High Fidelity Simulation.LK edits 4

PICO Lauren Kalember, BSN, RN; Maria McFaulds, BSN, RN; Meredith Reape BSN, RN THE EDUCATOR ROLE
Drexel University, Philadelphia, PA
In baccalaureate nursing students how does high-fidelity
simulation compare to traditional classroom based theory EVIDENCE TABLE
and clinical experience alone in the development of
clinical judgment and clinical reasoning? Title/Author Study Objectives Level/ Intervention and Outcome Results HFS can:
Design Measures • Help link classroom education and clinical experience
BACKGROUND Enhancing Nursing Determining if students • Develop knowledge and critical thinking which are both key to
Knowledge Using High- that participate in HFS A comparative study using a STATA 11 was used to analyze • HFS can improve knowledge acquisition
• There is a gap in knowledge from what students are learning in Fidelity Simulation (Gates, will receive higher test purposive sample of 104 BSN development of clinical reasoning.
BSN curriculum to what is current nurse practice. As students Parr, Hughen, 2012) scores than students who students . data collected. Variables and improve test scores. This data can be • Diversify experiences
transition into the role of professional nursing they are struggling did not participate in HFS The educator needs to:
to close this knowledge gap and function as independent measured included course used to utilize HFS in the educational • Support the student’s use of technology and simulation in
professional nurses. One way, as nurse educators, this gap can
close is through teaching the art of clinical reasoning to nursing examination scores for 2 different setting in adjunct with clinical experience. education
students. Clinical reasoning and judgment is the process • Encourage the use of reflection and debriefing with HFS to
involved in clinical decision making using reflection, cures, and simulations. Descriptive statistics
data to interpret patient needs (Cappelletti, Engel, & Prentice, enhance the ability to develop clinical reasoning and critical
2014). Currently, clinical reasoning is not a strong skill of some were used to report results. thinking (Lee, Lee, Lee & Bae, 2015).
nurses with over 70% of nurses in the United States scoring • Allow for open communication and boost teamwork.
poorly on clinical reasoning tests (Del Beuno, 2005). Systematic Review of Determine the most up-to- Systematic review of quantitative 7 quantitative studies were • The systematic review determined that
Clinical Judgment and clinical judgment is a process that The educator can measure clinical reasoning by utilizing the
• With a current lack of clinical nurse faculty and clinical Reasoning in Nursing date evidence on clinical & Qualitative studies from 1980- reviewed using the Cochrane develops over time using consistent script concordance test (SCT) (Nouh et al., 2011). This test offers
placement sites for nursing students, it is imperative for nurse (Cappelletti, Engel, & reflection in action and on action. three different case studies that are followed by a series of
educators to develop other means to teach clinical reasoning. The Prentice, 2014) judgment and reasoning in 2012. The terms “clinical Collaboration's tool for assessing questions divided into three parts. The answers can be compared to
use of high-fidelity simulation (HFS) can be used to develop • HFS has a promising impact as an a panel of experts.
clinical reasoning skills in the nursing student. HFS has long nursing and their judgment, nursing, and clinical risk bias. 12 qualitative studies educational tool in the development of • Part one: Diagnostic option
been used to bridge the gap between nursing theory and nursing clinical reasoning.
practice (Hallin, Backstrom, Haggstrom, & Kristiansen, 2016). implications on the reasoning” were searched on were reviewed using the o “If you were thinking of..”
HFS is an active learning strategy that allows nursing students • Part two: Clinical finding
the opportunity to care for various patient types in various educational setting. PubMed, CINAHL, MEDLINE, Worksheet for Critical
clinical situations through a simulated environment (Lee, Lee, o “And then you were to find..”
Lee, & Bae, 2015). Through HFS students can apply what was & ERIC. Assessment of Qualitative • Part three: Likert scale on decision
learned in the didactic setting to clinical scenarios. Students can
collect cues, interpret data, make assumptions, plan interventions, research. o “This option would become..”
evaluate outcomes, and then reflect on the simulation process.
From that simulation students can then apply knowledge gained Effects of high-fidelity Determine if students that Quasi-Experimental RCT using a 23 BSN students participated in • The clinical reasoning course using HFS CONCLUSION
in the simulation setting to future clinical situations. Thus patient simulation led received HFS would convenience sample of BSN the experimental group while 26 significantly improved nursing core
developing strong clinical reasoning skills and transitioning with clinical reasoning course: report a higher score in students and descriptive and participated in the control group. competencies, it did not however, show an Clinical reasoning is an important skill required in nursing. However,
those skills to professional nursing practice. focused on nursing core nursing core inferential statistics. The experimental group received improvement of problem solving and with the lack of clinical areas and the ever-growing practice-education
competencies, problem competencies, problem a 2 credit course on clinical academic self efficacy. gap, it is becoming increasingly more difficult for students to learn
solving, and academic self- solving, and academic reasoning while the control group clinical reasoning within their nursing education. The introduction of
efficacy (Lee, Lee, Lee, & self-efficacy. remained in the traditional HFS is a promising addition to classroom and clinical education that may
Bae, 2016) nursing track. help bridge the gaps that exist. The educator needs to allow for both
SPSS was used to analyze data reflection and debriefing after the use of HFS to help develop critical
collected. thinking and further gain knowledge. The use of the SCT measure is a
tool that measures clinical reasoning which can be utilized by the
Simulation-based learning in To review the quantitative A systematic review of 12 papers were reviewed for the • All 12 studies selected for review showed educator. As technology and more options become available to help
systematic review. Inclusion significant improvements in critical supplement traditional education, students will learn to thrive in a diverse
nurse education: A evidence for a medium to quantitative studies from 1999- criteria involved having a thinking, knowledge, skills, and world that they will face.
comparison of HFS to various confidence after HFS training. HFS is an
systematic review (Cant & high fidelity simulation 2009. The terms ”Simulation” other educational strategies effective educational strategy to promote
knowledge gain, critical thinking, and
Cooper, 2009) using manikins in nursing and “Human simulation” were confidence.

compared to other searched on CINAHL, ERIC,

educational strategies Embase, Medline, SCOPUS,

Proquest, & ProQuest

Dissertation.

High-Fidelity simulation: Identify nursing students’ The study is a descriptive design, BSN students were videotaped • In BSN student’s first HFS scenario they
Assessment of student ability to make clinical however it is a portion of a much
nurses’ team achievements judgments in terms of how larger quasi-experimental study during various simulation scored low on ability to make clinical
of clinical judgment (Hallin, they perceive, interpret,
Backstrom, Haggstom, and act in clinical scenarios. The scenarios designed judgments.
Kristiansen, 2016). situations.
utilized clinical judgment skills. • Relationships were established between

Scores of the student clinical judgment and scenario

performances were calculated and circumstances, debriefing and higher

used for descriptive statistics clinical judgment scores, and previous

using SPSS HFS experience with higher clinical

judgment scores.

Effectiveness of patient Identify the best available A systematic review of RCTs and 8 papers were chosen for review • The systematic review was inconclusive
simulation manikins in evidence on the use of in determining whether the use of HFS
teaching clinical reasoning HFS to teach clinical Quasi-RCTs. Publications from to meet the outcome manikins was effective in developing
skills to undergraduate reasoning skills to BSN clinical reasoning skills to BSN students.
nursing students: A students. 1999-2009 were searched on measurements. Outcome The evidence did support the use of HFS
systematic review (Lapkin, manikins in developing clinical reasoning,
Levett-Jones, Bellchambers, AMED, CINAHL, Cochrane measures include: critical knowledge acquisition, and critical
& Fernandez, 2010). thinking in the ability to identify a
Database, ProQuest Dissertations, thinking, clinical skill deteriorating patient.

EMBASE, ERIC, Ovid, performance, knowledge

MEDLINE, ProQuest Nursing, acquisition, confidence, and

and PsycINFO student satisfaction.

Nursing Nursing REFERENCES
Theory and Practice
Knowledge Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: systematic review. Journal of
advanced nursing, 66(1), 3-15.
Clinical
Reasoning Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment and reasoning in nursing.
Journal of Nursing Education, 53(8), 453-458.
From “Boise State University Nursing” by Boise State University. (https://s-media-
cacheak0.pinimg.com/originals/c5/85/71/c585717327828b6a7d7fdd7b8b96030c.jpg). In the public domain. Gates, M. G., Parr, M. B., & Hughen, J. E. (2012). Enhancing nursing knowledge using high-fidelity simulation.
Journal of Nursing Education, 51(1), 9-15.

Hallin, K., Bäckström, B., Häggström, M., & Kristiansen, L. (2016). High-fidelity simulation: Assessment of student
nurses' team achievements of clinical judgment. Nurse Education in Practice, 19, 12-18.

Lapkin, S., Levett-Jones, T., Bellchambers, H., & Fernandez, R. (2010). Effectiveness of patient simulation manikins
In teaching clinical reasoning skills to undergraduate nursing students: A systematic review. Clinical
Simulation in Nursing, 6(6), e207-e222.

Lee, J., Lee, Y., Lee, S., & Bae, J. (2016). Effects of high-fidelity patient simulation led clinical reasoning course:
Focused on core competencies, problem solving, and academic self-efficacy. Japan Journal of Nursing
Science, 13(1), 20-28.

Nouh, T., Boutros, M., Gagnon, R., Reid, S., Leslie, K., Pace, D., . . . Meterissian, S. H. (2012). The script
concordance test as a measure of clinical reasoning: A national validation study. American Journal of
Surgery, 203(4), 530-534. doi:10.1016/j.amjsurg.2011.11.006