Use Of High-fidelity Human Simulation Research Articles

Effects of the Use of High-Fidelity Human Simulation in Nursing Education: A Meta-Analysis.

This study was conducted to evaluate the effects of high-fidelity human simulation (HFHS) on cognitive, affective, and psychomotor outcomes of learning. PubMed, Cochrane Library, EMBASE, CINAHL, and Korean databases were searched. The RevMan program was used for analysis. A meta-analysis was conducted of 26 controlled trials, with a total of 2,031 nursing students. The use of HFHS tended to have beneficial effects on cognitive and psychomotor domains of learning. In analysis of cognitive outcomes, the weighted average effect size across studies was -0.97 for problem-solving competency, -0.67 for critical thinking, and -2.15 for clinical judgment. The effect size for clinical competence of the psychomotor domain was -0.81. Use of HFHS might positively impact a high level of cognitive skill and clinical skill acquisition. Further research is required to determine the effectiveness of use of HFHS as an educational strategy to improve knowledge acquisition and communication skills.

Board #118 - Research Abstract Real Time Quantification of Stress during High-fidelity Human Simulation for a Standardized Learning Experience (Submission #9956)

Hypothesis A curvilinear relationship exists between stress and learning, implying that both extremes of high or low stress negatively impacts learning and performance. Stress is a central component of the High-fidelity Human Simulation (HFHS), which is increasingly being used in nursing education as an active learning tool. A degree of stress during participation arises from factors intrinsic to HFHS, including anticipation of the event, requirement for quick clinical decision-making and acuity of the scenario. Additionally, being watched by peers or educators and being afraid of getting embarrassed in front of everyone adds to the total stress experienced. This study investigated how stress level changes on a real time basis during standardized HFHS and if participants with different personality types and learning styles show distinctive patterns of stress evolution. These results will have significant implications for optimizing stress and maximizing learning in HFHS. Methods First-year novice learners, who have no clinical or HFHS experience were included. Nursing students were involved in an hour-long clinical simulation experience, including a pre-brief session a 20-minute simulation session followed by a debriefing session. Salivary cortisol (pre and post simulation) and heart rate variability low frequency to high frequency ratio (LF/HF-HRV) calculated every 5-minute from real time EKG data (pre, during and post simulation) were used for stress quantification. The BIG 5 Personality test and the Honey and Mumford Learning Styles Inventory that were used to assess personality and learning style respectively were completed at a later time. Multiple regression analysis was used to examine the strength of association. Results Salivary Cortisol levels and LF/HF-HRV showed statistically significant increase from pre to post simulation p<0.05. There was a moderate positive correlation between Salivary Cortisol concentration and LF/HF-HRV, r(20) = .371, p < .0005, with LF/HF-HRV explaining 14% of the variation in salivary cortisol concentration. The Neuroticism personality trait and theorist style of learning had significant positive regression weights, indicating students with higher scores on these scales had higher post-simulation stress levels. Moreover, openness personality trait had a significant negative weight, indicating that students with higher scores on openness to experiences had lower post-simulation stress level. Conclusion Optimal level of stress is essential for effective use of HFHS for acquisition and retention of knowledge and skills. Therefore, this pilot study is important as it provides the first data elucidating the pattern of change in stress during a standardized HFHS scenario. Importantly, results show that LF/HF-HRV is a valid tool that can be used to provide stress level on a real time basis giving the researcher a very high temporal resolution for stress quantification that can be used non-invasively and without interfering the scenario performance. Future research should include larger participants with performance assessment.

Simulation Decreases Nursing Student Anxiety Prior to Communication With Mentally Ill Patients

IntroductionThe purpose of the study was to investigate the impact of high-fidelity human simulation on nursing student anxiety prior to attending clinical and interacting with a mentally ill patient. MethodThis quantitative, nonrandomized, quasi-experimental study was implemented with three groups of undergraduate nursing students who were enrolled in a psychiatric nursing course. The students participated in a 2-hour lecture on therapeutic communication techniques, followed by a simulation experience depicting a depressed patient or an anxious patient in alcohol withdrawal. A sample of 44 students participated by completing a demographic questionnaire, a pre- and postanxiety visual analogue scale, pre- and post–State-Trait Anxiety Inventory, and a Simulation Evaluation Survey. Data were collected during two semesters in 2010. ResultsThe findings support the use of high-fidelity human simulation to aid in decreasing nursing students' anxiety prior to communicating with patients experiencing mental illness.

The Impact of High Fidelity Human Simulation on Self-Efficacy of Communication Skills

Communication is a critical component of nursing education as well as a necessity in maintaining patient safety. Psychiatric nursing is a specialty that emphasizes utilization of communication skills to develop therapeutic relationships. Nursing students are frequently concerned and anxious about entering the mental health setting for their first clinical placement. High fidelity human simulation (HFHS) is one method that can be used to allow students to practice and become proficient with communication skills. The purpose of this study was to compare the effectiveness of two educational delivery methods, traditional lecture and HFHS, on senior level nursing student's self-efficacy with respect to communicating with patients experiencing mental illness. The results of this study support the use of HFHS to assist in enhancing undergraduate students’ self-efficacy in communicating with patients who are experiencing mental illness.

Integration of Simulation Across the Undergraduate Curriculum: Student and Faculty Perspectives

Background High-fidelity human simulation provides an innovative teaching method for nursing students. Faculty members face challenges related to the integration of this method of teaching within a curriculum. Method The purpose of this study was to implement and integrate the use of high-fidelity human simulation as a teaching and active learning strategy throughout the undergraduate nursing curriculum and evaluate the student and faculty perceptions related to this instructional technology. Kolb's experiential learning theory and Jeffries's Nursing Education Simulation Framework provided the framework for this research project. Creative methods for implementation of simulation in various courses are described. A mixed-methods (survey and focus group) research design was used to measure student and faculty perceptions of this process. Following the simulation experience, students ( N = 151) completed the simulation evaluation survey, and faculty ( N = 6) participated in focus groups to provide insight into the experience. Results/Conclusions Student responses related to the experience were overwhelmingly positive, and while faculty agreed that the use of simulation was beneficial to the achievement of learning objectives, many challenges related to the use of the technology were experienced. This study supports the use of simulation in an undergraduate nursing curriculum and offers suggestions for faculty faced with implementing simulation.

Expanding Acute Care Nurse Practitioner and Clinical Nurse Specialist Education

Programs educating advanced practice nurses (APNs), including acute care nurse practitioners (ACNPs) and clinical nurse specialists (CNSs) may struggle with the degree to which technical and cognitive skills necessary and unique to the care of critically ill patients should be incorporated within training programs, and the best ways these skills can be synthesized and retained for clinical practice. This article describes the critical care technical skills training mechanisms and use of a High-Fidelity Human Simulation (HFHS) Laboratory in the ACNP and CNS programs at the University of Pittsburgh School of Nursing. The mechanisms for teaching invasive procedures are reviewed including an abbreviated course syllabus and documentation tools. The use of HFHS is discussed as a measure to provide students with technical and cognitive preparation to manage critical incidents. The HFHS Laboratory, scenario development and implementation, and the debriefing process are discussed. Critical care technical skills training and the use of simulation in the curriculum have had a favorable response from students and preceptors at the University of Pittsburgh School of Nursing, and have enhanced faculty's ability to prepare APNs.