Simulation Design Characteristics Research Articles

Using a Standardized Patient to Teach Fall Safety

BackgroundPatient falls in acute care settings have become a major public concern. It is important that nurse educators use evidence-based teaching strategies to teach nursing students the necessary measures required to keep patients safe. MethodsUsing a multisite, mixed methods, experimental study, we tested the effect of using a standardized patient in simulation on cognitive gains, student attitudes toward patient safety and important simulation design features. ResultsStudents indicated debriefing followed by fidelity were the most important features of this simulation. Although there was no significant cognitive learning in the experimental group, there was a significant improvement in attitudes toward safety. ConclusionThis study adds to the science of nursing education providing evidence for best teaching practices. Using standardized patients in simulation improves student attitudes toward patient safety.

Board 148 - Program Innovations Abstract Program Evaluation of a New Concierge Simulation Model (Submission #354)

Introduction/Background Jeffries1 theoretical framework, developed for healthcare disciplines, suggests that high fidelity simulation (HFS) design characteristics are relevant to simulation learning. Inconsistencies in implementing HFS scenarios occur when different instructors have a different approach to the facilitator and debrief role. Despite a variety of simulation models, it is not known what constitutes best practice. There is little research on how to standardize the organizational and technical implementation of HFS. Inconsistencies in simulation practice may have a negative impact on successful completion of learning objectives and ultimately, student learning. Methods In the fall of 2012 a BSN program implemented a concierge model of simulation. A concierge is a faculty member who has been trained in simulation methodology and whose role is twofold: 1) to facilitate the scenario and 2) to conduct debriefings. Before initiation of the concierge model, HFS experiences were less organized. Nursing students were accompanied to the simulation center with their clinical instructor, who may or may not have been trained to facilitate or debrief the HFS experience. The concierge model with four simulation trained concierges provided much more consistency in the HFS learning experience for nursing faculty, BSN students and simulation technicians. Kirkpatrick and Kirkpatrick’s Model of Training Evaluation2 was selected to guide program evaluation of the new model. This abstract describes Kirkpatrick Level 2 evaluation, focusing on changes in students’ “knowledge, skills, and attitudes.” In the spring of 2013, after IRB approval and student consent, a quasi-experimental study was conducted to evaluate the concierge program. Our evaluation question was: How does the simulation experience, guided by the concierge, change students’ performance of clinical skills in the HFS lab? Performance measures were developed from the simulation learning objectives. The performance measure was reviewed by three nursing faculty who were medical surgical content experts and had a combined 18 years experience in HFS. Four groups of students participated in a 10 minute high-fidelity simulation scenario. Some students participated in the scenario and other students observed the real-time videotape of the scenario in a different room. The scenario was followed by 30-45 minutes of videotape review and debrief by the concierge for all students. After a 10 minute break, the scenario was repeated with students who had previously been the observers. A second debrief was conducted with all students. Results: Conclusion Evaluation faculty reviewed the videotapes and rated students on performance measures for both sessions. No significant difference was found in the 1st and 2nd session’s total summative scores. The students in the 2nd scenario (after debriefing) did not perform significantly better than the students in the 1st session. However, significant differences were found in selected subscores. Students in the 2nd session were quicker to identify the patient. Also, students administered an expectorant more often in the 2nd session. This provides information for improving the performance measure. Performance measures linked to time taken to complete skills may highlight the differences in sessions. While the Results of Level 2 evaluation are non-conclusive, the very act of observing student performance informed the research team on what skills were not transferring from didactic to the simulation. For example, evaluators observed that only some of the students used a systematic process to initiate care. But, these processes can be effective in a simulation lab. Other valuable information gained from this study is that research truly is a team effort by nursing faculty, concierge faculty and simulation technicians. No detail is too small to address. Everyone involved in implementing HFS must be trained right down to scripting the debrief for a successful research process.

High-fidelity simulation among bachelor students in simulation groups and use of different roles

Cost limitations might challenge the use of high-fidelity simulation as a teaching-learning method. This article presents the results of a Norwegian project including two simulation studies in which simulation teaching and learning were studied among students in the second year of a three-year bachelor nursing programme. The students were organised into small simulation groups with different roles; nurse, physician, family member and observer. Based on experiences in different roles, the students evaluated the simulation design characteristics and educational practices used in the simulation. In addition, three simulation outcomes were measured; knowledge (learning), Student Satisfaction and Self-confidence in Learning. The simulation was evaluated to be a valuable teaching-learning method to develop professional understanding and insight independent of roles. Overall, the students rated the Student Satisfaction and Self-confidence in Learning as high. Knowledge about the specific patient focus increased after the simulation activity. Students can develop practical, communication and collaboration skills, through experiencing the nurse's role. Assuming the observer role, students have the potential for vicarious learning, which could increase the learning value. Both methods of learning (practical experience or vicarious learning) may bridge the gap between theory and practice and contribute to the development of skills in reflective and critical thinking.

NLN-Jeffries Project: Expanding the Student Construct

The Jeffries Framework of Simulation (2005) identifying five major constructs— teacher, student, educational practices, simulation design characteristics and outcomes—had its origins as an academic structure. The singular term Student was used to identify and refer to the participant in simulation. However, as simulation in healthcare has evolved, so have the purposes of simulation and therefore, the types of participants. An extensive literature review and concept analysis uncovered a broader view of the construct.

NLN-Jeffries Project: Educational Practices Construct

Simulation has been at the forefront of nursing education recently and has advanced from simple task trainers to the integration of complex scenarios with high fidelity simulators. In many schools of nursing simulation exercises are replacing varying percentages of student’s hospital clinical hours. However, there have been concerns that simulation experiences are lacking in solid pedagogical foundations, rigor and consistently. The Jeffries framework (2005) identified five major constructs: teacher, student, educational practices, simulation design characteristics and outcomes. The educational practices construct has seven components including: collaboration, student/faculty interaction, active learning, diverse learning, feedback, time on task, and high expectations. An extensive literature review by three independent researchers revealed disparate uses of the educational practices terminology or, in some cases, that the terms were completely absent from the current literature. Consideration must be given to the use of alternative and consistent terminology and clear definitions when conducting research studies on simulation activities and when submitting the findings for publication.

NLN-Jeffries Simulation Framework Project - Simulation Design Characteristics

Following attendance at this session, participants will be able to: 1)Describe the NLN-JSF simulation framework and the goals of the Project. 2)Discuss the current state of the science of simulation design characteristics and areas for future research.

A critique of the National League for Nursing/Jeffries simulation framework

To present a critique of the National League for Nursing/Jeffries simulation framework. Fawcett's criteria for theory analysis and evaluation are used. Use of simulated learning experiences in nursing education is widespread; a sound framework to guide educators across the globe in implementing these experiences effectively is essential. The basic assertion of the National League for Nursing/Jeffries simulation framework is that student-learning outcomes are influenced by the concepts of teacher, student, educational practices, and simulation design characteristics. A literature search was performed using Cumulative Index to Nursing and Allied Health Literature, PubMed and Google Scholar to identify studies published in the English language, between 2005-June 2011, where the National League for Nursing/Jeffries simulation framework was tested or used as a theoretical framework for research. Sixteen publications (two articles in press) from the USA and UK were identified using the framework to guide research; outcomes included increased student satisfaction, confidence, and improved skill performance. As a newer theoretical framework, the National League for Nursing/Jeffries simulation framework offers promise to guide the construction and implementation of simulation experiences resulting in positive student outcomes. Empirically supported definitions of concepts would strengthen the framework and help educators to consistently produce and identify positive outcomes. Additional rigorous research is necessary to further test relationships among concepts and the associated concept variables in the framework. More studies outside of the United States are needed to confirm the framework is relevant to nursing programs in other countries.

Testing Simulation Design Features using an Insulin Management Simulation in Nursing Education

This study tested a theory and data-based framework that was used to design, implement, and evaluate a teaching simulation in an introductory nursing medical/surgical course. Concepts in the Simulation Model (Jeffries, 2005) include educational principles, student factors, teacher factors, simulation design features, and outcomes. The study specifically tested the simulation design features and selected outcomes outlined in the model with 60 students from a large Midwest university enrolled in a required medical/surgical course. A 15-minute simulation focused on caring for an insulin-managed patient followed by a 15-minute debriefing time designed and facilitated by the clinical instructor. Students were randomly assigned roles: nurse, student nurse, patient, family member, or observer for the simulation experience. Debriefing was found to be the most important design feature as perceived by the students. There were no significant gains from pretest to post-test on insulin management, however, the students reported that they gained self-confidence in caring for an insulin-managed patient in the clinical setting and overall were very satisfied with the instructional method.

A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing.

This article presents a framework that can be used to design, implement, and evaluate simulations used for teaching strategies in nursing education. Components of the framework include best practices in education, student factors, teacher factors, simulation design characteristics, and outcomes. Variables are identified for each of the framework components.

Simulation Design and Device Characteristics of AlAs/GaAs/AlAs Resonant Tunneling Structures with a GalnAs Emitter Spacer Layer

ABSTRACTElectrical and structural investigation of AlAs/GaAs/AlAs resonant tunneling structures with pseudomorphic strained Ga1−xInxAs (x=0, 0.05, 0.1, 0.15, and 0.2) emitter spacer layer are presented. As indium composition increased, the peak current density, peak voltage, and peak to valley ratio increased. For a theoretical understanding of these increases, a self-consistent simulation was employed. In the simulation, we treated the 2-dimensional electrons confined in the low energy bandgap GalnAs emitter spacer well as pseudo-3-dimensional electrons, distributed continuously down to the emitter launching energy. In the simulation, we used the bottom energy of the pseudo-3-dimensional electrons to be ⅔δEc below the emitter conduction band edge. Using the above values, an excellent agreement of peak current density and peak voltage between the experiment and the simulation was achieved. Also, for structural identification, standard double crystal x-ray rocking curve technique has been used. From the interference analysis of the x-ray results, we could obtain the indium composition times thickness product.

Simulator Design and Instructional Features for Air-to-Ground Attack: A Transfer Study

A transfer experiment was conducted to define simulator design requirements and instructional procedures for an air-to-ground attack trainer. Two levels of scene detail, three levels of field of view, and three levels of simulator training trials were manipulated. Student naval aviators were pretrained in the Visual Technology Research Simulator (VTRS) on a 30-deg bombing maneuver before their performances were assessed in their standard weapon training course. Other students not pretrained in the VTRS were used for control comparisons. Prior experience in the VTRS helped student pilots use their weapon flight time more effectively. The most substantial transfer gains were produced by the first 24 simulation training trials; there was little additional benefit from further training. There was no evidence of differential transfer from the different simulator conditions. These trends indicate that physical fidelity is not a requirement for positive transfer and lend further support to the need for a concept such as psychological fidelity or functional equivalence.

Simulator Design Features for Helicopter Shipboard Landings

The Vertical Takeoff and Landing Simulator (VTOL) at the Naval Training Systems Center's (NTSC) Visual Technology Research Simulator (VTRS) was used to study the effects of simulator design features on pilot performance in helicopter shipboard landings. The research was designed to evaluate the effects of current design features on the SH—60B Operational Flight Trainer (OFT) used to train helicopter shipboard landing and four proposed simulator design modifications. These were: (1) scene detail (SH—60B OFT scene versus an upgraded VTRS scene), (2) field-of-view (VTRS wide versus a smaller SH—60B OFT field-of-view), (3) dynamic seat cueing (on versus off), and (4) dynamic inflow (standard rotor model available in existing trainers versus an updated rotor model). These factors were tested across two levels of seastate. On the basis of the factors studied in the experiment, the wider field-of-view, the more detailed scene and the updated rotor model are recommended for use. The dynamic seat cueing evaluated in this study is not recommended at this time.

Simulator Design and Instructional features for Air-to-Ground Attack: Transfer Study

A transfer-of-training experiment was conducted to provide guidelines for simulator design and training procedures for air-to-ground attack. Two levels of scene detail (complex day scene versus a low detail dusk scene), three levels of field of view (160H X 80V, 135H X 60V, 103H X 60V), and three levels of simulator training trials (24, 48, 72) were tested in the experiment. Student Naval Aviators (SNAs) were trained in the Visual Technology Research Simulator (VTRS) in 30-degree bombing prior to their standard weapon training phase. Other students, not pretrained in the VTRS, were used for control comparisons. Training in the VTRS helped SNAs use their weapons flight time in the TA-4J more effectively. Forty-eight simulator trials were recommended as adequate pretraining for 30-degree bombing. There was no evidence of differential transfer for the scene detail and field-of-view factors. The least expensive field of view option tested was recommended. However, there were methodological problems with the scene type comparison and the apparent transfer equivalence of the two scenes may not fully indicate their relative training effectiveness. Data from other VTRS experiments suggest the superiority of the day scene and it was recommended.

Simulator Design Features for Helicopter Landing on Small Ships

The Visual Technology Research Simulator (VTRS) at the Naval Training Equipment Center was used to study the effects of six simulator features on performance for helicopter landings on small ships. The purpose of the experiment was to obtain information relevant to the design of simulators used for skill maintenance and transition training, and to obtain information for making decisions about future transfer-of-training studies. The six simulator equipment factors were ship detail (high-detail deck and hangar markings versus no deck and hangar markings), field of view (VTRS-wide versus reduced SH-60B operational flight trainer field of view), system visual lag (217 msec versus 117 msec), g-seat rate cuing (off versus on), g-seat vibration cuing (off versus on), and collective sound cuing (off versus on). These factors were tested across two levels of seastate and pilot expedience. Pilots who participated in the experiment were experienced Navy H-3 rotary wing pilots. Results indicated large effects of ship detail, moderate effects for visual lag, small effects for field of view, and no meaningful effects for the g-seat factors and collective sound.