Clinical Simulation in Nursing最新文献

Introduction

Simulation-based learning is robust, but the COVID pandemic created opportunities for novel modalities, including Artificial Intelligence Virtual Simulated Patient (AI-VSP) scenarios.

Methods

Between 2019 and 2022, the following health professional students experienced AI-VSP at one US university: (a) “Headache” scenario: 24 Family Nurse Practitioner (FNP) and 48 Physician Assistants (PA) students, (b) “Insomnia” scenario: 64 Bachelor of Science in Nursing (BSN) and 47 Accelerated Bachelor of Science in Nursing (ABSN) students. Each individually conducted a brief strongly encouraged encounter and subsequently optionally participated in our study.

Results

When asked about the scenario's realism, positive answers were 50% (FNP), 16% (PA), 63% (BSN), and 87% (ABSN). Also, 41% FNP, 52% PA, 65% BSN, and 82% ABSN felt capable of creating diagnoses and treatment plans as thoroughly as they would with human patients. Regarding improving diagnostic abilities, favorable responses were 73% (FNP), 74% (PA), 72% (BSN), and 90% (ABSN). When asked whether they would recommend AI-VSP encounters to others, 91% (FNP), 84% (PA), 93% (BSN), and 90% (ABSN) agreed.

Conclusions

AI-VSP scenarios were well accepted by students and demonstrated significant promise as a complementary simulation-based learning modality.

Background

Psychological safety is a foundational element for effective simulation-based experiences across all healthcare education. This project describes a novel tool the authors developed to visually enhance psychological safety for advanced practice nursing students. The “Simulation Tool to Enhance Psychological Safety” (STEPS) is essentially a photo cube with images that depict evidence-based constructs related to psychological safety. STEPS was designed and evaluated by simulation education experts.

Methods

STEPS was employed in simulation for advanced practice nursing students (N = 56). Pre and post surveys were conducted using the Psychological Safety Survey and open-ended responses.

Results

Findings revealed students’ responses on psychological safety improved post the STEPS intervention. Students’ comments also reflected they found STEPS valuable for enhancing psychological safety.

Conclusions

STEPS is an innovative visual aid that in combination with facilitators’ actions can foster psychological safety for learners in simulation-based experiences. We plan to further evaluate the tool in simulations across nursing programs.

Aim

The objective of this SR of SR is to answer the question: Is simulation effective for the acquisition of socio-emotional skills related to health care?

Background

Simulation has become a relevant methodology for the training of socioemotional skills; however, the effectiveness of this methodology is difficult to interpret due to the diversity of results obtained to date.

Methods

Searches were conducted in Medline, Scopus, Web of Science, and Cochrane Library databases for systematic reviews with meta-analyses published from 2011 to 2022. The searches were completed between December 2021 and January 2022. Study quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO (CRD42022339156).

Results

A total of 1285 studies were examined, of which seven systematic reviews were selected, yielding 88 studies with 8658 participants. The most commonly used methodologies were standardized patient (28.4%) and high-fidelity simulation (26.1%). The training consisted of an average of 3.6 sessions, with a mean duration of 153.8 minutes. The most trained socioemotional skills were communication (34.4%), self-efficacy (30.5%), and self-confidence (13.3%). Most studies (78.4%) reported statistically significant results favorable to the intervention group in all skills trained.

Conclusion

Simulation is an effective methodology for training a wide range of social and emotional competencies in students and health science professionals.

Background

"Cannot ventilate, cannot intubate" is a challenging airway emergency that can lead to negative patient outcomes. Screen-based simulation (SBS) as a learning adjunct could help anesthesia providers improve decision-making skills in difficult airway situations. The goal of this project was to evaluate the usability of a newly designed SBS for learning and reinforcing difficult airway management.

Methods

Seven anesthesia and simulation experts were recruited for this pre-post design project. Participants were pre-briefed, watched scenario one, selected interventions for difficult airway, and time-to-decision was recorded. After debriefing, participants completed a second scenario and time-to-decision was recorded again. A post-simulation survey was conducted to evaluate application usability and gather participant feedback.

Results

All seven participants (100%) completed simulations with a mean System Usability Score of 90.83 (SD = 6.65) and median score of 90, both of which indicated superior usability. The time-to-decision in scenario two decreased significantly (p < .05) between the two scenarios.

Conclusion

In approximately 40 hours and on a low budget, a user-friendly SBS was developed to effectively improve time-to-decision in difficult airway situations.

Background

Obstetric nursing students have less opportunity to practice due to limited clinical placement sites and safety concerns, which leads to inadequate clinical judgment. Previous studies used simulation as a learning method but there was a lack of structured activities for learning, which is a vital aspect to support clinical judgement development. The study aim was to investigate the effect of an Experiential Learning Simulation-Based Learning Program on clinical judgment among nursing students.

Methods

A quasi-experimental two-group pre-test post-test design was employed. The participants were 44 nursing students. The intervention comprised three obstetrics nursing clinical scenarios in antepartum, peripartum, and postpartum periods guided by Kolb's Experiential Learning Theory that included concrete experiences, reflective observations, abstract conceptualization, and active experimentation. Clinical judgment was assessed through a questionnaire.

Results

After the program, the experimental group had higher scores of clinical judgment than the control group. Significant differences in the clinical judgment scores were noted between groups.

Conclusions

The Experiential Learning Simulation-Based Learning Program demonstrated effectiveness in increasing clinical judgment among nursing students.

Background

The operating room (OR) is an intimidating environment for novice anesthesia learners. This study aimed to evaluate the feasibility and acceptability of introduction to commonly-used anesthesia equipment in virtual escape room simulations through augmented reality (AR) in comparison to virtual reality (VR).

Sample

Eighty-seven first-year graduate student registered nurse anesthetists completed a virtual simulated escape room experience.

Methods

A descriptive study was conducted over three years with data from three cohorts.

Results

In the AR cohort, 98% of learners found the AR user-friendly while 84% of learners found the application effective to become familiar with anesthesia equipment. With the VR cohort, 95% of learners found the VR user-friendly while 98% of learners indicated the application helped them understand use of the equipment.

Conclusion

Both AR and VR were reported as feasible and demonstrated comparable acceptability. Faculty should have a back-up plan for those who may experience cybersickness.

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes. Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Key recommendations: Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental levels is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.

It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.

We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.

Call for action: We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.

We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.

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