See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/313737193

Simulation is more than working with a mannequin: Student’s perceptions of

their learning experience in a clinical simulation environment

Article  in  Journal of Nursing Education and Practice · February 2017

DOI: 10.5430/jnep.v7n7p30

CITATIONS READS

3 220

5 authors, including:

Karla Rodriguez Noreen Nelson

University of Guadalajara New York University
3 PUBLICATIONS   3 CITATIONS    5 PUBLICATIONS   6 CITATIONS   

SEE PROFILE SEE PROFILE

Mattia J Gilmartin Lloyd Goldsamt

New York University New York University
18 PUBLICATIONS   298 CITATIONS    33 PUBLICATIONS   398 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Get Naloxone Now View project

All content following this page was uploaded by Lloyd Goldsamt on 19 February 2017.

The user has requested enhancement of the downloaded file.

http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

ORIGINAL RESEARCH

Simulation is more than working with a mannequin:

Student’s perceptions of their learning experience in a
clinical simulation environment
Karla G. Rodriguez ∗, Noreen Nelson, Mattia Gilmartin, Lloyd Goldsamt, Hila Richardson
College of Nursing, NYU Meyers College of Nursing, New York, United States

Received: September 14, 2016 Accepted: January 6, 2017 Online Published: February 14, 2017
DOI: 10.5430/jnep.v7n7p30 URL: http://dx.doi.org/10.5430/jnep.v7n7p30

A BSTRACT
Purpose: This paper describes undergraduate nursing students’ assessment of learning in a clinical teaching model that replaces
50% of the traditional clinical hours with high-fidelity simulation. We assessed students’ perceptions of the use of best practices
in simulation teaching, and the importance assigned to each teaching practice to support learning.
Methods: Longitudinal program evaluation design. We surveyed undergraduate nursing students with the Educational Practices
Questionnaire (EPQ) at the mid-point (semester 2) and end of the program (semester 4). We used paired t-tests to assess changes
in student EPQ scores between mid- and end-program.
Results: Results showed that students’ reported greater exposure over time to clinical simulation activities that fostered active
learning and high expectations; the degree to which they rated collaborative learning as important also increased.
Conclusions: Students’ perceptions of the use of educational best practices and the importance of simulation in nursing education
from program mid-point to end-point lends support for a clinical teaching model that uses a simulation to substitute for traditional
clinical hours.

Key Words: Nursing students, High-fidelity simulation, Educational best practices

1. I NTRODUCTION such as task-trainers used to develop psycho-motor skills;

standardized patients using actors; games and virtual reality
To meet the challenge of preparing a new generation of com-
platforms; and computerized mannequins that replicate the
petent practitioners, nurse educators have adopted teaching
human anatomy that can be programmed to imitate a realistic
approaches that favor learning-by-doing and reflective prac-
[1] physiologic response in a scripted situation.[4, 5]
tice. One of the active learning methods used in nursing
education is high-fidelity simulation.[2] Although simula- One advantage of high-fidelity simulation over traditional
tion has been used to teach basic nursing skills for most of clinical teaching approaches is the ability to create a realistic
the twentieth century, contemporary simulation approaches controlled learning environment that maximizes the poten-
give students experience working through complex clinical tial for student learning while minimizing potential harm to
scenarios in a safe learning environment.[2, 3] High-fidelity patients. Based on problem-based learning theories, high
simulation in nursing education involves teaching approaches fidelity simulation scenarios provide students with the oppor-
∗ Correspondence: Karla G. Rodriguez; Email: kgr215@nyu.edu; Address: College of Nursing, NYU Meyers College of Nursing, New York, United

States.

30 ISSN 1925-4040 E-ISSN 1925-4059

http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

tunity to work through progressively more complex scenarios ties, knowledge retention, self-confidence and communica-
to develop clinical reasoning and reflective practice skills.[5] tion.[8, 14] A student’s level of confidence during simulation
The American Association of Colleges of Nursing reports can greatly affect and sharpen critical thinking abilities, tech-
that there has been a large increase in the use of high-fidelity nical competence, and overall quality of nursing care.[3, 5]
simulation in higher nursing education[6] and the National Studies examining the relationship between self-confidence
Council of State Boards of Nursing endorses the use of well- and high-fidelity simulation show that high fidelity simula-
designed high-fidelity clinical simulation approaches as an tion increases self-confidence with clinical practice abilities
appropriate method to develop the clinical competencies of for the majority of students.[17–21]
new nurses.[7]
Because of the realism of high-fidelity human simulators, this
Although high-fidelity simulation using human mannequin form of clinical simulation can be viewed as equally valuable
simulators can facilitate problem-based learning among un- to learning experiences gained from traditional, hospital-
dergraduate nursing students, less attention has been paid to based clinical teaching.[18–22] Although substituting high fi-
student perceptions of the quality and usefulness of simu- delity simulation for traditional hospital-based clinical teach-
lation within the context of undergraduate education.[4, 8–11] ing holds much potential for modernizing nursing education,
Drawing from a larger program evaluation study, we present it is not without controversy.[3] To assess the effectiveness
data on student perceptions of their clinical training in an of high fidelity simulation in developing students’ clinical
undergraduate nursing program in which 50% of total clini- proficiency, the National Council of State Boards of Nurs-
cal contact hours in each of the four nursing core medical- ing sponsored a national randomized control trial comparing
surgical courses are taught using high-fidelity human man- student outcomes across three clinical teaching models with
nequin simulation. varying levels of high fidelity human mannequin simulation.
The trial results showed no significant difference in licensing
1.1 Literature review exam scores (NCLEX-RN) among participating students as-
1.1.1 Simulation signed to a simulation teaching model in which 50% of the
High fidelity simulation using human mannequin simula- clinical hours were spent in high-fidelity simulation sessions
tors is a common form of problem-based learning used in using human mannequin simulators as compared to students
higher nursing education.[3] Problem-based learning in un- educated in the traditional hospital-based clinical teaching
dergraduate nursing education cultivates clinical reasoning models with fewer total hours of simulated teaching.[7]
and effective problem solving skills that are fundamental for
1.1.2 Conceptual framework: Educational practices do-
expert clinical practice.[3, 6–8, 12] Teaching congruent with the
mains for effective high-fidelity clinical simulation
principles of problem based learning provides students with
in nursing education
the necessary structure, guidance, and skills to grapple with
clinically-relevant patient problems. Problem-based learning Current evidence suggests that key learning outcomes as-
is especially effective for solving problems with more than sociated with competent clinical nursing practice such as
one possible course of action, a situation that is common in self-confidence, mastery of clinical skills and critical think-
clinical nursing practice. ing abilities, are achieved when high fidelity simulation is
woven throughout the curriculum.[5] Parker and colleagues
Unlike traditional lecture teaching formats where students
found that simulation is most effective when individual pa-
are passive participants, problem-based learning requires
tient scenarios are designed to integrate both nursing theory
that students play an active role in mastering course content
and clinical skills, and progress in complexity over time.[23]
through a process of self-reflection, teamwork, communica-
Similarly, Katz and colleagues’ review of the integration
tion and performance feedback.[1, 8]
of baccalaureate nursing programs and simulation through-
Instructors serve as guides and coaches who facilitate stu- out the core nursing curriculum revealed student mastery
dents’ learning by framing problems, highlighting concepts of clinical skills and professional practice competencies are
and principles for problem solving, and support the process enhanced.[24]
of independent learning.[1, 2] To the extent that faculty follow
To improve the overall effectiveness of simulation in nursing
best practices to structure and manage student’s independent
education, Jeffries[12] describes four educational practice do-
learning, student performance and satisfaction with learning
mains necessary for designing and implementing high quality
are enhanced.[13–16]
simulation sessions. The educational practice domains as-
A growing body of evidence suggests that problem-based sociated with effective problem-based teaching set forth by
teaching methods promote students’ critical thinking abili- Jeffries include: active learning, collaboration, diverse ways
Published by Sciedu Press 31
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

of learning, and high expectations.[12] The extent to which and practicing clinical skills such as wound care or donning
nurse educators integrate these best practices in the design personal protective equipment.
and delivery of clinical simulation sessions, the higher the
Finally, although the role of high expectations is rarely ad-
quality of the student learning experience.
dressed in the literature, Jeffries and Rizzolo[12] suggest that
The first component of Jeffries’ model is active learning. high standards are necessary for students to achieve favor-
Active learning, including direct performance feedback, is able outcomes through simulation. Clear objectives and
integral to the clinical simulation experience.[25] It is ex- goals should be provided as well as support and assistance so
pected that new nurses possess the ability to be self-directed students can achieve mastery of skills and knowledge during
and engage in clinical situations, and can be facilitated by the simulated activity. In addition, when faculty set high per-
simulation. formance expectations, students’ perceptions of the realism
of simulation and expectations for collaborative learning and
The balance between participation and feedback is deter-
team building improve.[3, 8, 11]
mined in the design of the simulation experience. Instruc-
tional strategies associated with active-learning stress the
1.1.3 NYU meyers clinical teaching model
importance of allowing students to work through an evolv-
ing clinical situation by gathering and analyzing data to de- In 2006, the NYU Meyers College of Nursing developed
termine an appropriate course of action to resolve patient an innovative clinical teaching model in which 50% of the
problems.[8–11] The process of learning-by-doing inherent in clinical hours in the four core medical-surgical courses in the
the active-learning domain enables students to experiment, undergraduate program were replaced with high-fidelity hu-
develop critical thinking skills, and reflect on their overall man mannequin simulation.[3] Recognizing the advantages
performance prior to receiving feedback from their peers and and limitations of both simulation and traditional clinical
clinical instructor. teaching approaches, faculty adopted the high-dose clinical
The second component of Jeffries’ best practice model is simulation teaching model. At the outset of a curricular
collaboration. Howard and colleagues[26] suggest that learn- redesign initiative, faculty agreed that the realism of well-
ing is enhanced when it represents a team effort through designed clinical scenarios using high-fidelity simulation
collaboration rather than independent learning. Parker and was an equally valuable learning experience to the traditional
colleagues[23] identified students’ perception of collabora- hospital-based clinical teaching model. Simulation sessions
tion, peer solidarity, faculty support and guidance and self- are guided by Jeffries’ educational practices model to empha-
confidence as significantly higher in simulation teaching size the principles of active learning, collaboration, diverse
as compared to the traditional hospital clinical teaching. ways of learning, and high expectations.[2, 11, 28]
More broadly, effective collaboration among nurses and other Clinical simulation enabled the faculty to exert greater con-
health professionals is fundamental to providing high-quality, trol over the range of patient problems and exposure to spe-
well-coordinated patient care.[1, 8] Well-designed simulation cific clinical skills that students experienced across the four
scenarios emphasizing collaboration plays an important role core-medical surgical courses in the undergraduate program.
in developing new nurses’ skills to establish meaningful and In turn, the focus of the traditional hospital based clinical
productive professional relationships with clients, families, teaching shifted to emphasize learning opportunities to de-
and colleagues.[23, 26] velop students’ skills in therapeutic communication, care
The third aspect of Jeffries’s best practice model is diverse planning and goal setting, interprofessional collaboration
[2, 11, 28]
ways of learning. Given their varying social and cultural and reflective practice.
backgrounds, students have different learning styles and ex- To reinforce the value that faculty placed on each clinical
pectations. High-fidelity simulation provides a controlled teaching approach, the simulation sessions are referred to as
environment appropriate to these diverse learning styles.[8, 9] ‘on-campus’ clinical and the hospital based clinical sessions
High fidelity simulation enables instructors to facilitate stu- are referred to as ‘off-campus’ clinical. The faculty mem-
dents’ different learning styles because simulation requires ber teaching the didactic course serves as the course leader
students to use all of their senses to work through a clinical responsible for coordinating the work of the clinical faculty
scenario. In turn, the active learning process that is the hall- responsible for teaching the students in the on-campus and
mark of simulation enables students to internalize what they off-campus clinical sessions to ensure continuity across the
have experienced.[27] Examples include a variety of learn- teaching team. Students are required to follow the same
ing cues in the form of the physical set up of the simulation dress code and preparation policies for both clinical learning
room, the oral report, the physical exam with realistic sounds, experiences.[2, 29–31]
32 ISSN 1925-4040 E-ISSN 1925-4059
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

We integrated high-fidelity human mannequin simulation affiliated with the College of Nursing. All study procedures
into the undergraduate program curriculum in the following were approved by the Institutional Review Board at New
ways. First, we created learning objectives and course out- York University.
lines for the four core didactic medical surgical courses. The
content presented in each course was leveled to take students’ 2.2 Setting
experience and mastery with the underlying nursing practice Students were surveyed at two time points within the two-
principles into account. For example, the medical-surgical year (four semester) baccalaureate curriculum. We collected
course in the first semester emphasizes the basic principles of data from the student nurses using the Educational Practices
the nursing process, physical assessment and data gathering Questionnaire (EPQ) at the middle of their-program (at the
skills. In comparison, the fourth semester medical surgical end of the second semester), and at the end of their program.
course requires students to gather and analyze more complex A total of 168 students completed data collection at both time
physical assessment data, medical and nursing orders, as points and thus could be compared over time.
well as taking medications and their side effects into account,
to develop an appropriate nursing care plan. Next, the learn- 2.3 Instruments
ing objectives for each on-campus and off-campus clinical The EPQ is a 16-item validated measure that assesses aspects
session were aligned with the weekly topics taught in the of simulation-based learning, and includes the four domains
didactic course. Clinical topics covered in the weekly lecture of active learning; collaboration; diverse ways of learning;
course are reinforced and elaborated in the on-campus and and high expectations.[6, 28] In 2003, the NLN/Laerdal simu-
off-campus clinical sessions.[2, 29–31] lation research study developed the EPQ instrument.[31] The
EPQ has been shown to have good reliability, with Cronbach
To support the alignment of the course content across the
alphas ranging from .88 to .93 across the four domains[30]
four core didactic and clinical classes, the faculty developed
for both the presence of features in simulation and .91 for the
a portfolio of patient scenarios for each on-campus clini-
importance of these features.[28] For each statement, students
cal simulation session. The original case scenarios were
were asked two separate questions. First, they were asked
purchased from Laredal, the simulator manufacturer, and
to indicate how much they agreed or disagreed with state-
revised by faculty to reflect local population demographics
ments reflecting exposure to the domain (e.g., for the active
and clinical practice patterns. Supplemental materials for
learning domain, they were asked the degree to which they
instructors and students, including national clinical practice
agreed with the statement, “I received cues during the simu-
guidelines, discussion questions and rationales for the most
lation in a timely manner.”), and then to rate how important
appropriate nursing interventions, were also developed.
each item was in supporting their individual learning. Stu-
Finally, we created orientation programs with the goal of dents rated their answers on a five-point Likert scale ranging
preparing both the clinical faculty and the students with the from “strongly disagree" to “strongly agree” for the exposure
skills to gain the full benefits of the high-fidelity human items, and from “not at all important” to “very important”
mannequin simulation in the clinical teaching model. The for the important items.
faculty orientation program focused on developing skills in
both problem-based teaching and mastery of the technology 2.4 Procedure
required to animate the human mannequin simulators and The purpose of the study was explained orally to the students
create a realistic hospital environment for the students during by the independent evaluator after the professor had left the
the on-campus clinical simulation sessions. Similarly, the classroom. Paper copies of the survey were then handed
student orientation program emphasizes the goals of clinical out to the students. Participation was voluntary and students
simulation within the broader clinical teaching model and set who did not wish to participate were free to leave or sim-
forth the expectations for class preparation and participation ply not complete the survey. A written informed consent
in the simulation sessions. was included as the cover sheet of the survey, and students
were asked to voluntarily put their names on the survey to
2. M ETHOD enable us to track their perceptions over time. Surveys took
2.1 Design approximately 15-20 minutes to complete.
The data presented here were collected as part of a program
evaluation study at the NYU Meyers College of Nursing ex- 2.5 Measures and data analyses
amining the effects of the simulation clinical teaching model Names were converted to identification numbers and matched
described above on expanding faculty capacity.[3, 29] The across time points. Data from surveys were entered directly
study was conducted by an independent evaluation team not into SPSS (v. 21.0; IBM Corporation) for analysis. Domain
Published by Sciedu Press 33
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

scores for the EPQ were calculated by summing responses 3.2 EPQ domain scores at mid- and end-point program
to all items in the domain; higher scores represent student’s assessments
assessment of the use of best practices embedded in the Table 2 shows results from paired t-tests. These results show
simulation sessions and the importance assigned to each ed- significant increases on scores in two of the EPQ domains
ucational practice in the simulation sessions. There were and one of the EPQ importance domains. Student scores
eight items in the Active Learning Domain and two items in increased significantly on the items in the Active Learning
each of the other three domains. To make the domain scores and High Expectations domains, and on the importance items
comparable, the Active Learning Domain score was divided in the Collaboration domain.
by five, while all other domain scores were the sum of the
Table 1. Demographic characteristics of the participating
two items specific to each domain. Paired t-tests were used
students
to assess changes in student EPQ scores between mid- and N = 168 respondents
end-program data collection points. Variable N %
Gender
3. R ESULTS Male 21 12.5%
Female 147 87.5%
3.1 Participants
Mean Range
A total of 385 students completed the EPQ at the mid- Age 26.12 20-50
program assessment and 341 completed the EPQ at the end- Ethnicity N %
program assessment. We analyzed data from the168 students Latino/a 12 7.4%
who completed the EPQ at both assessment points. There Non-Latino/a 141 86.5%
Prefer Not to Identify 10 6.1%
were no statistically significant differences in demographic
Race
characteristics between students who completed the EPQ at African-American/Black 13 7.9%
both time points and those who did not. Asian/Pacific Islander 40 24.4%
Caucasian/White 101 61.6%
Table 1 shows demographic data from the 169 participants at Native American/Alaskan Native 2 1.2%
the mid-program assessment. As shown in Table 1, partici- Other 10 6.1%
pants were, on average, 26.12 years of age (range 20-50) and Prefer Not to Identify 6 3.7%
87.5% were female. Most (86.5%) identified as non-Latino/a, Program
Traditional 30 18.0%
and either Caucasian/White (61.6%) or Asian/Pacific Is-
Accelerated 137 82.0%
lander (24.4%). Most (82.0%) were in the accelerated degree
*Note. Inconsistent sample sizes reflect missing data on individual items.
program, which offers a bachelor’s degree in fifteen months
by including summer classes.

Table 2. EPQ domain scores at mid- and end-program assessments

Domain Mid End Sig. (p value) CI
Exposure Domains
Active Learning 7.89 8.18 .027 0.03-0.56
Collaboration 9.09 9.13 ns -0.20-0.28
Diverse Ways of Learning 7.30 7.41 ns -0.24-0.46
High Expectations 7.82 8.29 .004 0.15-0.79
Importance Domains
Active Learning 8.36 8.49 ns -0.10-0.36
Collaboration 8.35 8.72 .021 0.06-0.69
Diverse Ways of Learning 8.54 8.43 ns -0.39-0.17
High Expectations 8.62 8.60 ns -0.32-0.27

4. D ISCUSSION to support learning in an innovative clinical teaching model

that substitutes 50% of the clinical practice hours with high-
We examined, using the reliable EPQ instrument, students’ fidelity simulation. In this model, that substitutes 50% of the
perceptions of the presence of educational best practices clinical practice hours with high-fidelity simulation, faculty
and the importance that students assigned to each domain
34 ISSN 1925-4040 E-ISSN 1925-4059
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

view well-designed high-fidelity simulation sessions as an limitation of this study. In designing the overall study, we
equally valuable learning experience as traditional hospital- elected to allow students to decide whether to identify them-
based clinical teaching. selves on their surveys. These surveys were administered in
classroom settings, and many students may have therefore
Scores were generally high on all domains, suggesting that
been reluctant to provide their names, even though surveys
students recognize and value the role that high-fidelity sim-
were administered by an evaluator not affiliated with the pro-
ulation plays in their learning experience. As students pro-
gram. Nonetheless, our study is one of the few employing
gressed through the four semester curriculum, they increas-
a longitudinal design to assess changes in students’ percep-
ingly agree that they have been exposed to active learning
tions of effective curricular design to support problem-based
paired with high expectations of their performance. Although
learning in a simulation clinical teaching model.[29, 30]
no changes were seen in reported exposure to diverse ways
of learning or collaboration, this may have been due to the Finally, the study findings are not generalizable to all nursing
fact that scores were generally high on items in each of these students; 80% of the undergraduate students in this study
domains, leaving little room for improvement.[29, 30] were enrolled in the accelerated, second-degree program. Ac-
cording to the American Association of the Colleges of Nurs-
Students’ ratings also showed an increase in the degree to
ing (AACN), at the time we conducted this study, there were
which they believed collaboration was important. This find-
233 accelerated BS programs with approximately 13,605
ing may reflect a key advantage of clinical simulation, namely
enrolled students.[2] Our program is part of a larger trend in
that students have frequent hands-on learning experiences,
nursing education focused on increasing the supply of regis-
requiring that they work with other student nurses and often
tered nurses in a timely and efficient manner. The students
with members of other disciplines (via interactions that are
in the accelerated and traditional bachelor’s degree programs
built into the simulation scenarios). It is likely that high-
are in the same classroom, and as our results show, there
fidelity simulation provides a greater amount of hands-on
were no significant differences in perceptions of the presence
experience because this experience is programmed into each
or importance of educational practices known to promote
simulation session, in contrast to the potentially-limited clin-
effective problem-based learning between the two groups of
ical exposure these students may receive in a traditional
students, thus improving our confidence in the results.
clinical setting.

Limitations 5. C ONCLUSION
The limitations of this study should be considered when This study contributes to the literature on the efficacy of sim-
interpreting the results. First, it is important to note that ulation teaching models in undergraduate nursing education.
the number of clinical teaching hours spent in in-person or We show that students’ perceptions of their exposure to the
simulated learning activities is not regulated by our State active learning and high expectations domains, which are
Board of Nursing and the Department of Education. Thus, associated with effective problem-based teaching, increased
the market and the regulatory environment were conducive over time. Additionally, students valued the collaboration
for adopting a high-dose simulation model. Other schools of required to work through the patient care scenario presented
nursing may not face the same market demands, and thus, a every other week in the weekly clinical simulation sessions.
high-dose simulation model may not be a feasible or appro- We add to the growing body of research that examines the
priate. Nonetheless, a foundation of nursing practice is the effectiveness of different clinical teaching approaches that
cultivation of clinical reasoning skills and thus use of this promote problem-based teaching and students’ ability to en-
problem-based teaching approach is a viable alternative for act their roles as professional registered nurses.
clinical experiences.
ACKNOWLEDGEMENTS
Second, we demonstrate that the Educational Practices Ques- Supported in part by a grant from the Robert Wood Johnson
tionnaire (EPQ) is a useful instrument for gathering data Foundation’s Evaluating Innovations in Nursing Education
on student’s perceptions on the design and usefulness of Program Grant #68172. H. Richardson, DrPH, RN, FAAN,
simulation as a component of a robust clinical teaching Principal Investigator. L. Goldsamt, PhD and J. Simmons,
model.[13] Nurse educators and researchers can use the EPQ EdD, National Development and Research Institutes, Inc.,
to inform program improvement initiatives to promote the Program Evaluators.
use of evidence-based simulation teaching in higher nursing
education settings. C ONFLICTS OF I NTEREST D ISCLOSURE
The authors declare that there is no conflict of interest, finan-
Next, the relatively small number of students whose assess-
cial or otherwise.
ments could be matched across time periods is a second
Published by Sciedu Press 35
 http://jnep.sciedupress.com Journal of Nursing Education and Practice 2017, Vol. 7, No. 7

R EFERENCES [16] Chickering AW, Gamson ZF. Seven principles for good practice in un-
[1] Mennenga HA, Smyer T. A model for easily incorporating team- dergraduate education. American Association for Higher Education
based learning into nursing education. International Journal of Nurs- Bulletin. 1987; 39(7): 3-7.
ing Education Scholarship. 2010; 7(4): 14. https://doi.org/10 [17] Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simula-
.2202/1548-923x.1924 tion for health professions education: A systematic review and meta-
[2] Stroup C. Simulation usage in nursing fundamentals: Integrative analysis. JAMA: Journal of the American Medical Association. 2011;
Literature Review. Clinical Simulation in Nursing. 2014; 10(3): e155- 306(9): 978-988. https://doi.org/10.1001/jama.2011.1234
e164. http://dx.doi.org/10.1016/j.ecns.2013.10.004 [18] Kardong-Edgren S, Willhaus J, Bennett D, et al. Results of the Na-
[3] Richardson H, Goldsamt LA, Simmons J, et al. Increasing faculty tional Council of State Boards of Nursing National Simulation Sur-
capacity. Nursing Education Perspectives. 2014; 35(5): 308-314. vey: Part II. Clinical Simulation in Nursing. 2012; 8(4): e117-e123.
https://doi.org/10.5480/14-1384 http://dx.doi.org/10.1016/j.ecns.2012.01.003
[4] Spector N. Systematic review of nursing education outcomes: An [19] Norman J. Systematic review of the literature on simulation in nurs-
evolving review. NCSBN, 2006 April; Chicago, IL. Available from: ing education. ABNF Journal. 2012; 23(2): 24-28. PMid:22774355
https://www.ncsbn.org/Final_Sys_Review_04_06.pdf [20] Shinnick MA, Woo M, Mentes JC. Human patient simulation:
[5] Cant RP, Cooper SJ. Use of simulation-based learning in undergradu- State of the science in prelicensure nursing education. Journal of
ate nurse education: An umbrella systematic review. Nurse Education Nursing Education. 2011; 50(2): 65-72. PMid:21210612 https:
Today. 2017; 49: 63-71. PMid:27902949 http://dx.doi.org/10. //doi.org/10.3928/01484834-20101230-01
1016/j.nedt.2016.11.015 [21] National Council of State Boards of Nursing. NCSBN releases re-
[6] Tosterud R, Hedelin B, Hall-Lord ML. Nursing students’ percep- sults of National Simulation Study. 2014; Available from: https:
tions of high- and low-fidelity simulation used as learning methods. //www.ncsbn.org/685.htm
Nurse Education in Practice. 2013; 13(4): 262-270. PMid:23454066
[22] Kong LN, Qin B, Zhou YQ, et al. The effectiveness of problem-
http://dx.doi.org/10.1016/j.nepr.2013.02.002
based learning on development of nursing students’ critical think-
[7] American Association of Colleges of Nursing. New AACN Data ing: A systematic review and meta-analysis. International Jour-
Confirm Enrollment Surge in Schools of Nursing Washington, nal of Nursing Studies. 2014; 51(3): 458-469. PMid:23850065
D.C.: American Association of Colleges of Nursing: 2015. Avail- http://dx.doi.org/10.1016/j.ijnurstu.2013.06.009
able from: http://www.aacn.nche.edu/news/articles/20
[23] Parker RA, McNeill J, Howard J. Comparing pediatric simulation
15/enrollment
and traditional clinical experience: Student perceptions, learning out-
[8] Alfes CM. Evaluating the use of Simulation with beginning nurs-
comes, and lessons for faculty. Clinical Simulation in Nursing. 2015;
ing students. Journal of Nursing Education. 2011; 50(2): 89-93.
11(3): 188-193. http://dx.doi.org/10.1016/j.ecns.2015.0
https://doi.org/10.3928/01484834-20101230-03
1.002
[9] Howard VM, Englert N, Kameg K, et al. Integration of simu-
[24] Katz GB, Pfeifer KL, Armstrong G. Assessment of patient simula-
lation across the undergraduate curriculum: student and faculty
tion use in selected baccalaureate nursing programs in the United
perspectives. Clinical Simulation in Nursing. 2011; 7(1): e1-e10.
States. Simulation in Healthcare. 2010; 5(1): 46-51. PMid:20383091
http://dx.doi.org/10.1016/j.ecns.2009.10.004
https://doi.org/10.1097/SIH.0b013e3181ba1f46
[10] Schoening AM, Sittner BJ, Todd MJ. Simulated clinical experience:
[25] Jeffries PR. Simulation in Nursing Education: From Conceptualiza-
Nursing students’ perceptions and the educators’ role. Nurse Educa-
tion to Evaluation. 2007; New York: National League for Nursing.
tor. 2006; 31(6): 253-258. PMid:17108788 https://doi.org/10
.1097/00006223-200611000-00008 [26] Reese CE, Jeffries PR, Engum SA. Learning together: Using simula-
tions to develop nursing and medical student collaboration. Nursing
[11] Yuan HB, Williams BA, Fang JB. The contribution of high fidelity
Education Perspectives. 2010; 31(1): 33-37. PMid:20397478
simulation to nursing student’s confidence and competence: A sys-
tematic review. International Nursing Review. 2012; 59(1): 26-33. [27] Hallmark BF, Thomas CM, Gantt L. The educational practices
http://dx.doi.org/10.1111/j.1466-7657.2011.00964.x construct of the NLN/Jeffries simulation framework: State of the
[12] Jeffries PR, Rogers KJ. Simulation in Nursing Education: from science. Clinical Simulation in Nursing. 2014; 10(7): 345-352.
Conceptualization to Evaluation. 2005; 21-33. New York: National http://dx.doi.org/10.1016/j.ecns.2013.04.006
League for Nursing. New York. [28] Jeffries PR, Rizzolo M. NLN-Laerdal project summary report, de-
[13] Franklin AE, Burns P, Lee CS. Psychometric testing on the NLN signing and implementing models for the innovative use of simulation
Student Satisfaction and Self-Confidence in Learning, Simulation to teach nursing care of ill adults and children: a national multi-site
Design Scale, and Educational Practices Questionnaire using a sam- study. 2006. New York: National League for Nursing.
ple of pre-licensure novice nurses. Nurse Education Today. 2014; [29] Richardson H, Gilmartin MJ, Fulmer T. Shifting the clinical teaching
34(10): 1298-1304. PMid:25066650 http://dx.doi.org/10.10 paradigm in undergraduate nursing education to address the nursing
16/j.nedt.2014.06.011 faculty shortage. Journal of Nursing Education. 2012; 51(4): 226-231.
[14] Hayden JK, Jeffries PJ, Kardong-Edgren S, et al. The National Sim- http://dx.doi.org/10.3928/01484834-20120210-04
ulation Study: Evaluating simulated clinical experiences in nursing [30] Goldsamt L, Simmons J. Final Report to National Program Office
education. Unpublished research protocol, Chicago, IL: 2011. Na- Evaluating Innovations in Nursing Education Program. New York
tional Council of State Boards of Nursing. University College of Nursing. 2012; Grant Number 68172.
[15] Meakim C, Boese T, Decker S, et al. Standards of Best Practice: [31] Kardong-Edgren S, Adamson K, Fitzgerald C. A review of cur-
Simulation Standard I: Terminology. Clinical Simulation in Nursing. rently published evaluation instruments for Human Patient Simu-
2013; 9(6S): S3-S11. http://dx.doi.org/10.1016/j.ecns.20 lation. Clinical Simulation in Nursing. 2009; 6(1): e25-e35. https:
13.04.001 //doi.org/10.1016/j.ecns.2009.08.004

36 ISSN 1925-4040 E-ISSN 1925-4059

View publication stats