Nursing students’ clinical learning: Combining simulation training with nursing home practice

Background: The traditional clinical practice model for first-year nursing students in Norwegian nursing education is placement in nursing homes for six to eight weeks supervised by on-site registered nurses. In nursing homes, increased care complexity, high workloads, and a limited number of registered nurses serving as student supervisors can pose significant challenges to students’ clinical learning. Simulation training may provide an evidence-based learning alternative during students’ clinical practice period. However, research on clinical practice models that combine simulation training with clinical practice in nursing homes for first-year nursing students is limited internationally and unexplored in a Norwegian context. Aim: The overall aim of this thesis is to gain knowledge by investigating firstyear students’ experiences with and relevant outcomes of simulation training combined with clinical practice in nursing homes in a Norwegian context. To achieve the overall aim, we initially identified elements in simulation training (based on the National League for Nursing (NLN) Jeffries Simulation Theory) associated with student outcomes of satisfaction and self-confidence (Paper I). Second, student experiences of multiple simulation training as a supplement during the students’ clinical practice period were investigated (Paper II). The Clinical Learning Environment Comparison Survey (CLECS) was then translated and tested for its psychometric properties (Paper III). The CLECS was used in the final investigation, in which student outcomes regarding knowledge acquisition, self-efficacy, and fulfilment of clinical learning needs were examined after integrating the simulation training as a partial replacement for clinical hours during the students’ clinical practice period (Paper IV). Methods: A multimethod design was employed. First, a study with a cross-sectional design using the NLN questionnaire (n = 187) was conducted to identify associations. Data were analysed using descriptive and correlation statistics (Paper I). The second study, which investigated student experiences (n = 27) had a qualitative descriptive study design with focus group interviews. Data were analysed using systematic text condensation (Paper II). The third study had a cross-sectional design with a longitudinal component (n = 122), and the CLECS’ psychometric properties were investigated using validity and reliability statistics (Paper III). The fourth study had an experimental design with pre- and post-test comparisons of an intervention group (n = 52) versus a control group (n = 48) to examine student outcomes using a knowledge test and the General Self-Efficacy Scale. Furthermore, a descriptive, survey-based comparison was used to examine the fulfilment of clinical learning needs in the intervention group using the CLECS. Data in the fourth study were analysed using descriptive and inferential statistics (Paper IV). Results: Active learning was significantly associated with satisfaction, while active learning and clear objectives were associated with self-confidence (Paper I). Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between learning environments, and enhancing the sense of mastery (Paper II). The CLECS had acceptable construct validity and internal consistency, and most subscales displayed moderate to good test-retest reliability (Paper III). The mean improvement in knowledge acquisition from the pre- to post-test was higher in the intervention group than in the control group, and the difference was statistically significant, with a moderate to high effect size. No significant difference in self-efficacy improvement was observed. The intervention group scored the simulation training significantly higher on meeting their clinical learning needs compared with the nursing homes. Learning needs within the nursing process, self-efficacy, and the teaching–learning dyad especially excelled, showing moderate to high effect sizes (Paper IV). Conclusions: This thesis suggests that simulation training (based on a theoretical framework), either as a supplement to or as a partial replacement for clinical hours, combined with clinical practice in nursing homes, might be of great benefit for Norwegian first-year nursing students. Active student engagement in simulation training may increase both student satisfaction and self-confidence, and the first-year students experienced enhanced knowledge, confidence, and mastery due to the simulation training after attending simulation training combined with clinical practice. Active student engagement, collective reflections, and feedback from facilitators and peers in the simulation training seemed pivotal for promoting the students’ clinical learning during the practice period. The CLECS (Norwegian version) was proven adequate for evaluating clinical learning to meet students’ learning needs and; combining simulation training with clinical practice in nursing homes was positively associated with knowledge acquisition and with meeting the clinical learning needs of first-year students, especially within the areas of the nursing process, self-efficacy, and the teaching-learning dyad

HIV-stigma : En metasyntese av kvalitativ forskning om HIV-relatert stigma.

Formål: Utforske overordnede aspekter ved opplevelse av HIV-stigma hos HIV-positive mennesker, for å få økt kunnskap om hvordan sykepleiere kan forebygge og redusere HIV-relatert stigma. Studiens funn ble sammenlignet med resultat fra Fafo-rapporten "Fra holdninger til levekår. Liv med HIV i Norge" for å produsere en syntetisert viten, og for å vurdere overførbarhet til norske forhold. Teoretisk forankring: Studien er forankret i Goffmans (1963) beskrivelse av stigma som en sosial merking av enkeltmennesket med tap av egenverdi og attraktivitet. Metode: Metasyntese av et utvalg kvalitative studier med HIV-positive deltagere og med Hiv-stigma som primærfokus. Metasummary ble benyttet som empirisk grunnlag for metasyntesen. Syntesen ble gjennomført ved hjelp av konstant målrettet sammenligning. Resultater: Det ble funnet 8 overordnede aspekter av opplevelse av HIV-stigma som ble til 8 abstraherte funn under nøkkelkonseptene: skam, skyld, smittefrykt, stereotypier/forhåndsdømming, sosial avvisning/isolasjon, konfidensbrudd, møte med helsetjenesten og åpenhet/hemmeligholdelse. Funnet under nøkkelkonseptet skam, var det aspektet ved opplevelse av HIV-stigma som ble lavest vektet i studiens artikler (45 %), mens åpenhet/hemmeligholdelse var tema i 10 av studiens 11 artikler (91 %). Majoriteten av HIV-positive i studien praktiserer en svært begrenset åpenhet om diagnosen til omgivelsene, grunnet frykt for stigma. Studiens 8 overordnede aspekter av HIV-stigma har mange likhetstrekk med Fafos norske HIV-positive deltageres opplevelser. Konklusjon: Funnene viser at opplevelse av HIV-stigma er både en refleksjon av andres mulige reaksjon og faktisk erfart selv. Studiens resultat indikerer at det finnes opplevelse av HIV-stigma som er uavhengig av sosiodemografiske faktorer, og som sykepleiere kan forutse og forebygge. Nøkkelord: HIV-stigma, stigma, HIV, HIV/AIDS, metasyntese, sykeplei

Psychometric properties of the Norwegian version of the clinical learning environment comparison survey

Aim: To translate The Clinical Learning Environment Comparison Survey (CLECS) into Norwegian and to evaluate the psychometric properties of the Norwegian version. Design: A cross-sectional survey including a longitudinal component. Methods: The CLECS was translated into Norwegian following the World Health Organization guidelines, including forward translation, expert panel, back-translation, pre-testing and cognitive interviewing. Nursing students at a Norwegian university college were invited to participate in the study (psychometrical testing) based on informed consent. Reliability and validity of the translated version of CLECS were investigated using a confirmatory factor analysis (CFA), Cronbach's alpha and test–retest analysis. Results: A total of 122 nursing students completed the questionnaire and Cronbach alphas for the CLECS subscales ranged from 0.69 to 0.89. CFA goodness-of-fit indices (χ2/df = 1.409, CFI = 0.915, RMSEA = 0.058) showed acceptable model fit. Test–retest ICC ranged from 0.55 to 0.75, except for two subscales with values below 0.5.publishedVersio

Integrating simulation training during clinical practice in nursing homes: An experimental study of nursing students´ knowledge acquisition, self-efficacy and learning needs

Background Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students’ clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students’ knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment. Design The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison. Methods First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students’ outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests. Results Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges’ g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen’s d from 0.3 to 1.0). Conclusion Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.publishedVersio

Betydningen av deltakelse i skolen

Denne masteroppgaven handler om hvordan fem tidligere elever ved en alternativ skole opplevde mulighet for deltakelse. Gjennom politiske rapporter fremstår skolegang ved alternative opplæringsarenaer som annenrangs da det oppfattes som en ekskluderende praksis, og noe som fortrinnsvis burde avskaffes for å oppnå en inkluderende skole for alle. Målet med denne forskningen er derfor å løfte frem elevstemmen i denne debatten, ved å belyse noen elevers erfaringer med å gå på en alternativ opplæringsarena. Forskningsspørsmålet som undersøkes er «hvilke erfaringer med deltakelse har en gruppe elever som har gått på både ordinærskole og en alternativ opplæringsarena?». De fem informantene er tidligere elever ved den samme alternative opplæringsarenaen, Rosebakken skole (anonymisert navn). Deres oppstart på Rosebakken skyldes en rekke negative erfaringer fra nærskolen, hvor flere opplevde mobbing, utestenging og et for høyt faglig press. Erfaringene resulterte for alle i høyt skolefravær, og fare for å ikke oppnå vitnemål fra ungdomsskolen. På bakgrunn av dette fremstår funnene noe svart-hvitt, samtidig som det peker på rom for forbedring om målet er en inkluderende skole for alle. For å svare på forskningsspørsmålet ble det benyttet narrativt intervju. Ved at det ble stilt åpne spørsmål var det i stor grad informanten som ledet intervjuet. Dette sikret at det er informantens egen opplevelse av skolehistorien som fortelles. Dette gjør også at funnene om hvilke aspekter ved deltakelse som informantene vektlegger, har kommet frem ved at informantene selv trekker dette inn, og ikke ved at det etterspørres om for eksempel elevens opplevelse av medbestemmelse. Ut ifra funnene vektlegger informantene anerkjennelse, medbestemmelse, fellesskap og faglig mestring for deltakelse, og det fremkommer at de har hatt ulik erfaring med dette på de to arenaene. På nærskolen har informantene få erfaringer med medbestemmelse, mens elevens mening ofte etterspørres på Rosebakken. På Rosebakken forteller de også om møte med voksne som gir av seg selv, viser dem respekt og anerkjennelse – som uttrykkes som en stor kontrast til tildigere lærere. På nærskolen opplevde flere mobbing og utestenging, og selv om det forekom krangling og ‘bitching’ på Rosebakken, forteller informantene at dette ble tatt tak i umiddelbart og aldri utviklet seg til mobbing. Til tross for å være en skole med få elever (opp til 15 stykker), erfarte alle en form for vennskap i tiden på Rosebakken, der det ble et tydelig fellesskap mellom lærere og elever. På nærskolen var det faglige utfordrende for alle, men av ulike årsaker. Mens det for noen dreide seg om utrygghet som gjorde fokus på skolearbeid vanskelig, var det for andre snakk om for vanskelige oppgaver med lite tilpasninger til deres nivå. I motsetning til dette, fikk alle mestringserfaringer på Rosebakken, og de forteller om mer tilpasset opplæring. Samtidig savnet en av informantene mulighet for større faglig fokus når skolen var blitt en trygg arena igjen. For å svare på forskningsspærsmålet; det fremkommer tydelig fra funnene at elevene opplevde større mulighet for deltakelse ved Rosebakken. I en avsluttende kommentar drøftes det hvordan tilsvarende mulighet for deltakelse kan legges til rette for på nærskolen, med utgangspunkt i anerkjennelse og fellesskap

Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students’ Experiences

Introduction Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period. Objective The study aimed to explore nursing students’ experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes. Methods A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation. Findings Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery. Conclusion The supplementary simulation training seemed to complement clinical practice by consolidating the students’ learning during the clinical practice period, enhance the students’ motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.publishedVersio

Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students’ Experiences

Introduction: Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period. Objective: The study aimed to explore nursing students’ experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes. Methods: A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation. Findings: Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery. Conclusion: The supplementary simulation training seemed to complement clinical practice by consolidating the students’ learning during the clinical practice period, enhance the students’ motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment

Integrating simulation training during clinical practice in nursing homes: An experimental study of nursing students´ knowledge acquisition, self-efficacy and learning needs

Background Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students’ clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students’ knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment. Design The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison. Methods First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students’ outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests. Results Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges’ g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen’s d from 0.3 to 1.0). Conclusion Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning

Simulation-based learning in nursing education to address stigma and discrimination

A scoping review regarding the use of simulation-based learning to address stigma and discrimination in nursing educatio

Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Protocol for a Scoping Review

BackgroundCritical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based learning supported by technology to enhance critical thinking in nursing students. ObjectiveThe proposed scoping review aims to systematically map research on the use of simulation-based learning supported by technology to enhance critical thinking in nursing students. MethodsThe proposed scoping review will use the framework established by Arksey and O’Malley and will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and extract data. The data will be analyzed and thematically categorized. ResultsThe development of a comprehensive and systematic search strategy was completed in June 2021. The database searches were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by May 2023. ConclusionsThe results of this proposed scoping review may identify gaps in the literature and provide an overview of research on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research may identify nursing students’ reported barriers and enablers for learning critical thinking skills through simulation-based learning supported by technology, and the results may help educators enhance their educational approach through knowledge of students’ firsthand experiences and further development of successful teaching strategies in nursing education. International Registered Report Identifier (IRRID)DERR1-10.2196/3672