Developing online simulated practice placements: a case study.

The Nursing and Midwifery Council recognises that using simulated practice learning within the pre-registration nursing curriculum is a valuable way for students to develop nursing knowledge and skills. The University of Huddersfield developed simulated placements in the pre-registration nursing curriculum in 2021. Simulated placements are now embedded within all fields of the BSc and MSc programmes, providing structured, innovative learning experiences that embrace online technology in supporting the development of skills and knowledge relevant to all fields of nursing. Developing these placements has provided an opportunity for faculty staff to work collaboratively with clinical colleagues, service users and carers, academics and technologists. This article offers an overview of that work, addressing challenges, operational issues, and insight into some of the activities developed to support students' learning.

Malnutrition as a potential predictor of mortality in chronic kidney disease patients on dialysis: A systematic review and meta-analysis.

BACKGROUND & AIMS: Malnutrition, a significant problem in patients with chronic kidney disease (CKD), is linked to lower health-related quality of life, longer and more frequent hospital admissions, worse functional capacity, and higher levels of morbidity. However, the extent of its impact on mortality is poorly elucidated. This systematic review and meta-analysis aimed to investigate the impact of malnutrition on mortality among CKD patients on dialysis. METHODS: This meta-analysis was designed and performed in accordance with the PRISMA guidelines (CRD42023394584). A systematic electronic literature search was conducted in PubMed, ScienceDirect, and Embase to identify relevant cohort studies. The studies that reported nutritional status and its impact on mortality in patients were considered for analysis. The generic inverse variance method was used to pool the hazard ratio effect estimates by employing a random effects model. The Newcastle-Ottawa scale was used for the quality assessment. The statistical analysis was performed by utilizing RevMan and CMA 2.0. RESULTS: A total of 29 studies that comprised 11,063 patients on dialysis whose nutritional status was evaluated were eligible for quantitative analysis. Based on a comparison between the "malnutrition" category and the reference "normal nutrition status" category, the results showed that the overall pooled hazard risk (HR) for mortality was (HR 1.49, 95% CI: 1.36-1.64, p < 0.0001). According to the subgroup analysis, the hemodialysis subgroup had greater mortality hazards (HR 1.53; 95% CI 1.38-1.70, p < 0.0001), compared to the peritoneal dialysis subgroup (HR 1.26; 95% CI 1.15-1.37, p < 0.00001). Additionally, the overall incidence of mortality was explored but the authors were unable to combine the results due to limitations with the data. CONCLUSION: The findings conclude that malnutrition is a strong predictor of mortality among patients on dialysis, with the hemodialysis subgroup having a higher mortality hazard compared to the peritoneal dialysis subgroup. The results of this study will advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD and death.

Blended Learning in Health Care Education: An Overview and Overarching Meta-analysis of Systematic Reviews.

INTRODUCTION: Blended learning is an educational approach that integrates face-to-face with online instruction. This overview of existing systematic reviews aims to evaluate the impact of blended learning on educational outcomes in health care professional education, identify gaps in the current evidence, and direction for future reviews. METHODS: Five databases were searched (January 1, 2000 to January 14, 2021) for systematic reviews of blended versus nonblended learning approaches for health care education. "Flipped classroom", unpublished studies, abstracts, and study protocols were excluded. The extracted data included details of included reviews, description of populations, and outcomes according to Kirkpatrick levels. A narrative review is presented, along with an overarching meta-analysis, which evaluates a synthesized estimate of the effect of blended learning based on standardized mean differences. RESULTS: Eleven systematic reviews were included, comprising of 160 primary studies (including 117 randomized controlled trials) from 56 countries with over 18,000 participants. The overall level of evidence was very low quality. An overarching meta-analysis of 93 studies addressing knowledge acquisition favored blended over nonblended learning methods (standardized mean difference 0.768 [95% confidence interval 0.594-0.941]; P < .001). None of the reviews identified an adverse effect on other educational outcomes. DISCUSSION: Blended learning may be superior to traditional teaching approaches in improving knowledge acquisition. We recommend further research to describe the relative benefits of blended learning in each individual context and identify which elements of instructional design are beneficial for each outcome. Finally, we recommend the use of clear and consistent terminology in reported studies.

Educational theory and its application to advanced life support courses: a narrative review.

The knowledge, skills and attitudes taught on Advanced Life Support (ALS) courses are an important learning requirement for healthcare professionals who are involved with the care of acutely unwell patients. It is essential that the course design and delivery is appropriately planned to ensure that it optimises the learning opportunities for all learners. This paper offers a narrative review of how the application of educational theory has positively influenced the evolution of ALS courses since their inception in the late twentieth century. By embracing and understanding the relevant educational theories, the ALS course design has transformed from a predominantly lecture-based and behaviourist approach, to a more participative and social constructivist approach to learning. In addition, the advent of smarter technology and the challenges posed by the COVID-19 pandemic have facilitated a more connectivist approach to learning. It can therefore be demonstrated that the ALS course is influenced by a combination of theoretical approaches and provides a diverse framework of teaching and learning strategies that cater for many individual learning styles. Any further evolution and development of the course should be based upon contemporary educational theory to ensure that it remains fit for purpose.

Improving health and care for patients by redesigning services: the development and implementation of a clinical assessment service in Harrow Primary Care Trust.

The redesign of healthcare services in Harrow Primary Care Trust is due to a number of drivers including: centrally imposed targets as outlined in various policy documents; shifting the balance of care; service delivery in a challenging financial climate; response to national consultations which indicate that patients want services nearer to home; and local and national knowledge of providing different types of services. A local enhanced scheme was devised by the trust to support general practitioners to follow care pathways using evidence-based literature, best practice and discussions with clinicians, nurses and patient representatives. The result was an ambitious and innovative service which has attracted attention from neighbouring London primary care trusts, which are seeking to replicate the model.

Design-based research in designing the model for educating simulation facilitators.

The purpose of this article is to introduce the concept of design-based research, its appropriateness in creating education-based models, and to describe the process of developing such a model. The model was designed as part of the Nurse Educator Simulation based learning project, funded by the EU's Lifelong Learning program (2013-1-DK1-LEO05-07053). The project partners were VIA University College, Denmark, the University of Huddersfield, UK and Metropolia University of Applied Sciences, Finland. As an outcome of the development process, "the NESTLED model for educating simulation facilitators" (NESTLED model) was generated. This article also illustrates five design principles that could be applied to other pedagogies.

Developing and testing transferability and feasibility of a model for educators using simulation-based learning - A European collaboration.

BACKGROUND: There is a pragmatic and often inconsistent approach of embedding simulation-based learning into nursing programmes. This paper details a European collaboration that designed a model for educator facilitation for educators utilizing simulation-based education. OBJECTIVES: The objectives of the study were to develop a model to educate the educators who deliver simulation-based learning and to test to which extent this model could be transferred to education providers in different national settings. METHODS: This model, its transferability and feasibility, was tested across three European countries. Educators from three Schools of Nursing participated in the study. Design-based Research was used as an overall methodology. Data were collected by the use of pre- and post-programme questionnaires and focus groups. RESULTS: The content of the NESTLED model is consistent with the needs of the participants. The testing also demonstrated that the model is transferable across-countries. Additionally, the participants' preferences regarding amount of time and pre-reading for the different sessions vary depending on the background and level of seniority of the individual participant. CONCLUSION: The testing of the NESTLED model demonstrated that participants gained confidence and knowledge from undertaking the programme. Delivering the NESTLED model across-countries was found to be feasible, but flexibility is required in terms of logistical delivery of the programme.

Using simulation to prepare students for their qualified role.

It is important that qualified nurses are able make decisions and solve problems, so a group of 10 BSc adult branch nursing students undertook a ward simulation exercise in preparation for their role as qualified nurses. This article describes the planning, design, implementation and evaluation of the simulation day.

Towards an understanding of the attributes of simulation that enable learning in undergraduate nurse education: A grounded theory study.

BACKGROUND: Simulation has become an established feature of nurse education yet little is understood about the mechanisms that lead to learning. OBJECTIVES: To explore the attributes of simulation-based education that enable student learning in undergraduate nurse education. METHODS AND PARTICIPANTS: Final year students drawn from one UK University (n=46) participated in a grounded theory study. First, nonparticipant observation and video recording of student activity was undertaken. Following initial analysis, recordings and observations were deconstructed during focus group interviews that enabled both the researcher and participants to unpack meaning. Lastly emergent findings were verified with final year students drawn from a second UK University (n=6). RESULTS: A staged approach to learning emerged from engagement in simulation. This began with initial hesitation as students moved through nonlinear stages to making connections and thinking like a nurse. Core findings suggest that simulation enables curiosity and intellect (main concern) through doing (core category) and interaction with others identified as social collaboration (category). SUMMARY AND CONCLUSION: This study offers a theoretical basis for understanding simulation-based education and integration of strategies that maximise the potential for learning. Additionally it offers direction for further research, particularly with regards to how the application of theory to practice is accelerated through learning by doing and working collaboratively.

The psychometric properties of five scoring methods applied to the script concordance test.

PURPOSE: The Script Concordance Test (SCT) is designed to measure cognitive ability related to successful clinical decision making. An SCT's usefulness for medical education depends on establishing its construct validity. The SCT's present construct relates examinee's scores to experts' response patterns, which does not require a single-best-answer format. Because medical education assessments do require a single best answer, the authors compared the psychometric properties of two aggregate scoring methods with three single-best-answer scoring methods for an SCT. METHOD: A nephrology SCT was developed and administered to 85 examinees. Examinees' scores derived from a key developed using eight experts and a traditional aggregate scoring method on a five-point Likert-based scale were compared with four alternate scoring methods (one method eliminated the multipoint Likert-type scale and three eliminated the Likert-type scale and employed single-best-answer scoring). RESULTS: Two of the four alternate scoring methods performed as well as the traditional Likert-type aggregate scoring method. Scores from all five methods were highly intercorrelated. In addition, each method produced scores similarly correlated with level of experience, and none exhibited an intermediate effect. CONCLUSIONS: Single-best-answer scoring with three answer choices produced results similar to aggregate scoring on a Likert-type scale. Because SCT items appear to assess an examinee's understanding of the interrelatedness of medical knowledge, single-best-answer scoring on an SCT may be valid as an educational assessment. More research is needed to assess differential validity compared with multiple-choice question exams and the predictive validity related to clinical performance.

Developing a multi-method approach to data collection and analysis for explaining the learning during simulation in undergraduate nurse education.

Simulation has become an established feature of undergraduate nurse education and as such requires extensive investigation. Research limited to pre-constructed categories imposed by some questionnaire and interview methods may only provide partial understanding. This is problematic in understanding the mechanisms of learning in simulation-based education as contemporary distributed theories of learning posit that learning can be understood as the interaction of individual identity with context. This paper details a method of data collection and analysis that captures interaction of individuals within the simulation experience which can be analysed through multiple lenses, including context and through the lens of both researcher and learner. The study utilised a grounded theory approach involving 31 under-graduate third year student nurses. Data was collected and analysed through non-participant observation, digital recordings of simulation activity and focus group deconstruction of their recorded simulation by the participants and researcher. Focus group interviews enabled further clarification. The method revealed multiple levels of dynamic data, concluding that in order to better understand how students learn in social and active learning strategies, dynamic data is required enabling researchers and participants to unpack what is happening as it unfolds in action.

Towards identifying nurse educator competencies required for simulation-based learning: A systemised rapid review and synthesis.

OBJECTIVES: This paper presents the results of a systemised rapid review and synthesis of the literature undertaken to identify competencies required by nurse educators to facilitate simulation-based learning (SBL). DESIGN: An international collaboration undertook a protocol-based search, retrieval and critical review. DATA SOURCES: Web of Science, PubMed, CINAHL Plus, PsycInfo, ERIC, the Cochrane Library and Science Direct. The search was limited to articles published in English, 2002-2012. REVIEW METHODS: The search terms used: nurse*, learn*, facilitator, simula*, lecturer, competence, skill*, qualificat*, educator, health care, "patient simulation", "nursing education" and "faculty". The search yielded 2156 "hits", following a review of the abstracts, 72 full-text articles were extracted. These were screened against predetermined inclusion/exclusion criteria and nine articles were retained. Following critical appraisal, the articles were analyzed using an inductive approach to extract statements for categorization and synthesis as competency statements. RESULTS: This review confirmed that there was a modest amount of empirical evidence on which to base a competency framework. Those papers that provided descriptions of educator preparation identified simulation-based workshops, or experiential training, as the most common approaches for enhancing skills. SBL was not associated with any one theoretical perspective. Delivery of SBL appeared to demand competencies associated with planning and designing simulations, facilitating learning in "safe" environments, expert nursing knowledge based on credible clinical realism, reference to evidence-based knowledge and demonstration of professional values and identity. CONCLUSIONS: This review derived a preliminary competency framework. This needs further development as a model for educators delivering SBL as part of nursing curricula.

Time to unravel the conceptual confusion of authenticity and fidelity and their contribution to learning within simulation-based nurse education. A discussion paper.

High-fidelity patient simulation is a method of education increasingly utilised by educators of nursing to provide authentic learning experiences. Fidelity and authenticity, however, are not conceptually equivalent. Whilst fidelity is important when striving to replicate a life experience such as clinical practice, authenticity can be produced with low fidelity. A challenge for educators of undergraduate nursing is to ensure authentic representation of the clinical situation which is a core component for potential success. What is less clear is the relationship between fidelity and authenticity in the context of simulation based learning. Authenticity does not automatically follow fidelity and as a result, educators of nursing cannot assume that embracing the latest technology-based educational tools will in isolation provide a learning environment perceived authentic by the learner. As nursing education programmes increasingly adopt simulators that offer the possibility of representing authentic real world situations, there is an urgency to better articulate and understand the terms fidelity and authenticity. Without such understanding there is a real danger that simulation as a teaching and learning resource in nurse education will never reach its potential and be misunderstood, creating a potential barrier to learning. This paper examines current literature to promote discussion within nurse education, concluding that authenticity in the context of simulation-based learning is complex, relying on far more than engineered fidelity.

A concept analysis of simulation as a learning strategy in the education of undergraduate nursing students.

Simulation is increasingly referred to in the nursing literature and its use in healthcare has developed dramatically over the past decade. Whilst the concept of simulation is not new, there is now a greater emphasis on its use in nurse education (Murray et al., 2008). The purpose of this article is to develop understanding and define the concept of simulated learning as a strategy used in the education of undergraduate nursing students. The analysis outlined in this paper was guided by a systematic process of studying a concept presented by Walker and Avant (2005). The analysis sought to identify how the concept of simulation is interpreted in the existing literature printed in English and retrieved from databases (Medline, CINAHL, PubMed, and Cochrane Library), internet search engines (GoogleScholar) and hand searches. The definition offered is a work in progress and presents a theoretically grounded understanding of what simulated learning currently represents. The identified antecedents, critical attributes and consequences are presented as a basis to stimulate further research, development and understanding.