Healthcare Students' Experiences of Learner-Educator Cocreation of Virtual Simulations: A Phenomenographic Study.

INTRODUCTION: Cocreating virtual simulations with learners during a course is an innovative approach to improving student preparation for real-world practice while helping simulationists meet learner needs, support authentic assessment, and maximize the impact of simulation-based learning. This study explores differences in healthcare students' experiences of learner-educator cocreation of virtual simulations (LECoVSs) using phenomenographic methods. Identifying differences in perceptions of LECoVSs enables educators to make evidence-informed decisions about engaging in simulation cocreation as a tool to maximize learning. METHODS: Phenomenography focuses on identifying different ways that participants can experience the same phenomenon, in this case, LECoVSs. The setting was a collaborative interprofessional simulation assignment between navigation and nursing students. Participants completed a demographic survey then submitted reflective journals completed during the course and/or an open-ended survey. Data analysis occurred in iterative stages, from familiarization with the data to grouping and interpreting themes. RESULTS: Nineteen open-ended surveys and 13 reflective journals from navigation and nursing students who completed the simulation assignment between 2021 and 2023 were analyzed. Students experienced LECoVSs in 4 increasingly complex ways: (1) supporting consistent student progress, (2) amending course expectations, (3) sharing decision-making, and (4) fostering mutual growth. CONCLUSIONS: Simulationists may leverage cocreation to improve student learning, access, empowerment, and professional growth. However, for students to achieve higher learning outcomes, educators need to clearly communicate the full potential of cocreation, how it can occur, and why it can support learning. This study's findings may be used as a framework for explaining simulation cocreation to students to maximize their learning.

PROTOCOL: Learner-educator co-creation of student assessment in health professional education courses: A scoping review protocol.

This is a protocol for a Campbell Review following JBI scoping review methodology. The objectives are to answer the following questions: What has been reported in the literature about collaborative learner-educator design, implementation, or evaluation of learner assessment in health professional education? (1) Where is learner-educator co-creation of assessment occurring? (i.e., which disciplines, course types, level of learner, year of study). (2) What course assessment decisions are influenced or being made together? (i.e., assessment instructions and/or grades). (3) How much influence do learners have on decision-making? (i.e., where does it fall on Bovill and Bulley's ladder of participation). (4) How do learners and educators go about making decisions together? (i.e., discussion or voting, with a whole class or portion of the class). (5) What are the perceived benefits, disadvantages, barriers, and/or facilitators reported by the authors?

How to Partner With Persons Living With Mental Health Conditions: A Guide for Meaningful Simulation Cocreation.

SUMMARY STATEMENT: Screen-based simulation is an effective educational strategy that can enhance health care students' engagement with content and critical thinking across various topics, including mental health. To create relevant and realistic simulations, best-practice guidelines recommend the involvement of experts in the development process. We collaborated with persons with lived experience and community partners to cocreate a mental health-focused screen-based simulation. Cocreating meant establishing a nonhierarchical partnership, with shared decision-making from start to finish.In this article, we present 8 principles developed to guide our cocreation with persons with lived experience: person-centeredness, trauma-informed approaches and ethical guidance, supportive environment, two-way partnership, mutual respect, choice and flexibility, open communication, and room to grow. These principles provide practical guidance for educators seeking to engage the expertise of persons who have been historically disadvantaged in society. By sharing these principles, we strive to contribute to a more equitable process in simulation development and promote meaningful, respectful, and safer collaborations.

Identifying self-presentation components among nursing students with unsafe clinical practice: a qualitative study.

BACKGROUND: Maintaining patient safety is a practical standard that is a priority in nursing education. One of the main roles of clinical instructors is to evaluate students and identify if students exhibit unsafe clinical practice early to support their remediation. This study was conducted to identify self-presentation components among nursing students with unsafe clinical practice. METHODS: This qualitative study was conducted with 18 faculty members, nursing students, and supervisors of medical centers. Data collection was done through purposive sampling and semi-structured interviews. Data analysis was done using conventional qualitative content analysis using MAXQDA10 software. RESULTS: One main category labelled self-presentation emerged from the data along with three subcategories of defensive/protective behaviors, assertive behaviors, and aggressive behaviors. CONCLUSION: In various clinical situations, students use defensive, assertive, and aggressive tactics to maintain their professional identity and present a positive image of themselves when they make a mistake or predict that they will be evaluated on their performance. Therefore, it seems that the first vital step to preventing unsafe behaviors and reporting medical errors is to create appropriate structures for identification, learning, guidance, and evaluation based on progress and fostering a growth mindset among students and clinical educators.

Virtual clinical simulation to teach mental health concepts: a scoping review protocol.

OBJECTIVE: The objective of this review is to determine the extent of the literature on the use of virtual clinical simulation to teach health professional students about mental health. INTRODUCTION: Graduates of health professional programs need to be prepared to provide safe and effective care for persons with a mental illness in every practice context. Clinical placements in specialty areas are difficult to obtain and cannot ensure students will have opportunities to practice specific skills. Virtual simulation is a flexible and innovative tool that can be used in pre-registration health care education to effectively develop cognitive, communication, and psychomotor skills. Given the recent focus on virtual simulation usage, the literature will be mapped to determine what evidence exists regarding virtual clinical simulation to teach mental health concepts. INCLUSION CRITERIA: We will include reports that focus on pre-registration health professional students and use virtual simulation to teach mental health concepts. Reports that focus on health care workers, graduate students, patient viewpoints, or other uses will be excluded. METHOD: Four databases will be searched including MEDLINE, CINAHL, PsycINFO, and Web of Science. Reports with a focus on mental health virtual clinical simulation for health professional students will be mapped. Independent reviewers will screen titles and abstracts, then review the full texts of articles. Data from studies meeting the inclusion criteria will be presented in figures and tables, and described narratively. REVIEW REGISTRATION NUMBER: Open Science Framework https://osf.io/r8tqh.

Revisioning Assessment and Evaluation in Nursing Education Through Critical Caring Pedagogy: Using Authentic Examinations to Promote Critical Consciousness.

Instead of instilling in nursing students critical thinking to challenge injustice and oppression in nursing practice, nurse educators often rely on outdated traditional approaches to education. This situation is certainly true in traditional methods of evaluation that often propagate a banking mode of learning. One of the most commonly used methods of evaluating students is traditional examinations, which have recently become a source of pedagogical conflict among educators. In this article, we outline how educators unknowingly encourage surface learning, uncaring practices, oppression, inequity, and cheating when they rely on traditional examinations. We draw on critical caring pedagogy and universal design for learning to advocate for increased use of authentic assessment in nursing education. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A31.

Redefining Cheating on Written Exams: A Shift Toward Authentic Assessment to Promote Universal Design for Learning in the Context of Critical Caring Pedagogy.

Educators who recognize the value of authentic written exams for promoting student critical thinking may struggle with concerns about cheating. In this article, we explore how educators may use open-web take-home exams to help students develop integrity and evidence-based practice skills. Lang's theory is used to explore why students may cheat. We discuss the importance of caring assessment practices by drawing on critical caring pedagogy and universal design for learning. Throughout the discussion, we illustrate how authentic questions and instruction that is focused on dialogue, collaboration, and resource use may reduce cheating possibilities while improving student learning.

Motivation and Engagement of Nursing Students in 2 Gamified Courses: A Mixed-Methods Study.

BACKGROUND: Evidence suggests that gamification increases student engagement in course activities. However, student feedback about gamification in nursing contexts is needed. PURPOSE: The aim of this study was to describe nursing student perceptions of how gamification impacts student motivation and engagement. METHODS: A convergent mixed-methods study was conducted. Surveys were completed by 58 first-year nursing students. Survey comments and data extracted from the learning management system were also collected. RESULTS: Students generally found gamification valuable, interesting, and enjoyable. Gamification took effort and was perceived as important. Students felt that they had some choice in participation in the gamified activities. CONCLUSIONS: Gamification is a viable strategy for promoting motivation and engagement among first year nursing students. More qualitative research is needed to enable game design refinement through investigation of contextualized student experiences. Refined game design may impact the development of learner skills through a moderating effect on engagement in course activities.

First year nursing students' viewpoints about compromised clinical safety.

OBJECTIVE: Undergraduate nursing students must uphold patient safety as a professional and moral obligation across all clinical learning experiences. This expectation commences at entry into the nursing program. As part of a larger study exploring undergraduate baccalaureate nursing students' understanding of clinical safety, this paper specifically focuses on first year students' viewpoints about unsafe clinical learning situations. METHODS: Q-methodology was used. Sixty-eight first year nursing students participated in the ranking of 43 statements indicative of unsafe clinical situations and practices. Data was entered into a Q-program for factor analysis. RESULTS: The results revealed a typology of four discrete viewpoints of unsafe clinical situations for first year students. These viewpoints included an overwhelming sense of inner discomfort, practicing contrary to conventions, lacking in professional integrity and disharmonizing relations. Overall, a consensus viewpoint described exonerating the clinical educator as not being solely responsible for clinical safety. DISCUSSION: This information may assist students and educators to cooperatively and purposefully construct a clinical learning milieu conducive to safety.

Challenges to student learning in the clinical setting: a qualitative descriptive study.

Clinical education is used throughout nursing to promote competency. Although this experience can be rewarding, students may face a variety of challenges within this context. The purpose of this qualitative descriptive study is to explore senior nursing students' perceptions of challenges to learning within the clinical setting. Three interrelated themes emerged from the data: (a) internal reactions to external limitations; (b) barriers experienced within the clinical environment; and (c) ineffective programme organisation. Findings are meant to guide educators and policy makers during decision making. The goal is advancement towards making the clinical environment a superior form of nursing education.

Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology.

BACKGROUND: Nursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment. METHODS: Q methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives. RESULTS: A total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site. CONCLUSIONS: Senior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.

Typology of undergraduate nursing students' unsafe clinical practices: Q-methodology.

Undergraduate nursing students, as members of the health care team, must uphold patient safety as a professional and moral obligation during their clinical learning experiences. To address this imperative, in a humanistic paradigm, students engage in critical appraisal of self as a developing practitioner. Using Q-methodology, this study describes undergraduate nursing students' subjective understanding of unsafe clinical practices, and results revealed a typology of five groups of unsafe students. The results showed four discrete groups of students at risk for unsafe clinical practices-vulnerable, unprepared, unknowing, and distanced students. Overall, a consensus viewpoint described the presence of the displaced student as the greatest safety risk. Use of this typology as an assessment guide may help students and educators cooperatively create and maintain a culture of safety while developing competent novice nurses.

Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review.

Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.

Views on unsafe nursing students in clinical learning.

Clinical education is a cornerstone of undergraduate nursing education programs. Although protecting patient safety in clinical learning experiences is a standard of practice, no standard definition of the "unsafe" student exists. The purpose of this study was to describe the viewpoints of undergraduate student nurses and their clinical educators about unsafe clinical student practices. Using Q methodology, 57 students and 14 clinical educators sorted 39 unsafe student practice statements. These statements were generated from an integrated review of nursing and related literature and two undergraduate student focus groups. The use of centroid factor analysis with varimax rotation produced three dimensions of unsafe student practices. An unsafe student was characterized by his/her Compromised Professional Accountability, Incomplete Praxis, and Clinical Disengagement. A shared attribute among these three features was violated professional integrity. While students' affective, cognitive, and praxis competencies were priority elements in the conceptualization of unsafe student practice, this study also identified the salient role of educators as active participants in preparation of safe practitioners.