The use of simulation as a learning approach to non-technical skills awareness in final year student nurses

Understanding what non-technical skills are and their relevance for healthcare practitioners has become a new area of exploration. Although recent literature has highlighted the necessity of introducing non-technical skills training and assessment within medical education, nursing education has still to fully embrace this skills training. The purpose of this paper is to explore the use of simulated practice as a learning approach to demonstrate and assess non-technical skills for final year nursing students. An established ward simulation exercise was refocused to incorporate opportunities for these nursing students to be assessed on their ability to demonstrate application of non-technical skills. Opinions on whether this was a successful strategy were sought from the students by means of module evaluation questionnaires. Analysis of this data revealed that the majority of the students agreed that it was an effective learning approach, allowing them to demonstrate their non-technical skills, be assessed and subsequently identify further learning needs.     

Key issues and challenges in developing a pedagogical intervention in the simulation skills center – An action research study

Simulation skills centers (SSC) are considered important learning arenas for preparing and qualifying nursing students. Limited clinical placements and claims of diminished learning opportunities raise concerns that newly educated nurses lack proficiency in many psychomotor skills. Accordingly, there is an increased focus on learning in the SSC. However, it has been questioned if the pedagogical underpinning of teaching and learning in the SSC is missing or unclear. At a bachelor nursing education in Norway, there was a desire to change practice and enhance learning in the SSC by systematic use of The Model of Practical Skill Performance (Bjørk and Kirkevold, 2000). A participatory action research design was chosen. A pedagogical intervention was developed and implemented in 2010 in a cohort of eighty-seven first year bachelor nursing students during their basic nursing skill course. The intervention is shortly described. This article reports key issues and challenges that emerged during development of the new intervention. Data to inform the study were collected via thorough meeting minutes and the project leader's logbook, and analyzed using fieldnotes analysis. Six key issues and challenges were identified. These are presented and discussed consecutively in light of their importance for development and implementation of the new intervention.     

在真实临床情境中护理本科生综合临床技能的评价

目的：介绍在真实临床情境中护理本科生综合临床技能的评价。方法：本研究通过在真实临床情境中客观结构化临床考试,采用《综合临床护理技能评核表》直接观察、评价180名护理本科四年级学生的综合临床技能。结果：绝大部分学生能完成护理评估、病例分析、给予护理干预并进行健康教育。但存在护理评估不全面、不深入,健康教育内容不完整、不恰当,操作步骤紊乱等现象。教师及学生对OSCE评价较好。结论：在真实临床情境中的OSCE,增强了情境的逼真度,可以客观地测试学生的综合临床技能。     

在护理学研究生教育中开设循证护理课程的实践和反思

目的探讨在护理学专业研究生中开设循证护理（EBN）课程的经验和教训,以进一步改进课程。方法根据课程开发理论和技术构建EBN课程教学方案,并对复旦大学护理学院研究生课程进修班07级学生（n=33）开展54学时的循证护理教学,以06级学生（n=26）为对照组。教学结束后对实验组学生进行EBN理论知识、态度、文献评鉴技能及制作系统评价方案能力方面的测试,同时应用课程反馈问卷评价表和访谈法了解学生对EBN课程教学过程和效果的评价。结果教学后实验组学生EBN珲论知识得分高于对照组（P〈0．01）;教学后实验组学生EBN文献评鉴技能得分高于教学前（P〈0．01）。课程反馈的问卷评价和访谈结果提示：学生均认玎EBN课程是具有挑战性的课程,同时从该课程中收获很多,尤其是学生能够通过该课程整合并应用流行病学、卫生统计、文献检索、护理研究等课程的内容。学生体验中最具有挑战性的是文献质量评鉴、文献提取、Meta分析和证据的临床应用。学生认为该课程内容理论联系临床护理实践,绝大多数学生对教学内容、教材、教学方法满意,但对教学学时和开课方式提出改进意见。结论在护理学研究生中开设EBN课程具有可行性,该课程可提高学生的文献评阅和系统评价能力,并提高学生将证据应用到临床实践的意识。应进一步开展研究并改进课程内容和教学方法。     

组织护理实习生进行操作技能竞赛的实践与效果

目的通过每年举办护理操作技能竞赛,激发护理专业实习生的学习热情,提高实习生操作的规范性,以更快地适应临床工作。方法在每年临床实习的中后期开展护理操作技能竞赛,并评出名次给予奖励。结果各届实习生操作技能竞赛成绩均在90分以上;参加过操作技能竞赛的新护士岗前操作考核成绩高于未参加过操作技能竞赛的新护士(P<0.01)。结论实习期间举办操作技能竞赛可调动实习生的积极性,加强操作的规范性,为新护士适应临床护理工作打下良好基础。     

A comparative study of teacher directed and self directed methods of teaching clinical skills to undergraduate nursing students

The undergraduate nursing degree has within its curriculum a practical component that enables students to gain the skills required to function effectively in the clinical setting. These skills are often taught in the laboratory setting using a structured teacher directed approach. This study used a 'post-test only'experimental design to compare clinical skills acquisition (both cognitive and psychomotor) of students participating in two different teaching-learning modalities: (i) teacher directed; and (ii) self directed learning. The sample consisted of 59 year 2 nursing students enrolled in the acute care subject. The results demonstrated that, although students acquired a variety of skills by participation in either method of teaching-learning, those who undertook self directed learning showed a higher level of competency. The reasons for this difference require further investigation.     

Developing clinical scenarios from a European perspective: successes and challenges

This paper presents developmental work involving students from the University College Dublin (UCD), Ireland (n = 9), University of Surrey, England (n = 8) and University of Ljubljana and University of Maribor, Slovenia (n = 5) participating in the Erasmus Intensive Programme. The Erasmus programme offers a two week ‘Summer School’ in the Faculty of Health Sciences, University of Maribor, Slovenia. Using a participatory approach, facilitators from both the UCD and Surrey engaged with students from all of the universities to develop scenarios for simulated learning experiences, in the care of older people, for utilisation on an e learning facility and within the simulated clinical learning environment. Students developed key transferable skills in learning, such as information literacy, cultural diversity, team working, communication, and clinical skills acquisition whilst exploring differences in healthcare delivery in other European countries.     

Picture of Norwegian clinical learning laboratories for undergraduate nursing students

Clinical preparation for practice is a vital part of undergraduate education in nursing. This study explored contemporary constructions of clinical skills laboratories in two nursing undergraduate programs in Norway using qualitative collective case study methods. Data were gathered using individual and group interviews and observation during site visits. The data revealed slightly different ways of organizing teaching and experimenting with use of pedagogical methods to facilitate learning of technical skills as well as encouraging students to activate relevant theoretical knowledge. While there was a lively and striking enthusiasm among staff about the way learning was managed within the laboratories, the pedagogical underpinnings for their particular approaches were less certain amongst participants. The paper concludes with the necessity to provide evidence for the outcome of laboratories learning and investigate suitable pedagogical methods for effective teaching and learning of practice skills. Hence, a need for research on transfer of knowledge and skills between the different sites (academy, clinical settings, and laboratories) is identified.     

Nursing students learning transfer from classroom to clinical practice: An integrative review

AimThe aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.BackgroundAs nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students’ learning transfer has not yet been synthesized.DesignThis integrative review was conducted using the Whittemore and Knafl framework.Review methodsEight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute’s critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsTwenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students’ ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.ConclusionsThe information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students’ learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.     

The effect of computer-assisted learning versus conventional teaching methods on the acquisition and retention of handwashing theory and skills in pre-qualification nursing students: A randomised controlled trial

Background

High quality health care demands a nursing workforce with sound clinical skills. However, the clinical competency of newly qualified nurses continues to stimulate debate about the adequacy of current methods of clinical skills education and emphasises the need for innovative teaching strategies. Despite the increasing use of e-learning within nurse education, evidence to support its use for clinical skills teaching is limited and inconclusive.

Objectives

This study tested whether nursing students could learn and retain the theory and skill of handwashing more effectively when taught using computer-assisted learning compared with conventional face-to-face methods.

Design

The study employed a two group randomised controlled design. The intervention group used an interactive, multimedia, self-directed computer-assisted learning module. The control group was taught by an experienced lecturer in a clinical skills room. Data were collected over a 5-month period between October 2004 and February 2005. Knowledge was tested at four time points and handwashing skills were assessed twice.

Setting and participants

Two-hundred and forty-two first year nursing students of mixed gender; age; educational background and first language studying at one British university were recruited to the study. Participant attrition increased during the study.

Results

Knowledge scores increased significantly from baseline in both groups and no significant differences were detected between the scores of the two groups. Skill performance scores were similar in both groups at the 2-week follow-up with significant differences emerging at the 8-week follow-up in favour of the intervention group, however, this finding must be interpreted with caution in light of sample size and attrition rates.

Conclusion

The computer-assisted learning module was an effective strategy for teaching both the theory and practice of handwashing to nursing students and in this study was found to be at least as effective as conventional face-to-face teaching methods.     

Revolutionizing assessment in a clinical skills environment--a global approach: the recorded assessment

Assessment is an essential component of education and a key element of the student experience. This is never more apparent than in the assessment of student nurses competency in practice skills. The use of clinical skills centres to facilitate the acquisition of nursing skills continues to gain popularity, nonetheless the methods used to develop and assess competency within these environments remains diverse with contemporary literature suggesting that the objective structured clinical examination (OSCE) is predominantly used. This paper presents an innovative approach used within a skills environment to summatively assess nursing students at the end of their first year; one that seeks to cultivate clinical competency through a process of self-appraisal and appreciation of evidence-based literature. The recorded assessment is a unique strategy that endeavours to make the learning experience more meaningful for the students, through the use of an audio-visual tool and written critique. The critique is crucial to the learning process by encouraging the student to adopt a critical and holistic view of their practice; essential skills for future practitioners.     

Simulation in associate degree nursing education: A literature review

The use of simulation in nursing education is increasing in scope and popularity. Many undergraduate nursing programs have adopted high-fidelity patient simulation as an educational tool. The effect of simulation on teaching and learning is the focus of current research. The aim of this literature review is to synthesize the research findings evaluating simulation specifically in associate degree nursing education. The results of the review identified the following themes: critical thinking, clinical skill performance, knowledge acquisition, student satisfaction, self-confidence, and anxiety. Gaps in the literature are highlighted, implications for nursing education are explored, and recommendations for further research are provided.     

Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory

BACKGROUND: Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills. While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development. Self-regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts. AIMS: This paper reports on a study to explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills. METHODS: Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases. The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self-regulation and thinking. FINDINGS: Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition. This skill acquisition is best accomplished through teaching-learning attention to self-regulation learning theory. A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self-regulated learning theory. It is apparent that single-minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development. Likewise, single-minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development. While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self-regulated learning prompts. CONCLUSIONS: Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self-regulated learning strategies. The self-regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts.     

Peer learning partnership: an innovative strategy to enhance skill acquisition in nursing students

The development of clinical skills for nursing students is a critical component of any undergraduate nursing program. Providing sufficient quality experience for students to develop competence has been recognised as a problem in skill acquisition. At the same time, peer learning has been identified as a valuable strategy for teaching and learning. Nurse academics at a Sydney university recognized these facts and implemented a peer learning strategy into existing first and third year nursing therapeutics units of study. This innovative approach linked the Australian Nursing Council Inc (ANCI) standards of practice to skills acquisition, resulting in third year students increasing their understanding of the relevance of these competency standards to practice. The peer learning strategy involved partnering first and third year students for clinical skills practice sessions. Evaluation of the peer learning approach indicated students valued the experience.     

标准化患者结合临床模拟情境在《护理学基础》技能考核中的应用

目的探讨标准化患者结合临床模拟情境在《护理学基础》技能考核中的效果。方法在我校护理本科2009级《护理学基础》课程中采用标准化患者结合临床模拟情境对学生护理学基础技能进行考核,并考核后运用自制的问卷对参加考核的学生进行问卷调查。结果调查问卷结果显示,学生对于此种考核形式持肯定意见,认为有助于提高自身的综合技能。结论标准化患者结合临床模拟情境进行《护理学基础》技能考核可以为学生创设较为真实的临床情境,使考核教师能全面观察学生综合运用的知识和技能、职业情感、人文关怀意识和能力等各方面水平,但对教师的组织实施和学生的临场发挥等方面都有一定的挑战。     

Impact of experiential dementia care learning on knowledge,skills and attitudes of nursing students: A systematic literature review

AimThe aim of this systematic review was to synthesize evidence on the effect of clinical experiential learning approaches on pre-licensure nursing students' competence in dementia care and to identify associated challenges.BackgroundAs the prevalence of dementia increases, nurse educators must proactively prepare pre-licensure nursing students to care for people living with dementia. The limited number of physical clinical learning settings, especially during the current COVID-19 pandemic, has caused many nursing programs to use alternative experiential learning approaches.DesignSystematic Literature ReviewMethodsIn accordance with PRISMA guidelines, we conducted a systematic search for the literature in Cumulative Index to Nursing and Allied Health Literature, MEDLINE and ProQuest for relevant peer-reviewed studies published between 2010 and 2021. Using the Boolean operator search approach, the keyword "dementia care" was combined with "AND/OR" and other search terms. In addition, a descendent and an ascendent search were conducted to find other relevant studies.ResultsA total of 17 retrieved articles met the inclusion criteria. Five themes emerged, with the main findings being that face-to-face (in person), virtual and simulated experiential learning approaches increased pre-licensure nursing students' dementia care knowledge. However, the face-to-face experiential learning approach that provides physical contact with people living with dementia and clinical staff had more impact on their skills and attitudes.ConclusionThe evidence in this review could inform curriculum development, teaching methods, experiential learning experiences and clinical placements of pre-licensure nursing students with regards to dementia care. More research is needed to explore further the impact of virtual and simulated experiential learning approaches on pre-licensure nursing students' dementia care skills.Tweetable abstractThis systematic literature review synthesizes evidence of clinical experiential learning on prelicensure nursing students' competence in dementia care per PRISMA guidelines. Five themes emerged #dementia #experientiallearning #prelicensurenursingstudents #clinicalsducation     

Using constructive alignment theory to develop nursing skills curricula

Constructive alignment theory has been used to underpin the development of curricula in higher education for some time (Biggs and Tang, 2007), however, its use to inform and determine skills curricula in nursing is less well documented.This paper explores the use of constructive alignment theory within a study of undergraduate student nurses undertaking clinical skill acquisition in the final year of a BSc (Hons) Nursing course.Students were followed up as newly qualified nurses (NQN) (n = 58) to ascertain the impact of skill acquisition in this way. Comparisons were made with newly qualified nurses who did not participate in a constructively aligned curriculum.This mixed methods study reported skill identification within the immediate post-registration period and evaluated the constructively aligned curriculum as having positive benefits for NQNs in terms of confidence to practice. This was supported by preceptors’ views.The study recommends two process models for nursing skills curriculum development and reports that constructive alignment is a useful theoretical framework for nurse educators.