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Enhancing Simulation Preparation: Presimulation Role Rubrics and Expert Modeling Videos ✩

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Abstract

Role assignment in nursing simulation is a time met with great anxiety due to the fear of the unknown, performing in front of faculty and peers, and social evaluation anxiety. Using role rubrics and expert modeling videos may better prepare students for their role in simulation, reducing these barriers and promoting student learning. A convenience sample of 13 junior-level Bachelor of Nursing students enrolled in a summer medical surgical nursing course. quantitative cross-sectional design with a content analysis of students open-ended responses. All participants (n = 13) reported reading the role rubric and role-playing to prepare, as well as believing that the expert modeling video reduced their simulation anxiety. Providing students with role rubrics and role demonstrations through expert modeling videos may reduce students' anxiety and enhance preparation for simulated learning experiences. https://authors.elsevier.com/c/1iNnv6gbRTgCyZ

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... preserving a safe and realistic environment. In addition, they allow us to get closer to telehealth, which is growing in clinical practice and linked to an increase in healthcare (29)(30) . Another important factor is that role demonstrations through modeling videos with experts can also reduce student anxiety and improve preparation for simulated learning experiences (29) . ...
... In addition, they allow us to get closer to telehealth, which is growing in clinical practice and linked to an increase in healthcare (29)(30) . Another important factor is that role demonstrations through modeling videos with experts can also reduce student anxiety and improve preparation for simulated learning experiences (29) . ...
... Nursing students' experiences with technologies and active strategies during their undergraduate studies not only diversify the ways in which they learn, but also prepare them for an increasingly connected professional environment. In addition, these experiences bring them closer to telehealth, a growing trend in clinical practice, associated with advances in healthcare (29) . ...
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Objective:to assess the perception of self-efficacy, self-confidence, and satisfaction of undergraduate nursing students during the use of expert-modeling videos as a learning strategy in the period of social distancing. Method:this was a descriptive study with undergraduates studying disciplines of caring for hospitalized newborns and children at a higher education nursing institution in the interior of the state of São Paulo, Brazil. Activities were organized in three moments, in real time: prebriefing, expert-modeling videos and debriefing. The expert-modeling videos replaced the clinical simulation scenario during the social distancing required by the COVID-19 pandemic, for the development of telesimulation. Specific validated scales were used to analyze students’ self-confidence, self-efficacy and satisfaction. Content analysis assessed the advantages and disadvantages of using expert-modeling videos. Results:thirty-nine undergraduates took part in the study. High levels of self-confidence, self-efficacy and satisfaction were found among the participants. The advantages of expert-modeling videos were organized into the following categories: Convenience, Security and continuity of studies and Efficient teaching method, and the disadvantages into Problems with technology, Distractions, Lack of personal contact and Mental fatigue. Conclusion:telesimulation activities were consolidated as strategies that enabled learning in times of emergency online teaching due to the realness of telesimulation, the development of skills in caring for children and newborns and the link between theory and practice.
... Recently, expert modeling videos (EMVs), which provide exemplar demonstrations of nursing-specific behaviors and roles, have shown promise in promoting learning and performance in simulation. [3][4][5] However, while current simulation literature provides valuable insight into the impact of EMVs on overall competency and competency within domains (eg, assessment, clinical judgment, communication, and patient safety), the literature lacks discussion on specific behaviors for which EMVs may positively impact specific student performance, as well as areas for growth. Therefore, this study evaluated the effectiveness of an EMV on undergraduate nursing students' behavioral competencies in simulation as measured by the Creighton Competency Evaluation Instrument (CCEI). ...
... [1][2][3] Academic-practice pipelines-or the pipelines of students from admissions through graduation, licensure, and practice-depended on accelerated programs even before COVID-19 began. During the pandemic, almost every US hospital has had to rely upon travel nursing agencies to fill critical staffing vacancies and maintain daily operations, 4 and nursing turnover is now the number one concern of hospital chief executive officers, according to a 2021 survey by McKinsey & Co. 5 In this context, there is urgent need for accelerated sec-ond-degree nurses who can enter the workforce quickly and bring essential traits such as maturity, leadership skills, and resilience. 2,[6][7][8][9] Approach: Assess the Landscape, Present ...
... Each competency level represented an increase in the total CCEI competency for each behavior by 20%. The scale ranged from no competency demonstrated (0) to high competency demonstrated (5). Descriptive means of the 17 behaviors were used to compare the control group to the experimental group. ...
Article
Background Expert modeling videos (EMVs) have shown promise in improving students’ performance in simulation. However, research evaluating the impact of EMVs is limited to major performance areas, lacking exploration into specific student competency behaviors. Purpose This study evaluated the effect of an EMV intervention on undergraduate nursing students’ behavioral competencies as measured by the Creighton Competency Evaluation Instrument (CCEI). Methods Using a quasi-experimental pragmatic evaluation design, students in a medical surgical nursing course (n = 160) viewed either an expert model demonstration video (experimental) or expert model discussion video (control). Students’ behavioral competencies were measured and compared between groups using the CCEI. Results Students who viewed an expert model demonstration video performed at a higher level of competency in 11 of the 18 CCEI behaviors. Conclusion Using EMVs in nursing simulation may improve students’ ability to achieve clinical competency in nursing specific behaviors.
... Given that most included studies conducted virtual pre-briefing activities individually, such as pre-briefing lessons and quizzes, the findings imply that virtual pre-briefing can be actively utilized with comparable effectiveness in face-to-face simulations. Various pre-briefing methods, including role rubrics, are currently under development (45). Further research will be necessary to ascertain the effectiveness of these diverse pre-briefing approaches. ...
... Competency improved significantly when observation was measured rather than self-report. Role assignment in nursing simulation often elicits significant anxiety stemming from uncertainty, performing in front of faculty and peers, and social evaluation (45). Moreover, many individuals perceive themselves as lacking proficiency, particularly in terms of nursing competency. ...
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Aim Studies on the effectiveness of virtual reality (VR) in nursing education have explored its impact on learning outcomes, emotional immersion and engagement, learner self-confidence, and satisfaction, generally showing positive aspects. However, there is a need for a systematic review to examine the specific influence of VR-based education on nursing students’ practical competency. Method According to the PRISMA 2020 guidelines, 22 studies were selected based on inclusion criteria from 579 articles, published from January 1, 2018, to March 31, 2024, across nine major databases including PubMed and EMbase. The target population comprised nursing students, and the intervention focused on VR-based simulations aimed at enhancing competency, compared to control groups receiving either no intervention or conventional non-virtual simulation. The primary outcome, nursing competency, was analyzed using MIX 2.0 Pro (Ver. 2.0.1.6, BiostatXL, 2017) to calculate pooled effect sizes. Result The pooled effect size for nursing competency was determined to be large, with Hedge’s g = 0.88 (95% CI, 0.47 to 1.29). Meta-regression analysis identified several factors associated with an increase in nursing competency. These included studies published after 2022, approval of an IRB, absence of funding, randomized controlled trials (RCTs), interventions reported as shorter than 4 weeks or not reported, sessions fewer than 4 or not reported, session duration under 1 h or not reported, and observational measurement methods. Additional factors enhancing nursing competency were the inclusion of a pre-briefing before simulations, the absence of a debriefing afterward, and the exclusion of other activities during the simulation. Conclusion By combining the results of the included studies, the systematic review and meta-analysis accounted for variations in sample size, study methodology, and independent intervention effects, providing an overall evaluation of the effectiveness of simulation-based education in improving nursing students’ competency. Limitation The selection criteria for the studies analyzed, which included only those published in English or Korean and reported precise means, standard deviations, and sample sizes, could lead to selection bias and limit the generalization of our study results. Systematic review registration PROSPERO International Prospective Register of Systematic Reviews: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023446348.
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Objetivo: medición de la percepción de autoeficacia, autoconfianza y satisfacción de estudiantes universitarios de enfermería durante el uso de expert-modeling videos como estrategia de aprendizaje en el periodo de distanciamiento social. Método: se trató de un estudio descriptivo con estudiantes que cursaban cuidados a recién nacidos y niños hospitalizados en una institución de enseñanza superior de enfermería del interior del estado de São Paulo, Brasil. Las actividades se organizaron en tres momentos, en tiempo real: pre-briefing , expert-modeling videos y debriefing . Los expert-modeling videos sustituyeron al escenario de simulación clínica durante el distanciamiento social impuesto por la pandemia de COVID-19, con el fin de desarrollar la telesimulación. Se utilizaron escalas específicas validadas para analizar la autoconfianza, la autoeficacia y la satisfacción de los estudiantes. El análisis de contenido evaluó las ventajas e inconvenientes del uso de expert-modeling videos . Resultados: en el estudio participaron 39 estudiantes universitarios. Los participantes mostraron altos niveles de autoconfianza, autoeficacia y satisfacción. Las ventajas de los expert-modeling videos se organizaron en las siguientes categorías: Comodidad, Seguridad y continuidad de los estudios y Método de enseñanza eficaz, y las desventajas en Problemas con la tecnología, Distracciones, Falta de contacto personal y Fatiga mental. Conclusión: las actividades de telesimulación se consolidaron como estrategias que posibilitaron el aprendizaje a distancia en momentos de emergencia de salud por el realismo de la telesimulación, el desarrollo de habilidades en el cuidado de niños y recién nacidos y la articulación entre teoría y práctica.
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Objetivo: aferir a percepção da autoeficácia, autoconfiança e satisfação de graduandos em enfermagem durante a utilização do expert-modeling videos como estratégia de aprendizagem, no período de afastamento social. Método: estudo descritivo, com graduandos das disciplinas de cuidado ao recém-nascido e à criança hospitalizados de instituição de ensino superior de enfermagem do interior do estado de São Paulo, Brasil. As atividades foram organizadas em três momentos, em tempo real: prebriefing , expert-modeling videos e debriefing . O expert-modeling videos substituiu o cenário de simulação clínica durante o afastamento social da pandemia da COVID-19, para desenvolvimento de telessimulação. Para análise da autoconfiança, autoeficácia e satisfação dos estudantes, foram utilizadas escalas validadas específicas. A análise de conteúdo avaliou as vantagens e desvantagens do uso do expert-modeling videos . Resultados: participaram do estudo 39 graduandos. Foram encontrados níveis altos de autoconfiança, autoeficácia e satisfação entre os participantes. As vantagens do expert-modeling videos foram organizadas nas seguintes categorias: Conveniência, Segurança e continuidade dos estudos e Método de ensino eficiente, e as desvantagens em Problemas com tecnologia, Distrações, Ausência de contato pessoal e Fadiga mental. Conclusão: as atividades de telessimulação consolidaram-se como estratégias que permitiram o aprendizado em tempos de ensino remoto emergencial pelo realismo da telessimulação com desenvolvimento de habilidades no cuidado à criança e ao neonato e articulação entre teoria e prática.
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Modern healthcare requires the coordination of a team of professionals with complementary skillsets. To help facilitate teamwork, healthcare professionals, such as nurses, undergo rigorous training of their clinical skills in team settings. In this paper, we analyze a mixed-reality, simulation-based training exercise involving three nurses in a hospital room. We perform multimodal interaction analysis to contrast strategies used in two cases where the patient expressed doubts about their medical care. By analyzing these strategies and comparing them to the student nurses' self-reflections, we show connections among the nurses' clinical roles, their self-efficacy, and their teamwork.
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Background: High anxiety during simulation has been well documented with calls to reduce students' anxiety. Simulation anxiety is often assumed to be harmful to students and a variety of anxiety-reducing interventions have been suggested. The purpose of this study was to explore the effect of different types of anxiety on the clinical judgment of undergraduate nursing students in simulation. Methods: This research used a one-group repeated measures quantitative design using the conceptual framework of Tanner's (2006) model of clinical judgment. Results: Anxiety did not have a significant impact on clinical judgment, both overall and within each of the four phases of Tanner's (2006) model. Conclusion: The findings imply a changed focus to reframe anxiety and how we think about its effects. Understanding that not all anxiety is debilitating but some is facilitative challenges the assumption that faculty need to attempt to lower students' anxiety in simulation. Rather than seeking to lower anxiety for all students, nursing educators should help students function despite anxiety, in order to prepare them for real world nursing practice. Cite this article: Reed, J.M. (2022, Month). Simulation Anxiety and its Effect on Clinical Judgment for Undergraduate Nursing Students. Clinical Simulation in Nursing , 000, 1-8. https://doi.
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High-fidelity clinical simulation is currently a well-established teaching tool. However, high-fidelity representations of patients in critical conditions have the potential to elicit emotions among learners and impact their cognitive load (CL). Teaching with clinical simulation may induce both emotional and cognitive overloads. The relationship between anxiety and CL during clinical simulation was studied. Forty-one undergraduate medical students participated in this study; 19 males and 22 females. The state-anxiety component of State-Trait Anxiety Inventory was administered during clinical simulation teaching sessions at time points: pre-scenario, post-scenario and post-debriefing. The Cognitive Load Scale (Leppink et al.) questionnaire was also completed post-scenario. This assessed the three components of CL: intrinsic cognitive load (ICL), extraneous cognitive load (ECL) and self-perceived learning (SPL). Median CL scores for ICL, ECL and SPL were compared between groups of low-anxiety and high-anxiety participants using a Mann-Whitney U test. State-anxiety scores were high for both the pre-scenario and post-scenario time points with a significant reduction following post-debriefing. The median (interquartile range) state-anxiety scores were 41.0 (33.0–50.0), 46.0 (33.0–52.0) and 31.0 (23.0–39.0) for the pre-scenario, post-scenario and post-debriefing time points respectively. Students with high state-anxiety had higher ECL scores (median = 2.0) than students with low state-anxiety (median = 0.9) at the post scenario time point (U = 220, p = 0.043). No statistical relation was seen with state-anxiety for either ICL or SPL. State-anxiety immediately after the simulation scenario is associated with ECL but not ICL or SPL.
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Background: Nurse educators are called to develop innovative teaching strategies to build clinical competency. Expert modeling videos (EMVs) promote clinical competency by demonstrating exemplar nursing care. Methods: A quasiexperimental research study was conducted using a prebriefing intervention of a nursing process video for demonstration (experimental) and discussion (control) groups of nursing students. Simulation competency was measured using the Creighton Competency Evaluation Instrument (CCEI). Results: Students in the experimental group demonstrated a statistically significant improvement in simulation competency (p = .001) and performed significantly better in the CCEI domains of communication (p = .009) and patient safety (p = .002). Conclusion: The use of EMVs in simulation prebriefing is an innovative teaching strategy to prepare undergraduate nursing students with the knowledge and skills required to enter the simulated environment. Through watching an exemplar demonstration of desired behaviors, students significantly improved their simulation performance and demonstrated clinically competent care of an acutely ill simulated patient. [J Nurs Educ. 2023;62(8):454-460.].
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Background Nursing students are often assigned various roles during a simulation. Some nursing students prefer to provide direct care during simulation while others prefer to observe. Method A double-blind, randomized control trial was conducted to explore the impact of purposeful simulation role assignment, using preferred learning styles, on prelicensure nursing students’ clinical reasoning. Results There was a statistically significant increase in clinical reasoning scores for both the experimental and control groups. There was also a statistically significant increase in clinical reasoning scores for both the direct care provider and the observers. Conclusions The results support the random assignment of simulation roles. In addition, the results indicate that simulation observers can achieve the same learning outcomes as the direct care providers.
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Aim: The aim of the integrative review was to examine the prebriefing phase of simulation as the foundation for the learning experience of nursing students and to determine effective prebriefing activities to enhance learning. Background: There are currently no frameworks or specific time allotments for prebriefing comparable to those implemented for debriefing. Method: Eight electronic databases were searched for the period 2012 to 2019. Six studies were selected based on relevance and inclusion. Whittemore and Knafl's integrative review framework was used for data analysis. Results: The studies reviewed answer how to effectively prepare students for simulation to enhance their learning and have a positive effect on clinical judgment and self-confidence; yet, prebriefing is not considered the foundation of the simulation experience. Conclusion: A well-designed prebriefing process is essential to high-quality simulation experiences. Standardization of this process has yet to be established.
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Background This article explores undergraduate nursing students’ lived experience of learning during high-fidelity simulation (HFS). Literature is conflicting regarding the learning experience in different roles. Method An interpretive phenomenological qualitative study was completed to gain a better understanding of the lived experience of student learning in HFS. Data collection included both written reflections and semi structures interviews regarding student learning in simulation and factors that affected that learning. Results and Conclusions A supportive learning environment is a key for learning in HFS. Anxiety and stress can impact student learning, and measures to keep anxiety at optimal levels need to be continual focus in HFS. Observers in this study preferred the observer role and describe it as “pressure off” learning. Doing simulation more often in the program and having an opportunity for a “do-over” in simulation were identified as areas that would enhance student learning.
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Background: Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents the National Council of State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) and discusses the use of the model. Method: A multidisciplinary team conducted a qualitative comparative analysis of the relationships between the NCSBN-CJM and the three leading frameworks for providing clinical judgment education to entry-level nurses. Results: The NCSBN-CJM aligns with the Information-Processing Model and the Intuitive-Humanistic Model. The NCSBN-CJM also can be used to assess the Dual Process Reasoning Theory. Conclusion: The NCSBN-CJM can assist nurse educators in designing effective tools for assessing clinical judgment by helping them target specific cognitive operations. This flexible model expresses the complexities associated with decision making in a simplified manner to enable better measurement of clinical judgment. [J Nurs Educ. 2019;58(2):72-78.].
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Background Undergraduate nursing students experience anxiety during simulation. Excessive anxiety can impair learning and performance. Method Nursing students (N = 96) from first and final semesters of a program participated in an exploratory, sequential, mixed-methods study to identify and rank anxiety sources from simulation components occurring in preparation, prebrief, implementation, and debriefing. Results Participants experienced high normal levels of anxiety that did not change across the curriculum. Having the title or role of primary nurse caused the highest level of anxiety, followed by concern about making a mistake. Conclusion Results provide understanding of sources of anxiety during simulation and support use of the INACSL Standards of Best Practice: SimulationSM (2016). Recommendations to mitigate anxiety are identified, which may lead to enhanced learning in this setting.
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Background: Previous studies have evaluated the effectiveness of high fidelity patient simulators (HFPS) on nursing training; however, a gap exists on the effects of role assignment on critical thinking, self-efficacy, and situation awareness skills in team-based simulation scenarios. Objectives: This study aims to determine if role assignment and the involvement level related to the roles yields significant effects and differences in critical thinking, situation awareness and self-efficacy scores in team-based high-fidelity simulation scenarios. Design: A single factorial design with five levels and random assignment was utilized. Setting: A public university-sponsored simulation center in the United States of America. Participants: A convenience sample of 69 junior-level baccalaureate nursing students was recruited for participation. Methods: Participants were randomly assigned one of five possible roles and completed pre-simulation critical thinking and self-efficacy assessments prior to the simulation beginning. Playing within their assigned roles, participants experienced post-partum hemorrhaging scenario using an HFPS. After completing the simulation, participants completed a situation awareness assessment and a post-simulation critical thinking and self-efficacy assessment. Results: Role assignment was found to have a statistically significant effect on critical thinking skills and a statistically significant difference in various areas of self-efficacy was also noted. However, no statistical significance in situation awareness abilities was found. Conclusions: Results support the notion that certain roles required the participant to be more involved with the simulation scenario, which may have yielded higher critical thinking and self-efficacy scores than roles that required a lesser level of involvement.
An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students
  • B Mills
  • O Carter
  • C Rudd
  • L Claxton
  • R Brien
Mills, B., Carter, O., Rudd, C., Claxton, L., & O'Brien, R. (2016). An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students. Nursing Education Today, 45, 9-15.