14

Bibliography on Simulation

(With Annotations by Carol S. Coose, EdD, RN, CNE)

Journal Articles

Alinier, G., Hunt, B., Gordon, r., & Harwood, C. (2006). Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education. Journal of Advanced Nursing, 54(3), 359-369.

The authors hold a variety of degrees and faculty positions in health sciences at a UK university. They presented results of an experimental study with nursing students in the second year of a Diploma in Higher Education in Adult Nursing (n=99). The results supported their hypothesis that students exposed to scenario-based simulation training would perform better in posttests designed to assess clinical competence of healthcare students than a control group. Results of a pilot study, along with data to support the validity and reliability of the pre and posttests were presented. The improvement in mean score performance by the experimental group (scenario-based simulation training) was found to be statistically significantly higher than the control group. This study also examined student ratings of stress and confidence finding no significant differences between groups. These results provided support for the use of simulation in nursing education and an example/starting point for additional research on use of simulations in nursing education.

Alessi, S.M. (1988). Fidelity in the design of instructional simulations. Journal of Computer-Based Instruction, 15(2), 40-47.

The author, faculty at the University of Iowa, reported and summarized previous research on levels of fidelity for computer simulation and the effects on learning. He supported a conclusion that the relationship of learning to fidelity of a simulation is non-linear and also presented a proposed model of the relationship curve. The author discussed rationale and ideas regarding when to increase the fidelity of simulations and presented a taxonomy of the factors to consider when determining simulation fidelity. This taxonomy included four types of simulations along with four aspects of simulation to which fidelity is relevant. The author discussed each simulation type in relation to the 4 aspects and fidelity. He concluded with a proposal that learning varies with fidelity as an inverted U-shaped curve for beginning students and that as students progress, they benefit from increasing fidelity. The author discussed the specific research needed regarding the effects of fidelity on learning. Provided some thought-provoking research and insights into fidelity in computer simulation in relation to learning as well as clear ideas for further research.

Aronson, B., Rosa, J., Anfinson, J., & Light, N. (1997). A simulated clinical problem-solving experience. Nurse Educator, 22(6), 17-19.

The authors, faculty in an associate degree nursing program, presented rationale and descriptions, as well as positive results and feedback from both faculty and students (approximately 90), for the use of Clinical Problem Solving Learning Laboratories during the last two semesters of an established nursing program in a community college. They reported using an evaluation tool with students but did not discuss the tool, or provide statistical results. While the evidence presented supported the effectiveness/value of the described use of simulated problem solving for enhancing student learning, the scope is limited to a small/narrow population. Data regarding the survey instrument and some statistical information on the survey results would have been a valuable addition to this article.

Bearnson, C.S. & Wiker, K.M. (2005) Human patient simulators: A new face in baccalaureate nursing education at Brigham Young University. Journal of Nursing Education, 44(9), 421-5.

The authors, nursing faculty teaching for a baccalaureate program in Utah, presented results of a limited descriptive study exploring the benefits and limitations of using a human patient simulator (HPS) as a substitute for a day of actual clinical experience for two clinical groups (no number listed) of first year baccalaureate nursing students. The results indicated positive responses from students on a follow-up survey. Statistics were presented, along with examples of qualitative data to support positive results and effectiveness of HPS in enhancing student experiential learning. Instrument development, validity and reliability discussion would have been a valuable addition to this article. The authors discussed the limitations of the study and the need for continued study of HPS in nursing education. The article provided a good starting point for additional HPS research.

Becker, K.L., Rose, L.E., Berg, J.B., Park, H. & Shatzer, J.H. (2006). The teaching effectiveness of standardized patients. Journal of Nursing Education, 45(4), 103-111.

The authors hold positions in nursing and medical education at John Hopkins University ranging from program director, to coordinator, to instructor, and doctoral student. They reported results of a pilot intervention study that utilized standardized patients (SPs) for teaching therapeutic communication and evaluation of depression skills to senior undergraduate nursing students (n = 147) enrolled in a psychiatric nursing course. Two instruments were used to collect data from the participants, first was a pre and post-test of knowledge about communication and the second was a student self-evaluation measuring attitudes toward the SP experience. The control group received the traditional method of instruction and equivalent time using the same clinical scenario but without the use of the SP and took the same pre and posttest. No significant differences were found between the treatment and control group’s scores on the pre and posttests or on the ratings of students by SPs for a small sub-group of unannounced SP evaluations done by students. The authors reported that student self-evaluations and qualitative analysis of student responses to open-ended questions were both highly positive regarding the SP experience and therefore the study provided preliminary support for the use of SPs to augment the traditional method of instruction. Statistical data and qualitative examples were presented, along with limitations of the study. Validity of the instruments used in the study was discussed while reliability of the knowledge test developed for this study was untested. Instrument reliability testing would have been a positive addition to the article. The article presented a start for further research using SPs in nursing education.

Beyea, S.C. & Kobokovich, L.J. (2004). Human patient simulation: A teaching strategy. AORN Journal, 80(4), 738-742.

The authors, a director of nursing research and a director of nursing practice at a medical center in the northeast, reported on the use of high fidelity patient simulators for developing clinical skills with practicing nurses, and specifically with new graduates. They reported positive anecdotal data and details from the use of simulators in teaching and practicing skills to develop clinical competencies. A formal study, including statistical data would have been a valuable addition to this article.

Bramble, K. (1994). Nurse practitioner education: Enhancing performance through the use of the objective structured clinical assessment. Journal of Nursing Education, 33(2), 59-65.

The author, nursing faculty at a California university, reported a quasi experimental study on the use of Objective Structured Clinical Assessment (OSCA) with graduate nurse practitioner (NP) students (n = 29, 18 in control group) to determine the effect of this type of clinical simulation on their cognitive and clinical competency development. Results indicated no significant difference in OSCA participants’ performance (on subsections of midterm exams or clinical skills) from those taught using traditional methods (control group). The only variable noted to be significant was the GPA upon entering the NP program with higher GPA correlated with higher test scores in the program. However the subjective positive responses of the students supported the use of OSCA as a valuable learning experience. The author reported that all of the participants agreed that OSCA participation was helpful and that the feedback from this method was beneficial to their clinical performance and learning. Descriptive and comparative statistics are presented with the study results and discussion of the limitations of the study. Provided a clear example of a documented, well-planned and implemented study on the use of OSCA in graduate nursing education.

Bremner, M.N., Aduddell. K., Bennett, D.N. & VanGeest, J.B. (2006). The use of human patient simulators: best practices with novice nursing students. Nurse Educator, 31(4), 170-174.

The authors, doctorally prepared nurse educators at a university in Georgia, reported on a study using the human patient simulator (HPS) to teach physical assessment skills with baccalaureate nursing students (n=41) in their first clinical course. The questionnaire developed for the study was discussed and descriptive statistics along with qualitative responses from the students were presented. The authors presented recommendations for a beginning set of best practices in using HPS, based on analysis of the results of their study. Limitations of the study were presented as well as the benefits of using HPS. Discussion/establishing of instrument validity and reliability would have been a valuable addition to this article. Presented an excellent foundation for continued study of student’s responses regarding the value of HPS to their learning.

Bruce, S., Bridges, E.J., & Holcomb, J.B. (2003). Preparing to respond: Joint trauma training center and USAF nursing warskills simulation laboratory. Critical Care Nurse Clinics of North America, 15(2), 149-162.

The author (two nurses and one physician), leaders in the education and training of nurses for the US Air Force, reported on two programs, which both included the use of simulation with high fidelity human patient simulators (HPS), that were designed to ensure that AF nurses are prepared to respond to diverse medical problems. Outcome measures were tested from both of the programs and results indicated that nurses’ critical thinking was facilitated and clinical judgment increased after completion of the programs. Statistics are presented from one program comparing pre and post training test scores that evidenced significant improvement in performance. This program also included actual clinical experiences in trauma care along with simulated experiences, while the second program involved simulator training only. Additional statistical analysis along with validity/reliability analysis for evaluation tools used would have been a positive addition to these studies. Provided support for use of HPS in improving nurses’ performance in caring for complex trauma patients.

Chau, J., Chang, A., Lee, I., Ip, W., Lee, D. & Wootton, Y. (2001). Effects of using videotaped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme. Journal of Advanced Nursing, 36(1), 112-119.

The authors, baccalaureate nursing faculty at a Hong Kong university, presented the results of a pre-test/post-test designed study of the effects of using videotaped vignettes to promote first and second year nursing students’ critical thinking abilities. Participants (n=83) completed questionnaires testing knowledge of the specific vignettes viewed as well as a test of critical thinking skills. Post-test knowledge scores were reported to be significantly higher than pre-test scores and in contrast, there was no significant difference between the pre and post-test scores on critical thinking and no significant correlations were found between demographic variables and critical thinking scores. Interestingly, only the first year students evidenced statistically significant improvement from pre-test to post-test knowledge scores. Statistics were presented and validity of the vignettes and tests used in the study was discussed including that of the California Critical Thinking Skills Test (CCTST) used as the measure for critical thinking skills. Limitations of the study, along with discussion of results and needs for further study were presented. This article supported the use of vignettes in developing student knowledge and suggested additional study was needed to determine the effects of using vignettes on students’ critical thinking skills. Provided a good foundation for continuing research in the use of videotaped vignettes.

Chickering, A.W. & Gamson, Z.F. (1987). Seven principles for good practice in undergraduate education. American Association of Higher Education Bulletin (AAHE Bulletin), 3-7.

The authors, respected leaders in higher education in the United States, presented seven principles for good practice in higher education that were based on fifty years of research on teaching and learning in colleges and universities. These Principles were created with the help of AAHE and the Education Commission of the States, with support of the Johnson Foundation and distilled findings from decades of research on the undergraduate experience in higher education. This document was followed by the publication of a Seven Principles Faculty Inventory as well as an Institutional Inventory in 1989, and in 1990 a Student Inventory. Provided a well-documented foundation of good practices for higher education and for continuing research on educational practices in higher education. These seven principles, as guidelines for faculty and students, supported the use of simulation to enhance experiential learning within higher education and have provided direction/guidance in the development of simulations in nursing education (see Jeffries, 2005).

Chickering, A. & Ehrmann, S. (1996). Implementing the seven principles: Technology as lever. American Association of Higher Education Bulletin, October, 3-6. Retrieved August 11, 2007 at http://www.tltgroup.org along with an update by Ehrmann, S. (2003).

The authors, leaders in higher education in America, described some of the appropriate and most cost-effective methods for using communication technologies in implementing the seven principles of good practice in education. In the update, the author reported on the development and availability of a library of teaching ideas for advancing the seven principles and sorted by the seven principles. Provided a good resource for information on research and the use of technology in higher education.

Childress, R.M. (2006). Ask the nurse expert: Simulation advice. INACSL Online Journal, 2(1).

The expert, nursing faculty at a university in Virginia, responded to four questions posed by the guest editor regarding use of simulation in nursing education. This expert reported 3 strengths of simulation use, then listed creative ways to make simulation more realistic, and stated that increased development of critical thinking was a major outcome of simulation. She listed some of the methods used in her institution to provide faculty development and support in the use of simulation. Provided some realistic and detailed ideas for use in simulation.

Childs, J. (2006). Ask the nurse expert: Simulation advice. INACSL Online Journal, 2(1).

The expert, nursing faculty at a university in Maine, responded to four questions posed by the guest editor regarding use of simulation in nursing education. This expert reported that the strengths of simulation use were: the student responses to simulation, student changes after the experiences, and that professionalism in the lab is most essential to enhancing the realism/fidelity of simulation along with having the appropriate materials for the simulation. She responded that increased student self-evaluation and self-confidence was the major learning outcome of simulation, and described how she and her institution are providing development and support to nursing faculty in the use of simulation. Provided details of ways to increase faculty involvement and the use of simulation in nursing education.