Ranson Thomas University of Central Florida NGR6813 Summer 2014

PICO QUestion Do undergraduate nursing students who have made use of high fidelity simulation technology demonstrate improved student outcomes compared to those students who have only made use of traditional learning methods?

Defining High Fidelity Simulation Several terms- HFS, HFHPS, HFPS A simulation of patient conditions that mimic or recreate real patient scenarios and clinical environments for students to practice nursing skills and apply knowledge (Harder, et.al. 2013) HFS is a technique not a technology

Background & Significance This is a mode of instruction which is finding increasing use in nursing programs worldwide (Mills, et.al. 2014) Simulation has demonstrated effectiveness in learning psychomotor skills by nurses and other healthcare workers (Alexandrou, et.al. 2012) Allows risk-free learning in a safe and controlled environment (Schoening, et.al. 2006)

Background & Significance Only an approximation of clinical situations/practice Start up costs for HFS lab can be as high as $800,000 (NCSBN, 2009) Yearly cost in maintenance, worker-hours, etc. can be over $300,000 (NCSBN, 2009). Potential lack of familiarity for students and faculty

Methods Databases CINAHL Medline Education Resources Information Center Cochrane Database of Systematic Reviews Healthsourse Nursing/Academic Edition Database Google Scholar Search Terms Undergraduate nursing students, pre-licensure nursing students, registered nursing students, AND high-fidelity human patient simulation, simulated nursing laboratory, high-fidelity nursing simulation, AND traditional curriculum, didactic lecture, traditional clinical, low-fidelity nursing simulation, AND student outcomes, self- efficacy, critical thinking, test scores, academic performance, clinical competency

Methods Inclusion Criteria Peer reviewed English language Published since 2008 Undergraduate nursing students Exposed to HFS Exposed to traditional teaching methods Exclusion Criteria Used non-nursing students or a mix with non-nurses No quantifiable metric for student outcomes Simulations used for non-clinical nursing skills (think affective domain)

Methods 84 articles found 21 articles matched inclusion criteria 6 articles left after applying exclusion criteria 2 correlational design studies, 3 Quasi-experimental designs studies, 1 randomized control trial Combined sample population of 347 pre-licensure nursing students

Themes HFS vs. Traditional teaching methods Knowledge Acquisition Self-efficacy

HFS vs. Traditional AuthorFindings Beddingfield, et.al. (2011)Item 1=0.381, Item 2=1.2, Item 3=1.51, Item 4=0.67 P <0.05 Blum, et.al. (2010) Midterm Final Simulation Self conf Cl. Competence Traditional Self conf Cl. Competence P=0.001 Kirkman (2013)Pre test mean : Post test 1 mean: Post test 2 mean: Difference between 1-2: Difference between 2-3: P<0.05 Roh, (2014) High Medium Pre-test Post-test p<0.001 Schlairet, Pollock (2010) Sim/Trad Trad/Sim Pre Post Post P<0.05

Knowledge Acquisition AuthorFindings Blum, et.al. (2010)Clinical Competence Midterm: Final: P<0.001 Kirkman (2013)Test 1 (pre simulation): Test 2 (post simulation): P<0.05 Schlairet, Pollock (2010) Sim/Trad Trad/Sim Pre test Post test Post test P<0.05 Shinnick, Woo (2013)Clinical knowledge test scores showed mean improvement of 6.5 points overall p=0.02

Self-efficacy AuthorFindings Roh (2014)Pre-test 2.96 Post Test 3.82 p<0.001 Shinnick, Woo (2013)Logistic regression showed lower self- efficacy as a predictor for higher HSRT scores (p=0.01)

Limitations Small sample sizes Results measured over 1 semester/1 HFS experience In some cases, participants were from different schools Lack of randomized control trials

Recommendations HFS should be used by nursing programs when access to clinical sites is limited Strength B No statistically significant differences between outcomes from HFS or traditional clinical/didactic curriculum

Recommendations HFS can be used to replace didactic lecture material Strength B Knowledge acquisition/transfer of knowledge does occur during HFS experiences HFS should be provided to students with lower levels of self-efficacy Strength B Higher self-efficacy levels after HFS Students with lower self-efficacy demonstrate improvements in critical thinking scores

Recommendations More research Follow students/participants longer Any student characteristics that affect outcomes after HFS? What are outcomes after multiple HFS scenarios?

Conclusion No statistically significant differences between student outcomes following HFS versus student outcomes from traditional clinical or classroom curriculum HFS Gives students practice AND knowledge acquisition More benefit to students with lower self-efficacy

References Alexandrou, E., Ramjan, L., Murphy, J., Hunt, L., Betihavas, V., Frost, S. (2012). Training of undergraduate clinicians in vascular access: an integrative review. Journal of the Association for Vascular Access, vol. 17(3), pp Harder, B., Ross, C., Paul, P. (2013). Instructor comfort level in high-fidelity simulation. Nurse Education Today, vol. 33(10), pp Mills, J., West, C., Langtree, T., Usher, K., Henry, R., Chamberlain-Salaun, J., Mason, M.(2014). “Putting it together”: unfolding case studies and high-fidelity simulation in the first year of an undergraduate nursing curriculum. Nurse Education in Practice, vol. 14(1), pp National Council of State Boards of Nursing (2009). The Effect of High-Fidelity Simulation on Nursing Students’ Knowledge and Performance: A Pilot Study. NCSBN Research Brief, volume 40, June 2009 Schoening, A., Sittner, B., Todd, M. (2006). Simulated clinical experience: nursing students’ perceptions and the educators’ role. Nurse Educator col. 31(6), pp

References Beddingfield, S., Davis, B., Gilmore, M., Jenkins, L. (2011). The effect of high- fidelity simulation on examination performance. Teaching and Learning in Nursing, vol. 6(2), pp Blum, C., Borglund, S., Parcells, D. (2010). High-fidelity nursing simulation: impact on student self-confidence and clinical competence. International Journal of Nursing Education Scholarship, vol. 7(1), pp. 14. Kirkman, T. (2013). High fidelity simulation effectiveness in nursing students’ transfer of learning. International Journal of Nursing Education Scholarship, vol. 10(1), pp Roh, Y. (2014). Effects of high-fidelity patient simulation on nursing students’ resuscitation-specific self-efficacy. Computers, Informatics, Nursing, vol. 32(2), pp Schlairet, M., Pollock, J. (2010). Equivalence testing of traditional and simulated clinical experiences: undergraduate nursing students’ knowledge acquisition. Journal of Nursing Education, vol. 49(1), pp Shinnick, M., Woo, M. (2013). The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students. Nurse Education Today vol. 33(9), pp