Comparing didactic approaches for practical skills learning in Scandinavian nursing simulation centres: A qualitative comparative study.

AIM: To explore and compare the didactic approaches to practical skills learning at simulation centres in Scandinavian universities and university colleges. BACKGROUND: Academic simulation centres are an important arena for learning practical nursing skills which are essential to ensure competent performance regarding patient safety and quality of care. Knowledge of didactic approaches to enhance learning is essential in promoting the provision and retention of students' practical nursing skills. However, research on didactical approaches to practical nursing skills learning is lacking. DESIGN: A qualitative comparative design was used. METHODS: During November and December 2019, interviews were conducted with a total of 37 simulation centre directors or assistant directors, each of whom possessed in-depth knowledge of practical skills in teaching and learning. They represented bachelor nursing education in Denmark, Norway and Sweden. A qualitative deductive content analysis was conducted. RESULTS: The results revealed all five predetermined didactical components derived from the didactical relationship model. Twenty-two corresponding categories that described a variation in didactic approaches to practical skills learning in Scandinavian nursing simulation centres were identified. The didactical components of Learning process revealed mostly similarities, Setting mostly differences and Assessment showed only differences in didactic approaches. CONCLUSION: Although various didactic approaches were described across the countries, no common approach was found. Nursing educational institutions are encouraged to cooperate in developing a shared understanding of how didactic approaches can enhance practical skills learning. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Cross-country comparisons of practical nursing skills learning in Scandinavian countries highlight the importance of educator awareness concerning the impact diverse didactic approaches may have on competent performance in nursing education. Competent performance is pivotal for ensuring patient safety and the provision of high-quality care. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REPORTING METHOD: This study followed the Consolidated Criteria for Reporting Qualitative Research reporting guidelines.

Nursing students' clinical judgment skills in simulation and clinical placement: a comparison of student self-assessment and evaluator assessment.

BACKGROUND: Clinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment. AIMS: This study aimed to compare the same group of students' self-assessment of clinical judgment with an evaluator's assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students' self-assessment of clinical judgment. METHODS: The study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson's correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot. RESULTS: The results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator's assessment. Differences between students' scores and the evaluator's scores were larger when the evaluator's scores were low, indicating the presence of the Dunning-Kruger effect. CONCLUSION: It is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student's clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students' clinical judgment skills.

Changes in nursing students' self-reported professional competence in simulation-based education and clinical placement: A longitudinal study.

BACKGROUND: A primary learning outcome for nursing students is to achieve the professional competence necessary to provide safe and high-quality care in complex and specialized health services. Simulation-based education (SBE) and clinical placement are two educational settings in which nursing students' professional competence can be facilitated as a learning outcome. OBJECTIVES: The study objectives were to investigate changes in nursing students' self-reported professional competence in SBE and clinical placement and the transfer of this competence from SBE to clinical placement. We also aimed to investigate which competence areas were highest and lowest rated. DESIGN: A quantitative longitudinal survey design was applied. SETTINGS: The study took place from May 2019 to January 2020 in a simulation center at a Norwegian university and clinical placement in hospital units. PARTICIPANTS: Bachelor nursing students (N = 38) in their second and third year of a four-year part-time Norwegian nursing bachelor's degree program. METHODS: The Nurse Professional Scale Short Form (NPC Scale-SF) consisting of six competence areas was used to measure nursing students' self-reported professional competence across four time points. Paired sample t-test and descriptive statistics were used to analyse data. RESULTS: For changes in the longitudinal perspective, students' self-reported professional competence increased significantly. In the transfer perspective, from SBE to clinical placement, four competence areas declined significantly. Value-based nursing care were scored highest, whilst Development, leadership, and organization of nursing care were scored lowest score at all time-points. CONCLUSIONS: Findings indicate that nursing students' self-reported professional competence increased in the longitudinal perspective. Supporting students in transfer of professional competence should be addressed in SBE and clinical placement, whilst nursing education should be strengthened concerning development, leadership, and organization of nursing care.

Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions.

BACKGROUND: High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators' guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator's role during simulated scenarios. METHODS: A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation. RESULTS: One main category, "Alternating between active and passive facilitation," emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students' understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator's presence in the simulation room during the simulated scenarios influenced students' emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed. CONCLUSIONS: The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.

Development and Testing of an Instrument for Summative Assessment of Practical Skill Performance: A Generalizability Theory Approach.

BACKGROUND AND PURPOSE: Many newly graduated nurses lack proficiency in practical skill performance. Presently, nursing students' practical skill is assessed by summative instruments with overarching items. The purpose of this study was to develop a more detailed instrument to use in summative assessment of nursing students' practical skill performance and to assess its psychometric properties. METHODS: A 50-item instrument was developed. Video-recorded performances were rated by experienced clinical supervisors. A multifacet measurement design was developed. Relevant parameters were estimated by generalizability analysis. RESULTS: Findings indicated that error of measurement were mainly caused by raters far more than by items. CONCLUSIONS: The present study suggested that summative assessment in realistic settings may not apply one rater only. Two to three/four raters appear necessary to dependably measure most skills.

The art of balancing: the facilitator's role in briefing in simulation-based learning from the perspective of nursing students - a qualitative study.

BACKGROUND: Facilitators plays a key role in nursing student's learning when briefing them for simulation scenarios. However, few studies have explored the importance of the facilitator's role in preparing students from the students' perspective. The aim of this study was to explore undergraduate nursing students' perspectives of the facilitator's role in briefing. METHODS: An explorative, qualitative approach was used. Four focus group interviews with a total of 30 nursing students constituted the data source. Data collection took place in December 2017 and in May 2018. The data was analysed using systematic text condensation. RESULTS: Two main categories were identified: "The importance of framing the subsequent scenario" and "The importance of instructing students how to execute nursing actions in the subsequent scenario". The first category consisted of three subcategories: providing predictability, providing emotional support and providing challenges. The second main category also consisted of three subcategories: providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin. CONCLUSION: A briefing is more than a general introduction to a simulation scenario, learning objectives, roles, simulation environment and medical equipment. The information provided in a briefing is important for nursing students' understanding of what they will encounter in the simulation scenario and what is being simulated, as well as possibly being a prerequisite for mastery. The facilitator's role in the briefing is complex and requires a high level of educational expertise to balance the diversity of students' learning approaches. Students have to learn how to simulate before the briefing. Therefore, we suggest separating the concepts of prebriefing and presimulation from the concept of briefing, introducing prebriefing and presimulation preparation before briefing, and possibly dividing students into groups based on their learning approach. Such interventions will make it possible for facilitators to balance between students' needs and the time available for briefing. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12912-020-00493-z.

Psychometric testing of the Norwegian version of the Simulation Design Scale, the Educational Practices Questionnaire and the Student Satisfaction and Self-Confidence in Learning Scale in nursing education.

Introduction: Simulation-based learning is a well-established technique in nursing education. However, there is a need for reliable and validated evaluation tools across both national boundaries and cultural conditions. Such evaluation tools may contribute in identifying areas for improvement in simulation-based learning from the nursing students' perspective. Objectives: The aim of this study was to test three widely used American questionnaires - the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, for psychometric properties among Norwegian undergraduate nursing students. Methods: A descriptive cross-sectional study was conducted at a university simulation center in southern part of Norway. A total of 105 undergraduate nursing students participated, giving a response rate of 77%. An exploratory factor analysis was used to examine construct validity. Cronbach's alpha was applied in order to establish the questionnaires' internal consistency. Results: The exploratory factor analyses displayed the same number of extracted factors as the number of subscales in each of the original American questionnaires. However, the item-factor structure differed from the original item-subscales. The Cronbach's alpha was > 0.7 for all three questionnaires, indicating acceptable internal consistency. Conclusion: Psychometric testing of the Norwegian versions of the three questionnaires, the Simulation Design Scale, the Educational Practices Questionnaire, and the Student Satisfaction and Self-Confidence in Learning Scale, could be used as valid instruments for nursing students to evaluate important aspects of simulation-based learning. This also makes it easier to compare evaluation results of SBL across languages and cultural boundaries. However, to confirm the construct validity of the factors extracted in this study, further multi-site studies are needed to perform a confirmatory factor analysis in a new, large sample.

The Impact of a New Pedagogical Intervention on Nursing Students' Knowledge Acquisition in Simulation-Based Learning: A Quasi-Experimental Study.

Simulation-based learning is an effective technique for teaching nursing students' skills and knowledge related to patient deterioration. This study examined students' acquisition of theoretical knowledge about symptoms, pathophysiology, and nursing actions after implementing an educational intervention during simulation-based learning. A quasi-experimental study compared theoretical knowledge among two groups of students before and after implementation of the intervention. The intervention introduced the following new components to the existing technique: a knowledge test prior to the simulation, video-recording of the performance, and introduction of a structured observation form used by students and facilitator during observation and debriefing. The intervention group had significantly higher scores on a knowledge test conducted after the simulations in comparison to the scores in the control group. In both groups scores were highest on knowledge of symptoms and lowest on knowledge of pathophysiology; the intervention group had significantly higher scores than the control group on both topics. Students' theoretical knowledge of patient deterioration may be enhanced by improving the students' prerequisites for learning and by strengthening debriefing after simulation.

Structured debriefing: What difference does it make?

Debriefing in simulation is a cornerstone of learning. However, in-depth studies examining simulation debriefing are scarce. This study explored four key debriefing attributes-feedback, reflection, knowledge development, and psychological safety-prior and subsequent to the implementation of a new pedagogical intervention in a pre-clinical scenario simulation course. The scenarios focused on patients with deteriorating conditions and took place at bachelor's nursing degree level. The new intervention for the debriefing sessions contained a detailed observation tool describing specific, correct nursing actions for deteriorating patients; video playback watched only by students acting as nurses, and debriefing organized into two sections. The study design was explorative. To generate data, 12 debriefing sessions were audio and video recorded in 2013 and 11 in 2014. Two student groups participated each year, comprising 16 and 10 students, respectively. Qualitative analysis was performed to examine the transcribed audio and video recordings. Relative to the 2013 cohort, the reflections of observers and the students acting as nurses were more assertive, and students' feedback was more specific and comprehensive in the 2014 cohort. Conducting in-depth studies examining debriefing is important to increase knowledge regarding the impact of pedagogical underpinnings on debriefing content and processes.

Key issues and challenges in developing a pedagogical intervention in the simulation skills center--an action research study.

Simulation skills centers (SSC) are considered important learning arenas for preparing and qualifying nursing students. Limited clinical placements and claims of diminished learning opportunities raise concerns that newly educated nurses lack proficiency in many psychomotor skills. Accordingly, there is an increased focus on learning in the SSC. However, it has been questioned if the pedagogical underpinning of teaching and learning in the SSC is missing or unclear. At a bachelor nursing education in Norway, there was a desire to change practice and enhance learning in the SSC by systematic use of The Model of Practical Skill Performance (Bjørk and Kirkevold, 2000). A participatory action research design was chosen. A pedagogical intervention was developed and implemented in 2010 in a cohort of eighty-seven first year bachelor nursing students during their basic nursing skill course. The intervention is shortly described. This article reports key issues and challenges that emerged during development of the new intervention. Data to inform the study were collected via thorough meeting minutes and the project leader's logbook, and analyzed using fieldnotes analysis. Six key issues and challenges were identified. These are presented and discussed consecutively in light of their importance for development and implementation of the new intervention.

From theoretical model to practical use: an example of knowledge translation.

AIM: To present a case of knowledge translation in nursing education and practice and discusses mechanisms relevant to bringing knowledge into action. BACKGROUND: The process of knowledge translation aspires to close the gap between theory and practice. Knowledge translation is a cyclic process involving both the creation and application of knowledge in several phases. The case presented in this paper is the translation of the Model of Practical Skill Performance into education and practice. Advantages and problems with the use of this model and its adaptation and tailoring to local contexts illustrate the cyclic and iterative process of knowledge translation. DISCUSSION: The cultivation of a three-sided relationship between researchers, educators, and clinical nurses was a major asset in driving the process of knowledge translation. The knowledge translation process gained momentum by replacing passive diffusion strategies with interaction and teamwork between stakeholders. The use of knowledge creates feedback that might have consequences for the refinement and tailoring of that same knowledge itself. With end-users in mind, several heuristics were used by the research group to increase clarity of the model and to tailor the implementation of knowledge to the users. IMPLICATIONS FOR NURSING: This article illustrates the need for enduring collaboration between stakeholders to promote the process of knowledge translation. Translation of research knowledge into practice is a time-consuming process that is enhanced when appropriate support is given by leaders in the involved facilities. CONCLUSION: Knowledge translation is a time-consuming and collaborative endeavour. On the basis of our experience we advocate the implementation and use of a conceptual framework for the entire process of knowledge translation. More descriptions of knowledge translation in the nursing discipline are needed to inspire and advise in this process.