Kliinisen päätöksenteon oppiminen pelillisen simulaation avulla : Simulaatiopelien design-periaatteet

The aim of this study was to obtain knowledge about learning clinical reasoning through game-based simulation. This knowledge could be used in developing and embedding new learning methods for clinical reasoning in nursing education. Research has shown that nursing students lack knowledge and skills in detecting and managing changes in patients’ clinical conditions. This is often due to insufficient clinical reasoning, and thus, educational organisations need to more effectively enable the development of clinical reasoning during education. Digitalisation in higher education is increasing, and the use of virtual simulations and, recently, serious games to support professional learning and competence development is growing. The purpose of this research was to generate design principles for simulation games and to design and develop a simulation game for learning clinical reasoning. Furthermore, the purpose was to investigate nursing students learning through gaming. A design-based research methodology was used: iterative cycles of analysis, design, development, testing and refinement were conducted via collaboration among researchers, nurse educators, students, programmers, 3D artist and interface designers in a real-world setting. Mixed research methods were used. The results indicated that games used to provide significant learning experiences for nursing students need to share some of the characteristics of leisure games, especially visual authenticity, immersion, interactivity and feedback systems. In terms of the clinical reasoning process, students improved in their ability to take action and collect information. The findings showed that usability, application of nursing knowledge and exploration are the aspects of a simulation game that have the greatest impact on learning clinical reasoning. It was also revealed that authentic patient-related experiences, feedback and reflection have an indirect effect on learning clinical reasoning. This study provided opportunities to advance our knowledge of nursing students’ learning processes and experiences of learning clinical reasoning through game-based simulation. Its results add to the growing body of literature on game development in the field of nursing education by providing design principles for educational simulation games. The present study confirms previous findings and contributes additional evidence that suggests that game-based simulations are a valuable learning method for healthcare education. However, in order for serious games to add value to healthcare education, the essence of the profession needs to be built into the game, and here the contribution of healthcare professionals is priceless.Tutkimuksen tavoitteena oli tuottaa tietoa kliinisen päätöksenteon oppimisesta simulaatiopeliä pelaamalla sekä oppimiseen vaikuttavista tekijöistä. Tuotettua tietoa voidaan hyödyntää kehitettäessä uusia menetelmiä kliinisen päätöksenteon opetukseen. Aikaisempien tutkimusten mukaan sairaanhoitajaopiskelijoiden kliinisen päätöksenteon osaamisessa ilmenee puutteita erityisesti potilaan kliinisen tilan huononemisen havaitsemisessa ja ennaltaehkäisyssä. Tämän vuoksi koulutusorganisaatioiden tulee entistä tehokkaammin edistää kliinisen päätöksenteon kehittymistä koulutuksen aikana. Virtuaalisimulaatioiden ja viime aikoina myös hyötypelien käyttö terveysalan koulutuksessa ammatillisen osaamisen vahvistamisessa on lisääntynyt. Tämän tutkimuksen tarkoituksena oli muodostaa design-periaatteet oppimista edistävän simulaatiopelin kehittämiseen sekä suunnitella ja kehittää simulaatiopeli kliinisen päätöksenteon oppimiseen. Lisäksi tarkoituksena oli tutkia sairaanhoitajaopiskelijoiden oppimista simulaatiopelillä. Tutkimuksessa toteutettiin design-tutkimuksen lähestymistapaa. Tutkimus toteutettiin sykleissä, joissa simulaatiopelin suunnittelu, kehittäminen, testaaminen ja uudelleen suunnittelu vuorottelivat. Tutkimus toteutettiin tutkijoiden, hoitotyön opettajien ja opiskelijoiden sekä pelinkehittäjien (ohjelmoijat, käyttöliittymäsuunnittelijat ja 3D artisti) yhteistyössä aidoissa ympäristöissä. Tutkimus oli monimenetelmätutkimus. Tulosten mukaan merkittävät oppimiskokemukset edellyttävät, että oppimiseen tarkoitetuissa simulaatiopeleissä on hyödynnettävä viihdepelien ominaisuuksia kuten autenttisuus, immersiivisyys, interaktiivisuus ja palautejärjestelmät. Parhaiten opiskelijat kokivat oppivansa pelaamalla tiedon keräämistä ja hoitotyön toteuttamista. Tulosten mukaan oppimista simulaatiopeliä pelaamalla selittivät käytettävyys, hoitotyön tiedon käyttö sekä tutkiskelemalla oppiminen. Lisäksi oppimiseen vaikuttivat autenttiset potilaskohtaiset kokemukset, palautteen saaminen sekä reflektointi. Tutkimusprosessissa syntyneen tiedon pohjalta muodostettiin design-periaatteet simulaatiopelin kehittämiseen. Tutkimus tuotti tietoa simulaatiopelejä pelaavien sairaanhoitajaopiskelijoiden oppimisprosesseista sekä oppimiskokemuksista. Lisäksi tutkimus osoitti, että terveysalan ammattilaisten osallistuminen pelinkehitykseen on korvaamatonta, jotta ammatin syvin olemus saadaan rakennetua sisään pelimekaniikkaan. Tutkimus tuotti tietoa oppimista tukevien pelien kehittämisestä, jota voidaan hyödyntää kehitettäessä pelejä terveysalan koulutukseen sekä myös muille ammatillisen koulutuksen alueille

Design and Development of Simulation-based Instruction on Meaningful Use and Interprofessionalism Core Competencies in a Healthcare Team-based Learning Environment

Policymakers and electronic health records (EHR) experts agree that healthcare professionals lack proficiency in meaningful use of EHRs. This competency gap can result in increased medical errors. It is essential for health professions graduates to acquire skill sets that are adaptable to any electronic health information technologies including the EHRs to facilitate work process and information access. Simulation as an instructional method to create transformative learning experiences has shown promise in the medical profession. In simulations, learners are able to engage in real-life scenarios and practice their cognitive, affective, and psychomotor skills in a safe environment. The goal was to design and develop a simulation-based instructional module on meaningful use of EHR and interprofessional collaborative practice core competencies and evaluate students’ performance and satisfaction under an inter professional teambased setting. Using a design and development research approach, a simulation-based instructional module on meaningful use of EHR and interprofessional core competencies was designed. An internal validation of the module was conducted with an expert panel of medical professionals and instructional designers. Following validation, the instructional module was developed and pilot tested with a group of 21 second- and third year health professions students in medicine, pharmacy, and nursing in an interprofessional team-based learning environment. Students’ performance on meaningful use and interprofessionalism core competencies and their satisfaction during the simulation-based training were evaluated. The results confirmed that the students properly implemented the core competencies based on their performances during the immersive virtual patient encounter in the 3D virtual world. The analysis also showed how the students’ satisfaction was met as a reaction to the guided experiential learning’s (GEL) simulation-based instructional intervention, and in some instances were not sufficiently met. The analysis of the students’ testimonials further confirmed their overall satisfaction with the immersive simulation experience.The findings, based on the feedback from the students and faculty in this pilot implementation, highlighted simulation-based interactive gaming instruction and the hands-on experience in a 3D virtual world guided by GEL as an effective and engaging way to train healthcare professionals in the preparation to deliver care in a safe and effective manner under interprofessional team-based settings for better patient safety and outcome

Ludic Learning Lab: Serious Games for Nurses. Theatre Training Reimagined

Theatre improvisation supports the development of interpersonal skills, building verbal and physical imagination, whilst enabling compassionate interaction between people to enhance connections. Improvisation is emerging in health care as a pedagogical tool that can enhance human to human connections such as the interaction between a nurse and patient enabling experiential learning. This thesis argues that the ludic nature of improvisation exercises stimulates enhanced interaction skills (Toivanen, 2011). The ancient body-mind practices that improvisation draws on offer valuable skills to the learner, contributing to the andragogy of nurse practice and pre-registration education and training. Nurses require unique cognitive capabilities to multi-task, problem-solve and prioritise urgent needs in a fast-paced hospital environment. Human factors such as communication and situational awareness are essential to maintaining high-level patient care across a challenging environment (Eisenhardt, 2021). The World Health Organisation (WHO, 2019) and The Australian Commission for Quality and Safety in Health Care (Report The State of Patient Safety and Quality in Australian Hospitals, 2019; Fotis, 2010) found that deficiencies in human factor skills in hospital settings are affecting patient safety; fifty per cent of adverse events are preventable. Communicating for safety in training is a number one priority to reduce preventable adverse events. This thesis explores the principles and theories of theatrical improvisation through engaging with the work of Viola Spolin, Rudolph Laban, Augusto Boal, Jacob L Moreno, David Kolb and Howard Gardner. It comprises both a theoretical/critical component and a creative component which is a digital toolkit, the Improv-e-toolkit designed to be used in blended delivery, face-to-face and digital mode. The Improv-e-toolkit is a prototype that aims to unite important clinical nursing skills such as situational awareness, decision making and relationship management. I argue, drawing on the work of Hager (2004) that improvisation training develops team-based trust and effective communication to support positive nurse-patient connections which deliver favourable patient outcomes

Using Simulation and Critical Thinking in Speech-Language Pathology: A University Case Study

Abstract Education is changing. Virtual learning is now a common occurrence. Along with this change, more and more virtual learning tools are being used in the educational setting. The American Speech-Language-Hearing Association (ASHA) has recognized this change and has modified certification standards to include clinical simulation experiences in graduate speech-language training programs. Along with this modification, critical thinking skills are an expected goal, not only in face-to-face experiences, but also in simulation experiences. Educators need to meet this expectation to ensure that future speech-language pathologists are fully prepared to make sound decisions within the clinical setting. Educators may benefit from the following suggestions in regards to the use of critical thinking skills within a clinical simulation experience

Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis.

Background: The COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students. Method: A systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed. Results: The search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective. Conclusions: Virtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning

Efficacy of serious games in healthcare professions education : a systematic review and meta-analysis

Summary Statement Serious games (SGs) are interactive and entertaining software designed primarily with an educational purpose. This systematic review synthesizes evidence from experimental studies regarding the efficacy of SGs for supporting engagement and improving learning outcomes in healthcare professions education. Randomized controlled trials (RCTs) published between January 2005 and April 2019 were included. Reference selection and data extraction were performed in duplicate, independently. Thirty-seven RCTs were found and 29 were included in random-effect meta-analyses. Compared with other educational interventions, SGs did not lead to more time spent with the intervention {mean difference 23.21 minutes [95% confidence interval (CI) = −1.25 to 47.66]}, higher knowledge acquisition [standardized mean difference (SMD) = 0.16 (95% CI = −0.20 to 0.52)], cognitive [SMD 0.08 (95% CI = −0.73 to 0.89)], and procedural skills development [SMD 0.05 (95% CI = −0.78 to 0.87)], attitude change [SMD = −0.09 (95% CI = −0.38 to 0.20)], nor behavior change [SMD = 0.2 (95% CI = −0.11 to 0.51)]. Only a small SMD of 0.27 (95% CI = 0.01 to 0.53) was found in favor of SGs for improving confidence in skills

Use of Theory to Guide Integration of Virtual Reality Technology in Nursing Education: A Scoping Study

Background: There is growing interest among academic nurse educators in using virtual reality (VR) environments as a pedagogical tool to enhance student learning. Purpose: The aim of this scoping study was to identify the theories or conceptual models that informed the application of virtual reality technology in nursing education programs. Methods: A scoping study using the Arksey and O\u27Malley (2005) framework was conducted. A search strategy recommended and executed by a research librarian yielded 18 final articles for review. Findings: There is limited use of theory or a conceptual model, particularly of nursing origin, to guide the integration of VR technology for student learning. Discussion: More research is needed to define best practices for application of VR technology for specific curricular needs, and for theory development based on specific concepts and disciplinary perspectives of learning

Implementing Immersive Virtual Reality into a Nursing Curriculum

Due to workforce demands, new undergraduate nurses are hired directly into fast-paced units and are expected to manage complex patients with rapidly changing conditions and respond to time-sensitive situations. It is important for nurse educators to prepare undergraduate nurses for transition into clinical practice upon graduation. Simulation has been a valuable tool to provide experiential learning and promote clinical decision-making. The next iteration of improving clinical simulation as an experiential learning modality for nursing students is Immersive Virtual Reality (IVR): a realistic, immersive simulation in a 3-dimensional environment that is experienced by body movements and hand controllers. IVR can incorporate the layers of the clinical judgment model including recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating. The purpose of this study was to examine the use of IVR in a baccalaureate nursing program curriculum. A prospective, non-randomized study design was conducted at a midwestern academic medical center College of Nursing. A convenience sample of second-semester BSN nursing students (N=83) participating in an IVR clinical experience was included in this study. Statistically strong correlations were found between learning and engagement r (81) = .746, p \u3c .001, and engagement and immersion r (81) =.517, p \u3c .001. Moderate levels of correlation were found between learning and immersion r (81) = .466, p \u3c .001, and learning and challenge r (81) = .389, p \u3c .001. Incorporating IVR into a BSN curriculum is feasible and provides an engaging, flexible, learning environment. IVR provides a positive learning experience and overall students want to continue to use it in the future. Future research establishing best practices for IVR needs to be completed