The Evidence in Simulation-Based Learning Experiences in Nursing Education and Practice: An Umbrella Review

Enhancing nurse physician collaboration using pediatric simulation

Simulation-based training is used to develop nursing students’ clinical performance in assessing and managing situations in clinical placements. The use of simulation-based training has increased and become an integrated part of nursing education. The aim of this study was to explore nursing students’ experiences of simulation-based training and how the students perceived the transfer of learning to clinical practice. Eight focus group interviews were conducted with a total of 32 s- and third-year nursing students who participated in a simulation-based training organized as preparation for clinical placement. The transcribed interviews were analysed with thematic analysis. Three major themes emerged from the focus group interviews; first, the simulation-based training promoted self-confidence; second, understanding from simulation-based training improved clinical skills and judgements in clinical practice; and third, simulation-based training emphasised the importance of communication and team collaboration. This study revealed students’ transfer of learning outcomes from simulation-based training to clinical practice. The students’ experiences of the simulation-based training remain as enduring and conscious learning outcomes throughout their completion of clinical practice. The organisation of simulation-based training and its implementation in the curriculum are crucial for the learning outcomes and for students’ experiences of the transfer of knowledge to clinical practice.

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Nursing students' transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study.

Human error and system failures continue to play a substantial role in adverse outcomes in healthcare. Simulation improves management of patients in critical condition, especially if it is undertaken by a multidisciplinary team. It covers technical skills (technical and therapeutic procedures) and non-technical skills, known as Crisis Resource Management. The relationship between stress and performance is theoretically described by the Yerkes-Dodson law as an inverted U-shaped curve. Performance is very low for a low level of stress and increases with an increased level of stress, up to a point, after which performance decreases and becomes severely impaired. The objectives of this randomized trial are to study the effect of stress on performance and the effect of repeated simulation sessions on performance and stress. This study is a single-center, investigator-initiated randomized controlled trial including 48 participants distributed in 12 multidisciplinary teams. Each team is made up of 4 persons: an emergency physician, a resident, a nurse, and an ambulance driver who usually constitute a French Emergency Medical Service team. Six multidisciplinary teams are planning to undergo 9 simulation sessions over 1 year (experimental group), and 6 multidisciplinary teams are planning to undergo 3 simulation sessions over 1 year (control group). Evidence of the existence of stress will be assessed according to 3 criteria: biological, electrophysiological, and psychological stress. The impact of stress on overall team performance, technical procedure and teamwork will be evaluated. Participant self-assessment of the perceived impact of simulations on clinical practice will be collected. Detection of post-traumatic stress disorder will be performed by self-assessment questionnaire on the 7th day and after 1 month. We will concomitantly evaluate technical and non-technical performance, and the impact of stress on both. This is the first randomized trial studying repetition of simulation sessions and its impact on both clinical performance and stress, which is explored by objective and subjective assessments. We expect that stress decreases team performance and that repeated simulation will increase it. We expect no variation of stress parameters regardless of the level of performance. ClinicalTrials.gov registration number NCT02424890

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Randomized controlled trial of multidisciplinary team stress and performance in immersive simulation for management of infant in shock: study protocol.

Background Less than 20% of the 996 NICUs in the United States routinely practice kangaroo care, due in part to the inadequate knowledge and skills confidence of nurses Continuing education improves knowledge and skills acquisition, but the effects of a kangaroo care certification course on nurses' knowledge and skills confidence are unknown Method A pretest-posttest quasi-experiment was conducted The Kangaroo Care Knowledge and Skills Confidence Tool was administered to 68 RNs at a 25-day course about kangaroo care evidence and skills Measures of central tendency, dispersion, and paired t tests were conducted on 57 questionnaires Results The nurses' characteristics were varied The mean posttest Knowledge score (M = 8854, SD = 613) was significantly higher than the pretest score (M = 787, SD = 830), t [54] = -91, p = 000), as was the posttest Skills Confidence score (pretest M = 3206, SD = 349; posttest M = 2680, SD = 522), t [53] = -8459, p = 000) Conclusion The nurses' knowledge and skills confidence of kangaroo care improved following continuing education, suggesting a need for continuing education in this area J Contin Educ Nurs 2016;47(11):518-524

Kangaroo Care Education Effects on Nurses' Knowledge and Skills Confidence.

The lack of safe avenues to develop neonatal nursing competencies using human subjects leads to the notion that simulation education for neonatal nurses might be an ideal form of education. This integrative literature review compares traditional, teacher-centered education with high-fidelity simulation education for neonatal nurses. It examines the theoretical frameworks used in neonatal nursing education and outlines the advantages of this type of training, including improving communication and teamwork; providing an innovative pedagogical approach; and aiding in skill acquisition, confidence, and participant satisfaction. The importance of debriefing is also examined. High-fidelity simulation is not without disadvantages, including its significant cost, the time associated with training, the need for very complex technical equipment, and increased faculty resource requirements. Innovative uses of high-fidelity simulation in neonatal nursing education are suggested. High-fidelity simulation has great potential but requires additional research to fully prove its efficacy.

High-Fidelity Simulation for Neonatal Nursing Education: An Integrative Review of the Literature.

Background Education delivery in higher education institutions was severely affected by the COVID-19 pandemic, with emergency remote teaching developed and adapted promptly for the circumstances. This rapid review investigated the effectiveness of alternative education delivery strategies during the pandemic for medical, dental, nursing and pharmacy students, to help plan and adapt further education provision. Methods We included 23 primary studies in undergraduate education, all published in 2020-2021, no relevant UK-based or postgraduate studies were found. Included studies comprised 10 single cohort descriptive; 11 comparative descriptive; and two RCTs. There was considerable variability in terms of students, type of distance learning, platforms used and outcome measures. Results In medicine (n=14), self-reported competency and confidence, and demonstrable suturing skills were achieved through participating in remote learning. However, lower levels of knowledge were obtained by students who received virtual or blended learning compared to in-person teaching (low-very low confidence). Using bespoke interactive platforms in undergraduate medical training was superior to standard video (low confidence) or textbook presentations (very low confidence). In dentistry (n=2), remote learning led to knowledge gained (low confidence), but self-reported practical and interpersonal skills were lower with remote rather than in-person learning (very low confidence). In nursing (n=3), remote learning, when compared to in-person, resulted in similar knowledge and self-reported competency levels (very low confidence) pre-COVID, but confidence was higher when learning or assessment was conducted virtually (low confidence). In pharmacy (n=4), virtual learning was associated with higher skills, but lower knowledge compared to in-person, pre-COVID; self-reported competency and confidence scores were similar between the two groups (very low confidence). Conclusions Remote teaching was valued, and learning was achieved, but the comparative effectiveness of virtual versus in-person teaching is less clear. Supplementary alternative or in-person practical sessions may be required post-emergency to address learning needs for some disadvantaged student groups.

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A rapid review of the effectiveness of alternative education delivery strategies in medical, dental, nursing and pharmacy education during the COVID-19 pandemic

The National Health Service (NHS) is experiencing an acute workforce shortage in every discipline, at a time when waiting times are at a record high and there is a growing backlog resulting from the COVID-19 pandemic. This Rapid Review aimed to explore the effectiveness of interventions or innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff. The review is based on the findings of existing reviews supplemented by a more in-depth evaluation of included primary studies conducted in the UK or Europe. The review identifies a range of interventions that can be used for enhancing recruitment and retention in Wales, particular in rural areas, and supports multiple-component interventions. The findings highlight the importance of providing and locating undergraduate and post graduate training in rural locations. The findings also corroborate the use of bursary schemes for training, such as those already available for Nursing in Wales. Further, more robust evaluations, based on comparative studies, are required to assess the effectiveness of interventions to support recruitment and retention of clinical staff. There was limited evidence on interventions aimed at allied health professionals. Most of the primary studies included in the reviews used cohort (pre-post test) or cross-sectional designs. Most studies lacked a comparison group and did not use statistical analysis.

A rapid review of the effectiveness of interventions and innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff.

The COVID-19 pandemic further exacerbated disruptions to elective care services in the UK, leading to longer waits for treatment and a growing elective surgery backlog. There have been growing calls for the creation of surgical hubs to help reduce this backlog. Surgical hubs aim to increase surgical capacity by providing quicker access to procedures, as well as facilitate infection control by segregating patients and staff from emergency care. This rapid review aimed to assess the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity, to inform the implementation of these hubs in Wales. The review identified evidence available up until January 2023. Twelve primary studies were included, eight of which used comparative methods. Most of the studies were conducted during the COVID-19 pandemic and described surgical hubs designed mainly to mitigate the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Outcome measures reported included clinical, performance, economic, and patient reported outcomes across a variety of different surgical disciplines. Most of the studies did not describe surgical hubs based on their structure, i.e., standalone, integrated, or ring-fenced hubs. The evidence relating to the impact of surgical hubs on clinical outcomes appeared to be heterogenous and limited. Included studies did not appear to control for the impact of the COVID-19 pandemic on outcomes. Evidence of the impact of surgical hubs on performance outcomes such as efficiency, utilisation/usage, volume of surgeries/treatments, performance, cancellations, and time from diagnosis to treatment is limited. Evidence relating to the economic impact of surgical hubs is also limited, however there is evidence to suggest that total average costs are lower in surgical hubs when compared to general hospitals. Evidence relating to the impact of surgical hubs on patient reported outcomes is limited but indicates there may be a positive effect on patient satisfaction and compliance. Considerable variation in the types of surgical hubs reviewed, surgical disciplines, along with the small number of comparative studies, as well as methodological limitations across included studies, could limit the applicability of these findings.

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A rapid review of the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity

Innovation may provide a means for tackling challenges facing childrens social care, some of them deep-rooted and many exacerbated by COVID-19. Welsh Government has recently committed to a significant 3-year investment to support innovation in adults and childrens social care. The delivery of social care in Wales has a complex and multi-faceted approach, involving collaborative working between a range of organisations, which will likely affect decisions around implementation and scale-up of new and/or existing interventions. The aim of the review was to identify any factors (barriers and enablers) that affect the implementation and scale up of an innovation in childrens social care organisations. Ten studies were identified, comprising three secondary studies (reviews) and seven primary studies. Factors potentially influencing scale and spread of innovation were extracted and categorised. The domains (and sub-domains) covered by included studies were; adopters (staff role/identity; carer input), organisation (capacity to innovate; readiness for change; nature of adoption/funding; extent of change needed; work needed to implement), and wider system (political/policy; regulatory/legal; professional; socio-cultural). Enablers for which a clear consensus seems to be emerging across the literature included: specific training and support for professional staff, support and mutual respect within inter-professional and professional-carer relationships, senior management/leadership buy-in and support, multi-disciplinary communication and joint working, and developing compatible data systems to support joint working/collaboration. Barriers for which a clear consensus seems to be emerging across the literature were: short term or lack of funding (the need for funding was presented as an enabler in some studies), and implementation difficulties (e.g. multiple priorities and changing structures). Policy Implications: This review highlights the complexity of the social care models but provides some clear pointers for policy and practice. The findings indicate the need for: senior management buy-in and support, short and longer term funding, multi-disciplinary communication and joint working, good professional (and professional-carer) relationships with support and mutual respect, and specific training and support for professional staff. The confidence in the evidence is uncertain as the study designs included non-systematic reviews and service evaluations; most studies did not use a formal methodology and all had some quality limitations.

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Allyson Cooper

Papers

High-Fidelity Simulation for Neonatal Nursing Education: An Integrative Review of the Literature.

A rapid review of the effectiveness of alternative education delivery strategies in medical, dental, nursing and pharmacy education during the COVID-19 pandemic

A rapid review of the effectiveness of interventions and innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff.

A rapid review of the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity

A rapid review of what organisational level factors support or inhibit the scale and spread of innovations in childrens social care