Simulation has become an increasingly important new policy area in nursing education. Simulation-based education is a training method that seeks to replace or improve real learning experiences with guided experiences. Simulation is defined by an educational approach that utilizes technology to replicate real-world learning aspects to enable learners to be immersed in an interactive learning environment (Lavoie et al., 2018). Though research in simulation-based learning is still scarce, simulation in nursing has been used historically to equip learners with key nursing skills. Recently, there has been a growth in research in simulation-based learning as the next frontier in nursing education and practice. Recent studies have evaluated the effectiveness of simulation-based education by analyzing the purpose of the simulation, the nature of technology used and the method of assessing learning. This paper aims to critically evaluate the measurement validity of research studies on simulation-based learning.
Critique of the NCSBN Simulation Study
The NCSBN simulation study was conducted to provide empirical evidence on the effectiveness of simulation as a teaching pedagogy. The study aimed to discuss whether traditional clinical hours can be substituted with simulation learning in the nursing curriculum. The research also explored the educational outcomes of nursing students in key clinical units in which simulation was integrated and used throughout the course duration. Lastly, the study sought to determine how simulation in the learning curriculum influences the practice of graduate nurses in their clinical operations.
The study measured several outcomes of simulation-based learning, such as student's knowledge, critical thinking as well as their competency. Student's knowledge was assessed through the use of the 'ATI RN Comprehensive Predictor,' an online multiple-choice examination (Hayden et al., 2014). The web-based predictor gives a score for crucial nursing content areas, and an overall percentage of the correct answers scored out of the total 150 item questions. The student's knowledge of specialty content in eight major nursing units was measured using the 'ATI Content Mastery Series (CMS)' examination (Hayden et al., 2014). The outcome on student's knowledge is more likely to be valid since the measurement tool is web-based hence it can yield consistent results with repeated and equivalent assessments. Besides, the measurement tools are reliable as it assesses the student's knowledge on the major content categories thus providing content validity.
In the study, nursing competency was assessed based on three measurement instruments. The 'Creighton Competency Evaluation Instrument' was applied by nursing instructors to assess student's clinical competency (Hayden et al., 2014). The test tool consists of 23 items that measure student's assessment and judgement in a real clinical setting and a simulated setting. The validity and reliability of the tool were highly acceptable as it yielded an alpha value on the range of 0.974 to 0.979 (Hayden et al., 2014). The reliability and validity were further confirmed with an agreement between values obtained from faculty instructors and independent evaluators. The 'New Graduate Nurse Performance Survey' consisting of 36 items was also used as an assessment tool to measure the student's clinical competency and technical skills. The survey yielded an alpha value of 0.972 indicating high level of validity and a high corresponding reliability score of 0.916 (Hayden et al., 2014). Lastly, the 'Global Assessment of Clinical Competency and Readiness for Practice' scale was used by evaluators to rate the overall score of the new graduates. The reliability of this test was established with an intra-rater value of 0.8 indicating high reliability (Hayden et al., 2014). The 'National Council Licensure Examination (NCLEX)' was used to assess the competency of entry-level nurses. The examination is highly reliable because it is a secure testing facility that applies a computerised approach in measuring student's competency.
The NCSBN study measured the critical thinking ability of new nursing graduates. The study applied the 'Critical Thinking Diagnostic' test to assess five major items that constitute critical thinking (Hayden et al., 2014). The five items include the following: problem recognition, prioritization, reflection, clinical decision making, and clinical implementation. The diagnostic test yielded a high alpha value of 0.976 coefficient indicating high reliability of the survey items. Also, the study applied the 'Clinical Learning Environment Comparison Survey (CLECS) to compare the student's perceptions of the traditional clinical approach and simulation-based learning (Hayden et al., 2014). The measurement tool provides various fundamental areas of clinical learning in which students reacted to how they perceived the nursing process, critical thinking, self-efficacy, communication, and learning holism. The study reported that the alphas obtained from traditional clinical settings were lower than those yielded from the simulation-based learning environment. This further proves that the simulation-based approach to nursing education is highly reliable and that the measurement instruments are valid.
Critique of Subsequent Research Studies
Subsequent research studies have been done on the impact of simulation on nursing education. The paper will discuss three research studies that have been conducted to determine how clinical skills are assessed through simulation-based training. The first research article is based on a systematic review of the effects of simulation on learning outcomes of undergraduate nursing students. According to Cerra et al. (2018), the research was designed to analyze the effectiveness of 'high-fidelity patient simulation (HFPS)' on life-threatening scenarios. The researchers carried out a systematic review of retrieved studies and analysed their reporting against a preferred meta-analyses checklist. The main aim of the simulation in the studies was to assess effective and rapid interventions of life-threatening scenarios such as cardio-circulatory and respiratory conditions. The simulation also assessed the ability of the students to manage high-risk conditions in clinical practice.
Researchers in the first study used high-fidelity patient simulation technology. They measured its effectiveness on student's outcomes based on life-threatening conditions. It was noted that HFPS technology improves learner's knowledge and performance in clinical practice. HFPS is an important teaching tool that builds the competence of students particularly in dealing with critical scenarios. The increased use of HFPS technology in nursing education is likely to result in confident and proficient nursing graduates who can respond appropriately to patients with life-threatening conditions. The learning outcomes were measured using self-rating tools and direct observations by evaluators. The assessment of subjective outcomes such as student satisfaction and self-confidence were measured using instruments such as the 'Satisfaction with Clinical Experience Simulation Scale' (Cerra et al., 2018). The results obtained indicated high reliability and validity of the assessment of learning outcomes.
The second research was conducted to determine the effect of computer debriefing practices on retention of knowledge during simulation of neonatal operations. The study used screen-based simulation technology to determine its impact on memory and competency retention among midwives (Daphne, 2019). Screen-based simulation is applied in nursing education to improve competency and enhance the provision of quality patient care. Computer simulation is important in teaching anatomical knowledge to students to improve their know-how and gestures during clinical operations. Screen-based simulation develops the capacity of the students to practice complex clinical procedures without exposing the patients to any form of risk (Daphne, 2019).
Computer integrated training makes it possible to offer repeatability of different scenarios and present them to students numerous times. Computer simulation enables learners to improve their technical and non-technical competencies and skills since they learn from the errors that they commit during the training. Computer debriefing helps to improve competencies, clinical knowledge and professional practice (Daphne, 2019). Screen-based simulation is enhanced with different debriefing methods such as verbal instructor debriefing, post-simulation debriefing which facilitate the communication process between the educator and the students.
The study used different measurement techniques to assess learning outcomes. Primary outcomes such as knowledge retention were assessed using a validated questionnaire created for different time frames. The questionnaire measured knowledge retention before simulation and at different time intervals after the screen-based simulation. Secondary outcomes, such as technical and non-technical skills, were assessed using different evaluation scores, such as the 'Modified Neonatal Resuscitation Program Evaluation Score' after the first and second simulation sessions (Daphne, 2019). The co-efficient obtained from these evaluation tests indicated the strong validity and reliability of the learning outcomes assessment techniques.
The third research was carried out to determine the effectiveness of using virtual patient simulation in nursing education (Kononowicz et al., 2016). The simulation provides a patient story that presents the variations of signs that model a real medical condition. The student is cast as an active healthcare provider who is required to make decisions concerning the nature and type of information required, make differential diagnoses, manage, and follow-up on the patient progress. Virtual patients enable learners to acquaint themselves with a set of possible standardized medical conditions and scenarios whose access in clinical settings may be limited. Students also can monitor the patient's condition over a long duration of time, which is not always possible in short clinical operations. The virtual patient simulation technology is a key learning tool that provides educators with tools for authorizing medical cases, controlling access of learners and overall tracking of student's learning progress.
In the study, the learning outcomes were measured using several assessment techniques. The learning outcomes were grouped into cognitive and skill-based outcomes. The training outcome hierarchy was used to assess the level of evaluation of the different learning outcomes. The researchers applied several meta-analyses techniques to assess the measurement validity of the learning outcomes (Kononowicz et al., 2016). Independent evaluators were used to improve the validity and reliability of the study. There was a huge percentage agreement between the findings of expert evaluators and faculty educators, which indicated strong reliability and validity of the measurement of learning outcomes.
As a nurse educator, I strongly believe that the substitution of simulation-based learning for traditional clinical experiences does not result in similar learning outcomes. I have confidence that a simulation teaching approach is more effective and productive than the traditional person to person learning technique that has been employed for a long time in nursing education. Simulation training improves self-confidence, enhances clinical skills in nursing practice and promotes communication and team collaboration in a clinical environment.
Participants in a simulated environment often express confidence that the...
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