platform Based on Automatic Recording Technology

Digital media art is a brand-new course combining technology and art under the background of streaming media. Since digital art is based on computer technology, the course is required to keep up with the frontiers of science and technology, and the speed of knowledge update should keep pace with the development of the times. Traditional teaching methods are inflexible and outdated, so that students’ knowledge is lagging far behind market demands. In addition, the courseware produced by teachers themselves is not well-targeted and the production cost is high. With this regard, a micro-lesson teaching platform for Digital Art was designed based on the five-star teaching theory and the automatic micro-lesson recording system. The design follows the principles of driving learners’ interest with tasks and using learning activities to support services and deepen skills, covering design of micro-lesson learning content, design of learning activities to support services, design of application, and design of evaluation. The results show that the micro-lesson teaching platform can improve learners’ interest, achievement and self-confidence in learning; at the same time, it can improve the quality of teachers’ micro-lesson resources and reduce the workload of teachers in producing micro-lesson.

Staff Perception of Interprofessional Simulation for Verbal De-escalation and Restraint Application to Mitigate Violent Patient Behaviors in the Emergency Department

ProblemViolent behaviors in the emergency department are on the rise. Mitigation efforts are essential for staff and patient safety. The goal of this quality improvement project was to improve staff perception of knowledge, skills, abilities, confidence, and preparedness when managing violent patient behaviors using interprofessional simulation training and to evaluate staff learning style satisfaction and self-confidence using simulation. MethodsInterprofessional participants received individual computer-based training and simulation training on de-escalation techniques and restraint application. The participants’ perceptions were collected in a pre- and postsurvey and analyzed using Bowker’s test of symmetry. Revised tools from the National League for Nursing were used, including the Simulation Design Scale and Satisfaction and Self-Confidence in Learning, and results were analyzed by one-way analysis of variance, comparing results within and between the disciplines involved. ResultsGroup comparison (nursing, providers, security staff, and social services staff) using contingency tables illustrated a significant improvement (P < 0.0001) in knowledge (21%), skills (20%), abilities (19%), confidence (20%), and preparedness (30%). Satisfaction among nurses (P = 0.0021), patient care assistants (P = 0.0134), and security staff (P = 0.0060) was significantly greater than among social services staff. No significant differences were found among providers or by sex. Participants with less experience were more satisfied than those who have been in their role for 16 years or more (P = 0.0290). Implications for PracticeParticipants’ self-reported changes in knowledge, skills, ability, confidence, and preparedness demonstrated significance for a short-term change, with preparedness having the greatest increase. Simulation debriefing allowed participants to provide feedback; satisfaction was higher for persons with less experience. The application of skills through simulation can prepare staff to handle difficult patient encounters.

Uso da Escala de Satisfação dos Estudantes e Autoconfiança com a Aprendizagem (ESEAA) e da Escala do Design da Simulação (EDS) no ensino de enfermagem: relato de experiência

AIMS: To report the experience with using the Student Satisfaction and Self-Confidence in Learning (SSSCL) and the Simulation Design Scale (SDS) in a Nursing Undergraduate course.EXPERIENCE REPORT: The experience was held in a private educational institution of the city of São Paulo, in the discipline of Adult Health I, in the 4th semester of Nursing. This discipline has two simulated scenarios: care of a patient with glycemic alteration and care of a patient with respiratory distress. The objectives of the simulation were to discuss clinical reasoning, knowledge to identify the main problem (nursing diagnosis) and the student's abilities to perform care (nursing intervention). After the simulations, the students were invited to fill in the ESEAA and EDS instruments.CONCLUSIONS: Use of the instruments allowed to identify the level of the students' satisfaction regarding the use of simulation as a teaching strategy and provided the teachers of the discipline with a reflection on the worked scenarios, revising the clarity of the objective, content and conduct of the debriefing. The results obtained from the students' responses reinforce the importance of using simulation and stimulate the teacher in the building of scenarios and developing this strategy.

Simulation for emergency nurses (SIREN): A quasi-experimental study

BackgroundWithin nursing education, simulation has been recognised as an effective learning strategy. Embedding simulation within clinical units has the potential to enhance patient safety and improve clinical outcomes. However it is important to evaluate the effectiveness of this educational technique to support the actual value and effectiveness. ObjectiveThis study aimed to implement and evaluate an innovative simulation experience for registered nurses. MethodsA high-fidelity simulation focusing on nursing assessment was conducted with 50 Registered Nurses in an Emergency Department (ED) at a large tertiary referral hospital. Two questionnaires were completed pre and post simulation to assess anxiety related to participating in the simulation, and self-efficacy in patient assessment. Participant satisfaction and self-confidence in learning was assessed post simulation. Additionally a documentation audit from the patient's electronic chart was completed to review documentation entries before and after participation in the simulation. ResultsAnxiety scores decreased significantly from pre (M = 38.56, SD = 9.87) to post (M = 33.54, SD = 8.99), t(49) = 4.273, p < 0.001. There was a statistically significant increase in self-efficacy scores from pre (M = 195.16, SD = 28.09) to post (M = 214.12, SD =25.77), t(49) = 5.072, p < 0.001. ED nurses were highly satisfied with their simulation training and they were in agreement with the statements about self-confidence in learning. There was a statistically significant increase in two components of the documentation scores; initial clinical handover increased from pre (M = 7.88, SD = 1.76) to post (M = 8.79, SD =1.22), t(41) = 3.41, p < 0.001 and indicators of urgent illness increased from pre (M = 7.33, SD = 1.95) to post (M = 8.10, SD = 1.45), t(41) =2.27, p = 0.028. ConclusionsThis study has demonstrated that a high fidelity simulation decreased participants' anxiety, increased self-efficiency in patient assessment, and improved documentation in patient records. Additionally ED nurses were highly satisfied with the simulation training.