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
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
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
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
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
Methods Courseware development Simulation build-up model: Jeffries simulation framework (2006)
Methods Courseware development Theoretical framework: Tanner s Clinical Judgment Model (2006)
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
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
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
Data Collection
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
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
Findings Participants characteristics (N = 95) Characteristic Subcategory No. Percentage Mean SD Gender Female 86 90..5 Male 9 9.5 Age 22.30 1.91 Simulation course or None 4 4.2 practicum experience Once 35 36.8 Twice 36 37..9 >3times 20 21.2 Prior clinical hours 95 705.26 143.93 Prior CT class attendance Yes 51 53.7 No 44 46.4 CPR training Yes 81 85.3 No 14 14.8 CPR certificate Yes 16 16..8 No 79 83.2
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 ± 0.71 3.76 ± 0.52-3.735.000 Prudence 3.08 ± 0.58 3.36 ± 0.46-3.991.000 Confidence 3.53 ± 0.73 3.66 ± 0.50-1.823.071 Systematicity 3.19 ± 0.68 3.54 ± 0.53-4.841.000 Fairness 3.86 ± 0.72 4.13 ± 0.42-3.233.002 Skepticism 3.46 ± 0.72 3.67 ± 0.55-3.156.002 Objectivity 3.93 ± 0.70 4.00 ± 0.48-0.963.338 Total 94.44 ± 15.34 100.71 ± 8.51-4.032.000
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 ± 0.59 2.45 ± 0.77 2 Recognizing deviations from 2.45 ± 0.68 expected patterns 2.64 ± 0.57 3 Information seeking 2.57 ± 0.75 2.38 ± 0.78 Interpretation 4 Prioritizing data 2.83 ± 0.67 2.51 ± 0.70 5 Making sense of data 2.42 ± 0.58 2.34 ± 0.68 Responding 6 Calm, confident manner 2.99 ± 0.76 2.65 ± 0.76 7 Clear communication 2.92 ± 0.80 2.52 ± 0.81 8 Well-planned intervention/flexibility 2.68 ± 0.77 2.52 ± 0.74 9 Being skillful 2.37 ± 0.60 2.43 ± 0.65 Reflecting 10 Evaluation/self-analysis 2.92 ± 0.60 2.74 ± 0.64 11 Commitment to improvement 3.06 ± 0.61 2.80 ± 0.73 Total 29.86 ± 0.58 27.29 ±2.48
Findings Student satisfaction by SET Items Simulation I Mean(SD) Simulation II Mean Average Mean The instructor s questions helped me to think critically. 2.76 ± 0.46 2.84 ± 0.37 2.80 ± 0.41 I feel better prepared to care for real patients. 2.16 ± 0.67 2.32 ± 0.58 2.24 ± 0.62 I developed a better understanding of the pathophysiology of the conditions in the SCE. 2.55 ± 0.54 2.69 ± 0.48 2.62 ± 0.51 I developed a better understanding of the medications that were in the SCE. 1.83 ± 0.81 2.05 ± 0.84 1.94 ± 0.82 I feel more confident in my decision making skills. 2.30 ± 0.57 2.39 ± 0.53 2.35 ± 0.55 I am more confident in determining what to tell the healthcare provider. 2.43 ± 0.58 2.45 ± 0.58 2.44 ± 0.58 My assessment skills improved. 2.53 ± 0.55 2.52 ± 0.51 2.52 ± 0.53 I feel more confident that I will be able to recognize changes in my real patient s condition. 2.44 ± 0.60 2.41 ± 0.55 2.43 ± 0.58 I am able to better predict what changes may occur with my real patients. 2.37 ± 0.57 2.52 ± 0.50 2.45 ± 0.53 Completing the SCE helped me understand classroom information better. 2.83 ± 0.35 2.85 ± 0.45 2.84 ± 0.40 I was challenged in my thinking and decision-making skills. 2.73 ± 0.46 2.77 ± 0.50 2.75 ± 0.48 I learned as much from observing my peers as I did when I was actively involved in caring for the simulated patient. 2.79 ± 0.53 2.79 ± 0.46 2.79 ± 0.49 Debriefing and group discussion were valuable. 2.87 ± 0.34 2.86 ± 0.46 2.86 ± 0.40 Total 32.52 ± 3.85 33.43 ± 3.74 32.98 ± 3.79
Findings Comparison of variables between upper and lower groups by CT change Upper Lower x 2 /t p Age 22.41±2.19 22.16±1.51.629.531 Gender Female 46 40.571.620 Male 6 3 Previous CT course Yes 27 24.078.837 No 24 19 CPR course Yes 43 38.322.766 No 8 5 LCJR: Simulation I Noticing 8.21 ± 1.56 7.93 ± 1.39 0.92 0.361 Interpreting 5.52 ± 1.11 5.37 ± 0.95 0.69 0.495 Responding 10.98 ± 2.14 10.77 ± 2.02 0.50 0.621 Reflecting 6.21 ± 1.02 6.23 ± 1.21-0.09 0.927 Total LCJR 30.92 ± 4.86 30.30 ± 4.78 0.62 0.534 LCJR: Simulation II Noticing 7.71 ± 6.42 6.42 ± 2.23 3.01 0.003 Interpreting 5.06 ± 1.16 4.37 ± 1.59 2.43 0.017 Responding 10.65 ± 2.54 9.00 ± 2.63 3.09 0.003 Reflecting 5.58 ± 1.26 5.23 ± 1.62 1.17 0.246 Total LCJR 29.00 ± 5.96 25.17 ± 6.92 2.88 0.005 SET 1 32.58 ± 4.22 32.44 ± 3.72 0.16 0.87 SET 2 33.74 ± 3.34 33.05 ± 4.06 0.89 0.375 Pre-CT 90.98 ± 19.81 98.63 ± 4.23-2.48 0.015 Post-CT 104.29 ± 8.33 96.37 ± 6.52 5.07 0.000
Conclusions Students' CT improvement and integrated simulation courseware Mediating role of clinical judgment in CT improvement Recommended simulation learning experience in nursing practica