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Virtual Gaming Simulation in Nursing Education: A Focus Group Study
Abstract
Background:
The use of serious gaming in a virtual world is a novel pedagogical approach in nursing education. A virtual gaming simulation was implemented in a health assessment class that focused on mental health and interpersonal violence. The study's purpose was to explore students' experiences of the virtual gaming simulation.
Method:
Three focus groups were conducted with a convenience sample of 20 first-year nursing students after they completed the virtual gaming simulation.
Results:
Analysis yielded five themes: (a) Experiential Learning, (b) The Learning Process, (c) Personal Versus Professional, (d) Self-Efficacy, and (e) Knowledge.
Conclusion:
Virtual gaming simulation can provide experiential learning opportunities that promote engagement and allow learners to acquire and apply new knowledge while practicing skills in a safe and realistic environment. [J Nurs Educ. 2017;56(5):274-280.].
... Geriatric psychiatry was the the most widely represented topic (Buijs-Spanjers et al., 2018, 2020Chao et al., 2012;Goldman et al., 2008;Kelly et al., 2020;Matsumura et al., 2018;Robles et al., 2019;Rosen et al., 2013). Other topics included managing boundary-seeking patients (Kunaparaju et al., 2018;Taverner et al. 2000), assessing the risk of interpersonal violence (Verkuyl et al., 2017), combating stigma (Kerby et al., 2008;Wei Liu, 2021;Nguyen et al., 2012;Winkler et al., 2017), screening for suicidal ideation (Foster et al., 2015;Kullberg et al., 2020) and substance use disorders (Bremner et al., 2020;Burmester et al., 2019;Koetting & Freed, 2017;Lee et al., 2008;Tanner et al., 2012), assessment (Washburn et al., 2016(Washburn et al., , 2020, mental state examination Hansen et al., 2020;Martin, et al. 2020;;Williams et al., 2001), diagnostic skills (Gutiérrez-Maldonado et al., 2015), treatment of mental illness (Hayes-Roth, 2004;Kitay et al., 2020;Mastroleo et al., 2020;Smith et al., 2020;Warnell et al., 2005), patient-centered skills Choi et al., 2020;Foster et al., 2016;Pedersen et al., 2018Pedersen et al., , 2019Sunnqvist et al., 2016), behavioral medicine (Berman et al., 2017), and Virtual patients in undergraduate psychiatry education: a… perinatal mental health (Dubovi, 2018). One study did not clearly describe the topic focus of the virtual patient intervention (Nongmeikapam et al., 2019). ...
... Second, authenticity was important for developing students' empathy and understanding of the patient's perspective. Virtual patient interventions using actors or real patients were perceived as being authentic (Pedersen et al., 2018(Pedersen et al., , 2019Verkuyl et al., 2017), while virtual patient interventions using avatars (Washburn et al., 2020) or a videotape of a simulation between an actor and a manikin (Kelly et al., 2020) were perceived as being less authentic. The two latter studies revealed that lack of authenticity negatively influenced students' abilities to empathize with the patient. ...
... Fourth, integrated feedback was considered important for identifying knowledge gaps. In some of the reviewed qualitative and mixed-methods studies, students requested further feedback (Berman et al., 2017;Choi et al., 2020;Fog-Petersen et al., 2020;Kelly et al., 2020;Smith et al., 2020;Sunnqvist et al., 2016;Verkuyl et al., 2017). ...
Virtual patients are increasingly used in undergraduate psychiatry education. This article reports on a systematic review aimed at providing an overview of different approaches in this context, describing their effectiveness, and thematically comparing learning outcomes across different undergraduate programs. The authors searched PubMed, PsycInfo, CINAHL, and Scopus databases for articles published between 2000 and January 2021. Quantitative and qualitative studies that reported on outcomes related to learners’ knowledge, skills, and attitudes following an intervention with virtual patients in undergraduate psychiatry education were reviewed. Outcomes were thematically compared, and a narrative synthesis of the different outcomes and effectiveness was provided. Of 7856 records identified, 240 articles were retrieved for full-text review and 46 articles met all inclusion criteria. There were four broad types of virtual patient interventions: case-based presentation (n = 17), interactive virtual patient scenarios (n = 14), standardized virtual patients (n = 10), and virtual patient videogames (n = 5). The thematic analysis revealed that virtual patients in psychiatry education have been used for learners to construe knowledge about symptomatology and psychopathology, develop interpersonal and clinical communicative skills, and to increase self-efficacy and decrease stigmatizing attitudes towards psychiatric patients. In comparison with no intervention, traditional teaching, and text-based interventions, virtual patients were associated with higher learning outcomes. However, the results did not indicate any superiority of virtual patients over non-technological simulation. Virtual patients in psychiatry education offer opportunities for students from different health disciplines to build knowledge, practice skills, and improve their attitudes towards individuals with mental illness. The article discusses methodological shortcomings in the reviewed literature. Future interventions should consider the mediating effects of the quality of the learning environment, psychological safety, and level of authenticity of the simulation.
... Six studies showed that VRS allows students to act several roles in different settings [4,13,[16][17][18][19], and seven studies showed that VRS enhances the role of students in debriefing, orientation and interacting with a virtual environment, self-reflection, and clinical reasoning [20][21][22][23][24][25][26]. On the other hand, four studies showed the effectiveness of performing skills on actual patients after using various VRS techniques [26][27][28]. ...
... Fifteen (65%) of twenty-three studies examined that VRS can improve student learning or their knowledge. In cognitive context, six studies showed that VRS increase acquisition and retention of knowledge [4,13,16,18,22,25]. Furthermore, VRS enhances development, gained, and applying knowledge [13,19,23,27,29]. ...
... Eleven studies (48%) examined learner satisfaction after VRS use. Ten studies showed an increase in learner satisfaction [20,22,24,25,27,[30][31][32][33]35]. One study that compared VRS with face-to-face/manikin simulation showed no difference in satisfaction with the learning experience [21]. ...
Purpose:
This review was aimed to evaluate the effectiveness of virtual reality simulation as a teaching / learning strategy on the acquisition of clinical skills and performance, self-confidence, satisfaction and anxiety level in nursing education.
Methodology:
The Preferred Reporting Items for Systematic Reviews guidelines, using the PICO model that is based on an evidence-based practice process was matched. A total of twenty-three studies included six themes: performance skills (n = 13), self-confidence (n = 8), satisfaction (n = 10), anxiety level (n = 3), self-efficacy (n = 4), and knowledge (n = 15). Experimental randomised control trials and quasi-experimental studies from 2009 to 2019, conducted in English, were included. Nursing students (n = 1797; BSN, ADN, MSc, LPN) participated.
Results and conclusion:
This review was indicated that virtual reality simulation provides learning strategy to acquire clinical skills, improve knowledge acquisition, increase self-confidence, self-efficacy, and satisfaction level, and decrease anxiety levels among nursing students.
... The learners' experiences varied based on population, educational content, and teaching methodologies. One of the most prevalent themes was the advantage of providing the learner immediate feedback during the gaming and learning process (Boada et al., 2015;Cant & Cooper, 2014;Darragh et al., 2016;De Gagne et al., 2013;Del Blanco et al., 2017;Davidson & Candy, 2016;Fonseca et al., 2015;Foss et al., 2014;Lacey et al., 2016;Lemermeyer & Sadesky, 2016;Koivisto et al., 2016;Koivisto et al., 2017;Koivisto et al., 2018;Popil & Dillard-Thompson, 2015;Pront et al., 2018;Verkuyl et al., 2016;Verkuyl et al., 2017). This overwhelming positivity was further highlighted in two articles that cited that lack of immediate feedback was seen as a deficit to learners (Brull et al., 2017;Tan et al., 2017). ...
... Additionally, learner feedback reinforced the desire for games to be as true to life scenarios as possible (Darragh et al., 2016;Koivisto et al., 2017;Koivisto et al., 2018;Pront et al., 2018;Verkuyl et al., 2016;Verkuyl et al., 2017). Realistic scenarios allow users to make decisions and experiment without facing real-life risks (Cant & Cooper, 2014;Koivisto et al., 2017;Pront et al., 2018;Verkuyl et al., 2016;Verkuyl et al., 2017). ...
... Additionally, learner feedback reinforced the desire for games to be as true to life scenarios as possible (Darragh et al., 2016;Koivisto et al., 2017;Koivisto et al., 2018;Pront et al., 2018;Verkuyl et al., 2016;Verkuyl et al., 2017). Realistic scenarios allow users to make decisions and experiment without facing real-life risks (Cant & Cooper, 2014;Koivisto et al., 2017;Pront et al., 2018;Verkuyl et al., 2016;Verkuyl et al., 2017). Regardless of these attributes, ease of use was largely associated with overall learner satisfaction. ...
The objective of this literature review and evaluation project was to determine what evidence exists on the use of interactive digital learning and gamification for adult learners in nursing, for the purpose of guiding a redesign of our organization's online clinical education courses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in the literature search, with the critical analysis and leveling of evidence. After determining the search terms, four electronic databases (PubMed, CINAHL, ERIC, and Cochrane) were searched with the guidance of a medical librarian. Eight reviewers participated, and an evidence-based practice specialist served as auditor. Twenty-three articles were included in the review, which revealed overall support for the gamification process with specific findings about optimizing the process. The review further suggested that interactive digital learning in the form of games, gamification, or scenario-based learning has a positive effect on learner engagement and satisfaction; however, none of the studies were able to quantify objective data about knowledge retention. Further research is needed to test different modalities that improve both learner engagement and knowledge retention. [J Contin Educ Nurs. 2020;51(11):509-515.].
... Studies examined the student experience, appreciation, and perceived benefits of virtual simulation. Students described the virtual simulation experience as enjoyable, [68][69][70] fun, 19,39 easy to use, 71,72 great, 73 realistic, 74,75 engaging, 10,19,35,39,68,74,76 and express a high level of satisfaction. 6,15,18,20,24,25,37,41,[58][59][60]63,[76][77][78][79][80] Students enjoyed the ability to interact with others and work in groups. ...
... Students described the virtual simulation experience as enjoyable, [68][69][70] fun, 19,39 easy to use, 71,72 great, 73 realistic, 74,75 engaging, 10,19,35,39,68,74,76 and express a high level of satisfaction. 6,15,18,20,24,25,37,41,[58][59][60]63,[76][77][78][79][80] Students enjoyed the ability to interact with others and work in groups. 70 Students appreciated the ability to study at home and felt that the virtual simulations helped more than just reading from textbooks. ...
... 28 After virtual simulation, they felt better prepared. 44,76,81 Gerdprasert et al 28 found that the more the time students spent on the Web site, the higher the student satisfaction scores. Of 12 RCT's that examined satisfaction, 10 studies incorporating virtual simulation reported high student satisfaction. ...
Statement:
As virtual simulation is burgeoning, faculty and administrators are asking for evidence of its effectiveness. The objective of this systematic review was to identify how virtual simulation impacts nursing student learning outcomes. Applying the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, 80 studies were reviewed. Results indicate that most research (n = 69, 86%) supported virtual simulation as an effective pedagogy to support learning outcomes while highlighting gaps and areas of bias. Adding search terms could have expanded the findings. The body of evidence supports virtual simulation as an effective pedagogy. Future studies should use more robust research designs, prioritize curricular integration of virtual simulation, and determine best practices in virtual simulation methodology.
... 14,15,[32][33][34] Although there are few studies on the use of these technologies in medical and dental education, [35][36][37] are widely used in many others. [6][7][8][9]38,39 In this study, the effect of SGbased technology on BLS performance in dental students was investigated and 3DMedSim tablet-based BLS SG application and 3DMedSim VR-based BLS SG application modules were used providing both highly interactive and self-directed learning opportunities. The study's hypothesis was confirmed by the findings, which showed that the SG-based training program for BLS improved performance at both the knowledge and competence levels. ...
... It has been suggested that serious gaming can help students and instructors study actively and independently while also serving as a useful time management tool. 38 Our study's findings corroborate the existing literature. 1,6,7,9,10,41 Medical students, the majority of whom do not play video games, have very positive opinions about the use of video games and new media technology in medical education, according to research by Kron et al. into the experiences and attitudes of medical students toward video games as an educational tool. ...
Objectives:
The aim of this study was to investigate the impact of serious game training on the performance of undergraduate dental students during basic life support (BLS) training.
Methods:
Students at the Ankara University Faculty of Dentistry were divided into two groups at random: Serious Game (SG) (n = 46) and Traditional (Tr) (n = 45). Students completed the BLS pre-test following their lecture-based training. The SG set of students practiced until they achieved an 85 on the BLS Platform, after which they completed the BLS post-test. All students practiced cardiopulmonary resuscitation (CPR) on a manikin with the instructor's guidance, and then they independently applied CPR by using the model training component. The module evaluation scale was then used to determine each student's grade. Finally, the students provided input on surveys regarding technology perceptions of SG training, serious gaming, and hands-on training.
Results:
In the SG group, the BLS post-test scores were significantly higher than the pre-test results (p = 0.00). In the SG and Tr groups, there was no statistically significant difference in the overall hands-on training scores (p = 0.11). Students in both groups evaluated the hands-on training on the manikin favorably and with high levels of participation.
Conclusions:
The SG-based training platform for BLS training has enhanced the BLS performance of undergraduate dental students in terms of knowledge and skill. It has been shown that digital learners have a beneficial impact on game-based learning outcomes; it is advised to use SGs and develop new games for various learning objectives.
... "…I was just looking at a screen, but I felt really anxious, and I felt a lot of compassion...definitely made the learning experience a lot more personal" Verkuyl, Hughes, et al. (2017), p.276. ...
... Fun Davidson and Candy, 2016;Koivisto et al., 2017;Verkuyl, Hughes, et al., 2017 Alleviation of stress Besse et al., 2020;Frazer, 2007;Hodges, 2008; Different levels of stress ...
Background
To meet the evolving needs of today's nursing students and the demand for 21st century skills in modern healthcare, game-based learning has received increasing attention. It can improve learning outcomes, while enhancing learning experiences by promoting engagement and motivation.
Objective
To explore the learning experiences of using game-based education in nursing students.
Data sources
Electronic databases of PubMed, EMBASE, Cochrane Library, CINAHL (EBSCOhost), and Scopus were searched from inception till January 2021.
Review methods
Quantitative, qualitative, and mixed-methods studies were included, involving the use of games for education among nursing students. Both published and unpublished studies in English language without restrictions to the year of publication. Methodological quality of included studies was assessed using the mixed methods appraisal tool. Data synthesis used a convergent synthesis approach. Narrative synthesis was used for quantitative findings and thematic synthesis for qualitative findings. A result-based convergent synthesis was adopted to integrate both results.
Results
A total of 53 studies were included among 4612 nursing students across 16 countries. These included 32 quantitative studies, 7 qualitative studies, and 14 mixed-methods studies, with methodological quality ranging from low to high. The findings from this review demonstrate that game-based education interventions can enhance nursing students’ learning experiences. Three themes emerged from both quantitative and qualitative syntheses: 1) motivators of learning, 2) facilitators of engagement, and 3) affective response.
Conclusions
Game-based education is promising in promoting positive learning experiences among nursing students. This can better inform educators and healthcare leaders when considering gaming as an alternative education approach in motivating and engaging students in learning. Future research should provide greater focus on examining the use of specific games under similar contexts.
... Worldwide, numerous studies have been conducted to elucidate the impact of blended learning in nursing education on the students' engagement, satisfaction, and learning outcomes. Most of these studies have indicated that the use of the blended approach improved students' outcomes and increased their levels of satisfaction (Al-Hatem et al., 2018;Alvarez et al., 2017;Leidl et al., 2020;McCutcheon et al., 2018;Verkuyl et al., 2017). Blended approach was also seen as an innovative approach that would positively affect student engagement and success (Picciano et al., 2013). ...
... The findings of the present study were in agreement with the research of previous studies that indicated that the use of a blended approach improved students' outcomes and that their level of satisfaction was higher (Al-Hatem et al., 2018;Alvarez et al., 2017;Leidl et al., 2020;McCutcheon et al., 2018;Verkuyl et al., 2017). These findings propose that blended learning can be a viable option to maintain and increase students' satisfaction. ...
Background
Blended learning is a relatively new educational approach that has been introduced into higher education in Palestine. While it has many advantages, there is no empirical evidence, nor any case studies from Palestine to support the use of blended learning over traditional classroom.
Objectives
To compare students’ learning outcomes, learning perceptions of their educational environment, and satisfaction of blended learning versus traditional classroom.
Design
A quasi-experimental study.
Setting
A public university in Palestine.
Participants
102 Bachelor of Science in nursing students enrolled on the maternal health course.
Methods
Students freely chose to register for the blended teaching section (49 students) or traditional classroom (53 students), then the teaching method for each section was assigned. Student demographics, course component grades, perceptions of the educational environment, measured by the Arabic version of Dundee Ready Education Environment Measurement (DREEM) inventory, and degree of satisfaction were collected in this study. Descriptive statistics and the Independent Sample t-test were used to analyze the data.
Results
The sample included 49 students in the blended teaching section and 53 students in the traditional section. Overall DREEM scores, Student Perceptions of Learning, and Student Perceptions of Teachers were significantly higher for students taught with the blended method compared to traditional classroom settings. The total DREEM scores were between 101 and 151 for both sections, indicating that all students, regardless of teaching method, had more positive than negative perceptions of their educational environment. Moreover, there was no significant difference in scores and total course GPA (Grade Point Average), both with and without assignment grades, or between blended and traditional learning in first, second and final exams. However, students taught with the blended format scored significantly higher in assignments than students taught the traditional classroom.
Conclusions
Blended learning can be a useful educational approach in nursing education and Palestinian universities may consider using it for nursing courses.
... Nursing students can emulate the roles of registered nurses and provide therapeutic care to a virtual patient in the same way they would with a real-life patient based on information provided during simulation (Padilha et al., 2019). The integration of virtual simulation into nursing pedagogy fits with the new generation of nursing students' learning needs (Verkuyl et al., 2017). Reported advantages of nursing students using virtual simulation include providing a safe, nonthreatening practice environment (Cobbett & Snelgrove-Clarke, 2016), offering flexible and reproducible learning experience (Peddle et al., 2016), and catering to a large number of learners simultaneously (Sok Ying et al., 2014). ...
... Interestingly, it was noted that a greater percentage of older students (!25 years of age) was recruited into the comparison non-simulation cohort when compared with the current simulation cohort. Although age was not found to be associated with students' mental health knowledge and beliefs in the present study, the notable age difference between the two student cohorts reflected a growing number of young students entering nursing schools over the past few years, which further opens up the possibilities for incorporation of technologies into nursing pedagogy to fit with the young students' way of being and knowing (Verkuyl et al., 2017). ...
This prospective cohort study aimed to evaluate the long-term effects of virtual simulation on nursing education by measuring undergraduate nursing students’ mental health literacy. Students’ beliefs about the helpfulness of specific interventions for managing depression and schizophrenia were compared between the simulation cohort (n = 149) and the non-simulation cohort (n = 150) from a school of nursing in the U.S. Students in the simulation cohort showed significant increase in knowledge and acceptance of available treatment options for managing depression and schizophrenia over a one-year period. The finding supports the use of virtual simulation in undergraduate mental health nursing education with active faculty engagement.
... 10 Selain itu penggunaan virtual gaming reality juga memberikan peluang dalam memperoleh pengalaman pembelajaran tersendiri bagi siswa karena ilmu yang diperoleh langsung dipraktikan dalam suatu lingkungan yang aman serta realistis. 12 Penggunaan virtual gaming dalam pembelajaran juga meningkatkan pengalaman pembelajaran bagi para siswa, proses pembelajaran yang dirasa menarik, sikap professional yang ditunjukan, meningkatkan kemampuan diri serta meningkatkan pengetahuan. 12 Penelitian lainnya menyebutkan bahwa penggunaan game dalam Pendidikan dengan berbasis video dapat memberikan peningkatan dalam kemampuan penalaran dan pengambilan keputusan para siswa. ...
... 12 Penggunaan virtual gaming dalam pembelajaran juga meningkatkan pengalaman pembelajaran bagi para siswa, proses pembelajaran yang dirasa menarik, sikap professional yang ditunjukan, meningkatkan kemampuan diri serta meningkatkan pengetahuan. 12 Penelitian lainnya menyebutkan bahwa penggunaan game dalam Pendidikan dengan berbasis video dapat memberikan peningkatan dalam kemampuan penalaran dan pengambilan keputusan para siswa. 11 Skenario yang diberikan dalam game education berbasis video lebih mudah dipahami terutama yang berhubungan dengan kegiatan praktik klinis. ...
Development of information and communication technology that increases complexity in the education system where the learning process develops to be electronic-based, the use of electronic-based learning systems in nursing education provides an interesting development for students. one of them is the use of educational game platforms. The use of educational game platforms can provide convenience in learning the learning system. The method of reading this article is the Study of Literature Review through searching articles on 2 data-based, namely: Science Direct and Scopus. The inclusion criteria for this literature study are full text free, waiting for English, and published 2013-2018. The keywords used in the search article are Games, Educational Games, Platform Educational Games, Nursing Educational Games. search results found 294 articles starting with reading the title and abstract sections to find 10 articles that are relevant for use for literature review. The results of the conclusions study concluded that the use of educational game platforms in the learning process can increase learning interest, student satisfaction levels, increase self-efficacy, the level of punishment and the ability to make decisions. The use of educational games can also increase student learning prose, create active learning arrangements, easy to understand learning material, and improve students' clinical teaching skills. Educational games related to educational game platforms, collaboration between education and related parties Industrial games to educate game platforms according to the needs in the learning process.
... Debriefing provides an opportunity for learners to reflect on their actions and identify strengths and areas for improvement (Al Sabei & Lasater, 2016); these skills are essential for the reflective practitioner. Our earlier research (Verkuyl et al., 2017), in addition to other studies (Miller, Farra, & Simon, 2018;Roh & Jang, 2017), has led us to recognize that although game design is clearly important, the actual process of implementing the VGS, particularly the debriefing process, is equally important to achieving learning outcomes. ...
... This open-source VGS is currently being used in nursing programs internationally. The VGS design was based on Kolb's (2015) Experiential Learning Model and provides an interactive, experiential online opportunity for students to problem-solve and make decisions in a simulated clinical environment (Verkuyl et al., 2017). The game is constructed using video clips of standardized patients acting their assigned roles in typical clinical situations. ...
Background
Self-debrief alone and in combination with group debrief methods has not been well explored. Self-debrief requires self-assessment and reflection by the learner where one's strengths and areas for growth are identified. These skills are critical to the development of reflexive practitioners.
Method
A mixed methods study was conducted to examine debriefing methods. Participants completed a prenatal virtual gaming simulation and then were randomly assigned by lab section to one of three debriefing methods: self-debrief, self-debrief and small-group debrief, self-debrief and large-group debrief. Data were collected regarding two outcomes: prenatal knowledge and the debriefing experience.
Results
All groups made significant knowledge gains. The self-debrief–only participants had the lowest debriefing experience scores. The small- and large-group debriefing after self-debriefing offered many benefits.
Conclusion
Self-debrief after a virtual simulation encourages reflection and self-awareness. Combining self-debrief with a small- or large-group debrief can optimize the learning experience.
... The VGSs have been integrated into nursing programs locally, nationally, and internationally, and several studies indicate that students value the games and learn from them. [12][13][14] However, in all instances, students played the simulation individually; currently, there is no clear understanding of the best format for playing these simulations. Anecdotally, nursing faculty from across the country have reported that their students are playing the VGSs individually; however, some faculty are using the VGSs with small clinical groups or in a large class setting. ...
... This finding has been noted in previous research where students indicated they wanted a facilitated, group debriefing session following a self-debrief; this approach may optimize the learning experience. 13,14 While it was a challenge for some to find a partner who was able to play the VGS at the same time, playing in pairs offered the opportunity to clarify thinking and to gain perspective, two outcomes that could potentially support insight and knowledge retention. Participants in this evaluation preferred selecting their own partners, and there is evidence that working in self-selected teams can promote student engagement. ...
... The capacity to explore diverse strategies, learn from errors, and promptly receive feedback forms the foundation of reflective learning, nurturing a profound comprehension of medical concepts and their tangible implications. This holistic approach bridges the gap between theoretical knowledge and practical proficiency, a hallmark of virtual simulation's contribution to contemporary nursing education (17)(18)(19)(20). ...
Background: Nursing education is evolving with technological advancements, including the adoption of virtual simulation. This protocol outlines a systematic review and meta-analysis aimed at evaluating the effectiveness of virtual simulation in improving nurses' knowledge. Methods: The study adheres to PRISMA guidelines and is registered in PROSPERO (registration number CRD42022352907). Eligible studies encompass randomized controlled trials (RCTs) that examine virtual simulation's impact on registered nurses, student nurses, or nursing professionals. The intervention involves various virtual simulation tools (virtual reality, augmented reality, serious games) compared against traditional methods or control groups. The primary outcome is improved nursing knowledge, measured through validated assessment tools. Methodological quality will be assessed using the Cochrane Risk of Bias tool. Results: Electronic databases (PubMed, Scopus, Web of Science, PsycINFO) will be systematically searched for eligible studies. The search strategy combines controlled vocabulary terms and keywords to ensure comprehensive retrieval. Two reviewers will independently screen titles, abstracts, and full texts. Data extraction will be standardized to collect study details, participant characteristics, intervention specifics, outcome measures, and findings related to knowledge enhancement. Analysis: Quantitative synthesis (meta-analysis) will be conducted if sufficient homogeneity exists among the included studies. Heterogeneity will be assessed using statistical tests, with subgroup and sensitivity analyses for further exploration. The GRADE approach will assess evidence quality and recommendation strength, considering bias risk, heterogeneity, indirectness, precision, and publication bias. Conclusion: The systematic review aims to provide evidence-based insights into the impact of virtual simulation on nurses' knowledge enhancement. By synthesizing data from RCTs, the study intends to guide educational practices and policy decisions for optimizing nursing education through innovative methods.
... The review stressed the importance of looking for best practices and for a common understanding of terminology for virtual simulations (Foronda et al. 2020). Among other evidence of the effectiveness of the method are increased empathy towards people with mental health illness (Wan and Lam 2019) through virtual simulation and improved assessment skills through virtual gaming simulation (Verkuyl et al. 2017). ...
Purpose: to describe nursing students’ experiences of learning with help of virtual learning materials and virtual simulations. The aim was to produce knowledge that can be used to develop virtual simulation teaching and counseling further and to support students’ self-debriefing. Methods: This is a mixed method study conducted with 13 final-stage nursing students at a University of Applied Sciences in Finland. Following virtual simulations performed during an acute nursing course, the students completed a questionnaire with qualitative and quantitative items on their experiences and on the usefulness of the simulations. The findings are primarily based on an inductive content analysis of the students’ responses to qualitative items. The quantitative data, analyzed by means of SPSS, was used to support the qualitative analysis. Results: Most participants found virtual simulation learning and the use of virtual reality glasses a welcome change and a meaningful and safe way to promote their theoretical and practical competencies. They appreciated the possibility to choose the topic and the time and place of study. The simulations had been useful in practicing assessment and decision-making skills. Problem-solving, simulation of rare incidents, game-like elements and step-by-step feedback were proposed. A few students disliked the artificial setting and some reported headache and nausea. Conclusion: Virtual simulations and virtual reality glasses can be effectively used to teach final-stage nursing students as part of a blended learning approach. Careful planning of the learning contents and a suitable level of challenge in the simulations increase student motivation. Keywords: experience, nursing student, acute nursing, virtual simulation, virtual reality, VR glasses
... Alvarez, Dal Sasso & Iyengar (2017) and Verkuyl et al. (2016) used hybrid learning-based mobile applications in pain assessment courses. Both of the studies stated that hybrid learning was useful to increase nursing students' pain assessment skills (35,36). Shorey et al. (2018) explained that nursing students had enhanced communication skills after the hybrid learning process in their study (15). ...
Objective: This study aimed to examine the effectiveness of hybrid learning pedagogy in a redesigned diabetes nursing course for senior nursing students in enhancing knowledge and skills related to diabetes education. Methods: A single-group pre-test and post-test quasi-experimental design were used. The study was conducted between January-June 2018 in a state university's nursing department in Istanbul, Turkey. Sixteen senior nursing students were included in the sample group of the study. Results: It was detected that the Insülin Injection Skill Checklist (II-SC) post-test score, Blood Glucose Measurement Skill Checklist (BGM-SC) post-test score, and Educational Skills Checklist (ESC) post-test score were significantly higher than the pre-test scores. There was a significant difference between the Mini Exams (ME) pre-test and post-test scores of participants for each online lesson. Conclusions: The study results showed that a hybrid learning-based diabetes nursing course effectively increases the knowledge and skills of students regarding diabetes education.
... Virtual simulation and an adaptive learning technology have been used to increase student-learning efficiency in online nursing courses [5,6]. Online learning focuses on individual students, is flexible in time and place, enhances knowledge through easy access to information, and facilitates interaction through discussion forums and collaboration. ...
Nursing has embraced flexible online advanced education as a means of increasing the supply of nurse professionals. Virtual simulation and other adaptive learning technologies enhance learning efficiency and student outcomes. A simulated electronic health record (DocuCare) was adopted in an online graduate nursing informatics course. An assignment using DocuCare to learn core concepts of nursing informatics was developed for graduate students enrolled in a nursing informatics course. A validated standard informatics survey instrument was used to measure three individual domains (basic computer skills, roles, and advanced computer skills (clinical informatics)) as well as the combined informatics competency level. Overall, the nursing informatics competency level was between competent and proficient; basic computer skills and roles were above proficient; and advanced computer skills (clinical informatics) fell between competence and proficient levels.
... Evolving case studies have been used in the classroom, as well as for simulation development, and have been found to increase student selfconfidence (Debrew & Hensley-Hannah, 2017;Woda et al., 2017). Verkuyl et al. (2017) evaluated an online evolving case study and found students reported a high level of engagement, and an increased level of satisfaction, knowledge, and self-efficacy. Therefore, it seemed feasible to use simulations to develop evolving case studies for online use. ...
The purpose of this paper is to describe the conversion of in-person simulations into online evolving case study activities in an undergraduate nursing curriculum as a result of COVID-19 precautions. The School of Nursing at Eastern Kentucky University utilized technological resources to provide meaningful online learning activities to meet student learning outcomes. The key teaching strategies to maintain were application and synthesis of knowledge through guided reflective activities and discussion. Interactive evolving case studies were selected with critical thinking questions and video clips to promote student engagement. The curricular concepts were medication administration, prioritization of patient care, communication, patient safety, and clinical judgment. Student and faculty evaluations were overwhelmingly positive, resulting in sustained use of these teaching strategies within the curriculum.
... A virtual simulation approach may help address the learning gap by providing ongoing clinical training to students in situations where face-to-face is not possible. In previous studies, students described virtual simulation as engaging and motivating when compared with traditional learning and reported high levels of satisfaction and increased confidence in learned skills (Graham et al., 2018;Hanson et al., 2020;Verkuyl et al., 2017). ...
Aims and objectives
This study aimed to evaluate the effect of a virtual simulation education programme with debriefing in undergraduate nursing students. Perceived clinical competence and learning needs of students in a simulation environment were also measured.
Background
Evidence showed virtual simulation education programmes provided better knowledge acquisition. However, these studies to date did not incorporate virtual simulation in the combination of a debriefing model in nursing students.
Design
A one-group pre-test and post-test design.
Methods
188 final year undergraduate nursing students participated in the study. Linear mixed model analysis was conducted to evaluate the effect of the programme.
Results
Students have perceived a significant improvement in clinical competence and nursing process. Self-efficacy has also boosted. Communication and critical thinking were applied better in the traditional clinical environment.
Conclusion
Perceived clinical competence of Chinese nursing students has significant improvements by using virtual simulation combining a debriefing model during the COVID-19 period. Virtual simulation met students' learning needs. Future studies should include a control group for comparison and long-term measurement.
Relevance to clinical practice
The study provided an innovative clinical learning pedagogy to serve as a potential alternative with traditional clinical practicum during the COVID-19 period as this is substantially limited.
... Online education has shifted the focus of nursing faculty to continuously enhance online learning using technologies for students to bridge the gap between knowledge acquisition and practice. In online nursing courses, web-based and virtual simulation technologies are used to improve student learning efficiency [6][7][8]. ...
Objectives:
Nursing has embraced online education to increase its workforce while providing flexible advanced education to nurse professionals. Faculty use virtual simulation and other adaptive learning technologies to enhance learning efficiency and student outcomes in online courses. The purpose of this study was to assess the impact of simulated Electronic Health Records (EHRs) on informatics competency in a graduate online informatics course.
Methods:
A two-group independent measures study design was adopted to assess students' perception of a simulated EHR while comparing differences in informatics competencies between an intervention group and a control group. A simulated EHR assignment was provided to students in the intervention group, and a paper assignment was provided to those in the control group. The informatics competency of the students was measured using the Self-Assessment of Informatics Competency Scale for Health Professionals (SICS).
Results:
Students who were enrolled in a family nurse practitioner program in fall of 2019 participated in this study (n = 39). The students expressed positive perceptions of a simulated EHR experience. The SICS results indicated that students in the intervention (simulated EHR) group showed higher informatics competency than those in the control group.
Conclusions:
The positive results of this study support incorporating simulated EHR exercises in online courses. Higher informatics competency in the intervention group implies that the use of simulated EHR facilitated learning of complicated informatics concepts.
... In studies specific to mental health nursing education, researchers have reported findings in favor of simulation experiences. In a focus group study, Verkuyl et al. (2017) explored 20 Canadian nursing students' experiences of using virtual gaming simulation to conduct mental health and interpersonal violence assessments. Students reported that virtual gaming simulation allowed them to learn and apply new knowledge while practicing assessment skills in a safe and realistic environment. ...
Background
Virtual simulation as an emerging technology is thought to be most amenable to mental health nursing education. This study aims to evaluate the effects of virtual simulation on undergraduate nursing students’ beliefs about prognosis and long-term outcomes for people with depression and schizophrenia.
Methods
A prospective cohort design was used in this study. Students’ responses were compared between the simulation cohort (n = 149) and the nonsimulation cohort (n = 150) at a school of nursing in the United States.
Results
Nursing students developed a greater insight into the prognosis of people with depression after receiving virtual simulation. Furthermore, virtual simulation increased nursing students’ optimistic beliefs about the long-term outcomes for people with depression and decreased their pessimistic beliefs about the long-term outcomes for people with schizophrenia.
Conclusions
Virtual simulation can be used as an effective experiential learning tool to foster undergraduate nursing students’ positive beliefs about and attitudes toward mental illness.
... Interactive pre-simulation activities such as video simulation case studies and other types of virtual simulations are burgeoning. Future studies should prioritize curricular integration of more interactive presimulation preparatory activities and evaluate the impact on student learning, before in-person simulations or participation in virtual simulations [21][22][23][24][25]. Additionally, more experimental research is required that focuses on the pre-encounter learning aspect as simulations are being used for high stakes assessments and to replace clinical practice time. ...
Background
As simulation science continues to advance, the focus previously put on scenario creation and debriefing must now be applied to other components of the learning experience. There is a need to examine the effectiveness of pre-simulation activities and how they relate to the overall simulation experience and learning outcomes. However, few randomized controlled trials have been conducted comparing different approaches in the pre-simulation preparatory phase and the impact on learning outcomes.
Methods
A randomized controlled trial was conducted with undergraduate nursing students (n=83) who were randomized to a traditional paper case study (control group) or an interactive pre-simulation activity (intervention group). The use of the two-challenge rule and Satisfaction and Self Confidence in Learning (SSL) was evaluated.
Results
The proportion of students who utilized the two-challenge rule in the intervention group was significantly higher than the control group. Results from the two independent-samples Wilcoxon-Mann-Whitney test showed a significant difference in the median of the total score of the SSL W=2.5, p <0.001, satisfaction W=6.0, p <0.001, and self-confidence W=68.0, p <0.001 in learning between third-year nursing students in the control and intervention groups.
Conclusion
Our results showed significant differences in the use of the two-challenge rule by students who completed an interactive pre-simulation activity (intervention group) compared to those who completed the paper case study (control group). Additionally, students in the intervention group were more self-confident and satisfied with the entire simulation intervention than the control group. From a pedagogical perspective, this study also emphasizes the need to ground simulations in theory. Moreover, there is value in using progressive frameworks, i.e., revised Medical Research Council (2014) in simulation design and research to ensure high quality. More studies are required to examine the right dosage and type of pre-simulation activity and impact on learning outcomes.
... Two other articles involve blended approaches that utilize Second Life (Kidd et al., 2012;Al-Hatem et al., 2018), a virtual gaming platform that allows users to access an online 3-D virtual world. Another article blended a different virtual gaming platform with online learning modalities and lecture time (Verkuyl et al., 2017). A single article involved the use of LabTutor, a software suite developed by ADInstruments Inc. which provides a range of hands-on laboratory background for students including experimental background and protocols, data acquisition and analysis, and report generation (ADInstruments, 2019). ...
Objectives:
To provide a comprehensive scoping review of the existing literature regarding the use of blended learning in undergraduate nursing education. To align the varied educational terms and definitions with the broad definition of blended learning.
Design:
Scoping review following established methodology.
Data sources:
In consultation with library services, the academic literature was searched. Electronic databases searched included ERIC (OVID), Medline (OVID), PubMed, Nursing and Allied Health, and CINAHL Plus.
Review methods:
A total of 189 potentially relevant nursing research articles published between the years of 2009 and 2019. Three reviewers independently reviewed the articles, leaving 37 relevant primary articles in the nursing field to be included in the scoping review.
Results:
Nursing content delivered using blended learning approaches were organized into 8 themes. Themes include Professional Nursing Skills; Mental Health Nursing; Bioscience; Pharmacology, Specialty Populations; Nursing Assessment; Acute Care Nursing; and the Art of Nursing. A variety of blended learning approaches are being utilized in Undergraduate nursing education, the majority of which are happening in the classroom.
Conclusion:
This scoping review presents explicit the degrees to which blended learning is referred to in the nursing education literature and expanded the definition of blended learning to encompass the terminology associated with distributed, decentralized, hybrid, and flexible learning. There is a wide, varied, and expanding number of blended learning approaches currently being utilized in nursing education to teach a wide range of nursing content and skills. An expanded scoping review focused on blended learning in psychiatric nursing, licenced practical nursing, nurse practitioners, and all graduate level nursing education programs is recommended as is additional research into the use of blended learning in the lab or clinical setting.
... Recent literature supports virtual simulation as an effective learning strategy. Virtual simulation can trigger visceral responses and emotional connections between the learner and the virtual patient (Johnsen, Fossum, Vivekananda-Schmidt, Fruhling, & Slettebø, 2016;Verkuyl, Hughes, Tsui, Betts, St-Amant & Lapum, 2017a) and can promote learner engagement (Duff, Miller, & Bruce, 2016;Irwin & Coutts, 2015). The experiential nature of VGS has the potential to develop the skills required for clinical practice (Johnsen et al., 2016). ...
Background
Virtual simulations can provide students with an opportunity to apply theoretical concepts to simulated clinical experiences.
Method
A mixed-method design using surveys and focus groups was used to explore student satisfaction, self-confidence, engagement, and simulation design.
Results
High levels of effective simulation design elements were reported. Survey results indicated positive outcomes in self-confidence and satisfaction. Focus group data revealed three main themes: virtual gaming simulation design elements, expanding knowledge, and experiential learning.
Conclusions
The high level of realism and authentic storyline in this virtual gaming simulation contributed to the learning experience and enhanced knowledge, engagement, and self-confidence among bridging nursing students.
... 8 Virtual gaming simulations have been shown to promote learner engagement, and video gaming is a cost-effective way to provide repeated exposure to information, promote decision making, and motivate students to learn. 9 While gamification has been shown to engage students and enhance learning in nursing education, a variety of types of games should be implemented to determine the most motivating games as well as the types of course content best delivered through gaming. 10 The games should challenge students to get involved in learning. ...
... 8 Virtual gaming simulations have been shown to promote learner engagement, and video gaming is a cost-effective way to provide repeated exposure to information, promote decision making, and motivate students to learn. 9 While gamification has been shown to engage students and enhance learning in nursing education, a variety of types of games should be implemented to determine the most motivating games as well as the types of course content best delivered through gaming. 10 The games should challenge students to get involved in learning. ...
... Nursing education, as in all other health-related disciplines, has seen a dramatic increase in the use of simulation such as high fidelity manikins. More recently, the use of virtual gaming and reality simulations involving avatars has increased, however there has been little exploration of the theoretical foundations of simulation pedagogy (Hopwood, Rooney, Boud, & Kelly, 2016;O'Connor & Domingo, 2017;Verkuyl et al., 2017). ...
Public universities, as the predominant source of nurse education, serve an instrumental role as pressure mounts to produce large numbers of workready graduates to meet the needs of the labor market. Neoliberalism is recognized as the dominant political and economic philosophy across the globe, and new managerialist, corporatized practices, as its “organizational arms,” are ubiquitous within the higher education sector worldwide. Intersecting this agenda are dramatic developments in the way university courses are being conceived and delivered based upon the increasing integration of digital technologies. Given the radical transformations brought about by Web 2.0 technologies, it is timely to critically analyze current narratives shaping the teaching and learning agenda and their impact on the nature and quality of nursing higher education. This article draws on the “McDonaldization thesis” of George Ritzer, concepts from the work of the Italian philosopher Giorgio Agamben, Habermasian social theory, and critical pedagogy. It concludes with a short overview of possible outcomes of the new agenda, and some strategies for resistance. Although the focus is on Australia, it is relevant to other countries to the extent that they are facing similar challenges and undergoing analogous pedagogic transformations.
The integrative review's objective is to determine the effectiveness of incorporating virtual reality (VR) simulation teaching methods in pre-licensure psychiatric nursing curricula. While the demand for skilled nurses has increased, the COVID-19 pandemic exacerbated nursing educational resource shortages and reduced the number of qualified applicants accepted into nursing schools. Psychiatric assessment and communication skills are difficult to obtain. VR simulation may present an effective solution to enhancing nursing students' psychiatric education. The integrative review was the study design. Tailored search terms were applied to the following databases: PubMed, PsycINFO, ERIC, and CINAHL Plus with Full Text. The databases were searched by title and abstract during the period January 1, 2011, through October 14, 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to search strategies and results. The selected articles were evaluated using the Johns Hopkins research evidence appraisal tool. Eleven studies met the inclusion criteria for the integrative review. Study results were categorized into two main themes: (a) pedagogical approach and (b) usability. Three sub-themes emerged: (a) knowledge, (b) attitudes, and (c) skills. VR was found to be effective in increasing nursing students' knowledge; improving communication and decision-making skills; and impacting attitudes toward patients living with mental illness. VR was found to be the same as or superior to traditional and other simulation methods in teaching psychiatric nursing education to pre-licensure students. While convenient, virtual reality use involves managing technical difficulties and considering safety. VR simulation is an effective pedagogical approach for psychiatric nursing curricula and offers a potentially cost-effective alternative to traditional learning and other simulation methods.
Background
Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)–based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training.
Objective
The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training.
Methods
Participants were students from Acibadem Mehmet Ali Aydinlar University’s Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups’ performances in this study.
ResultsThe improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game–based training instead of classroom lectures.
Conclusions
Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups’ total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming.
Trial RegistrationClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910
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AIM: this scoping review aims to define the state of the art of virtual gamification in the specific field of mental health nursing education. Part of the aim is to identify the virtual tools used/developed and their contexts, the relevant theoretical reference frameworks, the received funds, and the possibility of using the tools in standalone mode (i.e., without third-party intervention). METHODS: a large three-step scoping review was performed following the Johanna Briggs Institute (JBI) criteria. PubMed, Scopus, CINAHL, Web Of Science, Embase, Cochrane Library were searched for relevant articles; references search and a large gray literature throught Google Scholar, ClinicalTrials.gov, Turn Research Into Practice, MedRXiv, OSF PrePrints, and Open Access Theses and Dissertations search were also performed. RESULTS: Substantial overall heterogeneity was found among the n = 35 studies included in this review. 29 virtual tools were described. The most commonly used type was the video-based serious games with responsive unfolding scenarios, followed by virtual realities. 19 out of 29 tools were usable in ‘standalone’ mode. CONCLUSIONS: The outcomes reported in this review support the use of Virtual Serious Games with mental health nursing students. Nursing educators who want to implement Virtual Game Simulations now have free tools and relatively inexpensive possibilities to create and use virtual serious games.KeywordsGamificationSerious GameVirtual SimulationNursingEducation
Temos de prazer de lançar o primeiro livro internacional do ano de 2023, voltado a área de saúde, que tem como título Collection of International Topics in Health Science- V1 , essa obra é editada pela Seven Publicações Ltda, tendo a composição de diversos capítulos voltados ao desenvolvimento e disseminação do conhecimento na área da saúde.
Aim
To investigate game-based learning in nursing education and summarize findings of its impact on nursing students’ learning outcomes.
Background
Nurses are the first point of contact for care and make up the largest proportion of the global health workforce. To respond effectively to the care needs of the population, nurses need to be adequately trained during their professional education. Game-based learning is increasingly becoming a strategy to complement simulation strategies in nursing education.
Design
A systematic review of mixed-methods studies.
Methods
A search was conducted in the electronic databases Medline, PubMed, Science Direct, Scopus and Web of Science. Quantitative, qualitative and mixed methods studies on nurse education published in English between 2000 and 2020 were considered. The Mixed Methods Assessment Tool was used for quality assessment. Data abstraction and synthesis was performed using a data extraction form.
Results
A total of 46 studies from the 15 countries were included. The included studies were eight quantitative randomized controlled trials, 12 quantitative non-randomized controlled trials, 15 quantitative descriptive, five qualitative and six mixed methods studies. The results showed that game-based learning was used for many different courses or content in nursing education. Simulation games were the most used game type. Game-based learning facilitated the achievement of learning outcomes primarily in the cognitive domain. Some gamification elements and design-related aspects of game-based environments were evaluated as positive and negative. Game-based learning is a useful approach to assessing learning outcomes in only three studies.
Conclusion
Game-based learning is a useful method to achieve learning outcomes mainly in the cognitive domain, with some positive and negative aspects. Further research should investigate the effects of games on affective and behavioral learning outcomes, as well as the use of games to assess learning outcomes. Potential limitations of this review are that some studies could not be identified because of access issues and that some studies included participants other than nursing students.
Background
Despite an increase in virtual simulation uptake in many institutions, relatively little is known about how simulations affect clinical practice.
Methods
A descriptive qualitative approach, using small group interviews, was used to address our research questions. Interviews were conducted with year two and year four students from a four-year baccalaureate degree program and their clinical instructors.
Results
Four main themes emerged from our data: Direct Linkage to Clinical Practice, Suitability of Virtual Simulation Design for Learning, Strategic Integration of Virtual Simulation and Facilitation Skills.
Conclusion
With sound design and facilitation, virtual simulation can positively impact students’ clinical practice.
Background
Our suite of openly available virtual games for nursing education is used worldwide, resulting in a need to better understand the learners’ experience.
Method
We evaluated the games, by providing a link at the end of our games to an abbreviated version of the Player Experience Inventory and through qualitative feedback from an open-ended question.
Results
A total of 568 players completed the survey. Findings confirmed that the virtual gaming simulation design choices we made during development were strongly linked to positive psychosocial consequences which in turn promoted game playing.
Conclusions
The simulations were well received by a diverse group of respondents.
Purpose: This review explored trends in studies on learning outcomes in nursing education using gamification, to provide directions for future research.Methods: This scoping review was conducted according to the Joanna Briggs Institute's guidelines. The literature search date was February 1, 2021.Results: Thirty-two studies were included. The largest proportion of studies were quantitative descriptive studies, including qualitative mixed methods (34.4%). More studies applied gamification in practical classes (53.1%) than in theoretical classes. Virtual simulation games (37.9%) and simple quiz games (34.4%) were most often used. Commonly used gamification elements included scores/points, feedback, badges, countdowns, challenges, competitions, and levels. Two themes emerged regarding the impact of gamification on learning: learners’ experiences and achievement outcomes with cognitive, affective, and psychomotor subthemes. Nursing education using gamification improved engagement, motivation, and learning achievement. However, there was less evidence for affective and psychomotor outcomes than for cognitive outcomes.Conclusion: Gamification can be an effective educational strategy if educator's have sufficient understanding and readiness and appropriate gamification elements are applied to nursing education. Further research should investigate knowledge retention in the cognitive domain, collaboration and empathy in the affective domain, and the improvement of nursing skills using new technologies in the psychomotor domain.
Background
Virtual Reality (VR) simulation has been a topic of interest in recent years as an innovative strategy for healthcare education. Although there are a handful of studies evaluating VR simulation on knowledge, motivation, and satisfaction; there is a paucity of evidence to evaluate the effectiveness, acceptability and usability of ‘Immersive’ VR (IVR) simulation in nursing students.
Objectives
A two-stage sequential mixed-methods feasibility study underpinned by gaming theory investigated; (1) the impact of IVR sepsis game on pre-registration nurses' self-efficacy and, (2) their perceptions of the acceptability and applicability of IVR sepsis game as an adjunct to nursing simulation education.
Methods
The IVR simulation intervention was designed in collaboration with serious game specialists. Stage one collated pre and post-intervention self-efficacy scores with 19 pre-registration nurses using the validated instrument, Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale. Stage two used a descriptive qualitative approach to explore student nurses' perceptions of the game.
Results
In stage one, pre and post-test scores revealed significant increase in self-confidence (26.1%, P < 0.001) and a significant decrease in anxiety (23.4%, P < 0.001). Stage two qualitative responses revealed four over-arching themes: acceptability, applicability, areas of improvement of IVR sepsis game and limitations of IVR game.
Conclusion
IVR simulation show promise as an adjunct for nurse simulation and it appears to increase self-efficacy in pre-registration nursing students. Further testing with a sufficiently powered sample size will ratify findings and provide effective solutions to distance and online learning.
Background
Debriefing has been widely explored; however, there has been little focus on debriefing virtual simulations.
Objective
This systematic review examined efficacy of debriefing methods for virtual simulation related to healthcare learner outcomes including satisfaction, knowledge, attitudes, and skills.
Methods
Seven papers were reviewed using Joanna Briggs Institute (JBI) methodology.
Results
Options to debrief virtual simulations included face-to-face, synchronous virtual debrief, asynchronous debrief, computer debrief or self-debrief.
Conclusions
All debriefing methods demonstrated some benefits, and debriefer experience was found to be important. Additional research is needed to determine methods that are most effective in supporting different levels of learners.
Nursing education and training based on content and technicality has undergone a process over the years mainly with the proposal of national curriculum guidelines to implement changes in the curriculum and the insertion of new teaching methodologies by educational institutions. Thus, realistic simulation is born with the proposal to actively teach students and promote the development of numerous skills and competences. Objective: to analyze evidence of the use and effectiveness of realistic simulation as an active method of teaching and learning in nursing in the academic and professional context. Methodology: Integrative review, carried out on the databases: Cochrane, ERIC, Medline, Science Direct and PubMed. The descriptors were selected based on the list of Health Sciences Descriptors - DeCS / MeSH were: Nursing, Active learning, simulation training, matching the search terms, using the Boolean operator AND. Results: The final sample resulted in 37 articles. It was possible to observe that the simulation helps in critical thinking, reasoning, clinical judgment, leadership, autonomy and decision-making favoring patient care and that it can be performed in different formats, such as virtual simulation, clinical case simulators, simulation with games and room simulation with simulated scenario. The introduction of this methodology in educational institutions ended up being a limitation found, in addition to the need for technologies and training for teachers. Conclusion: From the results of this study, it is concluded that realistic simulation is a method capable of preparing students and professionals to meet health needs.
The use of clinical simulation combined with digital games has shown to be a promising teaching strategy, with virtual reality being the most modern application. This study's objective was to test a virtual simulation game on medication preparation and administration using a quasi-experimental design with nursing students. The results revealed that the game's use increased the students' grades in knowledge the tests, contributing to learning about the theme besides being a relevant tool for simulating the practice environment that added an innovative teaching approach of virtual immersion.
In nursing education, virtual simulations are used to augment in-person simulation and prepare and supplement students for clinical placements. More recently, as a result of the COVID-19 pandemic, virtual simulations are being used to replace clinical hours. Many virtual simulations require the user to make decisions that affect the outcome of the simulated experience. In this article, we provide a historical account of the virtual gaming simulations that members of our team developed and the processes that led to successful uptake into curriculum. In addition, we share lessons learned from our experiences in terms of maximizing curricular uptake. We found engagement of the teaching team is essential when using VGS in a course. In addition, when using VGS, it is important to follow the process of prebrief, enactment, debrief and evaluation. Educators can build on and grow from our lessons learned so that the path to embedding virtual gaming simulation in curriculum becomes clear.
Objectives
Health professional education is transitioning to online platforms to meet students' need for flexibility and international access. However, there is a necessity for authentic presentation of educational material particularly in regard to clinical skills development. There has been major growth in the delivery of virtual simulated-based learning and assessment to provide clinical skill acquisition in an online platform. The aim of this review was to explore the use of virtual simulation to assess clinical competence in health education.
Design
Integrative review.
Data sources
Peer reviewed studies published between 2008 to March 2020 were searched across PubMed, Embase, Cochrane Library, CINAHL Medline, Scopus, and PsycINFO.
Review methods
The Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed. Twenty-three studies, which met the inclusion criteria, were downloaded, and a quality appraisal and analysis was completed by the research team.
Results
A thematic analysis identified four themes; pedagogy differences across disciplines, debriefing to enhance learning, preparing healthcare professionals in a safe and cost-effective environment, and managing challenges of virtual simulation. Debriefing with students within the online environment enabled students to share experience and reflect on choices for a deeper learning experience.
Conclusions
Virtual simulation can prepare students for the clinical environment by providing safe practice within complex clinical situations. Challenges related to managing and debriefing students must be overcome to ensure best student learning outcomes. Virtual simulation is a feasible strategy to assess students' clinical competency and support their learning in both medical and nursing programs, however simulation should be authentic and incorporate reflection.
Background:
Serious gaming is recognized as a training tool due its potential for a risk-free educational environment. There is still limited research about using serious gaming modules for emergency skills training.
Objective:
The aim of this study is to compare the effects on the knowledge level of participants after using a tablet-based serious game and a virtual reality (VR)-based serious game for Basic Life Support using a pretest/posttest method.
Methods:
The study was designed as a randomized trial comparing pretest and posttest results. A tablet-based and VR-based serious game with identical content was used for 40 participants. Over half of them (22/40, 55%) were included in the VR group and just under half (18/40, 45%) were in the tablet group. Student t test and Wilcoxon signed rank tests were used to determine the relation between the dependent and independent variables. In order to determine the effect size of the results, the effect size calculator (Cohen d) for t test was used. There is a significant difference between pre- and posttest results in both groups (P=.001; Wilcoxon).
Results:
Mean posttest results were significantly higher in both groups. The posttest results were significantly higher in the VR group in terms of pre- and posttest changes (P=.021; Student t test).
Conclusions:
Past research studies have shown that serious gaming presents a favorable additional tool for medical education. The results indicate that both serious gaming modules are effective and that VR-based serious gaming is more efficient in terms of learning outcome than tablet-based gaming.
Experiential learning is an important component of nursing education. Coupled with the limited opportunities to practice clinical skills in specialty areas and the pedagogical possibilities of virtual environments, our team started producing virtual gaming simulations. They incorporate an innovative pedagogical approach to simulation based on a branching scenario format. In this article, we share our experience in creating virtual gaming simulations with the aim to inspire other educators to engage in this technology-enabled, learning modality designed to enhance experiential learning among nursing students.
Background
The virtual world of Second Life ® is an emerging technology that is being considered as a simulation methodology for the education of professionals. Particularly for nursing, the adoption of simulation, although a response to technological advancement, is occurring during changes in population health care needs, the resultant impact on the workforce, and also the changing profile of students.
Method
This systematic review aimed to establish the current applications of Second Life in the education of undergraduate nursing students. Databases searched were CINAHL ® , Medline ® , Education Research Complete ™ , ERIC ™ , Computers and Applied Sciences Complete ™ , and Library, Information Sciences and Technology ™ .
Results
Fourteen studies met the inclusion and exclusion criteria. Evidence identified included the themes of transferability from theory to practice, focus on learner centeredness, and evaluative processes.
Conclusion
This review demonstrates that positive learning outcomes are achievable in Second Life. Evaluative research is in an early stage, and further investigation is warranted. [ J Nurs Educ. 2015;54(10):572–577.]
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Many nursing programs integrate high-fidelity simulation (HFS) into the curriculum. The manikins used are modeled to resemble humans and are programmed to talk and reproduce physiological functions via computer interfaces. When HFS design negates a theoretical framework consistent with the interpersonal and relational nature of nursing, it can problematically focus simulation on psychomotor skills and the physical body. This article highlights a theorized approach to HFS design informed by Carper’s seminal work on the fundamental patterns of knowing in nursing (i.e., empirics, esthetics, personal knowing, and ethics). It also describes how a team of Canadian nurse educators adopted these patterns of knowing as a theoretical lens to frame scenarios, learning objectives, and debriefing probes in the context of maternal and newborn assessment. Institutions and practitioners can draw on Carper’s work to facilitate focusing on the whole person and expanding the epistemological underpinnings of HFS in nursing and other disciplines.
Learning may be enhanced in mental health nursing education by applying virtual reality technologies in which students may safely practice communication and assessment skills with simulated patients. The purpose of this descriptive study was to assess the effectiveness of a Second Life(®) (SL) virtual simulation as a teaching strategy for undergraduate mental health nursing students. Data were collected via a researcher-developed survey questionnaire. Students perceived the simulation to be moderately effective as an educational strategy and slightly difficult as a technical program. Positive aspects included client assessment in an environment where mistakes were without consequence, working from home, and novelty. Drawbacks were dressing and maneuvering the avatar and lack of realism. Correlations were found between educational effectiveness and technical difficulty and between educational effectiveness and age of the computer. SL virtual simulation has potential to provide unique, easily accessible, safe, and fun learning for mental health nursing students.
The experiential learning process involves participation in key experiences and analysis of those experiences. In health care, these experiences can occur through high-fidelity simulation or in the actual clinical setting. The most important component of this process is the postexperience analysis or debriefing. During the debriefing, individuals must reflect upon the experience, identify the mental models that led to behaviors or cognitive processes, and then build or enhance new mental models to be used in future experiences. On the basis of adult learning theory, the Kolb Experiential Learning Cycle, and the Learning Outcomes Model, we structured a framework for facilitators of debriefings entitled "the 3D Model of Debriefing: Defusing, Discovering, and Deepening." It incorporates common phases prevalent in the debriefing literature, including description of and reactions to the experience, analysis of behaviors, and application or synthesis of new knowledge into clinical practice. It can be used to enhance learning after real or simulated events.
Contemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training. However, knowledge about the effectiveness of such training is incomplete, and there are no data regarding how students experience it. Cardiopulmonary resuscitation (CPR) is a field within medicine in high demand for new and effective training modalities.
In addition to finding a feasible way to implement CPR training, our aim was to investigate how a serious game setting in a virtual world using avatars would influence medical students' subjective experiences as well as their retention of knowledge.
An MMVW was refined and used in a study to train 12 medical students in CPR in 3-person teams in a repeated fashion 6 months apart. An exit questionnaire solicited reflections over their experiences. As the subjects trained in 4 CPR scenarios, measurements of self-efficacy, concentration, and mental strain were made in addition to measuring knowledge. Engagement modes and coping strategies were also studied. Parametric and nonparametric statistical analyses were carried out according to distribution of the data.
The majority of the subjects reported that they had enjoyed the training, had found it to be suitable, and had learned something new, although several asked for more difficult and complex scenarios as well as a richer virtual environment. The mean values for knowledge dropped during the 6 months from 8.0/10 to 6.25/10 (P = .002). Self-efficacy increased from before to after each of the two training sessions, from 5.9/7 to 6.5/7 (P = .01) after the first and from 6.0/7 to 6.7/7 (P = .03) after the second. The mean perceived concentration value increased from 54.2/100 to 66.6/100 (P = .006), and in general the mental strain was found to be low to moderate (mean = 2.6/10).
Using scenario-based virtual world team training with avatars to train medical students in multi-person CPR was feasible and showed promising results. Although we found no evidence of stimulated recall of CPR procedures in our test-retest study, the subjects were enthusiastic and reported increased concentration during the training. We also found that subjects' self-efficacy had increased after the training. Despite the need for further studies, these findings imply several possible uses of MMVW technology for future emergency medical training.
Background Increasingly, simulation is replacing some clinical hours as nursing schools struggle to find quality clinical placements for students. Methods An experimental study was conducted to compare a virtual gaming simulation with a laboratory simulation regarding three outcomes: students' pediatric knowledge, self-efficacy, and satisfaction. Results Both groups made modest knowledge gains. They made significant gains in self-efficacy scores with the gaming group making greater gains. Satisfaction survey scores were high for both groups. Conclusions Virtual gaming simulation combined with hands-on simulation could become part of the suite of best teaching and learning practices we offer students. © 2017 International Nursing Association for Clinical Simulation and Learning
Background:
As competition for specialty clinical placements increases, there is an urgent need to create safe, stimulating, alternative learning environments for students.
Objective:
To address that clinical gap, our team developed a virtual game-based simulation to help nursing students develop their pediatric nursing skills.
Design:
A usability study was conducted using the Technology Acceptance Model as a research framework.
Setting and participants:
The study was conducted at a community college and included nursing students, nursing faculty/clinicians and two gaming experts.
Methods:
The two experts evaluated the game using a heuristic checklist after playing the game. Participants engaged in a think-aloud activity while playing the game and completed a survey and interview based on the Technology Acceptance Model to explore ease of use and utility of the game.
Results:
We found a high degree of user satisfaction with the game. Students reported that they had learned about pediatric care, they had become immersed in the game and they were keen to keep playing. Several design changes were recommended.
Conclusion:
Usability testing is critical in the early stages of simulation development and the study provided useful direction for the development team in the next stage of game development.
Background:
With limited available public health nursing clinical placements, nurse educators are challenged to create alternative learning experiences that engage students.
Method:
Nursing faculty developed three Second Life® virtual learning scenarios in family health, disaster preparedness, and home safety areas of interest as a supplement to clinical experiences for undergraduate senior nursing students in a public health nursing course. Student perceptions of their learning were evaluated by a survey and focus group.
Results:
Although students perceived learning public health nursing knowledge, they were less likely to agree that the experience was as effective for learning about public health nursing when compared with on-site clinical experiences.
Conclusion:
The use of Second Life is an effective learning platform for teaching undergraduate nursing students public health nursing when clinical experiences are difficult to obtain. Nursing faculty need to ensure technological challenges are addressed and that scenarios are realistic, and engage students through interactive collaboration. [J Nurs Educ. 2016;55(9):536-540.].
Background: Virtual reality technology can range from bedside learning to computerized tools accessed exclusively online; yet there is little evidence of the effectiveness of online virtual simulation for teaching diagnostic reasoning to health care providers. To address this gap, an examination of virtual simulation encounters in the online classroom was undertaken to inform education of a variety of health care providers, including nurse practitioners, registered nurses, and physicians. Method: Arskey and O'Malley's (2005) framework was the methodology used to conduct the scoping review. Result: Twelve studies published between 2008 and 2015 were identified from a search of 14 databases. The study sample included physicians and medical students (seven), baccalaureate nursing students (two), associate degree nursing students (one), and providers from other fields such as pharmacists, physiotherapists, sports medicine, forensics, and veterinarians. Conclusion: Online virtual simulation was comparable or superior to traditional simulation methods where increased engagement with learning occurred in a safe environment with convenient access. © 2016 International Nursing Association for Clinical Simulation and Learning.
Background: The topics of inclusivity, diversity, and cultural awareness are difficult to adequately explore in a traditional classroom setting. The use of the virtual platform of Second Life® afforded a unique opportunity to use virtual role-play simulation to experience what it is like to walk in another's shoes. Method: Fifteen graduate nurse educator students enrolled in a course titled "Inclusivity in Nursing Education" were randomly assigned a customized avatar, representing a marginalized person for use in a role-play simulation in the virtual world of Second Life®. Two written assignments regarding the learning experience were evaluated using a simple qualitative analysis. Results: Students indicated that they increased their own capacity to understand, appreciate, and relate to people different from themselves. Conclusion: Although future research is needed to determine the full extent to which virtual platforms can be used effectively in nursing education, this case study demonstrated that valuable learning regarding complex topics can take place in the virtual world. © 2016 International Nursing Association for Clinical Simulation and Learning.
Qualitative analysis is often a textual undertaking. However, it can be helpful to think about and represent study phenomena or narrative accounts in nontextual ways. In this article, we share our unique and artistic process in developing and employing pictorial narrative mapping as a qualitative analytic technique. We recast a nontextual, artistic-analytic technique by combining elements related to narrative mapping and narrative art. This technique involves aesthetic attunement to data and visual representation through pictorial design. We advanced this technique in the context of a narrative study about how arts-informed dissemination methods influence health-care practitioners' delivery of care. We found that the Pictorial Narrative Mapping process prompted an aesthetic and imaginative experience in the analytic process of qualitative inquiry. As an analytic technique, Pictorial Narrative Mapping extends the inquiry process and enhances rigor through artistic means as well as iterative and critical dialogue. Additionally, pictorial narrative maps can provide a holistic account of the phenomenon under study and assist researchers to make meaning of nuances within complex narratives. As researchers consider employing Pictorial Narrative Mapping, we recommend that they draw upon this technique as a malleable script yielding to an organic process that emerges from both their own data and analytic discussions. We are further curious about its imaginative capacities in social and health science literature, its possibilities in other disciplinary contexts, and the prospects of what Maxine Greene refers to as becoming more wide awakein our case, in future research analytic endeavors.
AimThe aim of this study was to report an analysis of the clinical learning environment concept. Background
Nursing students are evaluated in clinical learning environments where skills and knowledge are applied to patient care. These environments affect achievement of learning outcomes, and have an impact on preparation for practice and student satisfaction with the nursing profession. Providing clarity of this concept for nursing education will assist in identifying antecedents, attributes and consequences affecting student transition to practice. DesignThe clinical learning environment was investigated using Walker and Avant's concept analysis method. Data sourcesA literature search was conducted using WorldCat, MEDLINE and CINAHL databases using the keywords clinical learning environment, clinical environment and clinical education. Articles reviewed were written in English and published in peer-reviewed journals between 1995-2014. Methods
All data were analysed for recurring themes and terms to determine possible antecedents, attributes and consequences of this concept. ResultsThe clinical learning environment contains four attribute characteristics affecting student learning experiences. These include: (1) the physical space; (2) psychosocial and interaction factors; (3) the organizational culture and (4) teaching and learning components. These attributes often determine achievement of learning outcomes and student self-confidence. Conclusion
With better understanding of attributes comprising the clinical learning environment, nursing education programmes and healthcare agencies can collaborate to create meaningful clinical experiences and enhance student preparation for the professional nurse role.
Background: There is a need to prepare new nurses in disaster procedures. Virtual reality simulation (VRS) offers a method for disaster training; yet, little is known about the student experience using this type of simulation. Methods: Senior baccalaureate students at two universities who experienced a VRS decontamination exercise were asked to participate in focus groups to describe their experience. Responses were analyzed using constant comparative analysis. Results: Student feedback was positive, and three themes emerged from the data: The Experience of VRS, The Learning Process, and The Implementation of the Learning Activity. Conclusions: VRS provides an engaging learning opportunity to learn the skill of decontamination. Educators and developers must work together to ensure optimal learning opportunities for students in virtual environments. © 2014 International Nursing Association for Clinical Simulation and Learning.
All simulation-based learning experiences should include a planned debriefing session aimed toward promoting reflective thinking. Learning is dependent on the integration of experience and reflection. Reflection is the conscious consideration of the meaning and implication of an action, which includes the assimilation of knowledge, skills, and attitudes with pre-existing knowledge. Reflection can lead to new interpretations by the learner. Reflective thinking does not happen automatically, but it can be taught; it requires time, active involvement in a realistic experience, and guidance by an effective facilitator. The skills of the debriefer are important to ensure the best possible learning; learning without guidance could lead the learner to negatively transfer a mistake into their practice without realizing it had been poor practice, repeat mistakes, focus only on the negative, or develop fixations. Research provides evidence that the debriefing process is the most important component of a simulation-based learning experience.
This integrative review explored the use of avatars and virtual worlds in education, synthesizing the articles and findings and presenting implications for nurse educators. Evaluation of available publications concluded that avatars allow students to practice in a safe environment, enhancing learning. The need now is for faculty who use avatars and virtual worlds in their teaching to plan more robust outcomes assessment that evaluates if the acquired knowledge of students, met program objectives, and achieved improved patient outcomes.
Disaster training is crucial to the mitigation of both mortality and morbidity associated with disasters. Just as clinical practice needs to be grounded in evidence, effective disaster education is dependent upon the development and use of andragogic and pedagogic evidence. Educational research findings must be transformed into useable education strategies. Virtual reality simulation is a teaching methodology that has the potential to be a powerful educational tool. The purpose of this article is to translate research findings related to the use of virtual reality simulation in disaster training into education practice. The Ace Star Model serves as a valuable framework to translate the VRS teaching methodology and improve disaster training of healthcare professionals. Using the Ace Star Model as a framework to put evidence into practice, strategies for implementing a virtual reality simulation are addressed. Practice guidelines, implementation recommendations, integration to practice and evaluation are discussed. It is imperative that health educators provide more exemplars of how research evidence can be moved through the various stages of the model to advance practice and sustain learning outcomes.
Although the literature has highlighted the use of virtual worlds in teaching-learning, little is known about the concepts associated with this technology in nursing education. Moreover, the application of virtual worlds to education has been underdeveloped theoretically, with much of the work being exploratory. Thus, the aim of this integrative review was to identify the current evidence on the use of virtual worlds in the education of nursing and other health professional students and to describe emerging themes surrounding this phenomenon. We searched seven electronic databases for relevant articles and used Whittemore's and Knafl's integrative review method to synthesize the literature. Twelve articles met the selection criteria for this review, from which three overarching themes emerged: (a) critical reasoning skills, (b) student-centered learning, and (c) instructional design considerations. This integrative review extends our understanding of virtual worlds in nursing education and the potential barriers and facilitators of their use. [J Nurs Educ. 2013;52(x):xxx-xxx.].
Engaging students in active techniques that promote learning and socialization in nursing may be achieved using Voki technology. The authors discuss a project, and its outcomes, that used avatar-assisted case studies. Instructors looking for a new teaching technology that can be integrated into case studies are encouraged to explore this venue as an active learning technology.
There is growing evidence that using e-learning and digital gaming technology can support students in their learning. An international project, Continuing/Higher Education in Research Methods Using Games, funded by the European Commission's Lifelong Learning Programme and led by a team at the University of the West of Scotland, aims to develop interactive activities and games to support nursing and social science students. This article looks at the scope of the project in helping to deliver nurse education.
Many nursing programs integrate high-fidelity simulation (HFS) into the curriculum. The manikins used are modeled to resemble humans and are programmed to talk and reproduce physiological functions via computer interfaces. When HFS design negates a theoretical framework consistent with the interpersonal and relational nature of nursing, it can problematically focus simulation on psychomotor skills and the physical body. This article highlights a theorized approach to HFS design informed by Carper's seminal work on the fundamental patterns of knowing in nursing (i.e., empirics, esthetics, personal knowing, and ethics). It also describes how a team of Canadian nurse educators adopted these patterns of knowing as a theoretical lens to frame scenarios, learning objectives, and debriefing probes in the context of maternal and newborn assessment. Institutions and practitioners can draw on Carper's work to facilitate focusing on the whole person and expanding the epistemological underpinnings of HFS in nursing and other disciplines.
The use of high-fidelity simulation as an accepted substitute for traditional clinical learning experiences in nursing education has gained acceptance over the past decade, as evidenced by the California Board of Registered Nursing now allowing up to 25% of student clinical learning to occur in simulation laboratories. However, little research evidence has documented the efficacy of these simulated learning experiences, particularly on objective outcomes such as examination performance. Therefore, this study examined the effects of high-fidelity simulation participation on knowledge acquisition in 104 undergraduate nursing students. Students who participated in high-fidelity simulation scenarios scored significantly higher on examinations than students who did not. These findings provide beginning evidence that high-fidelity simulation can be an effective substitute for traditional clinical experience. More importantly, the findings may help boards of nursing more effectively regulate the use of high-fidelity simulation in the future.
The delivery of effective life support measures is highly associated with the quality, design and implementation of the education that underpins it. Effectively responding to a critical event is a requirement for all nurses illustrating the need for effective educational approaches from pre-registration training through to enhancing and maintaining life support skills after qualification. This paper reports the findings of utilising a web-based multimedia simulation game PULSE (Platform for Undergraduate Life Support Education). The platform was developed to enhance the student experience of life support education, to motivate on-going learning and engagement and to improve psychomotor skills associated with the provision of Intermediate Life Support (ILS) training. Pre training participants played PULSE and during life support training data was collected from an intervention and a control group of final year undergraduate nursing students (N=34). Quantitative analysis of performance took place and qualitative data was generated from a questionnaire assessing the learning experience. A statistically significant difference was found between the competence the groups displayed in the three skills sets of checking equipment, airway assessment and the safe/effective use of defibrillator at ILS level, and PULSE was positively evaluated as an educational tool when used alongside traditional life support training.
The use of virtual worlds has exploded in popularity, but getting started may not be easy. In this article, the authors, members of the corporate nursing education team at University Health Network, outline their experience with incorporating virtual technology into their learning environment. Over a period of several months, a virtual hospital, including two nursing units, was created in Second Life®, allowing more than 500 nurses to role-play in a safe environment without the fear of making a mistake. This experience has provided valuable insight into the best ways to develop and learn in a virtual environment. The authors discuss the challenges of installing and building the Second Life® platform and provide guidelines for preparing users and suggestions for crafting educational activities. This article provides a starting point for organizations planning to incorporate virtual worlds into their learning environment.
Virtual communities are an emerging innovative teaching application in nursing education. The purpose of this multisite study was to examine variables associated with student-perceived benefits and utility among undergraduate nursing students using a virtual community. The study involved 350 student participants enrolled in 5 baccalaureate nursing programs using a virtual community. Data were collected using surveys, with a descriptive and comparative approach for data analysis. The relationship between the use of the virtual community and perceived benefits among learners was substantial: r = .416 (318), p = .000. The utility scale scores were higher among white/Asian students compared with minority students (t = .219, df = 330, p = .03), but there was no difference among students reporting frequent program use. Engagement was greater among minority students than white/Asian among students reporting frequent program use (F = 2.40 [4308], p = .05). Frequency of virtual community use in nursing education appears to be linked to positive learner benefits and engagement. Further research related to learning outcomes associated with virtual community use is needed in nursing education and practice.
This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies.
Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown.
A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were 'simulation' and 'human simulation'. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria.
Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7-11%). The validity and reliability of the studies varied due to differences in design and assessment methods.
Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement.
New simulation tools imply new opportunities to teach skills and train health care professionals. The aim of this study was to investigate the learning gained from computer simulation skills training. The study was designed for optimal educational settings, which benefit student-centred learning. Twenty-four second year undergraduate nursing students practised intravenous catheterization with the computer simulation program CathSim. Questionnaires were answered before and after the skills training, and after the skills examination. When using CathSim, the students appreciated the variation in patient cases, the immediate feedback, and a better understanding of anatomy, but they missed having an arm model to hold. We concluded that CathSim was useful in the students' learning process and skills training when appropriately integrated into the curriculum. Learning features to be aware of when organizing curricula with simulators are motivation, realism, variation, meaningfulness and feedback.
Today, faculty members are challenged to find meaningful learning activities that enhance online nursing education. Second Life is an innovative Internet-based strategy that may be used to engage students in active learning. The authors discuss how this technology was implemented into an accelerated online nursing program.
Debriefing is essential element of simulation; however, practices vary greatly. Common elements include critique, correction, and evaluation of student performance and discussion of the experience. Learning occurs in simulation through contextual task training and repetition, but significant learning occurs when deep insight is made explicit through reflection during debriefing. The value of the student's learning is in the student's ability to engage in reflection that translates into actionable knowledge. Facilitating debriefing emphasizing reflection is an essential competency, yet little research and resources are available to guide best practices in debriefing. This article analyzes the concept of debriefing and identifies essential components. Examples that demonstrate defining attributes of debriefing are included. This work supports the identification of best practices and future research agendas to enable nurse educators to master the knowledge and strategies needed to provide students with significant learning during simulation.
The aim of this paper is to critically review what is felt to be important about the role of debriefing in the field of simulation-based learning, how it has come about and developed over time, and the different styles or approaches that are used and how effective the process is. A recent systematic review of high fidelity simulation literature identified feedback (including debriefing) as the most important feature of simulation-based medical education. 1 Despite this, there are surprisingly few papers in the peer-reviewed literature to illustrate how to debrief, how to teach or learn to debrief, what methods of debriefing exist and how effective they are at achieving learning objectives and goals. This review is by no means a systematic review of all the literature available on debriefing, and contains information from both peer and nonpeer reviewed sources such as meeting abstracts and presentations from within the medical field and other disciplines versed in the practice of debriefing such as military, psychology, and business. It also contains many examples of what expert facilitators have learned over years of practice in the area. We feel this would be of interest to novices in the field as an introduction to debriefing, and to experts to illustrate the gaps that currently exist, which might be addressed in further research within the medical simulation community and in collaborative ventures between other disciplines experienced in the art of debriefing.
The quality of education, CPR guidelines and the chain of survival all contribute to patient outcome following cardiac arrest. Increasing concerns about patient safety have focused attention on the methods used to train and prepare doctors for clinical practice. Reductions in clinical exposure at both undergraduate and postgraduate level have been implicated in junior doctors inability to recognise and manage critically ill patients. Simulation is used as a central training tool in contemporary advanced life support teaching. Simulation provides a learning opportunity for controlled clinical practice without putting patients or others at risk. This review examines the history and rationale for simulation training in resuscitation and provides some background to the learning theories that underpin it. The role of task trainers, high and low fidelity patient simulators and computer assisted simulation as teaching tools are discussed.
Gaming is an innovative teaching strategy that research has shown to be effective for improving nursing student learning outcomes. Specifically, gaming enhances retention of knowledge, promotes problem-based learning, and motivates nursing students to become more engaged in their learning. The literature also indicates that the use of gaming during nursing education promotes active learning, encourages critical thinking, makes learning more exciting, and can replicate real-life scenarios. However, empirical support for these advantages is lacking. This manuscript discusses the literature related to gaming, describes its use as a teaching strategy, and addresses implications for nursing education.
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