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Item type Presentation

Format Text-based Document

Title Implementing Simulation Courseware in a PediatricNursing Practicum

Authors Shin, Hyunsook; Lim, Dahae; Shim, Kaka; Ma, Hyunhee;Kim, Hyojin; Lee, Yuna

Downloaded 29-Jun-2018 07:00:22

Link to item http://hdl.handle.net/10755/316881

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

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-children-parents, fever management techniques, administering oxygen, prioritizing medications, monitoring oxygen saturation and BP

• Evaluation – Critical thinking, Clinical Judgment-General, Clinical

Judgment-Scenario specific, Simulation satisfaction

Methods

Simulation operation

Integrated into regular pediatric nursing practicum

Uniform protocol

1st Sim 3hrs

Clinical

Vital-sim

2nd Sim 4hrs

Clinical

3rd Sim 4hrs

Case confere

nce

Case confere

nce

Pre-learning

Simulation orientation

Simulation operation

SBAR writing: What they did during operation

Watching the video-clip of their performance for self-evaluation

Debriefing

Courseware development

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

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 practicum experience

None 4 4.2

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 expected patterns 2.64 ± 0.57

2.45 ± 0.68

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 x2/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

Findings

Conclusions

• Students' CT improvement and integrated simulation courseware

• Mediating role of clinical judgment in CT improvement

• Recommended simulation learning experience in nursing practica