April 27, 2023By Teresa Gore

Clinical Simulation Research Journal Update | April 2023

The field of healthcare simulation has made tremendous strides forward over the past several decades. One way this revolution is made possible is through clinical simulation research being conducted across the globe. The journal Clinical Simulation in Nursing is constantly sharing updates that include article reviews, more information on standards of best practice, research briefs, and overall innovations in medical simulation. This HealthySimulation.com article provides an overview of the latest clinical simulation highlights as of April 2023 and explains how these updates impact the healthcare simulation community overall.

The Development and Pilot Testing of Immersive Virtual Reality Simulation Training for Prelicensure Nursing Students: A Quasi-Experimental Study : This article provides some guidance to assist nursing programs increase enrollment due to insufficient faculty and limitations in clinical site placements. The researcher identifies strategies to optimize learning, engage learners and ensure competency in nurses entering the workforce. Convenience sampling of junior-level prelicensure nursing students (n = 48) were assigned to the immersive virtual reality (VR) group (n = 24) or the hospital-based group (n = 24).

This mixed-methods quasi-experimental pilot study examined the effectiveness of an immersive VR simulation training program to replace pediatric clinical practice. The control group received the usual inpatient clinical training. Both groups then completed a traditional in-person simulation to compare performance outcomes. Performance scores for the immersive VR training group were significantly higher for total performance compared to the hospital-based training group. These preliminary results offer promise and demonstrate the potential of VR in the future of nursing education.

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Using a Telehealth Simulation to Prepare Nursing Students for Intraprofessional Collaboration : This pilot study measured the effect of a telehealth simulation-based learning experience on undergraduate (BSN) and graduate (NP) nursing students’ readiness for intraprofessional collaboration. Facilitators organized a sample of 66 on-campus BSN and eight online NP students into groups of 1-NP student to 6-9 BSN students. During the simulation, the “school nurse” (BSN student) collaborated with a telehealth provider (NP student) to provide patient care.

The Teamwork and Collaboration Subscale (TCS) of the Readiness for Interprofessional Learning Scale (RIPLS) measured the students’ intraprofessional collaboration. The TCS scores increased from pre- to post-simulation suggesting the simulation increased learner’s readiness for intraprofessional collaboration. Students expressed enthusiastic appreciation for the simulation experience and the importance of developing intraprofessional collaboration skills. This study demonstrates how intraprofessional simulation can expose students to a wide variety of experiential learning opportunities and supports the use of telehealth simulations.

Clinical to Simulation Ratio: The Impact on Quebec Nursing Students’ Success, Cognitive Load, and Mental Well-Being : There is no consensus regarding clinical hours to simulation hours ratios for pre-licensure nursing students. This topic has been a major topic of conversation for years. This research used a mixed methods study to compare eight hours of traditional clinical to four hours of simulation related to student achievement, cognitive load, and mental well-being. Test results showed a statistically significant difference in test score between the eight-hour clinical group and the four-hour simulation group, however both groups attained proficiency level.

There was no significant difference in overall workload scores between average workload, except in the domain of mental demand. Transcripts indicated time pressure to be a significant component of student stress. Time pressure is the major source of stress on nursing students’ mental well-being. Proficiency level learning occurred with a 2:1 clinical to simulation ratio. A benefit discovered was the additional four hours of personal time allows students to “recharge,” decreasing stress levels which may have a positive impact on performance and academic attainment providing additional support towards a 2:1 clinical to simulation ratio.

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Experiences of Nursing Students in Observer Roles During Simulation-Based Learning and the Impact on Patient Safety: A Scoping Review : Another topic of interest is the role of the observer in nursing simulation. During simulation experiences, nursing students are often split into observer and participant roles. The ability of students to meet learning objectives while assigned to the observer role in simulation has not been widely discussed. Guided by the frameworks developed by the Joanna-Briggs Institute and Arksey and O’Malley, a scoping review of the literature was conducted to explore nursing students’ experiences in the observer role during simulation, and identified four studies.

Three themes were identified, including (a) observer comfort level, (b) attention and awareness (situational awareness), and (c) well-defined directed observer role. Enhancing the experience of observer students during simulation and explicitly explaining the purpose of the observer role, along with assigning clear responsibilities to the student, can aid in the achievement of learning outcomes and promote patient safety. The professional performance of new nurses and nursing students can be improved by increased exposure to complex scenarios through tools such as simulation-based learning.

During these experiences, students assigned to both observer and active participant roles achieve the same learning outcomes, with equal development in clinical judgment, skills performance, and confidence in their abilities. The experience of the observer during the simulations can influence if and to what extent learning outcomes are reached. Reducing anxiety, improving attention and situational awareness, and explicitly explaining the purpose of the observer role along with assigning a duty or responsibility can aid in the achievement of these learning outcomes, and in turn, promote patient safety.

Simulation-Based Pediatric Interprofessional Team Training to Facilitate End-of-Life Discussions : This study evaluated the effectiveness of a live in-person pediatric Advance Care Planning simulation for an interprofessional team of learners, and the impact of its conversion to an online format. Professions included social work graduate students, spiritual care residents, undergraduate nursing students, and resident physicians in pediatrics. Learners were evaluated with the End-of-Life Professional Caregiver Survey, the Self-Efficacy for Interprofessional Experiential Learning survey, and a set of open-ended questions.

Results revealed the in-person and online formats yielded equivalent significant improvements in quantitative measures from pre- to post-simulation. Participants in both formats found the most helpful aspects of the simulations were the experience of interprofessional collaborations and the realism of the scenarios. Despite advantages of in-person interactions, an online platform provided similar benefits. With greater access for off-site participants, such an approach could facilitate dissemination of longitudinal training to improve communication skills and the use of Advance Care Planning.

More About INACSL

The International Nursing Association for Clinical and Simulation Learning (INACSL) is an association dedicated to advancing the science of healthcare simulation. With over 1,800 members worldwide, the organization’s mission is to be the global leader in the art and science of healthcare simulation through excellence in nursing education, practice, and research.

INACSL’s goal is also to advance the science of nursing simulation by providing professional development, networking resources, and leadership in defining healthcare simulation standards of best practice. INACSL membership provides the education, resources, and tools that best address current challenges and help support learner, educator, and professional goals related to the learning of healthcare simulation’s latest developments. This is while ensuring that these individuals are enabled to provide the most comprehensive education and training for high-quality patient care.

Whether someone is new to healthcare simulation and is looking to understand the fundamentals or is experienced and seeking the latest updates and research, INACSL can provide them with the support they need. Membership in INACSL is based on connection, engagement, support, and inspiration.

Learn More About INACSL’s Research Journal

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