High Fidelity Simulation Versus Traditional Teaching Methods in

NursingRanson Thomas

University of Central FloridaNGR6813 Summer 2014

PICO QUestion Do undergraduate nursing students who

have made use of high fidelity simulation technology demonstrate improved student outcomes compared to those students who have only made use of traditional learning methods?

Defining High Fidelity SimulationSeveral terms- HFS, HFHPS, HFPS

A simulation of patient conditions that mimic or recreate real patient scenarios and clinical environments for students to practice nursing skills and apply knowledge (Harder, et.al. 2013)

HFS is a technique not a technology

Background & SignificanceThis is a mode of instruction which is finding

increasing use in nursing programs worldwide (Mills, et.al. 2014)

Simulation has demonstrated effectiveness in learning psychomotor skills by nurses and other healthcare workers (Alexandrou, et.al. 2012)

Allows risk-free learning in a safe and controlled environment (Schoening, et.al. 2006)

Background & SignificanceOnly an approximation of clinical

situations/practiceStart up costs for HFS lab can be as high as

$800,000 (NCSBN, 2009)Yearly cost in maintenance, worker-hours,

etc. can be over $300,000 (NCSBN, 2009).Potential lack of familiarity for students and

faculty

MethodsDatabases

CINAHL

Medline

Education Resources Information Center

Cochrane Database of Systematic Reviews

Healthsourse Nursing/Academic Edition Database

Google Scholar

Search Terms

Undergraduate nursing students, pre-licensure nursing students, registered nursing students, AND high-fidelity human patient simulation, simulated nursing laboratory, high-fidelity nursing simulation, AND traditional curriculum, didactic lecture, traditional clinical, low-fidelity nursing simulation, AND student outcomes, self-efficacy, critical thinking, test scores, academic performance, clinical competency

MethodsInclusion Criteria

Peer reviewedEnglish languagePublished since 2008Undergraduate

nursing studentsExposed to HFSExposed to traditional

teaching methods

Exclusion CriteriaUsed non-nursing

students or a mix with non-nurses

No quantifiable metric for student outcomes

Simulations used for non-clinical nursing skills (think affective domain)

Methods84 articles found21 articles matched inclusion criteria6 articles left after applying exclusion criteria2 correlational design studies, 3 Quasi-

experimental designs studies, 1 randomized control trial

Combined sample population of 347 pre-licensure nursing students

ThemesHFS vs. Traditional teaching methods

Knowledge Acquisition

Self-efficacy

HFS vs. TraditionalAuthor FindingsBeddingfield, et.al. (2011) Item 1=0.381, Item 2=1.2 , Item 3=1.51, Item

4=0.67P <0.05

Blum, et.al. (2010) Midterm FinalSimulationSelf conf 11.30 12.48Cl. Competence 11.51 13.68TraditionalSelf conf 11.42 13.03Cl. Competence 11.88 14.13P=0.001

Kirkman (2013) Pre test mean : 3.2619Post test 1 mean: 4.8333Post test 2 mean: 6.5794Difference between 1-2: 1.571Difference between 2-3: 1.746P<0.05

Roh, (2014) High MediumPre-test 2.96 3.14Post-test 3.82 3.45 p<0.001

Schlairet, Pollock (2010) Sim/Trad Trad/SimPre 59.88 60.33Post 1 62.93 62.44 Post 2 64.77 64.77P<0.05

Knowledge AcquisitionAuthor Findings

Blum, et.al. (2010) Clinical CompetenceMidterm: 11.51Final: 13.68P<0.001

Kirkman (2013) Test 1 (pre simulation): 3.2619Test 2 (post simulation): 4.833P<0.05

Schlairet, Pollock (2010) Sim/Trad Trad/SimPre test 59.88 -Post test 1 62.93 62.44 Post test 2 - 64.77 P<0.05

Shinnick, Woo (2013) Clinical knowledge test scores showed mean improvement of 6.5 points overallp=0.02

Self-efficacyAuthor Findings

Roh (2014) Pre-test 2.96Post Test 3.82p<0.001

Shinnick, Woo (2013) Logistic regression showed lower self-efficacy as a predictor for higher HSRT scores (p=0.01)

LimitationsSmall sample sizes

Results measured over 1 semester/1 HFS experience

In some cases, participants were from different schools

Lack of randomized control trials

RecommendationsHFS should be used by nursing programs

when access to clinical sites is limitedStrength BNo statistically significant differences

between outcomes from HFS or traditional clinical/didactic curriculum

RecommendationsHFS can be used to replace didactic lecture materialStrength BKnowledge acquisition/transfer of knowledge does

occur during HFS experiences

HFS should be provided to students with lower levels of self-efficacy

Strength BHigher self-efficacy levels after HFSStudents with lower self-efficacy demonstrate

improvements in critical thinking scores

RecommendationsMore research

Follow students/participants longer

Any student characteristics that affect outcomes after HFS?

What are outcomes after multiple HFS scenarios?

ConclusionNo statistically significant differences

between student outcomes following HFS versus student outcomes from traditional clinical or classroom curriculum

HFS

Gives students practice AND knowledge acquisition

More benefit to students with lower self-efficacy

References Alexandrou, E., Ramjan, L., Murphy, J., Hunt, L., Betihavas, V., Frost, S.

(2012). Training of undergraduate clinicians in vascular access: an integrative review. Journal of the Association for Vascular Access, vol. 17(3), pp. 146-58.

Harder, B., Ross, C., Paul, P. (2013). Instructor comfort level in high-fidelity simulation. Nurse Education Today, vol. 33(10), pp. 1242-1245.

Mills, J., West, C., Langtree, T., Usher, K., Henry, R., Chamberlain-Salaun, J., Mason, M.(2014). “Putting it together”: unfolding case studies and high-fidelity simulation in the first year of an undergraduate nursing curriculum. Nurse Education in Practice, vol. 14(1), pp. 12-17.

National Council of State Boards of Nursing (2009). The Effect of High-Fidelity Simulation on Nursing Students’ Knowledge and Performance: A Pilot Study. NCSBN Research Brief, volume 40, June 2009

Schoening, A., Sittner, B., Todd, M. (2006). Simulated clinical experience: nursing students’ perceptions and the educators’ role. Nurse Educator col. 31(6), pp. 253-258.

References Beddingfield, S., Davis, B., Gilmore, M., Jenkins, L. (2011). The effect of high-

fidelity simulation on examination performance. Teaching and Learning in Nursing, vol. 6(2), pp. 46-49.

Blum, C., Borglund, S., Parcells, D. (2010). High-fidelity nursing simulation: impact on student self-confidence and clinical competence. International Journal of Nursing Education Scholarship, vol. 7(1), pp. 14.

Kirkman, T. (2013). High fidelity simulation effectiveness in nursing students’ transfer of learning. International Journal of Nursing Education Scholarship, vol. 10(1), pp. 1-6.

Roh, Y. (2014). Effects of high-fidelity patient simulation on nursing students’ resuscitation-specific self-efficacy. Computers, Informatics, Nursing, vol. 32(2), pp. 84-89.

Schlairet, M., Pollock, J. (2010). Equivalence testing of traditional and simulated clinical experiences: undergraduate nursing students’ knowledge acquisition. Journal of Nursing Education, vol. 49(1), pp. 43-47.

Shinnick, M., Woo, M. (2013). The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students. Nurse Education Today vol. 33(9), pp. 1062-1067.