Knowledge on Simulation based learning in Nursing Education among Nursing Fraternity in selected Nursing Institutions of India

 

Manashi Sengupta¹, Ms. Lireni C. Tungoe²

¹Dean in-charge, Faculty of Nursing, Assam Down Town University, Guwahati, Assam, India.

²Lecturer, Faculty of Nursing, Assam Down Town University, Guwahati, Assam, India.

 

ABSTRACT:

Simulation based nursing education is a good approach implemented in nursing education to provide students with varied opportunities to practice their clinical skills before they are expose to the real patient. Simulation in nursing education is used to teach learners concepts relating to the care of patients who are either sick or infirm. Through the replication of real-world nursing scenarios and experiences, learners can practice the skills necessary to succeed in the field, without ever putting a real life patient at risk. The investigators adopted a quantitative research design to provide a deep and broad understanding on simulation based nursing education through two days virtual training session. A total of 203 nurses were selected using convenient sampling technique. Post test was conducted at the end of the training session and feedback about the training session was taken from each participants. Data were collected using self-administered structured questionnaire through Google form. Data was analysed using descriptive research design. This study was carried out to assess the knowledge of Nurses towards simulation based learning in nursing education. Majority of the sample had score good knowledge regarding simulation in nursing education and excellent feedback on training was received from the participants. Simulation based education in nursing education is very helpful as it bridge the gap between theory and practical through innovative teaching learning process. It creates interest to the teacher as well as the learner. Students get to practice their procedure in those standardized patient before they actually practice with the patients.

 

 

INTRODUCTION:

Narrative pedagogy is an approach that evolves from the lived experiences of teachers, clinicians and students. To help prepare nursing students to meet the health care need and to be competent and proficient, nursing educators must continually realign curricula, approaches and programs with the requirements of nursing practice environments. One such approach developed over the last decade in utilizing narrative pedagogy in nursing education.  More simply termed, its story telling to teach complex clinical topics.

 

It is more than just what is taught: it is now how it is taught that creates the necessary changes in attitudes and behaviours. Lecture method alone can rarely develop all these competencies. Narrative pedagogy is used as a means of complementing a more than conventional method of teaching and learning. By focusing attention on the human element of health care, teachers and learners together explore meaning from the interpretations of stories. Learners consider the emotional experiences of participants, challenging conventional, wisdom and otherwise constructing their new understanding and perspectives.¹

 

One such domain of narrative pedagogy is Simulation. Simulations are an educational process that can replicate clinical practices in a safe environment. Nursing students who take part in education programs involving simulations perform less medical mistakes in clinical settings, and are able to better develop their critical thinking and clinical decision-making skills.² In 2010, a national survey of prelicensure nursing programs conducted by the NCSBN revealed that 87% of respondents were using medium- or high-fidelity patient manikins in their curricula.³

 

The faculty members use this domain with the technical aspects also using computer mannequins now move to center stage in nursing education. Simulation today includes role play, standardized patients, virtual simulation and computerized mannequins. It is now imperative to integrate simulation throughout the entire curriculum. Today, simulation allows students to learn skills, develop clinical reasoning abilities and to become competent in caring for patients and families in a safe environment.⁴

 

The variety of simulation based learning options can offer a way to replace traditional and often hard to find, clinical experiences.⁵ The use of patient simulators in nursing education is a relatively new instructional methodology. The rationale for using simulation as an educational strategy includes the absence of risk to a live patient; the ability to provide standardization of cases; the promotion of critical-thinking, clinical-decision making, and psychomotor skills; the provision of immediate feedback, and the integration of knowledge and behavior.⁶ Through patient simulation scenarios, essential elements of patient safety can be emphasized, such as prevention of medication errors, promotion of effective communication, and the importance of teamwork. Learners can be exposed to critical care scenarios and have the opportunity to respond without fear of harming a live patient.⁷

 

Over the past decade, nursing schools have gained momentum in the Middle Eastern countries to meet the changing societal needs, population demands and community needs. Nursing schools have raised the bar of standards of nursing practice by preparing baccalaureate nurses with efficient critical skills for safe practice in the critical settings in the Sultanate of Oman. There has been a need for increasing experiential practice in the critical care units in Oman to update to the clinical expectations and preparing the students to take on the role and responsibilities of Registered Nurses (RNs) in the acute and critical care settings. This application and clinical judgement is necessary for student nurses using high fidelity simulation.⁸

 

By providing students with exposure to a variety of clinical situations through clinical practicum experiences and patient simulations, they can be better equipped to provide safe, effective care and work as contributing members of the health care team.⁹

 

The challenge is for faculty to embrace patient simulation as an instructional strategy and to seek its effective implementation in nursing education programs. The exciting technology of patient simulation is only as good as the faculty who use it. The potential benefits to learners outweigh the costs of the equipment and faculty training.¹⁰

 

Simulation based education in nursing education is very helpful as it bridge the gap between theory and practical through innovative teaching learning process. It creates interest to the teacher as well as the learner. Students get to practice their procedure in those standardized patient before they actually practice with the patients. A qualitative study was selected for this study to provide a deep and broad understanding of this complex, multidimensional phenomenon. This study was carried out to assess the knowledge of Nurses towards simulation based learning in nursing education.

 

OBJECTIVES OF THE STUDY:

1.     To determine the post training knowledge on simulation based learning in nursing education

2.     To determine the feedback of simulation based learning in nursing education.

 

METHODS AND MATERIALS:

Research approach: Quantitative research approach

 

Research design: Descriptive research design

 

Research Setting                : Virtual

 

Population: Nurses who have completed their studies (B.Sc. Nursing, Post Basic   B.Sc. Nursing, M.Sc. Nursing and above)

 

Sample size: 203 Nurses

 

Sampling technique: Convenient sampling technique

 

Selection criteria:

Inclusion criteria

1.     Nurses who have registered on two days training programme on simulation based learning.

 

Exclusion criteria

1.     Nurses who are not willing to participate.

 

Tool

Tool I: Section A: Structured knowledge questionnaire on simulation based learning in nursing education, Section B: Feedback questionnaire on training session.

 

Ethical consideration: Ethical permission was taken from institutional ethical committee and the participants.

 

Data analysis: The collected data was analysed in terms of objectives of the study by using descriptive analysis.

 

RESULTS:

SECTION 1:

Frequency and percentage distribution of post training knowledge on simulation based learning in nursing education In order to find out the post training knowledge on simulation based learning in nursing education research hypothesis was stated.

 

H₁: There is a significant increase in knowledge of nurses on simulation based learning post training session

 

To determine the post training knowledge on simulation based learning in nursing education frequency and percentage distribution of post training knowledge on simulation based learning in nursing education among nurses was computed from the available data.

 

Table 1: Frequency and percentage distribution of knowledge score                                                                                                        N= 203

S. No.	Item	Frequency	Percentage (%)
1.	OSCE stands for ·      Observed structured clinical evaluation ·      Objective structured clinical evaluation ·      Observed standard clinical evaluation ·      Objective structured clinical evaluation	11 180 7 5	5.3 88.7 3.5 2.5
2.	OSCE is used to ·      Evaluate knowledge ·      Evaluate skills ·      Teach knowledge ·      Teach skills	17 173 4 9	8.4 85.2 2 4.4
3.	Conventional way of teaching critical thinking to nursing students is ·      Conference ·      Classroom teaching ·      Laboratory demonstration ·      Bed side teaching	9 37 66 91	4.5 18.2 32.5 44.8
4.	Standardized patient ·      Computer based simulators ·      Can move beyond the script and can change his/her reaction according to the need of the scenario ·      Are actors trained to reliably role play history taking physical test and communication skills in a clinical encounter ·      Could be any patient in the hospital	15 21   151   16	7.4 10.3   74.4   7.9
5.	Case study helps the ·      Students to complete patient care plans ·      Teacher to teach theory ·      Students to stoically think by focusing on the results ·      Teacher to teach skills	91 8 102 2	44.8 4 50.2 1
6.	Simulation is ·      Classroom demonstration ·      Only when manikins are used to recreate real-life situation ·      Another form of role play ·      Artificial representation of a complex real world  process with sufficient fidelity	3 27 4 169	1.4 13.3 2 83.3
7.	Fidelity means ·      The degree of realism and technical complexity of models ·      Level of participation of the facilitators ·      Level of participation of the participants ·      Level of usage of the manikins	177 9 8 9	87.2 4.43 3.94 4.43
8.	Components of debriefing after simulation scenario are ·      Reaction analysis and summary ·      Reaction analysis and debrief ·      Pre-brief, scenario and summary ·      Pre-brief, scenario and debrief	99 45 19 40	48.8 22.2 9.4 19.7
9.	Some important characteristics of a facilitator are ·      Judgmental, keen observation and provokes guilt ·      Non-judgemental, keen observation and provokes guilt ·      Non-judgemental, keen observation and content expert ·      Judgmental, keen observation and content expert	6 17 147 33	2.9 8.4 72.4 16.3
10.	Hybrid simulation is ·      Specific part trainers replicating a particular part of anatomy ·      A combination of computer based simulators and technical support ·      A combination of standardized patient and part task trainers ·      Computer based simulator	14 9 112 68	7 4.3 55.2 33.5
11.	Checklist can be used as ·      Clinical teaching tool only ·      Clinical skills teaching and practicing tool ·      Evaluation tool ·      Clinical practicing tool only	2 142 57 2	1 70 28.1 1
12.	Utilization of checklist ·      Helps the students memorize better ·      Is not an effective teaching methodology ·      Can replace the teacher ·      Makes sure that no steps is missed during a clinical procedure	17 3 0 183	8.4 1.5 0 90.1

 

The data presented in table 1 shows that out of 203 nurses, majority 88.7% has given the correct response on what OSCE stands for and majority 85.2% has given correct response on what OSCE is used for. Majority 44.8% has given correct response on what conventional way of teaching critical thinking to nursing students is and majority 74.4% has answered correctly on what is a standardised patient. 44.8% has given correct answer on how case study helps the students and 83.3% correctly answered on what simulation is. 87.2% knows what fidelity means and 48.8% knows about the components of debriefing after simulation scenario. Majority 72.4% has given correct answer on the important characteristic of a facilitator and 55.2% know what hybrid simulation means. 70% of nurses know the uses of checklist and 90.1% knows about the utilization of checklist.

 

SECTION 2: Frequency and percentage distribution of feedback on simulation based learning in nursing education training session.

n=203

 

 

Fig: 1 and Fig: 2 Shows that 87 (42.9%) nurses who participated in the training session on simulation found the training session as excellent and 79 (38.9%) responded that the training session was a good learning experience and met their expectations.                   n=203

 

Fig: 3 and Fig: 4 Depicts that 115 (56.7%) participants responded that the session was very relevant and 89.7% responded that they would like to attend such events in a similar medium in future.                                                                                                         n=203

 

Fig. 5 Depicts that 61.1% participants did not face any technical/connectivity issue during the course proceeding.

 

 

DISCUSSION:

The findings of the study have been discussed with the reference to the objectives, hypotheses and findings from other studies

 

The first objective was to determine the post training knowledge on simulation based learning in nursing education:

The level of knowledge regarding simulation based learning in nursing education among nursing fraternity was assessed by using structured knowledge questionnaire. The sample size was 203. It denotes that the level of knowledge on simulation based learning in nursing education among Nurses on analysis was majority 88.7% has given the correct response on what OSCE stands for and majority 85.2% has given correct response on what OSCE is used for. Majority 44.8% has given correct response on what conventional way of teaching critical thinking to nursing students is and majority 74.4% has answered correctly on what is a standardised patient. 44.8% has given correct answer on how case study helps the students and majority 83.3% correctly answered on what simulation is. Majority 87.2% knows what fidelity means and 48.8% knows about the components of debriefing after simulation scenario. 72.4% has given correct answer on the important characteristic of a facilitator and 55.2% know what hybrid simulation means and 70% of nurses knows the uses of checklist and 90.1% knows about the utilization of checklist. This study is supported with the findings of study conducted by Hanem F. Mohamed, Sarah Grace Gonzales and Hend M. El Azazey (2016) showed a mean age of 20.26(75) years old and a mean of 3.1 out of 5 for GPA.  Majority were singles, has no previous hospital experience and few previous simulation experience. Students showed positive attitude toward the use of simulation in the pre-test. Students reported improvement in their confidence in preparation for real patients, decision making, what to tell health care providers, recognizing and predicting changes in patients’ condition. Regarding learning outcomes, majority reported that they developed critical thinking abilities, better understanding of clinical experience, assessment skills, decision making skills, and learned from debriefing, observation and peer.¹¹

 

The second objective was to determine the feedback of simulation based learning in nursing education:

The feedback of simulation based learning in nursing among Nurses post training session revealed that 87 (42.9%) nurses who participated in the training session on simulation found the training session as excellent and 79(38.9%) responded that the training session was a good learning experience and met their expectations. Majority 115(56.7%) participants responded that the session was very relevant and 89.7% responded that they would like to attend such events in a similar medium in future and 61.1% participants did not face any technical/connectivity issue during the course proceeding.

 

CONCLUSION:

The present study was conducted to assess the knowledge of nurses on simulation based learning in nursing education as simulation based education is accepted globally in nursing education. Keeping the demand in mind, two days training session was organized for the nurses in order to make the faculty, instructors, educators adapt the change and can switch themselves from traditional way of teaching to simulation based teaching.

 

The findings of the study revealed that the participants have acquired knowledge on simulation based learning in nursing education and a good feedback has been collected from the participants.

 

LIMITATIONS:

The study was limited only on virtual training.

 

RECOMMENDATIONS:

Based on the findings of the study, the following recommendations have been made.

·       Similar study can be conducted by using different training/teaching method by setting up a standardized patient.

·       Hands on training can be given to the participants.

·       More number of samples can be included.

 

REFERENCES:

1.      Carol Fowler Durham; Kathryn R. Alden. Enhancing Patient Safety in Nursing Education Through Patient Simulation, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Available at:  https://pubmed.ncbi.nlm.nih.gov/21328731/

2.      Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system A report of the Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press; 2000.

3.      AJN, American Journal of Nursing: April 2018, Volume :118 Number 4, page 17 - 18

4.      Beaubien JM, Baker DP. The use of simulation for training teamwork skills in health care: how low can you go? Qual Saf Health Care. 2004;13(suppl 1): i51–6. 

5.      Gaba DM. The future vision of simulation in health care. Qual Saf Health Care. 2004;13 (suppl 1): i2–i10.

6.      Jeffries P. A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nurs Educ Perspect. 2005; 26: 96–103.

7.      Maran NF, Glavin RF. Low- to high-fidelity simulation: a continuum of medical education? Med Educ. 2003; 37(suppl 1): 22–8.

8.      Orjan Lestander, Niklas Lehto, Asa Engstrom. Nursing students' perceptions of learning after high fidelity simulation: Effects of a Three-step Post-simulation Reflection Model. Nurse educ today. 2016, May, 40, pp 219-224

9.      METI. Human patient simulator: Clinical features. 2006. [Accessed October 12, 2006]. Available at: http://www.meti.com/downloads/HPSCF.pdf.

10.   Laerdal. Advanced simulation in emergencies: SimMan™. 2006, October 12, Available at: http://www.laerdal.com/binaries/ ACJHBLQB.pdf

11.   Hanem F. Mohamed, Sarah Grace Gonzales and Hend M. El Azazey. Effect of Simulation Based Practice on Attitude, Confidence and Perception of Learning Outcomes of Nursing Students. Journal of Biology, Agriculture and Healthcare. 2016, Vol.6, No.24, pp 2224-3208 

 

 

Received on 15.02.2021         Modified on 28.02.2021

Accepted on 13.03.2021      ©A&V Publications All right reserved