Evaluation of Simulation Courseware in Pediatric Nursing Practicum

Transcription

1 Evaluation of Simulation Courseware in Pediatric Nursing Practicum * Hyunsook Shin, PhD, APN, CPNP, Associate professor * KaKa Shim, Doctoral candidate, RN, Lecturer * Yuna Lee, MSN, RN, Clinical instructor * Hyunhee Ma, Master s student, RN, Simulation coordinator * Dahae Lim, Master s student, RN, Research assistant * Hyojin Kim, Master s student, RN, Research assistant * Kyung Hee University, Seoul, Republic of Korea

2 Introduction Nursing education and simulation Gap between theory and clinical practice in nursing education Simulation as an alternative or supplementary strategy to traditional clinical practicum for improving nursing student s CT abilities

3 Introduction Gaps Lack of theory-driven integrated courseware Previous studies focused on evaluation of student satisfaction about new strategies, self-reported performance, or clinical judgment Systematic review of studies on CT revealed unclear relationships with simulation

4 Aims To evaluate the effectiveness of an integrated pediatric nursing simulation courseware in pediatric practicum On students critical thinking And clinical judgment To identify contributing factors and their relationships

5 Methods Design One group, pre-and post-test Participants 95 senior undergraduate nursing students enrolled in 3 weeks pediatric nursing practicum between Feb. to Nov. 2012

6 Methods Courseware development Simulation build-up model: Jeffries simulation framework (2006)

7 Methods Courseware development Theoretical framework: Tanner s Clinical Judgment Model (2006)

8 Methods Courseware development Courseware components Pre-learning checklist, scenario template, evaluation tools, scripts for standard patients Scenarios 1) Rapport building, 2) Febrile infant care, 3) Emergency measure for high risk newborn with apnea Pre-course: mobile based infant vital training program

9 Methods Courseware development Scenario contents Simple and complex pediatric nursing cases with basic nursing assessment and interventions Vital sign checking in infants, respiratory interventions, interaction among nurses-childrenparents, fever management techniques, administering oxygen, prioritizing medications, monitoring oxygen saturation and BP Evaluation Critical thinking, Clinical Judgment-General, Clinical Judgment-Scenario specific, Simulation satisfaction

10 Courseware development Simulation operation Integrated into regular pediatric nursing practicum Uniform protocol Pre-learning Simulation orientation Clinical Vitalsim Clinical 2nd Sim 4hrs Simulation operation 1 st Sim 3hrs Case confere nce 3 rd Sim 4hrs Case confere nce SBAR writing: What they did during operation Watching the video-clip of their performance for self-evaluation Debriefing

11 Data Collection

12 Measures Critical thinking Critical Thinking Disposition Tool Yoon, 2008 Clinical judgment Lasater Clinical Judgment Rubric: LCJR, 2007 Simulation satisfaction Simulation Effectiveness Tool:SET Elfrink et al., 2012

13 Data Analysis SPSS 19.0 Descriptive data Frequencies, percentages, means, and standard deviations for the overall scales Pre and post critical thinking scores Paired t tests Critical thinking, Clinical judgment, and Simulation satisfaction scores by the general characteristics ANOVA Relationship among variables Pearson s correlation and chi-square analysis

14 Findings Participants characteristics (N = 95) Characteristic Subcategory No. Percentage Mean SD Gender Female Male Age Simulation course or None practicum experience Once Twice >3times Prior clinical hours Prior CT class attendance Yes No CPR training Yes No CPR certificate Yes No

15 Findings Comparison of CT scores: Analysis of CT total score post-simulation compared to pre-simulation Domain Pre-CT Mean ± SD Post-CT Mean ± SD t p Eagerness 3.48 ± ± Prudence 3.08 ± ± Confidence 3.53 ± ± Systematicity 3.19 ± ± Fairness 3.86 ± ± Skepticism 3.46 ± ± Objectivity 3.93 ± ± Total ± ±

16 Findings Comparison of test scores: Clinical judgment scores post-simulation LCJR Simulation I Mean ± SD Simulation II Mean ± SD Noticing 1 Focused observation 2.75 ± ± Recognizing deviations from 2.45 ± 0.68 expected patterns 2.64 ± Information seeking 2.57 ± ± 0.78 Interpretation 4 Prioritizing data 2.83 ± ± Making sense of data 2.42 ± ± 0.68 Responding 6 Calm, confident manner 2.99 ± ± Clear communication 2.92 ± ± Well-planned intervention/flexibility 2.68 ± ± Being skillful 2.37 ± ± 0.65 Reflecting 10 Evaluation/self-analysis 2.92 ± ± Commitment to improvement 3.06 ± ± 0.73 Total ± ±2.48

17 Findings Student satisfaction by SET Items Simulation I Mean(SD) Simulation II Mean Average Mean The instructor s questions helped me to think critically ± ± ± 0.41 I feel better prepared to care for real patients ± ± ± 0.62 I developed a better understanding of the pathophysiology of the conditions in the SCE ± ± ± 0.51 I developed a better understanding of the medications that were in the SCE ± ± ± 0.82 I feel more confident in my decision making skills ± ± ± 0.55 I am more confident in determining what to tell the healthcare provider ± ± ± 0.58 My assessment skills improved ± ± ± 0.53 I feel more confident that I will be able to recognize changes in my real patient s condition ± ± ± 0.58 I am able to better predict what changes may occur with my real patients ± ± ± 0.53 Completing the SCE helped me understand classroom information better ± ± ± 0.40 I was challenged in my thinking and decision-making skills ± ± ± 0.48 I learned as much from observing my peers as I did when I was actively involved in caring for the simulated patient ± ± ± 0.49 Debriefing and group discussion were valuable ± ± ± 0.40 Total ± ± ± 3.79

18 Findings Comparison of variables between upper and lower groups by CT change Upper Lower x 2 /t p Age 22.41± ± Gender Female Male 6 3 Previous CT course Yes No CPR course Yes No 8 5 LCJR: Simulation I Noticing 8.21 ± ± Interpreting 5.52 ± ± Responding ± ± Reflecting 6.21 ± ± Total LCJR ± ± LCJR: Simulation II Noticing 7.71 ± ± Interpreting 5.06 ± ± Responding ± ± Reflecting 5.58 ± ± Total LCJR ± ± SET ± ± SET ± ± Pre-CT ± ± Post-CT ± ±

19 Conclusions Students' CT improvement and integrated simulation courseware Mediating role of clinical judgment in CT improvement Recommended simulation learning experience in nursing practica