Simulated Learning Experiences Research Articles

Trauma Teams That Train as One Work as One: Invasive Procedure Training in Residency Education

Invasive surgical procedures occur infrequently in an emergency department setting; however, procedural competence is expected from trauma residents. Emergent procedures are challenging to train in a formal manner because of the urgent nature when they present. To supplement education, new and creative teaching tools such as simulation and multidisciplinary training are being used. Our study organized a multidisciplinary simulated learning workshop with surgery and emergency medicine residents for invasive, emergent procedures. In total, 14 surgical and 36 emergency medicine residents at our institution participated in a simulated learning experience. Ten workshops were organized, with six to seven residents participating in each session. Using a human cadaveric model, all residents were taught by senior-level residents and attendings from both specialties on how to perform uncommonly or anatomically challenging emergent invasive procedures. A pre- and post-laboratory survey was completed by all the residents to assess confidence in performing each of the 13 procedures. All residents (N = 50), who participated in the study, completed pre- and post-laboratory surveys. Comparison of the pre- and post-laboratory confidence levels indicated significant increases in confidence in performing all procedures. Residents stated that this multidisciplinary approach to education in a controlled setting was helpful and fostered a collaborative relationship between both specialties. Although some surgical procedures remain uncommon in the emergency department, competency is nevertheless expected for appropriate patient care. Using a collaborative simulation-based cadaver laboratory to teach emergent procedures significantly improved residents' confidence while concurrently fostering professional relationships.

Analysis of Undergraduate Nursing Students' Sensitivity to Microethical Dilemmas During Simulation.

Simulation can extend ethics education in undergraduate nursing programs beyond the cognitive domain. However, the degree to which nursing students recognize and respond to microethical dilemmas in simulation is unknown. Using a mixed-methods convergent parallel design, 68 third- and fourth-year undergraduate nursing students completed a sensitivity questionnaire. Twelve students also participated in an interview. Data were compared to create meaning. Many students reported having a high level of ethical sensitivity toward microethical dilemmas during simulation. However, some students expressed uncertainty in their ability to identify microethical dilemmas during nurse-patient interactions. Students also reported limited confidence in being able to transfer their ethical knowledge to the practice setting. Nurse educators must be moral agents during simulated learning experiences by helping students learn what microethical dilemmas are and strategies to manage them. [J Nurs Educ. 2020;59(2):88-92.].

Learning how to SMILE. Improving physical and mental health through nurse education and creative practice

The purpose of this pilot study was to explore how best to prepare and support nursing undergraduate students learning in a community/primary care setting through a Student Managed Initiatives in Lifestyle Education (SMILE) project. Further to this our intention was to evaluate the ways in which students were able to apply nursing theory to the practice of identifying and responding to the health needs of vulnerable people.Using a collaborative approach and a qualitative method, this pilot study used focus group discussions to explore both the experiences of community participants and undergraduate nursing students.This project found that students were able to draw on theoretical understandings and their simulated learning experiences to support their learning in a complex, non-clinical practice setting. It also illustrates the way in which community centres and other naturalistic environments where individuals and groups meet, can provide spontaneous and rewarding opportunities for nursing students to develop and apply health promoting knowledge and skills. Shaping nursing curricula with this in mind, creates the potential for nurses to make a significant contribution to improved health outcomes for vulnerable and/or marginalised people.

Student Experiences with Engagement in a Nursing and Physical Therapy Interprofessional Education Simulation

Purpose: Interprofessional Education (IPE) incorporated into healthcare discipline instruction has been shown to be successful in improving the understanding perceptions of complimentary professions. The purpose of this mixed method study was to measure differences in perceptions of early Baccalaureate of Science in Nursing (BSN) students and Doctor of Physical Therapy (DPT) with participation in a immersive interprofessional education experience. Method: Students completed a pre and posttest survey consisting of the Readiness for Interprofessional Learning Scale and several short answer qualitative questions. Cohorts of BSN and DPT students participated in a computerized mannequin simulation experience or a hybrid simulation. Results: Students indicated they learned about each other’s scope of practice and recognized the benefits of teamwork through collaboration. Conclusion: Students showed increased knowledge of the other profession, appreciated the opportunity for interprofessional learning, and were interested in having more IPE simulation learning experiences.

Simulation-Based Learning to Improve Athletic Trainers’ Knowledge of Exertional Sudden Death Conditions: A Pilot Study

Purpose: Continuing education for the practicing clinician typically involves reading peer-reviewed journals and attending professional conferences. These mechanisms do not allow for practice and real-time evaluation of healthcare skills. Simulation-based learning has been widely used in professional education yet is not common in the continued development of the clinician in their lifespan. Method: We used a cross-sectional, repeated measures pilot study. The participants included 11 athletic trainers (age=40±14 years; certified experience=17±14 years) that engaged in a multi-modal continuing professional development session that included a lecture, large-scale simulated learning experience, and debriefing session at a healthcare conference. The outcome measures included 1) a 6-item effectiveness tool to assess the overall program, 2) pre, post, and 6-month follow-up knowledge assessments, and 3) a 6-month follow-up qualitative viewpoint statement. Results: The participants rated the program as effective and useful. On the knowledge assessment, the participants scored an average of 74% on the pre-test and 87% on the post-test with an average change score of a 20.5% increase following the educational session. We identified a significant improvement (P=0.002) in the participants from pre-test to post-test, however a decay in the knowledge improvements from post-test to follow-up at six months (P=0.188) was noted. Conclusion: A multi-modal educational intervention was effective at improving knowledge immediately following the session. This study offers promise that continuing education through simulation may improve knowledge acquisition while serving as a catalyst for clinical practice behavior change.

Faculty and Student Perspectives of a Graduate Online Delivery Model Supported by On-Campus Immersion.

The purpose of this article is to describe an immersion model implemented in a doctor of nursing practice program with the goal of engaging students and optimizing learning. The immersion model was designed to support learners in an online doctor of nursing practice program to promote self-direction and active involvement in diagnosing, planning, implementing, and evaluating their own learning. The Community of Inquiry framework, based on learning and teaching theory, was used in developing this immersion model. Students expressed positive opinions about immersion. Students valued simulation and skills practice, peer interaction, engagement with faculty, and the leadership colloquium. Faculty reported value in having group advising meetings and in collaborating across specialty tracks for skills laboratory experiences. The immersion model has enhanced student engagement and helped optimize learning outcomes. Students and faculty found the use of the immersion model to be beneficial for practicing skills, use of simulated learning experiences, and student advising.

Managing student workload in clinical simulation: a mindfulness-based intervention

BackgroundSimulation places multiple simultaneous demands on participants. It is well documented in the literature that many participants feel performance stress, anxiety or other emotions while participating in simulation activities. These...

A Systematic Process for Evaluating Teaching Methods in Nursing Education.

An evidence-based process for the evaluation of teaching methods in nursing education, including classroom assignments, is not well described in the literature. Nurse educators are familiar with evidence-based teaching but may be less knowledgeable about evidence-based methodologies to evaluate the effectiveness of teaching methods. Global measures of students' success, such as passing a licensing or certification examination, are often used as benchmarks for nursing education programs. The authors suggest an evidence-based, 8-step evaluation process for evaluating the effectiveness of teaching methods. This process is demonstrated using simulation learning experiences in 2 courses in an advanced practice nursing education program. The 8-step evaluation process was found to be effective for evaluating teaching methods within a graduate-level nursing education program. The proposed evaluation process is applicable for evaluating teaching methods at all levels of nursing education. This systematic evaluation of teaching methods may ensure that students are engaged in learning activities leading to the attainment of assignment and course objectives.

A simulation-based learning experience in augmentative and alternative communication using telepractice: speech pathology students\u2019 confidence and perceptions

BackgroundSimulation, as an activity in speech-language pathology training, can increase opportunities for students to gain required skills and competencies. One area that has received little attention in the simulation literature, yet is a growing area of clinical practice, is alternative and augmentative communication (AAC). Also growing, is the use of telepractice to deliver services. This exploratory study investigated graduate entry speech-language pathology student perceptions of a simulation learning experience working with an adult with complex communication needs via telepractice.MethodsFirst year Master of Speech Pathology students completed a 1-day simulation using a videoconferencing delivery platform with an actor portraying an adult client with motor neurone disease requiring AAC. Quantitative and qualitative survey measures were completed pre- and post-simulation to explore students’ confidence, perceived impact on clinical performance, and perceived extent of learning, specifically, their interest, competence, and tension. Further, students’ perceptions about the telepractice system useability were explored. Fifty-two responses were received and analysed using descriptive statistics and content analysis.ResultsPost-simulation, students reported increased confidence and perceived positive impacts on their confidence and clinical skills across communication, assessment, and management domains. They felt better prepared to manage a client with a progressive neurological condition and to make AAC recommendations. For telepractice delivery, technology limitations were identified as impacting its use, including infrastructure (e.g., weak internet connection). In addition, some students reported feeling disconnected from the client.ConclusionThis study supports the use of simulation in AAC through telepractice as a means of supporting Masters-level speech pathology student learning in this area of practice.

Mobile community learning programme's effectiveness in case management for psychiatric nurses: A preliminary randomised controlled trial

BackgroundThe global health care system has applied case management (CM) as a care delivery service provided by nurses. Nurses require continuing education in CM to enhance their professional knowledge and competence. Mobile communities have been used to promote continuing education for medical professionals. However, limited studies have examined the effectiveness of such learning programmes in CM for psychiatric nurses. ObjectiveTo evaluate the effectiveness of a mobile community learning (MCL) programme in CM for psychiatric nurses. DesignThis study used an experimental two-group pre- and post-test design. Settings and participantsPsychiatric nurses employed in a psychiatric teaching hospital situated in northern Taiwan were recruited. MethodsNurses were randomly allocated to the experimental or comparison group. The former participated in the learning intervention in CM. The CM knowledge index and a competence scale were used to determine outcomes. Pre-tests and 2-month post-tests were conducted. The MCL programme comprised five simulated learning modules, self-assessment questions, learning cases, learning resources and experience sharing. A two-way repeated-measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes. ResultsThe questionnaires were completed by 48 participants. The two groups possessed high homogeneity with regard to characteristics and pre-test outcomes. Differences between the two groups regarding CM knowledge (F = 22.99, p < .01) and competence (F = 6.33, p = .015) were significant. The programme had a positive benefit on the learning experience in the experimental group; the mean satisfaction score for the programme reached 4.27 (range, 1–5). ConclusionsMCL programmes for psychiatric nurses can effectively enhance CM knowledge and competence. However, these methods cannot completely replace the continuing education approach for achieving CM competence.

Self-Confidence of Nursing Students Related to their Simulation Learning Experience

Simulated learning environments are integral to the clinical training process in many nursing programmes. Active involvement through simulation may promote critical thinking skills and increase self-confidence levels. High-fidelity and low-fidelity simulation may impact students’ self-confidence differently due to the differences in their ability to project a real-life scenario. The purpose of this study was to compare the effect of high-fidelity and low-fidelity simulation on self-confidence among student nurses. The study was an analytic cross-sectional in design and took place in a public women’s university in the Kingdom of Saudi Arabia, Princess Nourah University. The College of Nursing has access to both low and high fidelity simulation Center. A total of 85 participants were included in the sample and used questionnaires to compare the effect of high-fidelity and low-fidelity simulation on self-confidence among student nurses. The data analysis methods used were frequency percentages, arithmetic mean, Standard Deviation and Pearson correlation. About 74.1% of the respondents were between 19-21 years of age, and 70.4% had a GP of 3.55-4. In addition, 95.1% had not practiced in a hospital before. Students were “hesitant” about their self-confidence after a low-fidelity simulation and “confident” after a high-fidelity simulation. The high-fidelity simulation technique had statistically significant effects on self-confidence compared to low-fidelity simulation. Nursing students who are put through the high fidelity simulation exhibit high degrees of self-confidence relative to their counterparts who are subjected to the low fidelity simulation training. Similar to the existing literature, the findings from the current research backed up this position. Keywords: High-fidelity simulation training, Low-fidelity simulation training, Nursing Students, Patient simulation, Self-confidence. DOI : 10.7176/JEP/10-15-20 Publication date :May 31 st 2019

An Evaluation of Simulation Debriefings on Student Nurses' Perceptions of Clinical Reasoning and Learning Transfer: A Mixed Methods Study.

It is assumed that students will transfer what they have learned from simulation to real world practice, however, some students are unable to identify the relevance of simulated learning experiences if scenarios are dissimilar to clinical placement settings. The nature and extent what is able to be transferred from simulated to real settings is unclear, particularly in relation to complex processes such as clinical reasoning. Transfer of learning to a new situation involves deliberate cognitive effort, including reflection and mindful abstraction of central attributes of a problem. As reflection is a key element in learning transfer, the debriefing element of simulation was seen to be a platform for this study. A convergent parallel mixed methods design used a pre-test, post-test survey and focus group interviews. No statistically significant difference in post-test clinical reasoning scores between groups was found. There was a statistically significant improvement in 12 out of 15 criteria among the control group and in 8 of the criteria among the intervention group. Qualitative findings provided some evidence that learning had transferred to clinical settings. Evidence of "near" transfer was more evident than "far" transfer. Positive findings included that all students perceived they had transferred the skills of patient assessment and effective communication during episodes of patient care. The concept of a "framework" being verbalized by many of the intervention group during practice is a promising finding and may be a useful direction for further research focusing on the instructional demonstration of explicitly promoting a level of abstraction of problems and prompting participants to search for conceptual connections. This may indicate retained idea or concepts from the debriefing which may be useful in future practice.

Simulation-Based Interprofessional Education: A Nursing and Social Work Collaboration.

Contemporary teaching and learning pedagogy commands interprofessional collaboration among allied professions such as nursing and social work, two professions that have a natural inclination to partner in the workforce. Nursing and social work students participated in a structured simulated learning experience where they demonstrated their respective professional practice skills in a supported learning environment while working collaboratively to assess one of two patient types: high-fidelity or simulated. Both groups expressed initial worry during prebriefing but articulated their appreciation for and usefulness of working with the other profession. Future collaboration includes learning about respective professional roles, more direction regarding the professional handoff, and prior exposure to the appearance and functionality of high-fidelity patient types in an effort to establish best strategies for partnership. Interprofessional collaboration diverges from the silo effect, leading to collegiality among affiliated professionals, as well as increased patient safety and improved patient outcomes. [J Nurs Educ. 2019;58(2):110-113.].

What's in a Name? Clarifying the Nomenclature of Virtual Simulation

Clinical simulation is an essential component of health professional education. Digital technologies can provide students with near-reality, interactive virtual simulation learning experiences on static and mobile appliances. Clarification is needed, however, regarding the various types of virtual simulation and the different program components. We drew on published literature to define virtual simulation modalities and to offer definitive terminology to clarify the nomenclature and composition of virtual simulation. Reporting should include description of ‘Fidelity’, ‘Immersion’, and ‘Patient’ to add clarity and utility to research in the field.

Simulation as a component of introductory physiotherapy clinical placements

Simulated learning experiences (SLEs) assist students to acquire knowledge and skills and are an effective teaching tool in physiotherapy education. The aim of this project was to explore physiotherapy student attitudes towards SLEs as a preparatory component of an introductory clinical placement. The project was a quasi-experimental, pre/post-test repeated measures design. Participants were second year physiotherapy students (n = 57) allocated to a placement which included one week of SLEs and three weeks in a healthcare setting. The SLE week consisted of sessions to develop students’ clinical skills in preparation for placement. Data on participant attitudes towards SLEs were collected via anonymous survey before and after the SLE week, and at the completion of the three week clinical placement. Attitudes of respondents (n = 43) towards SLEs were significantly more positive at the completion of the SLE week. At the completion of the three week clinical placement, all responses remained more positive than at the commencement of the project, however participant responses were generally less positive than at the conclusion of the week of SLEs. Students valued the use of SLEs in preparing for introductory clinical placements. Simulated learning experiences should be considered as a useful tool for pre-placement preparation for early year physiotherapy.

Reprint of: Computer-Based Simulation Training in Surgery

Computer-based simulation training methods have emerged in mainstream residency training in response to evolving educational demands. These methods include surgical virtual reality (VR), computer driven full patient simulation, and screen-based simulations, of which immersive virtual environments reflect the most recent area of development. Over a single decade, surgical VR has progressed from demonstration of concept to a practical training tool, with a body of validation literature for part-task VR trainers that supports their expanded use, as well as the development of more robust and capable systems to satisfy the need for procedural training. Patient simulation is gradually entering surgical residency training for crisis resource management and team training that might not otherwise be feasible outside clinical settings. In the future, simulation of patient care in virtual environments may constitute a similar experience without the resource demands associated with full patient simulation. Collectively, the use of computers to create simulated learning experiences for surgeons is representative of an experiential learning model that has been far more developed in other undertakings, but which will certainly be more relied on in surgical training in the future.

Effectiveness of Two Varying Levels of Virtual Reality Simulation.

The aim of the study was to assess two levels of immersive virtual reality simulation (VRS) to teach the skill of decontamination. Little is known about the use of VRS in providing disaster education, including retention. Quasiexperimental design with repeated measures, supplemented by qualitative data, using a convenience sample of senior baccalaureate nursing students (n = 197) from four Midwest campuses was used. Students were randomly assigned to a group (two levels of immersive VRS and a control group) to learn the skill of decontamination. Cognitive learning, performance, and performance time were measured pre/post and at six months. Outcome measures were significant with immediate postintervention improvements and lower retention scores at six months. No significant differences were noted between groups. Students were satisfied with the VRS but found immersive VRS more interactive. VRS provides another alternative for simulated learning experiences; best practice approaches for its use still need to be explored.

Consideration of using virtual reality for teaching neonatal resuscitation to midwifery students.

Within the last decade, there has been significant change in the way tertiary midwifery education has been delivered to students. The use of blended teaching methods and the introduction of simulated learning experiences has been observed in the literature to improve students' self-confidence, competence, clinical judgement and decision-making abilities. Simulation is seen to be particularly important when practising skills that may be infrequently encountered in practice, such as clinical emergencies. Neonatal resuscitation is the most common neonatal emergency encountered within midwifery today, with up to 15% of babies requiring some form of resuscitation at birth. Recent research describes the benefits of using a multi-modal approach to teaching neonatal resuscitation, utilising both theory and simulated learning methods. One emerging method of simulation is that of virtual reality (VR), which has been recognised for its enormous educational potential in risk-free clinical skills training. Currently, however, there is limited research looking at the use of VR in emergency skills training. This article examines the literature to highlight the potential benefits that VR simulation could provide for emergency skills training, as well as the potential challenges that should be acknowledged.

Designing simulation learning experiences to reduce technological burden on nursing academics: a discussion paper

Objective: The literature reports nursing academics avoid manikin-based simulation because they feel intimidated by the technology. With that in mind, we sought to design a manikin-based simulation learning experience for nursing students, with low technological burden for those nursing academics expected to work with the technology. Setting: A multi-campus Australian regional university school of nursing. Subjects: Nursing academics with little or no experience in manikin-based simulation. Primary argument: Nursing academics are encouraged to use manikins in their clinical teaching but little has been done to address their fears and concerns around the technology. We argue that taking simple steps to decrease the technological burden will help to encourage nursing academics uptake of manikin-based simulations, as a favoured pedagogy in clinical teaching. Conclusion: The technological burden around manikin-based simulation was reduced by: (1) choosing medium level fidelity simulations, (2) designing simulations where students operate the equipment, (3) preparing participants for the SLE with a pre-brief video and instruction handouts, (4) offering academics roles as observers, and (5) providing on-site technological support. Nursing academics were encouraged by the process and more inclined to engage with manikin simulations. Designing simulations that address nursing academics’ fears and concerns around simulation technology encourages simulation uptake.

Impacts of a Simulation-Based Interprofessional Intervention on Chinese Health Students

BackgroundInterprofessional education is essential for developing a collaborative workforce. However, interprofessional education is not the norm in health professional education in China. More evidence is needed to testify to the effectiveness of interprofessional education. This study describes the process of developing a simulation-based interprofessional intervention in academic settings in China and explores the impacts on baccalaureate health students. MethodsA quasi-experimental, pre and post design was used. Thematic analysis analyzed the students’ feedback in debriefing. ResultsSatisfaction with the simulated interprofessional learning experience was high. Positive attitudinal changes towards teamwork were expressed after simulation; however, significant gaps existed in the students’ team performance. Also, the nursing students’ prescores and postscores of teamwork attitudes were lower than the medical students. ConclusionFurther studies should address: (a) building a more comprehensive, constructive organizational culture through integrating patient-centered, holistic care model in all health curriculum designs; (b) threading interprofessional education and collaborative practice in the entire trajectory of professional education, assessing of the impact of doing so, and redesigning the clinical learning to improve students’ actual performance; and (c) exploring Chinese students’ perceptions of different components of simulation, and engaging them in the simulation design.