July 4, 2023By Teresa Gore

Research Update: Clinical Simulation in Nursing May – June 2023

The healthcare simulation community regularly publishes journal articles that provide key research updates to further expand the clinical simulation community. Such research is crucial to the continued expansion of clinical simulation across all healthcare disciplines, showing validity through evidence-based practice for education, training and patient safety initiatives. This HealthySimulation.com article provides an overview of several of these articles which have recently been published. In addition, at the INACSL 2023 Annual Conference: Imagining the Future of Simulation, the winners of the 2023 Research Article and Non-research Article of the Year were announced and are shared here. Subscribe to our free newsletter to stay informed!

The Use of Simulation Best Practices When Investigating Virtual Simulation in Health care: A Scoping Review : The use of virtual simulation in health professional education has seen rapid advancement. Considering critiques of health care simulation in general, it is prudent to ask if virtual simulation is being tested and implemented optimally, especially with the rapid development and enthusiasm for the modality. This scoping review was conducted to understand better if simulation best practices are being applied when designing and investigating virtual simulation. We set search limits to ensure that recent and higher-quality studies were considered. We screened 171 articles, with ten articles selected for inclusion in the final review. We found that simulation best practices related to outcomes and objectives, simulation design, facilitation, prebriefing, and debriefing are generally not followed or not reported when investigating virtual simulation. Adhering to and reporting simulation best practices while designing and investigating virtual simulation can enhance the external validity of the research and improve virtual simulation in practice.

Virtual Reality and Screen-Based Simulation Learner Outcomes Using Kirkpatrick’s Evaluation Levels: An Integrative Review : Simulation-based learning, including virtual reality (VR) and screen-based simulation, has emerged as widely adopted virtual methods that can provide an effective way to enhance learning. The purpose of this integrative review was to explore the current state of learning outcomes derived from virtual simulation modalities and determine if it is a viable option to deliver health care education and nursing professional development. Whittemore and Knafl’s (2005) integrative review framework was followed for this review. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and ESBSCO databases were searched and yielded 499 articles. Data were analyzed in three phases and learning outcomes synthesized according to the four evaluation levels in Kirkpatrick’s Model (1996). Twenty-five articles met inclusion criteria. Of the studies reviewed, 88% showed improved outcomes including high levels of learner satisfaction (76%), knowledge or skill acquisition (73%), and behavior change (89%). Organizational outcomes were not reported. VR and screen-based simulation are effective educational delivery options for health care related education and nursing professional development, although more robust research that measures higher level learner outcomes is needed.

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The Effect of Structured Reflection on Nurse Practitioner Students’ Diagnostic Reasoning Within Simulation: Qualitative Outcomes of a Mixed Methods Experiment : Medical learners who use structured reflection demonstrated improved diagnostic accuracy. This has not been explored in nurse practitioner students. The qualitative purpose of the mixed methods intervention study was to understand how nurse practitioner students experience cognitive bias and their perception of structured reflection’s utility to explain any diagnostic reasoning competency and accuracy changes within simulation. Qualitative description was used to explore themes. Structured reflection users noted its utility was diagnostic justification. Control participants did not identify using structured reflection but did note using its disconfirming elements for why they changed their initial diagnosis. The conclusion is that structured reflection education and application may build competency.

Interprofessional Gratitude: Partnering With Registered Nurses as Embedded Participants in a Medical Education Patient Death Simulation Experience : Embedded participants (EPs) are non-learners trained to specific roles in simulation encounters. EPs contributing to specialized simulations may require unique skills. Partnering with health care providers with competencies complementary to desired EP roles is a possible way to address this need. Our team partnered with registered nurses (RNs) as EPs in a simulation in which the objective was for medical students to experience a simulated death in a supported environment. In this qualitative descriptive study, we address: What are medical students’ reactions to experienced RNs partnering as EPs during a simulation about the death of a patient? Two hundred seventy-seven preclinical, second-year medical students wrote written reflections that were thematically analyzed with high levels of interrater reliability. Students expressed gratitude for RNs partnering as EPs, described by subthemes of gratitude for nursing leadership, team-based medical care, and processing opportunities. RNs partnering as EPs effectively guided medical students through a patient death simulation. Simulationists should seek ways to leverage the deep, varied skill set of experienced RNs to partner as EPs in specialized medical education simulation.

INACSL 2023 Research Article of the Year: Relationships Between Internal Factors, Social Factors and the Sense of Presence in Virtual Reality-Based Simulations

Virtual Reality (VR) has proven to be an interesting and expanding tool for healthcare education, especially with the impact of the Sense of Presence (SoP) on learning. The study was designed to investigate to what extent users’ social and internal factors might influence the SoP and to further identify members of occupations’ characteristics influencing immersive experiences. A cross-sectional study immersing 83 undergraduate students (ambulance attendants, students nurses, and medical students) in a mass casualty incident simulation was performed. Questionnaires were administered to assess personal, environmental, and experiential in pre and post-simulation. SoP was associated with gender, disaster medicine education, propensity for immersion, and members of occupations.. Immersion characteristics specific to occupational categories have been identified. Personal differences were discovered between ambulance attendants, student nurses, and medical students. Consideration should be given on how best practices could promote the design of VR experiences that cater to professional groups’ needs. Identifying in the future what level of experience is needed for a sufficient SoP also seems necessary. The highlights of this study are:

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  • VR trainings should be adapted to participants’ occupational categories
  • Insufficient past anchoring could significantly reduce expected learning
  • Further investigation of personality or intelligence types may be necessary

INACSL 2023 Non-Research Article of the Year: Co-constructing a Diverse Hybrid Simulation-based experience for First Nations Culture

The Truth and Reconciliation Commission of Canada [TRC]: Calls to Actions in 2015 appealed to nursing schools to provide cultural training to address the cultural gaps between the First Nations people of Canada and registered nurses. In collaboration with First Nations social workers and Elders, a pre-existing simulation-based experience (SBE) was transformed into a diverse hybrid SBE. In the diverse hybrid SBE, a Knowledge Keeper, embedded actors, and a medium-fidelity manikin were used to present First Nations knowledge and cultural practices associated with end-of-life care. This article is a self-report of the co-construction and implementation of the diverse hybrid SBE with First Nations cultural experts. The co-construction and implementation of this diverse hybrid SBE required great effort and resources. Although the student anecdotal feedback identified a heightened understanding of First Nations cultural practices, moving forward, alternative debriefing models and evaluation by valid and reliable measures are required. The highlights of this article are:

  • Co-constructing a hybrid simulation with cultural experts ensures respectful representation of cultural knowledge.
  • The hybrid simulation design supports the use of embedded actors and a medium-fidelity manikin.
  • Nursing students shared that the diverse hybrid SBE was a meaningful learning activity.

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