Development and Effects of Leukemia Nursing Simulation Based on Clinical Reasoning.
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ABSTRACT:
SUBMITTER: Jang A
PROVIDER: S-EPMC8071219 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students.MethodA systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed.ResultsThe search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective.ConclusionsVirtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning.
| S-EPMC9212904 | biostudies-literature
Project description:BACKGROUND:The clinical environments are more complex, diverse and rapidly changing. Patients' conditions were chronic and complexed, healthcare providers require clinical reasoning for patient safety care. One of the learning methods to foster clinical reasoning is simulation education. The aim of this study was to develop a simulation education debriefing protocol that can improve clinical reasoning. METHODS:This study was conducted following steps. For the first step, the literature review was performed to constitute a preliminary debriefing protocol. Secondly, content validity was evaluated by five simulation learning experts. Thirdly, in-depth interview was conducted to re-examine content validity with education experts. Finally, the final debriefing protocol was applied to 7 undergraduate nursing students to examine feasibility of the protocol. RESULTS:The protocol consisted of debriefing steps, learning outcome, clinical reasoning attributes, core questions and guideline for instructor. Results of applicability of debriefing protocol represented that participants mentioned their reasoning competency was improved and understood the overall flow of reasoning. CONCLUSIONS:The debriefing protocol is important to educate healthcare providers 'clinical reasoning. It would be able to contribute to develop healthcare providers' clinical competencies.
| S-EPMC6560888 | biostudies-other
Project description:BackgroundClinical reasoning is a vital competency for healthcare providers. In 2014, a clinical reasoning assessment rubric (CRAR) composed of analysis, heuristics, inference, information processing, logic, cognition and meta-cognition subdomains was developed for osteopathy students.MethodsThis study was conducted to verify the validity and reliability of the CRAR in nursing education. A total of 202 case vignette assessments completed by 68 students were used for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach's α coefficient of the CRAR was calculated.ResultsThe content validity indices ranged from 0.57 to 1.0. The EFA resulted in three factors: assessment in nursing, nursing diagnosis and planning, and cognition/meta-cognition in nursing. The CFA supported a 3-factor model. The Cronbach's α coefficient of the CRAR was 0.94. This study confirmed the content validity, construct validity, and reliability of the CRAR. Therefore, the CRAR is a useful rubric for assessing clinical reasoning in nursing students.ConclusionsThe CRAR is a standardized rubric for assessing clinical reasoning in nurses. This scale will be useful for the development of educational programs for improving clinical reasoning in nursing education.
| S-EPMC8456525 | biostudies-literature
Project description:BACKGROUND:In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students' intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple "lecturers" and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. OBJECTIVE:This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. METHODS:A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students' levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. RESULTS:The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). CONCLUSIONS:The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.
| S-EPMC6447149 | biostudies-literature
Project description:ContextSituativity theory posits that learning and the development of clinical reasoning skills are grounded in context. In case-based teaching, this context comes from recreating the clinical environment, through emulation, as with manikins, or description. In this study, we sought to understand the difference in student clinical reasoning abilities after facilitated patient case scenarios with or without a manikin.MethodsFourth-year medical students in an internship readiness course were randomized into patient case scenarios without manikin (control group) and with manikin (intervention group) for a chest pain session. The control and intervention groups had identical student-led case progression and faculty debriefing objectives. Clinical reasoning skills were assessed after the session using a 64-question script concordance test (SCT). The test was developed and piloted prior to administration. Hospitalist and emergency medicine faculty responses on the test items served as the expert standard for scoring.ResultsNinety-six students were randomized to case-based sessions with (n = 48) or without (n = 48) manikin. Ninety students completed the SCT (with manikin n = 45, without manikin n = 45). A statistically significant mean difference on test performance between the two groups was found (t = 3.059, df = 88, p = .003), with the manikin group achieving higher SCT scores.ConclusionUse of a manikin in simulated patient case discussion significantly improves students' clinical reasoning skills, as measured by SCT. These results suggest that using a manikin to simulate a patient scenario situates learning, thereby enhancing skill development.
| S-EPMC8368304 | biostudies-literature
Project description:BackgroundUsing virtual patients integrated in simulators expands students' training opportunities in healthcare. However, little is known about the usability perceived by students and the factors/determinants that predict the acceptance and use of clinical virtual simulation in nursing education.ObjectivesTo identify the factors/determinants that predict the acceptance and use of clinical virtual simulation in learning in nursing education.MethodsObservational, cross-sectional, analytical study of the use of clinical virtual simulation in nursing to answer the research question: What factors/determinants predict the acceptance and use of a clinical virtual simulator in nursing education? We used a non-probabilistic sampling, more specifically a convenience sample of nursing degree students. The data were collected through a questionnaire adapted from the Technology Acceptance Model 3. In technology and education, the Technology Acceptance Model is a theoretical model that predicts the acceptance of the use of technology by users.ResultsThe sample comprised 619 nursing students, who revealed mean values of perceived usefulness (M = 5.34; SD = 1.19), ease of use (M = 4.74; SD = 1.07), and intention to use the CVS (M = 5.21; SD = 1.18), in a Likert scale of seven points (1-the worst and 7 the best possible opinion). This study validated the use of Technology Acceptance Model 3 adapted and tested the related hypotheses, showing that the model explains 62% of perceived utility, 32% of ease of use, and 54% of intention to use the clinical virtual simulation in nursing by nursing students. The adequacy of the model was tested by analysis of the direct effects of the relationships between the internal constructs (PU-BI, β = 0.11, p = 0.012; PEOU-BI, β = -0.11, p = 0.002) and the direct relations between some of the constructs internal to the Technology Acceptance Model 3 and the external determinants Relevance for learning and Enjoyability. In the proposed model, the external constructs that best predicted perceived usefulness, ease of use, and behaviour intention to use the clinical virtual simulation in nursing were Relevance for learning and Enjoyability.ConclusionsThese study results allowed us to identify relevance for learning and enjoyability as the main factors/determinants that predict the acceptance and use of clinical virtual simulation in learning in nursing.
| S-EPMC10943828 | biostudies-literature
Project description:BACKGROUND:Early detection and response to patient deterioration influence patient prognosis. Nursing education is therefore essential. The objective of this randomized controlled trial was to compare the respective educational value of simulation by gaming (SG) and a traditional teaching (TT) method to improve clinical reasoning (CR) skills necessary to detect patient deterioration. METHODS:In a prospective multicenter study, and after consent, 2nd year nursing students were randomized into two groups: Simulation by gaming "SG": the student played individually with a serious game consisting of 2 cases followed by a common debriefing with an instructor;Traditional Teaching "TT": the student worked on the same cases in text paper format followed by a traditional teaching course with a PowerPoint presentation by an instructor. CR skill was measured by script concordance tests (80 SCTs, score 0-100) immediately after the session (primary outcome) and on month later. Other outcomes included students' satisfaction, motivation and professional impact. RESULTS:One hundred forty-six students were randomized. Immediately after training, the SCTs scores were 59?±?9 in SG group (n?=?73) and 58?±?8 in TT group (n?=?73) (p?=?0.43). One month later, the SCTs scores were 59?±?10 in SG group (n?=?65) and 58?±?8 in TT group (n?=?54) (p?=?0.77). Global satisfaction and motivation were highly valued in both groups although significantly greater in the SG group (p?<?0.05). The students declared that the training course would have a positive professional impact, with no difference between groups. CONCLUSIONS:In this study assessing nursing student CR to detect patient deterioration, no significant educational difference (SCT), neither immediate nor 1 month later, was observed between training by SG and the TT course. However, satisfaction and motivation were found to be greater with the use of SG. TRIAL REGISTRATION:ClinicalTrials.gov; NCT03428269. Registered 30 january 2018.
| S-EPMC7031947 | biostudies-literature
Project description:AimTo examine the effects of neonatal simulation-based practice by applying flipped learning based on Tanner's clinical judgement model to pre-simulation briefing for nursing students.DesignA quasi-experimental non-equivalent control group pre- and postintervention design.MethodsUsing Tanner's clinical judgment model, flipped learning was developed and applied to the pre-simulation briefing curriculum prior to the neonatal nursing simulation exercise. Flipped learning was compared with a general pre-simulation briefing with 65 South Korean students. From September 7, 2019, to October 25, 2019.ResultsThe experimental group's critical thinking, self-confidence and clinical judgement ability increased, but knowledge, satisfaction and anxiety did not differ from that of the control group. Pre-simulation briefing design focuses on improving students' environmental comfort and reducing anxiety rather than developing complex reasoning skills and clinical judgement abilities. Applying flipped learning based on Tanner's clinical judgement model to pre-simulation briefing increased critical thinking, self-confidence and clinical judgement ability.
| S-EPMC8046145 | biostudies-literature
Project description:Introduction:Clinical reasoning is a complex cognitive process that involves multiple steps. Diagnosing and remediating clinical reasoning difficulties requires faculty to have an understanding of the cognitive theory behind clinical reasoning, familiarity with terminology, and a framework to identify different domains of struggle in their learners. Published resources on faculty development to diagnose and remediate clinical reasoning difficulties are limited. We created and implemented a workshop to assist faculty in developing these skills based on the five-domain framework described by Audétat, Laurin, and Sanche. This workshop provides all the materials needed to replicate this training with faculty at other institutions. Methods:The workshop consists of a didactic component and case-based active learning in small groups. Each case focuses on different domains of clinical reasoning difficulties and targets different learner levels (preclinical medical students through residents). The workshop was given in multiple venues in 2016 and 2017. Results:Participants reported the session was valuable (4.71/5.0), the facilitators were effective (4.5/5.0), and the objectives were met (4.28/5.0). They highlighted the strengths of the interactive format, the framework to diagnose and remediate clinical reasoning difficulties, and the excellent take-home resources. They suggested more time for the workshop, revision of cases to better highlight difficulties, and refinement of instructions to approach the cases. These suggestions were incorporated into the current iteration of the workshop. Discussion:We successfully implemented a workshop for diagnosing and remediating clinical reasoning difficulties in multiple venues. The sessions were diverse in terms of faculty participants and learner groups addressed.
| S-EPMC6338136 | biostudies-literature
Project description:BackgroundResearch into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure.MethodsSimulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.ResultsPhysical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.ConclusionThis work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.
| S-EPMC10693037 | biostudies-literature