Virtual simulation in healthcare education: a multi-professional, pan-Canadian evaluation.

BACKGROUND: As we experience a shortage of healthcare providers in Canada, it has become increasingly challenging for healthcare educators to secure quality clinical placements. We evaluated the impact of virtual simulations created for the virtual work-integrated learning (Virtu-WIL) program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. Evaluation was important since the virtual simulations are freely available through creative commons licensing, to the global healthcare community. METHODS: Students self-reported their experiences with the virtual simulations and the impact on their readiness for practice using a survey that included validated subscales. Open-ended items were included to provide insight into the students' experiences. RESULTS: The evaluation included 1715 Nursing, Paramedicine and Medical Laboratory students enrolled in the Virtu-WIL program from 18 post-secondary universities, colleges, and institutions. Results showed most students found the virtual simulations engaging helped them learn and prepare for clinical practice. A key finding was that it is not sufficient to simply add virtual simulations to curriculum, careful planning and applying simulation pedagogy are essential. CONCLUSION: Virtual simulation experiences are increasingly being used in healthcare education. Results from this rigorous, large-scale evaluation identified ways to enhance the quality of these experiences to increase learning and to potentially decrease the number of hours healthcare students need in clinical practice to meet professional competencies. Further research is needed regarding many aspects of virtual simulations and, in particular, curriculum integration and the timing or sequencing of virtual simulations to best prepare students for practice.

Usability Testing of a Web-Based Empathy Training Portal: Mixed Methods Study.

BACKGROUND: The prepandemic period saw a rise in web-based teaching. However, web-based tools for teaching the essential clinical skill of cognitive empathy (also known as perspective taking) remain limited. More of these tools are needed and require testing for ease of use and understanding by students. OBJECTIVE: This study aimed to evaluate the usability of the In Your Shoes web-based empathy training portal application for students using quantitative and qualitative methods. METHODS: This 3-phase formative usability study used a mixed methods design. In mid-2021, we conducted a remote observation of student participants interacting with our portal application. Their qualitative reflections were captured, followed by data analysis and iterative design refinements of the application. Overall, 8 third- and fourth-year nursing students from an undergraduate baccalaureate program at a Canadian university, in the western province of Manitoba, were included in this study. Participants in phases 1 and 2 were remotely observed by 3 research personnel while engaged in predefined tasks. In phase 3, two student participants were asked to use the application as they liked in their own environments, after which a video-recorded exit interview with a think-aloud process was conducted as participants responded to the System Usability Scale. We calculated descriptive statistics and performed content analysis to analyze the results. RESULTS: This small study included 8 students with a range of technology skills. Usability themes were based on participants' comments on the application's appearance, content, navigation, and functionality. The biggest issues that participants experienced were with navigating the application's "tagging" features during video analysis and the length of educational material. We also observed variations in 2 participants' system usability scores in phase 3. This may be because of their different comfort levels with technology; however, additional research is required. We made iterative refinements to our prototype application (eg, added pop-up messages and provided a narrated video on the application's "tagging" function) based on participant feedback. CONCLUSIONS: With increasing engagement in web-based teaching, technology has become an essential medium for receiving health care education. We developed a novel prototype application as a supplemental classroom tool to foster students' self-directed learning of empathy. This study provided direction for refinements to optimize the usability of and satisfaction with this innovative application. Qualitative feedback revealed favorable input toward learning perspective taking place on the web and helpful recommendations for improving user experiences with the application. We could not fully assess the application's key functions owing to the COVID-19 protocols. Thus, our next step is to obtain feedback from a larger sample of student users, whose experiences performing "live" video capture, annotation, and analysis will be more authentic and wholesome with the refined application. We discuss our findings in relation to research on nursing education, perspective taking, and adaptive e-learning.

Telesimulation in healthcare education: A scoping review.

OBJECTIVES: To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education. DESIGN: A scoping review. DATA SOURCES: A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022. REVIEW METHODS: Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised. RESULTS: 29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies. CONCLUSION: Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.

Psychological safety in simulation: Perspectives of nursing students and faculty.

BACKGROUND: As simulation education continues to grow, more consideration has been given to creating and maintaining a psychologically safe simulation learning environment. It is known that failing to provide psychological safety can lead to feelings of incompetence and a lack of confidence with students. However, it is essential to understand what makes and maintains psychological safety in simulation from both student and facilitator's perspectives. In further understanding psychological safety, nursing educators can challenge students to think beyond that of task attainment and into the deeper realm of critical thinking and critical reflection. OBJECTIVES: The aim of this study was to understand students' and facilitators perspectives of psychological safety in simulation. METHODS: Participants in this qualitative interpretive description study were seven students and four faculty that were chosen using convenience sampling. The data was collected over a 2-week period where semi-structured interviews were used to collect the participants perspectives. Data analysis was continuous and iterative and used inductive analysis. RESULTS: There were two student themes which focused on the student-facilitator interaction: 1) dynamic interaction, 2) student self-efficacy. The facilitators results showed two themes which focused on 1) simulation design and 2) trust. CONCLUSION: Diverging thoughts are present between faculty and students in what constitutes psychological safety. In describing both the similarities and differences, we have a better understanding on how to create and maintain psychological safety thereby, providing students with the best learning experience possible.

Evaluating the impact of an arts-based multimedia knowledge translation assignment on undergraduate nursing students.

BACKGROUND: Despite the expectation that nurses utilize research to provide excellent patient care, students often fail to recognize the value of learning about evidence-informed practice. Experiential, creative pedagogical approaches are needed to engage undergraduate nursing students in evidence-informed practice. In two undergraduate courses, we implemented an innovative assignment in which students created an arts-based multimedia knowledge translation presentation to communicate systematic review findings to patients. OBJECTIVE: To evaluate how the assignment affected nursing students' satisfaction, learning, and anticipated behaviour changes regarding evidence-informed practice and to assess what factors influenced their evaluation of the assignment. DESIGN AND METHODS: Kirkpatrick's Evaluation Model and Groff's Theory of Whole-Mindedness informed our study, incorporating an observational cross-sectional survey design. We recruited a convenience sample of nursing students (N = 242) from two baccalaureate programs. We collected data with an online survey comprised of closed- and open-ended questions. Quantitative data were analyzed with descriptive statistics, univariate analysis, and general linear models, and qualitative data with content analysis. RESULTS: Most students were satisfied (68%) and reported learning (77%) and benefits for their future practice (75%). Age, enjoyment of and experience with the arts, type of motivation, and valuing evidence-informed practice were significant predictors (p < 0.01) and the model predicted 59% of the variance in positive student perceptions of the assignment. Students reported experiencing relational and engaged learning, translating research findings creatively and clearly, understanding complex research concepts through experiential learning, and having frustrations and pragmatic concerns. CONCLUSION: Creative approaches that contextualize research findings hold potential to deepen students' understanding of evidence-informed practice. This study identified key factors that influenced students' evaluation and experience of the assignment. These results provide valuable insights to inform effective implementation of arts-based assignments in nursing education.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning.

AIMS AND OBJECTIVES: To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes. BACKGROUND: The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed. DESIGN: A scoping review was conducted using the Arksey and O'Malley framework. METHOD: CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used. RESULTS: Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation. CONCLUSION: The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes. RELEVANCE TO CLINICAL PRACTICE: Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.

Undergraduate nursing students' perspectives of intercultural communication: A qualitative descriptive study.

BACKGROUND: Problematic communication in nurse-client relationships is a contributory factor to healthcare disparities and negative health outcomes. Information and practice sessions about intercultural communication in nursing education are vital to equip the future health workforce. Limited evidence was located regarding undergraduate nursing students' perspectives on intercultural communication, which is crucial in determining the effectiveness and appropriateness of incorporating intercultural communication in nursing curricula. OBJECTIVE: This study explored the perceptions of undergraduate nursing students regarding intercultural communication in their nursing program. DESIGN: This study used a qualitative descriptive design guided by the Integrated Model of Intercultural Communication Competence. SETTING: A Western Canadian university. PARTICIPANTS: Ten fourth-year undergraduate nursing students. METHODS: Participants volunteered to participate in a semi-structured, one-on-one interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using content analysis. Another data source was the first author's reflective journal. Member checks were conducted. RESULTS: Participants perceived that limited intercultural communication content existed in nursing curricula; however, they acknowledged that learning about and engaging in intercultural communication facilitated more empathetic and culturally safe nursing practice. Barriers identified during intercultural communication in students' clinical practice included language, power differentials, gender, and limited staffing. However, students' cultural background, experiences, social media, and learning within culturally diverse environments were perceived to enable them to facilitate intercultural communication. Based on the findings, recommendations were formulated to integrate a cultural component in health assessment protocols with the addition of active teaching strategies to equip nursing students with the requisite skills and knowledge for effective intercultural communication. CONCLUSION: This study highlighted the perceived barriers, facilitators, and outcomes of intercultural communication education. Participating nursing students described how they developed empathetic intercultural communication skills and adjusted care with culturally diverse clients. Findings indicate that nurse educators use active teaching strategies that offer students opportunities to engage with culturally diverse clients.

Teaching Crisis Resource Management Skills to Nurses Using Simulation.

BACKGROUND: Education programs teaching crisis resource management (CRM) skills (problem solving, situational awareness, resource utilization, communication, and leadership) have been shown to positively affect learner competence in handling crisis events. As part of an education program, a high-fidelity simulation program was used as a learning intervention to teach these skills to practicing nurses. METHOD: In this repeated-measures observational study, 11 RNs were evaluated at four time points, measuring the effect of an education program on observed performance of CRM skills. Performance was measured using the Ottawa Global Rating Scale and a checklist tool. RESULTS: Statistically significant changes in mean scores occurred between times one and two, and nonstatistically significant improvement occurred in means overall. CONCLUSION: This study adds evidence of the effectiveness of high-fidelity simulation education and highlights the need for further research. [J Contin Educ Nurs. 2020;51(6):257-266.].

Applying Simulation Design Criteria to Non-Manikin-Based Experiences: A Modified ShadowBox Technique.

Creating simulation-based learning experiences is a process. With tools such as the 2016 INACSL Standards of Best Practice: Simulation Simulation Design and theories to guide development, nurse faculty have the opportunity to create rich simulation-based learning experiences that promote student learning. The purpose of this article is to describe an innovative simulation-based experience that applies simulation design criteria in a non-manikin experience. Using a ShadowBox approach, novice nursing students were exposed to expert decision-making in a simulated environment. We describe this approach and how the simulation design criteria are applied.

Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review.

AIMS AND OBJECTIVES: To synthesise and map the literature on the psychological outcomes reported following debriefing of healthcare providers who experience expected and unexpected patient death in either clinical practice or simulation setting. BACKGROUND: Patient death occurs in both the clinical and simulation environments and can result in psychological stress in healthcare providers and students. While debriefing following patient death has demonstrated the ability to promote positive psychological outcomes, addressing the psychological or emotional stress of the event is inconsistently addressed. DESIGN: A scoping review was conducted using the Arksey and O'Malley framework. METHOD: The Cochrane Library, MEDLINE, CINAHL, PsycINFO, JBI and Scopus databases were searched with English language constraints and no limit on publication date. The Scoping Reviews (PRISMA-ScR) Checklist was used (Annals of Internal Medicine, 2018, 169, 467) (see Appendix S1). RESULTS: Eighteen articles (16 research papers and 2 review papers) met the inclusion criteria. Of the 16 research papers, 9 reported on debriefing models in the simulation environment and 7 in the clinical setting. The types of debriefing models found in the simulation setting tended to focus on healthcare providers' learning, while those in the clinical setting typically focused on healthcare providers' emotional reactions and resulted in positive psychological effects. CONCLUSION: Debriefing has the potential to positively affect psychological outcomes of healthcare providers who experience patient death. The type of debriefing that is selected is a key component to achieving these positive outcomes. RELEVANCE TO CLINICAL PRACTICE: This scoping review identified the debriefing frameworks used in both simulation and clinical environments following patient death events, and any associated psychological outcomes. There is a need for debriefing to occur after each death in either environment; however, there is a lack of evidence-based debriefing frameworks that can be used in both the clinical and simulation environments to promote positive psychological outcomes.

Debriefing and Palliative Care Simulation.

BACKGROUND: Palliative simulation is a beneficial bridge between theory and practice; however, it can be emotionally laden. Often overlooked during a debrief session of a palliative simulation is ensuring that participants have the skills to process the feelings they may experience. METHOD: The purpose of this mixed-methods concurrent triangulation study was to understand the perceived value and usefulness of debriefing in palliative simulation process feelings and emotions. RESULTS: The simulation modality affects the intensity of feelings. A debriefer who is skilled in both debriefing simulation and coping with emotionally stressful situations allowed students to feel prepared to cope with their own feelings about palliative care. Having other students talk about their feelings in debriefing helped students to normalize their feelings. CONCLUSION: The debriefing in palliative-based simulations requires additional considerations regarding modality and the skill set of the debriefer to adequately assist students to process feelings and emotions. [J Nurs Educ. 2019;58(10):569-576.].

Use of mobile devices and medication errors in acute care: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to synthesize the best available evidence on the effects of healthcare providers using mobile devices at any stage of medication provision on medication errors in acute care settings. Provision of medication includes prescribing, dispensing or administrating medicine in the acute care setting.

Development of a novel empathy-related video-feedback intervention to improve empathic accuracy of nursing students: A pilot study.

BACKGROUND: Stressed family carers engage in health-risk behaviours that can lead to chronic illness. Innovative strategies are required to bolster empathic dialogue skills that impact nursing student confidence and sensitivity in meeting carers' wellness needs. PURPOSE: To report on the development and evaluation of a promising empathy-related video-feedback intervention and its impact on student empathic accuracy on carer health risk behaviours. DESIGN: A pilot quasi-experimental design study with eight pairs of 3rd year undergraduate nursing students and carers. METHODS: Students participated in perspective-taking instructional and practice sessions, and a 10-minute video-recorded dialogue with carers followed by a video-tagging task. Quantitative and qualitative approaches helped us to evaluate the recruitment protocol, capture participant responses to the intervention and study tools, and develop a tool to assess student empathic accuracy. MAIN RESULTS: The instructional and practice sessions increased student self-awareness of biases and interest in learning empathy by video-tagging feedback. Carers felt that students were 'non-judgmental', inquisitive, and helped them to 'gain new insights' that fostered ownership to change their health-risk behaviour. There was substantial Fleiss Kappa agreement among four raters across five dyads and 67 tagged instances. CONCLUSION: In general, students and carers evaluated the intervention favourably. The results suggest areas of improvement to the recruitment protocol, perspective-taking instructions, video-tagging task, and empathic accuracy tool.

Interprofessional education using simulation of an overnight inpatient ward shift.

In healthcare it is rare for professionals to practice together before they practice together. Nightmare Night Care is an annual interprofessional voluntary event for health sciences students in nursing, medicine and pharmacy to come together for a simulated hospital overnight ward shift. The purpose of this study was to investigate the interprofessional knowledge, skills and attitudes the students learn from this experience. Students responded to surveys before (n = 45) and after the event (n = 11) regarding their understanding of the goals of interprofessional education (IPE), roles and responsibilities of other professions, and what they learned from this event. Responses demonstrated that students are eager to learn in interprofessional settings and that IPE events may aid in building understanding and communication between professions. IPE events are an opportunity to allow students to learn about each other; however, they must occur frequently, and must include an orientation on role clarification if they are to have an effect on changing preconceived stereotypes of the other professions.

A formative approach to student remediation.

Nursing instructors strive to use the most effective means when remediating students who are failing to meet clinical course objectives in clinical and practicum courses. Building on teaching and learning theory, the authors critically analyze the merits of using a simulation framework and a clinical judgment rubric as tools to create an effective formative remedial strategy to support student learning. Suggestions for future research and implications for faculty practice are included.

Overcoming the challenges of providing clinical/practice education.

The responsibility of educating increasing numbers of students presents major challenges for nursing education. The Canadian Association of Schools of Nursing (CASN) established a task force to examine the issues and barriers associated with provision of clinical/practice education for nursing students and to assist in the development of national guidelines for practice education. In this article, the authors present key findings and recommendations resulting from a literature review, a survey of member schools and a national forum on clinical practice education. All schools of nursing are encouraged to continue to develop innovative ways of providing practice experience to meet growing demands.