A cross-national study to objectively evaluate the quality of diverse simulation approaches for undergraduate nursing students.

The aim of this paper is to report the results of a cross-national study that evaluated a range of simulation sessions using an observation schedule developed from evidence-based quality indicators. Observational data were collected from 17 simulation sessions conducted for undergraduate nursing students at three universities in Australia and the United Kingdom. The observation schedule contained 27 questions that rated simulation quality. Data were collected by direct observation and from video recordings of the simulation sessions. Results indicated that the highest quality scores were for provision of learning objectives prior to the simulation session (90%) and debriefing (72%). Student preparatiosn and orientation (67%) and perceived realism and fidelity (67%) were scored lower than other components of the simulation sessions. This observational study proved to be an effective strategy to identify areas of strength and those needing further development to improve simulation sessions.

Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool.

Snapshots of simulation: creative strategies used by Australian educators to enhance simulation learning experiences for nursing students.

Simulation in nursing is a flourishing area for nurse educators' practice. Defined as learning that amplifies, mimics or replaces real-life clinical situations, simulation aims to give students opportunity to reason through a clinical problem and make decisions, without the potential for harming actual patients. Educators in nursing are contributing to simulation learning in diverse and creative ways. Yet much of their craft is not being widely disseminated because educators are not always confident in publishing their work. This paper aims to stimulate creative development in simulation by providing short summaries, or snapshots, of diverse approaches that nurse educators are using. The objective is to inspire others to share other ideas in development or in practice that are improving learning for nursing students and practitioners, so that simulation scholarship is advanced. The snapshots presented range from approaches that: better support educators to attend to the whole process of simulation education, give students quick access to short skill-based videos, orientate students to the laboratory environment, harness the power of the group to develop documentation skills, use simulation to enrich lectures, develop multidisciplinary knowledge, and finally, which teach therapeutic communication with children in a fun and imaginative way.

Quality indicators for the design and implementation of simulation experiences: a Delphi study.

Simulation is widely used in nursing education. Previous studies have examined the impact of simulation on the acquisition of psychomotor skills, knowledge, critical thinking and non-technical skills such as teamwork. Challenges associated with the integration of simulation into nursing curricula have also been examined, however only limited research addresses the most effective simulation design and teaching strategies for quality educational outcomes. This paper reports a Delphi study that synthesises expert opinion on the pedagogical principles and teaching strategies that are indicative of quality in simulation based learning activities. The resultant set of Quality Indicator Statements is presented and opportunities for application and further research are discussed.

Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators.

Student evaluation of the implementation of evidence-based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high-fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student-evaluation instrument was an effective means of measuring student-related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions.

Examining the impact of high and medium fidelity simulation experiences on nursing students' knowledge acquisition.

AIM: This paper describes a study that measured and compared knowledge acquisition in nursing students exposed to medium or high fidelity human patient simulation manikins. BACKGROUND: In Australia and internationally the use of simulated learning environments has escalated. Simulation requires a significant investment of time and money and in a period of economic rationalisation this investment must be justified. Assessment of knowledge acquisition with multiple choice questions is the most common approach used to determine the effectiveness of simulation experiences. METHOD: This study was conducted in an Australian school of nursing; 84 third year nursing students participated. A quasi-experimental design was used to evaluate the effect of the level of manikin fidelity on knowledge acquisition. Data were collected at three points in time: prior to the simulation, immediately following and two weeks later. RESULTS: Differences in mean scores between the control (medium fidelity) and experimental (high fidelity) groups for Tests 1, 2 and 3 were calculated using independent t tests and were not statistically significant. Analysis of covariance (ANCOVA) was conducted to determine whether changes in knowledge scores occurred over time and, while an improvement in scores was observed, it was not statistically significant. CONCLUSION: The results of this study raise questions about the value of investing in expensive simulation modalities when the increased costs associated with high fidelity manikins may not be justified by a concomitant increase learning outcomes. This study also suggests that multiple choice questions may not be the most appropriate measure of simulation effectiveness.

The development and psychometric testing of the Satisfaction with Simulation Experience Scale.

AIM: This paper reports the development and psychometric testing of the Satisfaction with Simulation Experience Scale, an instrument designed to measure and compare differences in satisfaction levels between nursing students exposed to medium and high fidelity human patient simulation manikins. BACKGROUND: Student satisfaction is important to engaged and meaningful learning and it facilitates active and purposeful participation in simulation experiences. There are suggestions that student satisfaction may have some correlation with performance. Few studies have explored in a rigorous way the impact of manikin fidelity on nursing students' satisfaction with simulation experiences. METHOD: The items for the Satisfaction with Simulation Experience Scale were identified following a critical review of the literature. Content validly was established by use of an expert panel. During 2009 and 2010 the instrument was tested with second year (n=268) and third year nursing students (n=76) from one Australian university. Exploratory factor analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Differences in satisfaction levels between groups were analysed using an independent t test. Responses to an open ended question were categorised using thematic content analysis. RESULTS: The scale demonstrated satisfactory internal consistency (alpha 0.77). Exploratory factor analysis yielded a three-component structure termed Debriefing and Reflection, Clinical Reasoning, and Clinical Learning; each subscale demonstrated high internal consistency: 0.94; 0.86; 0.85 respectively. Mean satisfaction scores were high for each group. However, statistically significant differences were not apparent between second or third year students exposed to medium and high fidelity manikins. Content analysis identified 13 main categories including supplementing versus replacing clinical placements and the need for increased exposure to simulation sessions. CONCLUSION: The results of this study indicate that simulation is highly valued by students, irrespective of the level of fidelity. This raises questions about the value of investing in expensive simulation modalities. The Satisfaction with Simulation Experience Scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

Implementing a clinical competency assessment model that promotes critical reflection and ensures nursing graduates' readiness for professional practice.

AIM: This paper describes the design, implementation and evaluation of the Structured Observation and Assessment of Practice (SOAP), a model used to assess third year undergraduate nursing students' clinical competence. BACKGROUND: Competence is a complex concept that is difficult to define and measure. The assessment of nursing students' clinical competence has confronted universities with problems of validity, reliability, subjectivity and bias for many years. This presents particular problems in nursing as patient outcomes may be compromised by incompetent practice. Too often assessments of nursing students' competence comprise brief assessments of psychomotor skills, vague global assessment of generic skills/attributes or assessments undertaken in simulated laboratory settings rather than the real world of practice. METHODS: The Structured Observation and Assessment of Practice (SOAP), is a full day holistic practice-driven clinical competence assessment approach that motivates nursing students' learning, promotes critical reflection and confirms graduates' readiness for professional practice. This model was introduced in 2004 and since then 1031 students have been assessed. Quantitative and qualitative data has been collected via an anonymous online evaluation. RESULTS: Survey results have been statistically analysed using The Statistical Package for the Social Sciences (SPSS) (Version 13) with exploratory factor analysis employed to ascertain construct validity. This paper will report on the four components that showed acceptable factor loadings and that together accounted for 77.65 per cent of the variance: perceived learning outcomes, consistency with general clinical performance, quality of assessors, and anxiety/stress impact. CONCLUSION: The results of the SOAP approach supports the premise that quality clinical assessment requires nursing students' exposure to complex challenges undertaken in authentic clinical contexts, observed by registered nurses who are trained as assessors and have a strong educational and clinical background.