Project - literature review
Ellie177
4example_literature_.pdf
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Simulation Based Learning to Improve Nurse
Education on Hand Expression
Student Name
Course Number: Course Title
Instructor Name Here
Date
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Simulation Based Learning to Improve Nurse Education on Hand Expression
Hypoglycemia is a major concern in newborn infants worldwide because this metabolic
condition can cause infants to have trouble breathing or feeding. Neonatal hypoglycemia can be
defined as a metabolic condition which refers to low blood glucose concentration in the newborn
infant (Oren et al., 2020). According to Oren et al. (2020), in 2011 the American Academy of
Pediatrics published the hypoglycemia guidelines as a means to appropriately screen and manage
newborns who were at risk for metabolic conditions such as hypoglycemia. By screening
newborns at birth, caregivers will be aware of those infants who may be at a higher risk for
glucose disturbances. One of the implementations brought forth by the World Health
organization in 1991, to prevent hypoglycemia was the Baby- Friendly-Hospital Initiative
(BFHI), which promotes the Ten steps in successful breastfeeding (Oren et al., 2020). By
utilizing both the hypoglycemia guidelines and the BFHI, infants can be screened, monitored and
treated for hypoglycemia resulting in a decrease in the number of hypoglycemic infants.
Recent evidence has shown that hypoglycemia is still affecting up to 15% of infants and
that the use of dextrose gel in conjunction with feeding can be utilized as an intervention to
correct asymptomatic hypoglycemia (Ponnapakkam et al., 2021). Breastmilk such as colostrum
has been proven to help infants regulate their blood glucose levels, thus preventing
hypoglycemia (Cleveland Clinic, 2022). Therefore, it is important that healthcare providers
working in conjunction with patients are well-versed on hand expression, breastfeeding and the
benefits of these interventions as stated in the BFHI and the Ten steps in successful
breastfeeding. Over the past several months at South Shore University Hospital, a BFHI
accredited institution, there has been an increase in the number of breastfed infants being
supplemented with formula instead of colostrum in the delivery room secondary to
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hypoglycemia (Mentor, personal communication, October 26, 2022). Furthermore, it has become
evident that many of the labor and delivery staff nurses at South Shore University Hospital are
not hand expressing colostrum because they need to be re-educated on it (Mentor, personal
communication, October 26, 2022). Therefore, by properly re-educating the labor and delivery
staff there will be a decrease in formula supplementation and an increase in both hand expression
and patient education. The current clinical practice that is in place for the labor and delivery
nurses is a PowerPoint lecture regarding hand expression, how to do it and the benefits (Mentor,
personal communication, October 26, 2022).
Furthermore, it would be beneficial for the labor and delivery nurses to be re-educated on
the technique of hand expression, not only so they are properly doing it themselves, but also
teaching their patients the correct technique. This will benefit any newborn that is at risk for
hypoglycemia because the colostrum that is expressed can be given to the infant to regulate
glucose levels. Additionally, it will help maintain the institute’s compliance with the BFHI and
Ten Steps in successful breastfeeding.
The proposed PICOT question is as follows: In Labor and Delivery staff (P), will
simulation-based learning (I) compared to PowerPoint lectures (C) improve understanding of
hand expression to adequately educate patients (O) over 8 weeks (T)? The educational
intervention that will be utilized to re-educate the labor and delivery staff is simulation-based
learning. By presenting the staff with a simulation on what hand expression entails, it will help
them gain more confidence in their technique and encourage them to do it more frequently rather
than unnecessarily supplement with formula. This will also aide them in properly educating their
patients.
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The theoretical framework that will be utilized in this educational project is Kolb’s
experiential learning theory. Kolb’s experiential learning theory states that, “learning is enhanced
when students, through active experience, gain competence with problem solving” (Svellingen et
al., 2021. p.1). Therefore, learners should incorporate real-life scenarios into their educational
process rather than the traditional education tools to gain competence on a subject. The main
concept of Kolb’s experiential learning theory is to apply what has been learned (Syellingen et
al., 2021). Furthermore, this learning theory supports simulation-based learning rather than a
traditional education tool because it promotes the application of gained knowledge through
hands-on learning. Thus, allowing the learner to utilize their knowledge and apply it to a real-life
scenario, in comparison, to learning with a PowerPoint lecture where the learner is not actively
participating in the learning process. Simulation based learning can be defined as allowing a
learner to mimic a real-life scenario, in a safe learning environment where they can learn from
their mistakes and get feedback in real-time based on their performance before caring for real
patients (Al Khasawneh et al., 2021). The labor and delivery nurses will have the opportunity to
work through a scenario that involves them initiating hand expression using a fake breast. This
simulation exercise will help the nurses learn the proper technique themselves and properly
prepare them to educate their patients.
This project is a beneficial educational tool for labor and delivery nurses at South Shore
University hospital because it allows them to be re-educate on hand expression. This not only
benefits the nurses, patients, and hypoglycemic infants, but also the facility because they are a
Baby Friendly accredited institution. This practicum project will include a written pre-test to
identify the nurses’ initial level of knowledge regarding hand expression and its benefits. A
simulation-based learning exercise will follow, involving the labor and delivery nurses
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conducting a real-life scenario based on hand expression using a fake breast. A post-test will
follow to assess what the nurses have learned and their level of confidence regarding hand
expression. Once the simulation-based education has concluded, the nurses can utilize their
gained knowledge and use it to teach their patients about hand expression and the technique. The
idea behind this educational project is to apply and analyze the proposed PICOT question with
the belief that simulation-based learning will improve the labor and delivery nurses’
understanding of hand expression. Upon further reading, this paper will explain the PICOT
question, reflect on the chosen educational intervention and synthesize the peer reviewed
literature. The paper will conclude with the implementation and evaluation plan, and the
outcomes of the educational project with implications for research, teaching and practice.
Synthesis of the Literature
A review of literature serves as a guide to gaining better insight, knowledge, or
understanding of a research topic. The following literature review consists of ten scholarly peer
reviewed articles that focus on the proposed intervention of this educational project which is
simulation-based learning. There were four common themes found within this literature review.
The themes that emerged out of these ten articles were communication, self-confidence, anxiety,
and skills and knowledge base competency.
Communication
Communication is a key component in the healthcare industry because it is utilized to
collaborate with interdisciplinary groups. However, many people find it very hard to effectively
communicate due to feeling timid, intimidated or embarrassed. Thus, it is a skill that needs to be
well-developed before going out into the healthcare field because it is essential for teamwork and
collaboration. Simulation-based learning is a phenomenal educational intervention because it
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involves mimicking real-life scenarios in which a group of people must utilize teamwork, critical
thinking skills, and communication skills in order solve a problem. According to Mahmood et al.
(2021), after completing a study that utilized TeamSTEPPS in a simulation-based learning
environment, researchers concluded that interdisciplinary communication improved.
Furthermore, simulation-based learning can also help students gain self-confidence in both
verbal and non-verbal communication which aides in providing quality patient care (Chang et al.,
2021). Although simulation learning exercises can be beneficial to students and their learning
needs, it can also have a negative effect on them. Students who participated in an exploratory
qualitative study conducted by Park and Kim (2021), stated that they felt uncomfortable and
intimidated when being watched so closely by others, especially their faculty members. The
participants also stated that they did not communicate well with their peers during the simulation
exercise because they had never interacted with them outside of this particular learning
environment (Park & Kim, 2021). A part of having well-developed communication skills is that
an individual will be able to effectively communicate with anyone whether they know them or
not. Overall, simulation-based learning is beneficial and can positively impact interdisciplinary
communication.
Self-Confidence
Self-confidence is essential in any aspect of life especially the healthcare industry. One
must be able to believe in oneself in order to overcome any obstacle. This was one of the major
themes found in this literature review because it has become evident that by utilizing simulation-
based learning there has been an increase in self-confidence and resilience in nursing students
(McIntosh, 2022). Simulation-based learning also allows students to find confidence within
themselves not only immediately after completing a simulation, but one month after because they
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are able to repeatedly practice their nursing skills in a safe environment before they are faced
with a similar situation in real-life (Green & Tesler, 2022). Moreover, in a descriptive cross-
sectional study conducted by Al Khasawneh et al. (2021), researchers concluded that over 75%
of nursing students agreed that simulation improved their self-confidence, as well as
collaborative teamwork, and active learning.
Anxiety
Anxiety is a major mental health illness that is found in many healthcare providers today.
This mental health illness has been known to hinder individuals’ everyday life, especially when
it comes to learning and self-confidence. Simulation-based learning exercises have been found to
decrease anxiety and increase self-confidence, based on the number of times the student repeated
the scenario (Yu et al., 2021). Therefore, there is a positive correlation between the number of
simulation scenarios and students’ level of confidence. The more scenarios the student is a part
of the higher their self-confidence will be. Furthermore, Kim and Kim (2022), conducted a study
in which students were broken up into two groups, one group was able to pre-observe their peers
in simulation exercises, while the second group was not. Kim and Kim (2022) concluded that
those that were able to pre-observe their peers had higher levels of confidence and less anxiety
when performing just much like the study conducted by Yu et al. (2021). Therefore, not only
does simulation increase self-confidence, but it also hinders mental health issues like anxiety.
Skills and Knowledge Base Competency
Skills and knowledge-based competency has been a common theme throughout this
literature review. In fact, there is a correlation between self-confidence and competency levels.
This literature review found that as competency levels increased, so did self-confidence. Al
Khasawneh et al. (2021), found that simulation based-learning not only improved students’
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confidence, but also enhanced their problem-solving skills and competencies. In a
phenomenological study conducted by Dante et al. (2021), post graduate nursing students
documented their experiences when exposed to high-fidelity simulation exercises, in which they
noted that simulation enhanced their ability to apply nursing theory into practice. The students
reported that they went from feeling embarrassed and having negative feelings to feeling
confident in themselves and their skills set (Dante et al., 2021). Additionally, even though
students may feel more confident in their skill, knowledge and competencies, they may not
always apply it into practice. According to Valen et al. (2021), students conducting palliative
care simulations self-reported improvement in their nursing knowledge, skills and competence.
Nonetheless, many of the students reported not applying what they practiced in simulation into
real-life during their clinical rotation (Valen et al., 2021).
Summary of the Literature
The four main themes found within this literature review include: communication, self-
confidence, anxiety, and skills and knowledge base competency. Individually each theme
highlighted the benefits that simulation-based learning brings to any educational setting. Most of
the participants involved in this literature review reported that simulation-based learning was a
great way to prepare them for what is to come. Simulation-based learning helps students feel
prepared for future patients because it gives them the opportunity to put theory to practice by
applying gained knowledge, physical skills, and critical thinking skills in a safe environment.
It is evident that the four themes that were synthesized from the literature review
correlate with the proposed PICOT question. This is because it is essential that all nurses are
competent in their skill set and knowledge base in order to properly educate their patient or
fellow peers. Nurses are the first line of education, and it is important that they are not only in
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the right mindset to be able to teach the correct information but relay the correct information.
Additionally, the increased competency that they possess will also increase their level of self-
confidence and decrease anxiety, which in return allow them to communicate more effectively.
In order to portray the correct information accurately not only do the nurses need to be
competent and confident in their own competencies, but they must also have effective
communication skills when they are teaching. Overall, this will allow for there to be a better
rapport between the nurse and the patient or the nurse and her peer, which is essential for proper
education. Furthermore, by utilizing these four themes the labor and delivery nurses will be re-
educated on hand expression, in which they will be a part of a simulation where they will hand
express a fake breast and properly educate their patient. A debrief will follow the simulation
exercise allowing the educator to point out what was done correctly or what needs improvement.
This will also allow the nurses to self-reflect and note what can be done better when performing
hand expression or adequately educating the patient. The educator can also get an idea of what
the labor and delivery nurses are teaching the patients in real-time. All in all, the hope is that this
educational project will allow labor and delivery nurses to be properly re-educated on hand
expression, so they can properly educate their patients.
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References
Al Khasawneh, E., Arulappan, J., Natarajan, J. R., Raman, S., & Isac, C. (2021). Efficacy of
simulation using NLN/Jeffries Nursing Education Simulation Framework on satisfaction
and self-confidence of undergraduate nursing students in a middle-eastern country. SAGE
Open Nursing, 7, 237796082110113. https://doi.org/10.1177/23779608211011316
Chang, Y.-Y., Chao, L.-F., Xiao, X., & Chien, N.-H. (2021). Effects of a simulation-based
nursing process educational program: A mixed-methods study. Nurse Education in
Practice, 56, 103188. https://doi.org/10.1016/j.nepr.2021.103188
Cleveland Clinic. (2022) Colostrum: What is it, benefits & what to expect.
https://my.clevelandclinic.org/health/body/22434-colostrum
Dante, A., Masotta, V., Marcotullio, A., Bertocchi, L., Caponnetto, V., La Cerra, C., Petrucci, C.,
Alfes, C. M., & Lancia, L. (2021). The lived experiences of intensive care nursing students
exposed to a new model of high-fidelity simulation training: A phenomenological study.
BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00667-3
Green, G., Ofri, L., & Tesler, R. (2022). The role of fundamental nursing practices simulation on
students’ competencies and learning satisfaction: Repeated measured design. Healthcare,
10(5), 841. https://doi.org/10.3390/healthcare10050841
Kim, S.-H., & Kim, E. J. (2022). Effects of preobserving peers’ performance on students’
anxiety, perceived competency, and satisfaction during a clinical simulation: A
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quasiexperimental study. Nurse Education in Practice, 62, 1–5.
https://doi.org/10.1016/j.nepr.2022.103384
Mahmood, L. S., Mohammed, C. A., & Gilbert, J. H. V. (2021). Interprofessional simulation
education to enhance teamwork and communication skills among medical and nursing
undergraduates using the teamstepps® framework. Medical Journal Armed Forces India,
77. https://doi.org/10.1016/j.mjafi.2020.10.026
McIntosh, R. (2022). Improving nursing student resilience using online simulation and
resilience-based content in a pediatric course. Journal of Nursing Education, 61(6), 348–
351. https://doi.org/10.3928/01484834-20220404-09
Oren, M. S., Barkhuff, W. D., Stefanescu, A., Stefanescu, B. M., & DuPont, T. L. (2020). The
impact of the Baby Friendly Hospital Initiative on neonatal hypoglycemia. Journal of
Perinatology, 40(12), 1828–1833. https://doi.org/10.1038/s41372-020-00822-9
Park, J. E., & Kim, J. H. (2021). Nursing students’ experiences of psychological safety in
simulation education: A qualitative study. Nurse Education in Practice, 55, 1-7.
https://doi.org/10.1016/j.nepr.2021.103163
Ponnapakkam, A., Rees, D., Gallup, M. C., Ahmad, K. A., Miller, D., Fagiana, A., & Carr, N. R.
(2021). Supplementation-based hypoglycemia guidelines including donor breast milk
reduce NICU admission. Journal of Perinatology, 41(8), 2088–2094.
https://doi.org/10.1038/s41372-021-01069-8
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Svellingen, A. H., Røykenes, K., Forstrønen, A., Assmus, J., & Brattebø, G. (2021). Examining
predictive factors of nursing students’ self-confidence in multiple simulation sessions: A
randomized controlled study. Nurse Education in Practice, 57, 103231.
https://doi.org/10.1016/j.nepr.2021.103231
Valen, K., Simonsen, M., Holm, A. L., Jensen, K. T., & Grov, E. K. (2021). Impact of palliative
care simulation on nursing students’ learning outcomes and reported use in hospital
placement. Nursing Open, 9(6), 2847–2857. https://doi.org/10.1002/nop2.991
Yu, J. H., Chang, H. J., Kim, S. S., Park, J. E., Chung, W. Y., Lee, S. K., Kim, M., Lee, J. H., &
Jung, Y. J. (2021). Effects of high-fidelity simulation education on medical students’
anxiety and confidence. PLOS ONE, 16(5). https://doi.org/10.1371/journal.pone.0251078
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Appendix A, Research Summary Table
Author (Date) Design Sample/ Setting
Findings Measures (Outcomes) Limitations/Evidence Level
Al Khasawneh et al. (2021)
• Descriptive, cross sectional, correlational research design to determine nursing students’ level of self-confidence and satisfaction when completing simulation exercises.
• The population for this study consisted of 370 undergraduate nursing students from Sultan Qaboos University located in the Middle East.
• There were more female participants (274) than male participants (96).
• The participants were broken up into 8 different groups where different simulation exercises were conducted.
• The study used high-fidelity simulators in a
• Almost 80% of students agreed that there was an increase in their satisfaction when conducting simulation exercises. Furthermore, 6% disagreed and 14% were undecided.
• 75% of the students agreed that they experienced an increase in self- confidence when conduction the simulation exercises. Moreover, 7% disagreed and 18% were undecided
• The study used a questionnaire with a five-point Likert scale to measure several educational practices.
• The Simulation Design Scale is a 20-item tool with a five-point Likert scale, helped in evaluating the simulation designs.
• The student Satisfaction and Self Confidence in Learning questionnaire is a 13-item questionnaire that uses a five-point Likert scale. This measurement tool
• The study used a self-report method for data collection, making the data extremely subjective.
• The researchers failed to collect data regarding the student’s levels of satisfaction and confidence before starting the study.
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skills lab at a nursing school.
regarding their self-confidence.
• Over 75% of nursing students agreed that simulation improved their collaborative work and 80% stated that simulation enhanced active learning.
• Over 80% of students reported that simulation enhanced diverse learning.
• Over 75% agreed pre-briefing enhanced their learning and almost 80% of the students agreed that simulation enhanced their problem-solving skills.
• Overall, the students all reported an increase
measures the student’s satisfaction and confidence when doing simulation exercises.
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satisfaction in simulations and self-confidence. The study also proved that 20% of clinical learning is done through simulation.
Chang et al. (2021)
• A mixed methods randomized controlled design in order to examine the effects of simulation-based learning on communication and fundamental nursing competencies.
• The study included 107 nursing students total between the ages of 19-23 years old. They were then broken up into two groups.
• One group was the experimental group consisting of 58 nursing students. This group conducted online interactive virtual simulation to complete.
• The other group was the control group which was 49 students was
• Self-confidence in communication increased for both groups. The experimental group went from 35.95 to 43.71 and the control group went from 38.22 to 44.02.
• Assignment and examination results only increase for the control group by 1 point. The experimental group decreased by 7.6 points.
• The experimental group reported that virtual simulation interactive
• Data was collected using the confidence in communication pre-post self- assessment surveys.
• Grades from different assignments and tests were utilized.
• Self-reported satisfaction questionnaires were collected at the completion of the study and simulation reflection logs were kept by the students and later used for data collection.
• The study focused only on interactive animation using patient simulation versus a case study for nursing fundamentals. This was a very specific topic.
• The study relied heavily on the use of technology and Wi-Fi. Accessibility to technology is not always an option for many participants.
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given a case study.
• The participants were nursing students from a northern university in Taiwan.
animation made them feel more confident and have the ability to communication and engage with
virtual patients. • The experimental
group also self- reported that they understood the content better when they interacted with a patient via simulation, and it made them want to learn. They stated that the animation felt more engaging when compared to written work.
• Overall, the study concluded that simulation-based learning contributed to nursing education. Furthermore, it increased students’ self-
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confidence in communication skills and fundamental nursing competencies.
Dante et al. (2021)
• A phenomenological study that explored post graduate nursing students lived experiences when exposed to high-fidelity simulation exercises.
• The participants for this study consisted of 15 postgraduate nursing students. There were nine female and 6 male nursing students with the average age being 26 years old.
• The study took place at the University of L’Aquila in Italy.
• The students felt that the simulation exercises allowed them to gain a positive attitude during their learning exercises.
• The students went from having negative feelings like anxiety and embarrassment to then having positive feelings like confidence.
• Many of them reported that their emotions became more positive once they got more comfortable as they repeated the exercises. They
• In person interviews were audio recorded and conducted by a researcher in conjunction with notes taken by the researcher during simulations.
• 6 open-ended questions were used in the interviews to gain better insight on the students lived experiences.
• 3 main themes were outlined in all of the interview questions: learning experience, emotional path, and confidence.
• The design that was used in this study does not allow other statistical data collection. There were only in- person interviews and observation.
• This was the first time the lived experiences of nursing students were investigated. Therefore, there is limited data.
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reported feeling a sense of safety and satisfaction.
• Overall, the students felt that the repetition of the simulation exercises improved their confidence in their own clinical and critical thinking skills.
Green & Tesler (2022)
• A one-group, three- point time repeated measures study was used to assess the nurses level of satisfaction and nursing competencies when part of a simulation learning exercise.
• The study took place at Ariel University in Israel.
• The population consisted of 93 undergraduate nursing students with the average age being 23 years old.
• Majority of the population was female (88 out of 93 participants).
• The study results suggest that all nursing competencies increased significantly from before the simulation learning activity took place to immediately after completion and 1 month later. However, there was no significant change from immediately after completion to 1
• The students completed a questionnaire before starting the simulation program, immediately after the completion of the 6 days and 1 month later.
• The questionnaire was composed of 3 different parts: sociodemographic, nursing competencies, and learning satisfaction. There were 7 nursing
• The study only collected data up to one month, which does not allow for the study to investigate long term effect of simulation exercises.
• The outcomes measured were based on the participants’ self- reported surveys. Self-reported surveys can skew results because participants do not always answer
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month later. Competencies did not decline, the effectiveness of the simulation continued.
• Critical thinking was 2.66 (before), 3.51 (immediately), and 3.65 (1 month later) Clinical care was 2.89, 3.63, and 3.80 Interpersonal relations 2.94, 3.66, and 3.81. Professional development 2.94, 3.84, and 3.90 Satisfaction 7.15 8.95, and 8.81.
• Nursing satisfaction increased from before the simulation exercise to immediately after completion and 1 month after.
competencies that were included in the questionnaire: critical thinking, clinical care, interpersonal relations, professional development, teaching/coaching, legal/ethical practice, and leadership.
truthfully, or they fail to complete the surveys.
• The sample size was small with less than 100 participants.
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However, there was no increase in nursing satisfaction from immediately after the completion to
a month later. • Overall, this
study concluded that simulation exercises are effective in increasing nursing fundamental competencies not just immediately after performing the simulation, but also one month after.
Kim & Kim (2022)
• Quasi- experimental design to test the effects of students’ anxiety, competency, and learning satisfaction when performing in a high-fidelity simulation exercise.
• The study included 95 senior nursing students in a university in South Korea.
• These 95 students were split into two groups. One group consisted
• The students anxiety scores showed no significant differences between the two groups. However, those that did pre- observed the simulation exercises reported
• The students’ levels of anxiety, stress, competency, satisfaction and preference for pre- observation were all measured by this study.
• To measure their anxiety by using
• Some of the limitations that this study had included the fact that the two groups were not randomly assigned, and the study was only conducted in one university resulting
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of 48 students observing their classmates performance before completing the simulation (experimental group) themselves. While the second group of 47 students did not observe the scenario beforehand (control).
lower anxiety levels.
• Competency scores were higher in those who observed the simulation scenario beforehand.
• Satisfaction with simulation learning exercises did not differ significantly between the two groups. However, the group that was able to pre- observed reported a higher level of satisfaction.
• Over 85% of the students self- reported that they preferred to participate in the scenario after observing their classmates performance.
• Overall, the group who pre- observed had
the State-Trait Anxiety Inventory (STAI) with a four-point Likert scale, with 1 as “not at all” anxious and 4 as “very much so.”
• Stress was measured with a 10-point grading scale, with 1 as “not at all stressed” and 10 as “extremely stressful.”
• Nursing competency was assessed using the nursing competence scale in simulation. The competencies that were assessed were nursing skills, reasoning, communication, communication in healthcare team, leadership and teamwork and professional practice. This was
in a small sample size.
• Another limitation was that the students could have mimicked what they observed from their classmates in the simulation exercises, which cannot be measured unless self-reported.
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lower anxiety and stress levels as well as higher competency and satisfaction levels.
utilized as a four- point rating scale.
• Satisfaction with the simulation exercises were rated on a 10-point scale, with 1 as “not satisfactory” and 10 as “very satisfactory.”
• Lastly, the students preference for pre- observation was self-reported by the nursing students, in which they stated which they preferred and why.
Mahmood et al. (2021)
• The design that was utilized was a mixed method interventional study. A simulation was done with a multidisciplinary team using TeamSTEPPS (Team Strategies and Tools to Enhance Performance and
• The team consisted of undergraduate medical and nursing interns. It also included the faculty, that interacted with the students.
• The sample size was 40 students and 8 faculty members that
• Over 85% of the participants agreed that their skills improved in regard to teamwork and interdisciplinary communication.
• A TeamSTEPPS observation tool was utilized to assess teamwork and communication.
• After each simulation exercise was completed, the students were asked to complete a self-
• The study did not have a control group which skewed results due to not having a group that did not complete simulation exercises to assess teamwork and collaboration.
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Patient Safety) and they were assessed for their teamwork and collaboration skills.
were split up into two groups of 20 students and 4 faculty per group (2 different module sessions).
• Student doctor to student nurse ratio was 3:2 per session. That included mainly female students (75%).
• The study was based out of India at a college simulation and skill center for medical and nursing interns.
assessment. The assessment included self- competency and collaboration with other team members
• Both a five-point Likert scale, five- point agreement scale, and a 7- point Likert scale were used in this study.
• Lastly, a debrief was performed at the end of the simulation exercises with the medical and nursing interns as well as all the faculty members involved.
• There was only a pre and post assessment.
• There was a small sample size because only medical students and nurses involved in the simulation exercises.
• The researchers did not physically observe the participants in a real clinical setting to assess for improvement. They only took the participants’ own subjective data instead of collecting their own.
McIntosh (2022)
• The design used was a modified pre and postsurvey design to measure the students resilience after
• The participants were 93 nursing students in a large
• The study found that implementing resilience simulation
• There were two cohorts in this study. The first cohort (control) already completed
• The biggest limitation in this study is that the measurement tool CD-RISC is not
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completing online resilience stimulation program in order to measure nursing resilience.
Midwestern nursing school.
• The project was approximately over the course of 4 months.
programs can increase new graduate nurse resilience using online simulation.
• Resilience scores increased by 2 points between the 2 cohorts. The first cohort had a 72.21 and the second cohort, which took the resilience simulation had a 74.21 CD-RISC score.
the course without the resilience simulations.
• The second cohort (current cohort with 93 students) is in the middle of completing the course with the resilience simulations.
• Both cohorts completed the presurvey and the post-survey, the Connor-Davidson Resilience Scale (CD-RISC) before starting the class and after completion.
specific to healthcare.
• Only 28 of the 93 students provided the same personal ID number on the pre- and post- surveys, not allowing the researchers to compare pre and post surveys.
• The covid-19 pandemic also affected results because it affected many of the participants.
Park & Kim (2021)
• The design that was utilized in this study was an exploratory qualitative design to measure the students’ experiences when completing simulation learning exercises.
• The participants consisted of 20 nursing students from two universities who have already experienced simulation-based learning.
• The study took place in
• Students felt overwhelmed and like they could not sympathize with a manikin.
• The participants did not like being watched so closely by faculty as they completed their simulation. They also felt
• There were focus groups that consisted of 3-7 participants.
• The focus groups occurred over the span of 2 months which allowed for interviews with participants and data collection.
• The study group consisted of volunteers rather than randomly chosen students.
• The sample size was small with only 20 participants.
• The researchers encourage having a larger sample size
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Gyeonggi-do, South Korea.
uncomfortable being filmed.
• They stated that they felt intimidated and nervous when being watched.
• The students felt that communication with other team members was hard because they were not friends with them and did not know them on a personal level.
• They also did not want to make a mistake because that could affect not only their grade but their classmates’ grades.
because it will allow for a more diverse population and culture. They believe this will aide in better understanding the students’ psychological safety.
Valen et al. (2021)
• This study used a longitudinal, intervention design to assess the impact simulation had on nursing students and patient care outcomes in a
• The sample included 55, second year nursing students at a university in Norway. They were broken up into two groups.
• The study indicated that palliative care simulation improved the nursing students self-reported knowledge, skills
• The students were all given pretests, post simulation tests via mail and were electronically answered and input into the
• A limitation found within this study was the small sample size skewing results.
• Clinical placements did not necessarily
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palliative care setting.
• The first group had completed s clinical placement in a nursing home,
• The second group had also completed a clinical rotation in a nursing home as well as home care, hospital or mental health care. They had more experience.
• The students had to complete a 3- hour simulation where the students were divided into sub- groups of 6.
and competence. However, many of the students reported not utilizing the skills they practiced and learned in real-life at their clinical setting.
Quest back program.
• Post-tests were given immediately after their clinical rotation which was approximately 8 weeks long.
• A Likert Scale was utilized for the questionnaires that were based off the European Qualifications Framework on nursing knowledge, skills and competence.
specialize in palliative care; therefore, students did not practice the skills they were utilizing in the simulation setting.
• There was a lot of self-reporting involved in the data collection, therefore that increased the chance for bias and inaccurate data collection. Students could have been untruthful in what they reported.
Yu et al. (2021)
• In this study Manikins were used to act as patients that were diagnosed with either pulmonary or gastrointestinal diseases.
• The study consisted of 40 medical students experiencing their first simulation. All of the participants were in their 5th year
• Anxiety levels decreased on Cronbach alpha report with first simulation
• The levels were .752 to .809 after the second simulation.
• Anxiety was measured using a 4-point Likert scale by utilizing the Spielberger State-Trait Anxiety Inventory (STAI).
• 37 out of 40 students responded to the post survey. Meaning that 3 of them did not respond, skewing results.
• The data collection tool was
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at Ajou University School of Medicine.
• The confidence levels decreased from .931 to .923 on Cronbach alpha report after the first simulation.
• After the second simulation the levels went from .904 to .857.
• The student’s anxiety levels decreased after the second simulation and their confidence levels increased after the first simulation.
• Confidence was measured using a 5-point Likert scale. The students received survey questions before and after their simulation exercises.
questionnaires that the medical students answered on their own which is extremely subjective.
• The simulation scenario was not consistent between all study groups which could have skewed the results in regard to the student’s anxiety and confidence levels.
