- •Findings from simulation research and reviews revealed significant differences in design and assessment methods leading to a wide variety of measurement outcomes and limitations.
- •Standardization of implementation of high-fidelity simulation by nurse educators is essential.
- •A need for research that translates simulation outcomes to future practice.
- Moher D.
- Liberati A.
- Tetzlaff J.
- Altman D.G.
- 1.What topics are well studied in undergraduate nursing education and HFS?
- 2.What topics in undergraduate nursing education and HFS require more investigation?
|1. Review addressed a clearly focused question?||1||1||1||1||0|
|2. Authors looked for right type of articles?||1||1||1||1||1|
|3. Important, relevant studies were included?||1||1||1||1||1|
|4. Authors assessed the quality of included studies?||0||1||1||1||0|
|5. If results of review are combined, was it reasonable to do so?||1||0||1||1||0|
|6. What are the overall results of the review? (cannot be answered by a 1 or 0)||See below||See below||See below||See below||See below|
|7. How precise are the results? (cannot be answered by a 1 or 0)||See below||See below||See below||See below||See below|
|8. Can results be applied to a local population?||0||1||1||0||1|
|9. Were all important outcomes considered?||0||0||1||1||0|
|10. Are the benefits worth the harms/costs?||1||1||1||1||1|
|Summary Responses for Questions 6 and 7|
|6. What are the overall results of the review? (cannot be answered by a 1 or 0)||If yes/no||7. How precise are the results? (cannot be answered by a 1 or 0)||If yes/no|
|Berndt||The results are reported as qualitative summary vs. statistical results. No statistical data provided for the results.|
“The evidence supports the use of simulation to teach patient safety competencies”
Simulation is effective in teaching prelicensure nursing students
Simulation can be used to educate prelicensure nursing students on patient safety.
|1||They lack precision. They are qualitative or a summary rather than statistical.||0|
|Blum||Overall results are reported, but not numerically. There is a lack of unequivocal evidence to support a change in the nursing education toward simulation-based education for prelicensure safety competencies. Evidence is still lacking to support simulation as a method to improve patient safety.||1||Not precise at all||0|
|Fisher||Results were expressed clearly through coding of themes that emerged through thematic analysis of the findings. These themes were: “transferability of simulation skills to clinical practice,” “exposure to broader range of experiences,” “confidence levels in relation to simulation training,” “competence/performance,” “clinical judgment and knowledge,” and “student perceptions of preparedness for practice after simulation.”||1||Both authors reviewed studies and performed thematic analysis. Then, a comparison of coding was performed. The thematic analysis was performed with color coding and numbering of codes.||1|
|Shearer||The results were summarized according to subheaders: medication errors, patient identification, hand hygiene, communication and knowledge, and skills and attitudes. Articles were analyzed by outcome and coded and scored. Only those with a score more than four were analyzed in matrix. Two studies provided evidence for effectiveness of high-fidelity simulation on outcomes of safety. Effect of communication was inconsistent.||1||This is difficult to tell. The data table is helpful, but the matrix of scores is not available in table format to indicate which studies had the higher scores.||0|
|Weaver||Concepts of confidence, knowledge, knowledge transfer, value, realism, and stress emerged from the review on the effects of HFPS in nursing education. More research is needed because of large gaps in literature.|
The question posed in second paragraph (does the evidence support HFPS as an alternative to clinical experience with real patients?) was never addressed. The narrative also questioned if the benefit of HFPS outweighed the cost for equipment and faculty training. This question was also never addressed.
Results expressed in narrative form only.
|0||Results were expressed in narrative form only. It is unknown how precise the results are.||0|
Inclusion and Exclusion Criteria
|Inclusion Criteria||Exclusion Criteria|
- Blum C.A.
- Parcells D.A.
- Shearer J.E.
- Blum C.A.
- Parcells D.A.
- Shearer J.E.
|Citation||Type of Review||The Objective of This Review Was to:||Findings/Results||Conclusion||Limitations||Implications/Future Research|
|Berndt, J. (2014). Patient safety and simulation in prelicensure nursing education: An integrative review. Teaching and Learning in Nursing 9, 16-22.||Integrative review||Critically analyze the evidence on the use of simulation as an educational intervention to teach patient safety competence||Included studies focused on simulation, patient safety and simulation, and patient safety in prelicensure nursing education. Found 13 studies that investigated simulation as an educational intervention, and five studies that studied simulation as the outcome of patient safety.||The authors concluded that simulation is an effective educational intervention to teach patient safety competencies in prelicensure nursing education.||The review included all types of studies including qualitative and quantitative. It is surprising that given this lack of exclusion that they only found 13 studies examining simulation as an educational intervention in prelicensure nursing education.||Review suggests that studies focusing on patient safety and simulation effectiveness of simulation in interprofessional simulation, knowledge retention, and the National Council Licensure Examination will evolve and will bolster the incorporation of simulation into curricula as a standard educational intervention to improve patient safety.|
|Blum, C. A., & Parcells, D. A. (2012). Relationship between high-fidelity simulation and patient safety in a licensure nursing education: A comprehensive review. Journal of Nursing Education, 51(8), 429-35. doi:10.3928/01484834-20120523-01||Comprehensive review||Evaluate the current quantitative evidence from preintervention–postintervention and control–experimental research studies related to the use of simulation in prelicensure nursing education directed at enhancing safety in nursing practice||This review of 18 studies found that evidence is still lacking on measuring outcomes of simulation related to patient safety.||The authors concluded that simulation is essentially equal to traditional methods of teaching safety in nursing education.||The review did not list limitations to the review but discussed limitations to methodology as each study was critiqued.||The review suggests a reevaluation of clinical training paradigms and on best practice in teaching. One recommendation is to continue research on the use of simulation to cultivate safety competency in undergraduate nursing students. The use of simulation should be validated in longitudinal studies using safety-based educational models.|
|Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. Journal of Advanced Nursing, 69(11), 2375-2388.||Integrative review||To review current research studies on the effectiveness of simulation to prepare nursing students to recognize and respond to a patient in decline and to inform future undergraduate nurse educators and researchers in simulation||This review of 18 research studies found that Thematic analysis identified six main themes: “transferability of simulation skills to clinical practice”; “exposure to broader range of experiences”; “confidence levels in relation to simulation training”; “competence/performance”; “clinical judgment and knowledge”; and “student perceptions of preparedness for practice following simulation.”||The authors concluded that confidence, clinical judgment, knowledge and competence, all vital in the care of a deteriorating patient, were enhanced due to simulation learning. However, evidence of simulation used specifically to prepare nursing students to recognize and respond to the deteriorating patient appeared limited.||The review listed limited sample size, single locations, and limited statistical rigor.||This review describes the need for more robust research, longitudinal studies to explore skill transferability, clinical judgments, knowledge, confidence, competence, performance, and effective preparation of nursing students.|
|Shearer, J. E. (2013). High-fidelity simulation and safety: An integrative review. The Journal of nursing education, 52(1), 39-45. doi: 10.3928/01484834-20121121-01||Integrative review||To evaluate the evidence that the use of high-fidelity simulation (HFS) in nursing education may improve patient safety outcomes. Safety was operationalized as self-efficacy, perceptions of abilities, knowledge, attitudes, and safety competencies observed as safety behaviors and nursing skills that were thought to avoid patient harm||The results were summarized according to the following outcomes: medication errors, patient identification, hand hygiene, communication and knowledge, skills, and attitudes. Two studies provided evidence for effectiveness of HFS on outcomes of safety. The effect of communication was inconsistent.||From this review, the author concluded that two studies provided evidence HFS was effective on the outcome of avoiding medical errors and patient identification. The other 18 studies did not provide equivocal evidence that HFS as a learning strategy has an impact on patient safety behaviors.||The review listed limitations: as a limited time range 2007-2012, search terms may not have been optimal; fidelity of simulation was assumed in some of the studies to be HFS, timing during the semester students went into clinical rotations, In addition, bias by the author for positive findings for a published work.||This review recommends more research on safety outcomes with comparison groups and based on a simulation model or theory to advance nursing science in HFS.|
|Weaver, A. (2011). High-fidelity patient simulation in nursing education: An integrative review. Nursing Education Perspectives, 32(1), 37-40.||Integrative review||To evaluates the findings of recently published research||From this review of 24 articles, the outcomes of confidence, knowledge, knowledge transfer, realism, value, and stress were discussed.||From this review, the author found that HFS benefits nursing students in terms of knowledge, value, and realism. More research is needed to support the use of HFS||The review did not list limitations.||This review recommends further research in the areas of communication, feedback and support during the implementation of simulation. Student satisfaction is listed but is not needed. New theories and models, knowledge acquisition compared with traditional findings. Knowledge transfer, debriefing and vidoetaping, since this article was published in 2011, some of these topics have been addressed in research studies. Confidence is considered a topic that is well studied in HFS.|
|Neill, M. A. & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: A literature review. Clinical Simulation in Nursing, 7(5), e161-e168. doi:10.1016/j.ecns.2011.02.001||Review of the literature||To analyze the literature on the use of simulation debriefing in nursing education. In addition, to make recommendations for further research.||Thematic analysis revealed six themes: structured and unstructured debriefing, faculty debriefing demeanor, a safe and trusting environment, the use of probing and cueing questions, the best time to debrief and allocation of adequate time for debriefing.||This literature review confirmed that debriefing is central to successful HFS education strategies. However, the review identified the scarcity of nursing research exploring debriefing (this may not be so true anymore).||No real limitations noted. Since this has been published, there has been a great deal more done on debriefing.||The identified themes of the review revealed that much is still in debate on the foundations for a recognized debriefing framework. Further research is required to guide refinement of best practices leading to a debriefing environment more conducive to reflection and experiential learning. Also, missing comparison studies|
|Page-Cutrara, K. Use of Prebriefing in Nursing Simulation: A Literature Review. Journal of Nursing Education, 53(3), 136-141.||Review of the literature||To comprehensively review available nursing simulation literature on the phenomenon of prebriefing and to critically evaluate its current role as a component of undergraduate nursing simulation||Narrative findings for the review were organized into themes: the definition and purpose of prebriefing, alternate learning structures used in prebriefing, and it uses in relation to learner outcomes.||This literature review concluded prebriefing is an important role as one component of HFS. Prebriefing should be leveled to the learner. Prebriefing may have a positive effect on the development of clinical judgment||One study of 15 was specific to prebriefing. Some of the articles did not fully describe simulation experiences of participants or the prebriefing activities. There were undefined time frames and differences the content and complexity of prebrief.||Prebriefing is an understudied component of HFS. Further research is needed to validate its practice. Recommend replicating small sample studies using larger sample sizes; investigate if more time in prebrief and orientation to simulation has an impact on learning; does prebriefing have an impact on the development of clinical judgment.|
- Blum C.A.
- Parcells D.A.
Reviews of the Literature
- Blum C.A.
- Parcells D.A.
- Foronda C.
- Liu S.
- Bauman E.B.
- Blum C.A.
- Parcells D.A.
- Foronda C.
- Liu S.
- Bauman E.B.
- Hallenbeck V.J.
- Shinnick M.A.
- Woo M.A.
- Mentes J.C.
- Hallenbeck V.J.
- Levett-Jones T.
- Lapkin S.
Implications for Future Research
- Patient safety and simulation in prelicensure nursing education: An integrative review.Teaching and Learning in Nursing. 2014; 9: 16-22
- Relationship between high-fidelity simulation and patient safety in a prelicensure nursing education: A comprehensive review.Journal of Nursing Education. 2012; 51: 429-435https://doi.org/10.3928/01484834-20120523-01
- Simulation-based learning in nurse education: Systematic review.Journal of Advanced Nursing. 2009; 66: 3-15https://doi.org/10.1111/j.1365-2648.2009.05240.x
- CASP checklists.CASP, Oxford2014 (Retrieved from)
- Successful debriefing-best methods to achieve positive learning outcomes.Nurse Education Today. 2014; 34: 372-376https://doi.org/10.1016/j.nedt.2013.06.026
- An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient.Journal of Advanced Nursing. 2013; 69: 2375-2388
- Evaluation of simulation in undergraduate nurse education: An integrative review.Clinical Simulation in Nursing. 2013; 9: e409-e416https://doi.org/10.1016/jecns.2012.11.003
- Educational research: An introduction.8th ed. Pearson Publishing, New York2007
- Use of high-fidelity simulation for staff education/development: A systematic review of the literature.Journal for Nurses in Staff Development. 2012; 28: 260-269https://doi.org/10.1097/nnd.0b013e31827259c7
- Simulation in nursing education: current regulations and practices.Journal of Nursing Regulation. 2014; 5: 25-30https://doi.org/10.1016/S2155-8256(15)30084-3
- Higgins J.P.T. Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration, 2011 (Retrieved from)
- Standards of best practice in simulation I-IX.Clinical Simulation in Nursing. 2013; 2015; 9: S1-S35
- A systematic review of the effectiveness of simulation debriefing in health professional education.Nurse Education Today. 2014; 34: e58-e63https://doi.org/10.1016/j.nedt.2013.09.020
- Standards of best practice: simulation standard I: terminology.Clinical Simulation in Nursing. 2013; 9: S3-S11
- The PRISMA Group (2009) preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.PLoS Medicine. 2009; 6: e1000097https://doi.org/10.1371/journal.pmed.1000097
- High-fidelity debriefing in nursing education: A literature review.Clinical Simulation in Nursing. 2011; 7: e161-e168https://doi.org/10.1016/j.ecns.2011.02.001
- PICO (T) Project toolkit: Welcome.2015 (Retrieved from)
- Use of prebriefing in nursing simulation: A literature review.Journal of Nursing Education. 2014; 53: 136-141
- High-fidelity simulation and safety: An integrative review.Journal of Nursing Education. 2013; 52: 39-45https://doi.org/10.3928/01484834-20121121-01
- Human patient simulation: State of the science in prelicensure nursing education.Journal of Nursing Education. 2011; 50: 65-72https://doi.org/10.3928/01484834-20101230-01
- Effectiveness of patient simulation in nursing education: Meta-analysis.Nurse Education Today. 2015; 35: 176-182https://doi.org/10.1016/j.nedt.2014.09.009
- High-fidelity patient simulation in nursing education: An integrative review.Nursing Education Perspectives. 2011; 32: 37-40
- The integrative review: Updated methodology.Journal of Advanced Nursing. 2005; 52: 546-553
- A systematic review of selected evidence on improving knowledge and skills through high-fidelity simulation.Nurse Education Today. 2012; 32: 294-298
- The contribution of high fidelity simulation to nursing students' confidence and competence: A systematic review.International Nursing Review. 2012; 59: 26-33