Clinical Simulation in Nursing - Articles in Press

Passing the Baton: Using Simulation to Develop Student Collaboration - Corrected Proof

Lynn Senette, Maureen O'Malley, Thomas Hendrix — 2012-01-20

Abstract: Background: There is scant research about the effectiveness of teaching collaborative handoff strategies.Method: Following a collaborative simulation, this pilot project used a quasi-experimental, 2-group, posttest design to (a) identify differences between nursing and paramedic students' perceptions of collaboration, (b) determine satisfaction and intention-to-act, and (c) compare communication preferences.Results: Responses were positive for collaboration, satisfaction, and intention-to-act. Nursing students showed increased preference for structured formats. Qualitative themes included interaction, experience, uncertainty, realism, and mental models.Conclusions: Collaborative simulation is potentially useful as a teaching–learning strategy to improve handoff communication.

Using Problem-Based Learning Scenarios to Prepare Nursing Students to Address Incivility - Corrected Proof

Cynthia M. Clark, Sara M. Ahten, Rosemary Macy — 2012-01-20

Abstract: Introduction: Incivility may be a problem for nursing students as they progress through their nursing education and enter the workplace. Nursing faculty are challenged to construct meaningful learning experiences to address the problem and consequences of incivility.Method: A problem-based learning scenario and Kirkpatrick’s model for evaluation were used to address incivility and the “reality shock” between what students learn about the practice of nursing and the interactions they may experience in the workplace.Results: Students expressed a favorable reaction to the scenario and reported being better prepared to address incivility in the workplace.Conclusions: Problem-based learning scenarios are an effective teaching strategy for instructing nursing students on the topic of incivility.

Using Objective Structured Clinical Evaluation for Simulation Evaluation: Checklist Considerations for Interrater Reliability - Corrected Proof

Mary Cazzell, Carol Howe — 2012-01-20

Abstract: Background: Reliability of simulation outcome measurements is infrequently reported in nursing education. The purpose of this study was to establish interrater reliability of a checklist for a pediatric medication administration objective structured clinical evaluation.Method: Two raters scored 207 videotaped nursing student objective structured clinical evaluation performances using a 14-item checklist. Item interrater reliability statistics were calculated.Results: Adequate interrater reliability was obtained on six items from the cognitive and psychomotor domains of learning. Unacceptable interrater reliability was obtained on four items from the affective domain.Conclusion: Results verified the difficulty of quantitatively measuring affective domain behaviors and the need for consistency in rater roles.

Simulating Nursing School to Engage High School Students - Corrected Proof

Ceil Flores, Mary Jane Ashe — 2012-01-20

Abstract: With the growing number of minority citizens receiving health care, increasing the number of minority students who will become nurses is important. Minority representation in professional nursing is low, and innovative steps are needed to encourage enrollment into nursing programs. A large university in the southwest United States has taken a proactive role by conducting a summer camp that introduces high school students to the profession of nursing. Campers learned foundational skills and applied them using an infant simulation scenario. End-of-camp simulation revealed active learning occurred. Simulation was an effective strategy to educate high school campers.

Simulating Simulation: Promoting Perfect Practice With Learning Bundle–Supported Videos in an Applied, Learner-Driven Curriculum Design - Corrected Proof

Alice Blazeck, Gretchen Zewe — 2012-01-19

Abstract: In professional practice, patient safety hinges on accurate nursing assessment and surveillance, disciplined clinical reasoning, communication, and skilled interventions, as reported by the Institute of Medicine. While critical to patient safety, skilled interventions are often taught in isolation, with insufficient practice for mastery. To prevent such segregation, the learning-bundle approach uses a hybrid of appropriate learning tools supporting a weekly scaffolding of applied theory, lab, and clinical. Key to the success of this bundled approach is sufficient opportunity for deliberate practice with the creation of learner-driven perfect practice simulation videos.

Masters Nursing Students' Perceptions of an Innovative Simulation Education Experience - Corrected Proof

Michelle A. Kelly, Margaret Fry — 2012-01-19

Abstract: Background: Simulation was introduced into a master of nursing course, embedded within patient safety and clinical practice contexts. Student groups developed, enacted, and debriefed simulation scenarios from lived experiences. The study aimed to explore masters students' perceptions of the innovative simulation education strategy.Method: A 2-year qualitative, exploratory study retrospectively analyzed students' written reflections about the innovative educational strategy and application of simulation for clinical practice.Results: The study enrolled 21 participants. Five themes emerged from the analysis: a new awareness of the extent and range of simulation activities; building teams and meaningful work; supported, realistic, and extended learning; sharing and reconstructing “clinical stories”; and using simulation in practice.Conclusion: Masters nurses highly valued the innovative simulation education strategy to develop authentic scenarios and identified a wide range of clinical applications and ways to initiate simulation in the workplace.

Implementation of Mental Health Simulations: Challenges and Lessons Learned - Corrected Proof

Shoni Davis, Jayne Josephsen, Rosemary Macy — 2012-01-19

Abstract: Boise State University School of Nursing faculty faced several challenges and learned important lessons in attempting to implement mental health simulations with standardized patients when clinical practicums with actual patients were no longer an option. Challenges faced included (a) establishing strategies to recruit a large pool of authentic standardized patients, (b) determining the optimal level of complexity for each simulation, and (c) providing useful feedback to students about noted deficiencies while at the same time making the reflections a positive experience. Important lessons are shared that may help other faculty avoid similar challenges.

How Often do BSN Students Participate in Pediatric Critical Events during Simulation and Hospital Rotations? - Corrected Proof

Susan Pauly-O’Neill, Susan Prion, Judith Lambton — 2012-01-16

Abstract: Background: With nursing students’ limited access to pediatric patients. coupled with an expectation that the novice nurse be proficient in managing deteriorating patient conditions, nurse educators may choose to supplement students’ clinical rotation with simulation. The question remains, What experiences are “available” in clinical, and which ones are rarely seen and therefore should be simulated?Method: A list of 18 pediatric critical events was rated by pediatric nurse experts as not important, somewhat important, very important, or vitally important for the novice nurse to recognize, report, and intervene in. Students were asked to report on the number of times they intervened to correct these critical events in both the clinical arena and the simulation laboratory. Students were also asked to rate their confidence in performing these interventions after their clinical and their simulation experiences.Results: The survey results indicate that students had significantly more experiences with most of the pediatric critical events in the simulation lab than in the pediatric inpatient unit. For each of the pediatric critical events, the mean comfort level was higher after simulation than after clinical.Conclusions: A mixed educational model is effective in introducing students to the competencies expected of the novice nurse.

Evaluating An Interprofessional Pediatrics Educational Module Using Simulation - Corrected Proof

2012-01-16

Abstract: Background: High-fidelity simulation (HFS) has been shown to be effective in health sciences education for practicing team approaches to managing complex care. Interprofessional (IP) collaboration contributes to patient well-being. This prospective study was conducted to evaluate an interprofessional pediatrics educational module using HFS.Methods: Nursing and medical students (N = 96) attended one asthma exacerbation simulation and a second on sepsis. Performance of basic pediatric skills and team skills was evaluated using a checklist. Participants (N = 86) completed a survey regarding their confidence performing pediatric skills and their comfort with IP communication and collaboration. Fifty-three nursing students completed the scenarios in non-IP groups.Results: Team skills improved significantly for the IP groups between the two scenarios (p < .001), but not for the non-IP groups. Pediatric skills scores were lower than team scores in both sessions for all groups.Conclusion: HFS may be a useful strategy to teach interprofessional teamwork in pediatrics.

Debriefing Experience Scale: Development of a Tool to Evaluate the Student Learning Experience in Debriefing - Corrected Proof

Shelly J. Reed — 2012-01-12

Abstract: Background: Debriefing represents the reflection phase of the simulation process, in which feelings are resolved and learning is solidified, but the nursing student experience during debriefing is largely unknown.Method: The Debriefing Experience Scale was developed from debriefing literature and expert opinion. This scale was used in 2 research studies and refined through the use of factor analysis.Results: The resulting scale, divided into 4 subscales, consists of 20 items defining the nursing student debriefing experience.Conclusions: The Debriefing Experience Scale the potential to assist in providing further insight.

Effectiveness of a Role-Modeling Intervention on Student Nurse Simulation Competency - Corrected Proof

Barbara Aronson, Barbara Glynn, Timothy Squires — 2012-01-09

Abstract: Novice nurses are often inadequately prepared to respond to complex, patient care situations where patients' conditions deteriorate. Exposure to a video-taped intervention that role-models and reinforces expected behavior of an expert nurse before participation in a simulation may improve student nurse performance in a cost-effective manner. The primary purpose of this quasi-experimental pre-test, post-test study was to assess the preliminary effectiveness of a theory based role-modeling intervention on enhancing student nurse competency in responding to a simulated response to rescue event. Performance was measured by a previously validated Heart Failure Simulation Competency Evaluation Tool © (HFSCET). Total mean scores on the HFSCET for the pre-test (59.08) and post-test (87.08) were significantly different (p = .000); students performed better on the post-test after exposure to the role-modeling intervention. A power analysis indicated a large effect size (effect size = .926; alpha = 0.50; power = 0.991). Students who had a greater number of days between the intervention and the post-test had a lower score. This innovative intervention based on established learning theory may change the way educators prepare novice students to achieve expected clinical competencies in graded simulation performance assessments.

A Hospital and University Partnership Model for Simulation Education - Corrected Proof

Brenda Senger, Lynn Stapleton, Mary Sue Gorski — 2011-12-15

Abstract: Nursing has been given the challenge to develop innovative methods for clinical education. Human patient simulation is a creative a way for students and staff nurses to improve clinical reasoning and refine psychomotor skills in a safe and controlled environment. Practice–education partnerships can provide a unique framework for multi-institutional nursing education. This article describes the development of a practice–education partnership between a small nursing program and a local community hospital; human patient simulation was used to provide a combined multi-institutional training program for professional staff nurses and student nurses. Feedback from students and staff nurses regarding this training program was positive, noting improved confidence and greater appreciation for teamwork. Nurse educators considered the benefits and challenges associated with a multi-institutional educational framework and affirmed the value of a practice–education partnership.

Comparison of Three Simulation-Based Teaching Methodologies for Emergency Response - Corrected Proof

2011-12-15

Abstract: Background: The purpose of this study was to compare the effects of 3 simulation methodologies (low-fidelity, computer-based, and full-scale) on the outcomes of emergency response knowledge, confidence, satisfaction and self-confidence with learning, and performance. Additionally, interrater reliability was assessed for the Emergency Response Performance Tool (ERPT).Method: An experimental, pretest–posttest, control-group design was used to evaluate the effects of the 3 teaching methodologies. In all, 28 participants enrolled in a Critical Care Orientation program participated in the study. Each participant was randomized to 1 of the 3 groups. Participants completed pre- and posttest written examinations and confidence questionnaires, the Student Satisfaction and Self-Confidence in Learning instrument, and baseline and posttest performance assessments.Results: No significant differences were found among the 3 groups in emergency response knowledge, confidence, or performance. There were significant differences in participants’ results on the Student Satisfaction and Self-Confidence in Learning instrument, with the full-scale simulation group rating the highest in satisfaction and self-confidence. The interrater reliability for the ERPT ranged from 0.58 to 1.0.Conclusions: Although the statistical findings did not support the hypothesis that critical care RNs who receive full-scale simulation training will score higher in knowledge, confidence, and performance, this study advances the current knowledge base of simulation-based education and research. The ERPT can be a reliable measure for assessing performance in full-scale simulation. However, further studies with larger sample sizes are warranted.

Using Standardized Patients to Teach Leadership Competencies - Corrected Proof

Patricia A. Sharpnack, Laura Goliat, Kathleen Rogers — 2011-12-12

Abstract: Faculty at a Midwestern college designed a simulation experience that used standardized patients to help students develop leadership skills and increase awareness of quality and safety competencies required of the new graduate. Students were responsible for task delegation, prioritization decisions, and allocation of resources for a team of patients. Standardized assessment scores and student mindfulness of leadership and quality and safety proficiencies showed improvement. Independent parametric testing results indicate a significant increase in the group that was administered the standardized assessment after the simulation, t(64) = 3.55, p < .01). Student evaluations suggest the use of complex scenarios involving standardized patients provided an opportunity to apply leadership principles to realistic patient care experiences.

Developing Cultural Competency in Life and Simulation: A Year in Qatar as an Exemplar - Corrected Proof

Colette Foisy-Doll — 2011-10-24

Abstract: Globalization is creating rich opportunities for nurse educators to interact in teaching and learning environments with people from all over the world. When the author accepted a job in the Middle East for the University of Calgary, Qatar, as clinical assessment and simulation manager, she fully expected an amazing experience. What ensued was profound lesson in valuing the importance of culture and cultural competence in education and, in simulation learning and in life. Adaptations in the delivery of simulation learning experiences in the nursing curriculum at the University of Calgary, Qatar, are highlighted in this non–research-based, personal account by an experienced simulation educator. The most salient cultural learning experiences are described.

Integrative Learning Through Simulation and Problem-Based Learning - Corrected Proof

Nuala Walshe, Sinéad O'Brien, Siobhan Murphy, Irene Hartigan — 2011-10-13

Abstract: Background: An integrative framework was used to guide the teaching, learning, and assessment approach taken in a final-year undergraduate nursing module.Method: Students participated in three cycles of problem-based learning and associated simulations. An assessment rubric focused on patient assessment, clinical decision making, and technical and communication skills was used by students and assessors to score simulation performances. This study evaluated the trajectory of assessor and student self-assessed simulation performance scores over the course of the module.Results: Descriptive statistics for assessors' scores show a mean improvement in all 4 competencies and for overall performance. Students' self-assessed scores do not show a mean improvement but are more closely aligned with assessor scores for later simulations.

Using a Multicultural Family Simulation in Public Health Nursing Education - Corrected Proof

Jennan Phillips, Joan S. Grant, Gary W. Milligan, Jacqueline Moss — 2011-10-13

Abstract: Clinical sites are a challenge to find for students in some areas of nursing, including experiences in community and public health settings. The use of clinical simulation is gaining popularity and allows worthwhile experiences that emphasize concepts important in the home care environment. This article discusses how faculty developed both a simulated home environment and a simulation experience to facilitate students' learning how to address client safety and culturally competent home care across the life span.

Simulation Apprenticeship: A Southern California Experience - Corrected Proof

Terry A. Larsen — 2011-10-10

Abstract: Although an experienced simulation educator, the author was given the opportunity to improve her expertise by attending an apprenticeship in Southern California at a large regional medical center's simulation center. Cutting-edge technology, interdisciplinary collaboration, and both manikin-based and standardized patients helped accomplish her learning goals.

The Effect of Preparation on Anxiety and Performance in Summative Simulations - Corrected Proof

Laura T. Gantt — 2011-09-14

Abstract: Background: Historically, studies that looked at how anxiety affects simulation performance have not included information about how students were prepared for those experiences. There is little research into best practices for preparing nursing students for evaluative simulation experiences. The purpose of this study was to examine how preparation for simulation affects anxiety and how anxiety affects simulation performance.Method: Thirty-nine student nurses were alternately assigned to experimental and control groups. Both groups received the Spielberger State-Trait Anxiety Inventory before and after evaluative simulations. The experimental group received an additional supervised simulation practice with focused debriefing. The groups were compared to determine differences.Results: No significant differences were found between experimental and control groups' trait anxiety scores at the time of enrollment, nor were there differences found between groups on state anxiety scores either at enrollment or during the period around the summative evaluations.Conclusions: This study provides evidence about what is helpful and necessary to ensure that students are adequately prepared for evaluative scenarios.

Effectiveness of Human Patient Simulator as A Classroom Teaching Strategy - Corrected Proof

Deborah A. Beyer — 2011-09-12

Abstract: Background: The majority of simulation studies have small groups using a human patient simulator in lieu of or as practice before attending clinical experiences with actual patients. In order to increase the use of and exposure to the simulator, the human patient simulator was used in the classroom with 45 associate degree nursing students as a teaching strategy.Methods: A pre–post test design was used to see if there was significant learning that occurred after the classroom simulation. A questionnaire was given to determine if the students were satisfied with this teaching strategy.Results: The results showed that significant learning occurred and that the students positively rated the classroom simulation.Conclusions: Simulation activities may be able to be used in larger groups such as in a theory classroom as an interactive, engaged teaching strategy.

A Descriptive Analysis of Nursing Student Communication Behaviors - Corrected Proof

Eileen R. O'Shea, Michael Pagano, Suzanne H. Campbell, Gregory Caso — 2011-09-12

Abstract: This article describes a pilot study to examine communication behaviors in nursing simulations. The nursing and communication faculty researchers used an interdisciplinary descriptive approach to examine 55 student nurses in 19 video recordings of patient simulations. The results demonstrated that using an interdisciplinary process can lead to a more diverse and thorough assessment of communication skills. This study supports the need for psychometrically sound evaluation tools for the measurement of communication behaviors of nursing students during simulation scenarios.

Developing a New State of the Art Simulation Learning Center - Corrected Proof

RuthAnne Kuiper, Anne Zabriskie — 2011-09-07

Abstract: Coordinating and facilitating the creation of a new Simulation Learning Center is a daunting task. This article reports the planning, developing, building, and implementing of a simulation laboratory within a new School of Nursing building. The Activity Model of technology adoption describes the activities in the timeline that are divided into six specific work phases. A move-in schedule displays the essential activities that were sequentially carried out to effectively coordinate the transition into a new space to begin an academic year. The take away points and lessons learned during each of the phases are summarized as well as future considerations for growth of the Center.

Simulation and Psychomotor Skill Acquisition: A Review of the Literature - Corrected Proof

Jennifer Gunberg Ross — 2011-09-07

Abstract: Decreased opportunities for skill practice and mounting concerns that graduate nurses are not competent in basic psychomotor skills requires nurse educators to reevaluate methods to teach these skills. Simulation offers a fresh approach to psychomotor skills education allowing the student to integrate knowledge from all three learning domains while practicing the skill. This article discusses the current state of the science on the use of simulation for psychomotor skill acquisition. This literature review identifies that limited empirical evidence exists to support the efficacy of simulation to teach psychomotor skills, most notably within the discipline of nursing. The existing data stem from studies with limitations that affect the interpretation and generalizability of the results. These findings suggest the need for further research in the area of simulation and psychomotor skill acquisition within nursing education.

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

Janene Luther Szpak, Kirstyn M. Kameg — 2011-09-07

Abstract: Introduction: The 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.Method: This 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.Results: The findings support the use of high-fidelity human simulation to aid in decreasing nursing students' anxiety prior to communicating with patients experiencing mental illness.

Second Life®: A New Strategy in Educating Nursing Students - Corrected Proof

2011-09-05

Abstract: The purpose of this article is to discuss how the University of Michigan School of Nursing designed and implemented a virtual hospital unit in Second Life® to run virtual simulations. Three scenarios were developed about topics that represent areas that contribute to patient safety, as well as key student learning challenges. Fifteen students completed a 6-question survey evaluating their experience. Comments indicated students did identify the potential benefits of the Second Life® simulation. The Second Life® platform may also provide avenues for learning in the clinical arena for a multitude of health care professionals. The opportunity to simulate emergent, complex situations in a nonthreatening, safe environment allows all members of the team to develop critical communication skills necessary to provide safe patient care.

Distance Learning and Clinical Simulation in Senior Baccalaureate Nursing Education - Corrected Proof

2011-08-18

Abstract: Background: This study evaluates the effectiveness of combining distance education, point-to-point video teleconferencing (P2PVTC), and remote operation of a human patient simulator to connect a simulator technology specialist and instructors with the human patient simulator and distant trainees.Methods: Didactic material was delivered via an online course management system. Simulation at a distance was carried out using a Laerdal SimMan, P2PVTC, and remote desktop control. Data were collected and included health care knowledge gained (via pre- and posttest scores) and measures of participant satisfaction.Results: Participants evaluated the course favorably (p < 0.05) with the exception of their satisfaction with presimulation materials (p = 0.086). On a Likert scale of 1 (very low) to 10 (very high), six of the seven students (87%) rated their workshop experience as “very high.”Conclusions: Combining distance learning with high-fidelity human patient simulation at a distance is feasible. Participants acknowledged the value of simulation at a distance, but the low sample size prevented the generalizability of results.

Development of the Obstetric Nursing Self-Efficacy Scale Instrument - Corrected Proof

Mary Elizabeth Guimond, Mary Colleen Simonelli — 2011-08-08

Abstract: Background: The objective of this study is the development of the Obstetric Nursing Self-Efficacy (ONSE) Scale instrument and the reporting of psychometric data gathered from a pilot completed in fall 2009 at 2 major universities.Method: The ONSE is an 18-item instrument designed with the use of Bandura’s social-cognitive theory. Instrument development consisted of 2 rounds of expert review. The average content validity index of the scale was .91.Results: For preliminary reliability testing, students (N = 20) completed the ONSE survey after participating in a 45-hour clinical rotation in obstetric nursing. A range of split-half reliability scores was calculated at .85 to .96. For preliminary validity testing, students (N = 46) completed the ONSE pre- and postsimulation. Paired t tests revealed a statistically significant improvement in self-efficacy scores for both pre- and posttest scores.Conclusion: The findings were encouraging for initial validity and reliability testing of the ONSE as an instrument to measure self-efficacy of students caring for obstetric patients.

Second Life® as a Clinical Conference Environment: Experience of Students and Faculty - Corrected Proof

Melinda Hermanns, Carol Kilmon — 2011-08-08

Abstract: The purpose of this article is to discuss the students’ and faculty members’ experience of using Second Life® during a psychiatric mental health clinical conference. The clinical conference is explained, as well as the process in which students were oriented to the use of Second Life. The students’ and faculty members’ experience, obstacles encountered, and lessons learned are also presented.

HPS more effective than CD-ROM for improving cognition and performance - Corrected Proof

2011-08-08

Abstract: Background: Military health care personnel need to have knowledge and skills relative to caring for patients on the battlefield. No studies have compared the two strategies of using the human patient simulator (HPS) and a CD-ROM in caring for combat injuries.Method: A prospective, pre–post test, experimental, mixed design (within and between) was used to determine whether there were statistically significant differences in HPS and CD-ROM educational strategies in lower-level, higher-level cognition, critical thinking, and performance.Results: A repeated analysis of variance and a least significant difference post hoc test were used to analyze the data. The HPS group performed better than the CD-ROM and control groups relative to all the variables (p < .05).Conclusion: The HPS method of instruction is a more effective method of teaching than the CD-ROM approach.

Simulated Learning Activities: Improving Midwifery Students' Understanding of Reflective Practice - Corrected Proof

2011-08-08

Abstract: Background: Graduate Diploma in Midwifery students at an Australian university poorly evaluated a compulsory theoretical subject (unit of study) titled Becoming a Reflective Practitioner over several years.Method: Authentic practice-based simulated scenarios were introduced to improve student learning and as an innovative approach to teaching reflective practice. The introduction was evaluated using student feedback surveys, pre- and post simulation knowledge questionnaires, and 6-week retention-of-knowledge questionnaires.Results: Students reported improved levels of satisfaction, greater learning, and increasing knowledge in the simulated practice area. The students rated the scenarios as useful in increasing reflective practice, but this was secondary to skill acquisition.Conclusion: Simulated activities may prove useful in developing reflective practice, but further investigation is required to examine how to shift the focus from clinical skill acquisition to reflective practice.

Standardized Patients Versus Simulated Patients: Is There a Difference? - Corrected Proof

Christopher Churchouse, Chris McCafferty — 2011-08-08

Abstract: The rapid development of simulation as a modality for education has created some confusion in terms, especially when applied to standardized patients and simulated patients. Some authors report them as being the same, whereas others define them in a different context, causing confusion for facilitators and researchers. The purpose of this article is to offer a discussion and definition of the roles of a standardized patient and a simulated patient and to define the differences between the two genres.

From Static Lab to Simulation Lab: Students Reflect on Their Learning - Corrected Proof

Sherrilyn Coffman — 2011-08-05

Abstract: Background: Nursing faculty are challenged to incorporate use of low, moderate, and high-fidelity simulators into the curriculum and to evaluate student learning. This study compares students’ perceptions of learning across levels of simulation.Method: Colaizzi’s descriptive phenomenological method was used, with data collection at two times: (a) after a static lab using low-fidelity task trainers and (b) after a simulation lab incorporating high-fidelity manikins. Students were asked to describe their learning after each lab. Written comments were analyzed, and themes from each time were compared. Findings were taken back to participants for validation.Results: Students’ comments indicated a progression of learning from the what, when, how, and why of psychomotor skills in the static lab to more complex concepts such as assessing, prioritizing, relating information, and formulating therapeutic interventions in the high-fidelity simulation lab.Conclusions: Study results confirm that students are able to recognize progression in learning, from performing psychomotor skills to making clinical judgments, as they engage in strategically planned lab experiences.

Baccalaureate Student Perceptions of Integrating Simulation as a Teaching Strategy in an Acute and Critical Care Nursing Course - Corrected Proof

Jesus (Jessie) Casida, LaVonne Shpakoff — 2011-08-05

Abstract: Background: This article describes the context and student perceptions of integrating simulation into the baccalaureate acute and critical care nursing course.Method: A total of 209 teaching evaluation tools completed by senior students from 2007 to 2010 were analyzed retrospectively.Results: The response agreement on specific items was high; in addition, the effectiveness of simulation as a teaching strategy was elaborated by three themes that emerged from students’ comments: (a) More simulation experience is needed, (b) simulation should be introduced early in the program, and (c) simulation is a great way to learn.Conclusion: Simulation is an effective teaching strategy that can be successfully integrated throughout the baccalaureate nursing curriculum.

Virtual Case Studies in the Classroom Improve Student Knowledge - Corrected Proof

Carol Heinrich, Rand R. Pennington, Ruthanne Kuiper — 2011-08-05

Abstract: Background: Multiple studies have validated that student satisfaction and student learning are enhanced with the use of high fidelity simulation. Virtual case scenarios may offer another way for simulation to be brought into the classroom to facilitate development of student clinical reasoning skills.Method: A pre–post test design was used to assess content knowledge of senior nursing students after participating in MicroSim® patient scenarios in the classroom setting. MicroSim® provides simulation learning activities that can be used asynchronously or in group settings.Results: Significant differences in content knowledge, measured by multilogical multiple choice questions, were found in both virtual simulation activities. Students indicated satisfaction with this active learning experience and desired increased use in class.Conclusion: Content knowledge increased after use of MicroSim® in this study. Further research is needed to examine the use of classroom simulation as an active learning strategy.

Piloting a Method for Comparing Two Experiential Teaching Strategies - Corrected Proof

Katie Anne Adamson — 2011-08-05

Abstract: Background: Experiential learning activities allow students to apply abstract concepts in realistic patient-care scenarios. The knowledge, values, and abilities that are essential to nursing practice require aptitude in the affective, cognitive, and psychomotor domains. Therefore, research aimed at assessing the effectiveness of teaching strategies should address how they affect learning outcomes in each of these domains.Method: This pilot study used a quasi-experimental, nonequivalent comparison, modified Solomon four-group design. A total of 14 student participants were exposed to either case study clinical conference or human patient simulation learning activities. Cognitive, affective, and psychomotor learning outcomes were measured and compared between groups.Results: No significant differences in cognitive, affective, or psychomotor learning outcomes were detected between the groups.Conclusions: There is much to be learned from the design, methods, analyses, and results of this study. As a pilot, this study tested the feasibility of coordinating and carrying out the complex study procedures and provided data for a power analysis to inform future research.

Effect of High-Fidelity Simulation on Pediatric Nursing Students’ Anxiety - Corrected Proof

2011-08-05

Abstract: This study examined the effect of practice with a high-fidelity infant simulator on anxiety in undergraduate student nurses before the first head-to-toe assessment of a hospitalized child. Students were assigned to experimental (N = 27) and attention intervention (N = 25) groups. The experimental group provided postoperative assessments using the SimBabyTM manikin, and the attention intervention group administered infant formula and oral medications through a gastrostomy button without a manikin. State anxiety (STAI), self-confidence, and satisfaction with the learning experience were measured before and after simulated experiences in the Learning Resources Center, and before and after assessing a hospitalized child. On the students’ first clinical day, anxiety scores were significantly lower than attention intervention students by 12 points before the assessment of a hospitalized child for students who practiced assessment with the manikin. Students provided suggestions for additional pediatric simulations.

Creating an Introductory Video Library to Set the Simulation Stage - Corrected Proof

Celeste M. Alfes — 2011-08-04

Faculty in the Frances Payne Bolton School of Nursing at Case Western Reserve University created a series of brief videos to introduce their simulation experiences. Rather than simply reading a case study to students, faculty use the introductory videos to bring to life the clinical scenario and provide students with a visual introduction to each simulation activity. Every clinical course is paired with a unique and clinically focused simulation throughout all 4 years of the baccalaureate curriculum.

Comparison of Simulation Debriefing Methods - Corrected Proof

Connie Chronister, Diane Brown — 2011-07-22

Abstract: Background: Debriefing following clinical nursing simulation plays a critical role in student learning. Methods of debriefing include verbal feedback or video-assisted verbal discussion that allows reflection-on-action and should immediately follow the simulation exercise to assist the students in assessing their performance.Methods: A comparative, crossover design was used. Students in an undergraduate critical care course were randomly divided into two groups. Both groups participated in a standardized simulation, and then one group received only verbal debriefing (V) and the other received video-assisted verbal debriefing (VA+V). Outcomes measured included quality of student skills (assessment and psychomotor), skills response time, and knowledge retention.Results: Quality of skill improvement was higher and response times were faster for students in the VA+V group (time to initiate cardiopulmonary resuscitation, time to shock, and time to resuscitation. Higher knowledge retention was seen in the V group.Conclusions: VA+V positively affects nursing skills and response times. Knowledge retention was more positively affected by V.

High-Fidelity and Gaming Simulations Enhance Nursing Education in End-of-Life Care - Corrected Proof

Wendy Kopp, Melissa A. Hanson — 2011-07-11

Abstract: Existing research suggests that nursing education has not adequately prepared nurses to provide quality end-of-life care. As the population in the United States ages and chronic diseases increase, the number of dying patients will also increase. It is now more important than ever that nurses provide high-quality end-of-life care to those patients dying in hospitals or other inpatient facilities. Opportunities to care for dying patients are often unavailable to students in traditional clinical settings. This article describes the use of simulation as an innovative teaching strategy to prepare students in providing end-of-life care. The authors describe how an end-of-life scenario using high-fidelity simulation and an experiential gaming simulation, Seasons of Loss©, were used to enhance the curriculum on end-of-life care presented to nursing students.

An Interprofessional Simulation Promoting Collaboration and Problem Solving among Nursing and Allied Health Professional Students - Corrected Proof

Jennifer L. Titzer, Constance F. Swenty, W. Gale Hoehn — 2011-07-04

Abstract: An interprofessional simulation was developed to improve collaboration and problem solving among nursing, radiologic technology, respiratory, and occupational therapy students. The learning objective of the simulation was to facilitate a mutual and professional respect among health care professionals in an educational setting that would be modeled in clinical practice. Instructors from each discipline collaborated on the learning objectives for the simulation. Each discipline specified the expectations and the perceived roles their student would have within the simulation. The simulation allowed students the opportunity to interact with each other to provide safe and effective care for a patient with multiple health care needs. The postsimulation debriefing allowed students to discuss how patient care was prioritized and coordinated by the health care team. The study results indicated that students felt the simulation provided for interdisciplinary team work and an environment that supported working in a clinical situation involving peers. Students reported that they were permitted to explore various paths of delivering patient care during the simulation and that independent problem solving was facilitated.

TeamSTEPPS®: The Patient Safety Tool That Needs to Be Implemented - Corrected Proof

Timothy C. Clapper, Mei Kong — 2011-06-30

Abstract: Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®), crew resource management, and human factors, or ergonomics principles, have received the attention of many clinicians and administrators in health care today. For those conducting simulation or preparing an education initiative aimed at improving patient safety, these team-based concepts, directed toward improving system and team functioning for patient safety, can be overwhelming and confusing. This article explores the key components of crew resource management and human factor principles and how they fit into the more complete teamwork tool known as TeamSTEPPS®. In addition, barriers, especially the lack of leadership training in nursing and medicine, are identified, as are suggestions for incorporating the TeamSTEPPS® competencies through simulation.

Competency Assessment in Simulated Response to Rescue Events - Corrected Proof

Barbara Aronson, Barbara Glynn, Timothy Squires — 2011-06-15

Abstract: Background: Reliable and valid instruments are needed to assess patient safety competencies, specifically nursing students’ ability to appropriately respond to simulated rescue events.Methods: This was an instrument development study conducted with 152 senior nursing students in 2 phases.Results: Student groups performed poorly during the simulation scenario, with mean scores on the Heart Failure Simulation Competency Evaluation Tool ranging from 46% to 56%. Interrater reliability increased to .839 after item revision during Phase 2 of the study.Discussion: This simulation competency assessment package is ready to be tested with more diverse student groups and novice nurses in the practice setting.

Instructional Problems in Briefings: How to Prepare Nursing Students for Simulation-Based Cardiopulmonary Resuscitation Training - Corrected Proof

Sissel Eikeland Husebø, Febe Friberg, Eldar Søreide, Hans Rystedt — 2011-06-13

Abstract: Background: An important condition for serving the educational objectives of simulation in nursing education is that the facilitator’s instructions during the briefing bridge the gap between the simulation and the real situation it simulates. This study aims to explicate instructional problems in the briefing, focusing both on how students understand that tasks should be performed in resuscitation teams and how these tasks should be adapted to the specific conditions of the simulation.Method: Videotaped data from 11 briefings were analyzed by means of interaction analysis. Analytical focus was put on the instructional problems that emerged during the briefings and how the facilitators made use of the students’ understandings to overcome these problems.Results and Conclusion: The findings reveal 3 types of tasks that were consistently problematic for all students to understand and master and that facilitators dealt with in every briefing: (a) taking the correct position, (b) keeping airways open, and (c) ventilating with a bag mask. To further improve simulation-based environments as tools for training crucial aspects of resuscitation teamwork, it is important that facilitators take into account how the briefing can bridge the gap between simulation and clinical practice. This can be achieved by systematically using not only the students’ claimed understanding but also their exhibited understanding for the correction of their performance. It is also concluded that simulation settings should not presuppose a higher level of skills than expected in nursing education since such a presupposition might interfere with opportunities to learn from simulation experiences.

Enhancing Critical Reflection on Simulation Through Wikis - Corrected Proof

Deborah A. Beyer — 2011-06-09

Abstract: This article discusses using wikis as a teaching strategy for follow-up debriefing after students participated in human patient simulator activities. Wiki tools assist students in collaborating, sharing, creating, and editing documents that reinforce learning developed during simulation. Students are actively engaged in the learning process by sharing information and experiences obtained in simulation scenarios. The use of a wiki enhances debriefing reflection. Wikis provide students with a written document to answer questions, discuss content, and develop notes and study guides after a classroom simulation activity.

A Bi-national Simulation Study to Improve Cultural Awareness in Nursing Students - Corrected Proof

Sheila Grossman, Diana Mager, Helene M. Opheim, Astrid Torbjornsen — 2011-06-09

Abstract: A School of Nursing in North America and one in Norway collaborated in examining student cultural awareness using simulation technology. Students practiced skills including cultural assessment using simulated scenarios. Scenarios were developed by project faculty, and depicted one patient with respiratory failure and the other with a systemic infectious process. While both schools used the same scenarios, the Norwegians specifically tailored their scenario around Muslim and Somalian patients/families while the Americans focused on Muslim and Italian/Catholic patients/families. Presimulation, both groups had the lowest score with perceived skill in obtaining cultural data. Individual paired t tests found statistically significantly improved scores in cultural awareness using The Transcultural Self-Efficacy Tool after practicing with simulation scenarios focused on cultural differences. Students perceived increased practice with simulated patients improved confidence in cultural awareness. The two cohorts in this study showed an improvement in their cultural awareness after participation in a simulation experience. This finding suggests that simulation may be a useful teaching methodology for use in American and international nursing schools. A Cultural Assessment Checklist was developed to assist students in collecting cultural assessment data on their simulated and real patients. Collaboration between the faculties of the two countries continues and will focus on graduate student education including simulation pedagogy in the future.

Nurse Educator Simulation: Preparing Faculty for Clinical Nurse Educator Roles - Corrected Proof

Teresa Shellenbarger, Taylor Edwards — 2011-06-06

Abstract: Simulation use continues to expand in nursing education, specifically at the undergraduate level. Graduate nursing students can also benefit from simulation activities. Faculty need to consider the use of simulation to help graduate nursing students enrolled in clinical nurse educator programs learn how to address clinical teaching issues. Graduate nurse educator students’ exposure to clinical teaching issues may be limited; therefore, simulation provides a realistic, safe environment for students to practice the development of the teacher role. This manuscript provides ideas for planning, implementation, and suggestions for simulation technology use in the training of nurse educators for their role in clinical teaching.

Using Simulation to Teach Veteran-Centered Care - Corrected Proof

2011-05-30

Abstract: The purpose of this article is to provide information about the health care needs of veterans through dissemination of a simulation scenario that can be used to educate and prepare students in schools of nursing or in clinical settings to improve the quality of care for veterans. An estimated 23 million veterans live in the United States and Puerto Rico. Only 8 million veterans are enrolled in the Veterans Health Administration (VHA). As a result, millions of veterans receive care in civilian hospitals, where nurses and other health care providers may be unaware of the many health care needs related to military service. This high-fidelity clinical simulation scenario and the discussion of unique needs of patients who are veterans are presented to improve this situation.

Situated Cognition: Its Relationship to Simulation in Nursing Education - Corrected Proof

Ellen L. Onda — 2011-05-25

Abstract: Health care settings have dramatically evolved into highly complex technical practice environments that demand high competency levels for nurses. As such, many educators are struggling to integrate strategies that will help to ensure a competent workforce. A challenge faced by nurse educators is the implementation of teaching strategies that promote the clinical competency of learners while strengthening their clinical reasoning and reflective-thinking skills. For use in nursing education, standardized, reproducible, clinically accurate simulated patient care experiences can be developed to help provide students with the opportunity to identify common patient problems and demonstrate appropriate interventions. Situated cognition (also known as situated learning) is a learning theory that is based on the premise that learning is influenced by the situation in which it occurs. This article addresses the relationship of situated cognition to the use of simulation in nursing education.

From the Simulation Lab to the Ward: Preparing 4th Year Nursing Students for the Role of Staff Nurse - Corrected Proof

Mary McGrath, Colette Lyng, Susan Hourican — 2011-03-16

Abstract: This article describes the processes of developing and implementing a ward management exercise for 4th-year student nurses in preparation for the role of staff nurse. In 2005 the need to develop a teaching method that would enable students to consolidate the skills of caseload management, critical thinking, decision making, and prioritizing patient care was identified. Simulation was identified as a way of addressing these skills, and a project team including both academic and clinical colleagues developed the exercise. This article presents the experience of designing and implementing the exercise and discusses the challenges encountered.

Student Perceptions of Simulation’s Influence on Home Health and Hospice Practicum Learning - Corrected Proof

Melody K. Eaton, Kathy Floyd, Susan Brooks — 2011-03-16

Abstract: Background: The purpose of this qualitative study was to begin to explore whether an end-of-life simulation enhances baccalaureate senior-level nursing student learning in a home health and hospice practicum setting.Method: A phenomenological approach was used to study simulation’s influence on practicum learning. 30 senior-level baccalaureate nursing student participants experienced an end-of-life simulation lab scenario and were asked to describe their experience and relate it to preparation for their home health and hospice practicum, once immediately following the scenario and once at the end of their practicum experience approximately 3 to 4 weeks later. The Colaizzi approach was used and was assisted by the use of a qualitative analysis software tool, Ethnograph©.Results: Three main themes emerged, experiential learning, affirmative outcomes, and family as client.Conclusion: Perceptions of the influence of simulation learning on senior-level nursing students’ experience with a home care and hospice practicum promote its value and continued use.