A cost-utility analysis of medium vs. high-fidelity human patient simulation manikins in nursing education

Aims and objectives. This study presents a cost–utility analysis that compared medium- vs. high-fidelity human patient simulation manikins in nursing education. The analysis sought to determine whether the extra costs associated with high-fidelity manikins can justify the differences, if any, in the outcomes of clinical reasoning, knowledge acquisition and student satisfaction. Background. Investment in simulated learning environments has increased at an unprecedented pace. One of the driving forces is the potential for simulation experiences to improve students’ learning and engagement. A cost-effectiveness analysis is needed to inform decisions related to investment in and use of simulation equipment. Method. Costs associated with the use of medium- and high-fidelity manikins were calculated to determine the total cost for each. A cost-utility analysis using multiattribute utility function was then conducted to combine costs and three outcomes of clinical reasoning, knowledge acquisition and student satisfaction from a quasi-experimental study to arrive at an overall cost utility. Results. The cost analysis indicated that to obtain equivalent clinical reasoning, knowledge acquisition and student satisfaction scores, it required $AU1Æ21 (US$ 1Æ14; €0Æ85) using medium-fidelity as compared with $AU6Æ28 (US$6Æ17; €4Æ40) for high-fidelity human patient simulation manikins per student. Conclusion. Based on the results of the cost-utility analysis, medium-fidelity manikins are more cost effective requiring one-fifth of the cost of high-fidelity manikins to obtain the same effect on clinical reasoning, knowledge acquisition and student satisfaction. Relevance to clinical practice. It is important that decision-makers have an economic analysis that considers both the costs and outcomes of simulation to identify the approach that has the lowest cost for any particular outcome measure or the best outcomes for a particular cost

A cross-sectional survey examining the extent to which interprofessional education is used to teach nursing, pharmacy and medical students in Australian and New Zealand universities

The current status of interprofessional education (IPE) in Australian and New Zealand universities is largely unexamined despite its generally acknowledged benefit. Data are also limited about the use of IPE in teaching medication safety to nursing, pharmacy and medical students. For this reason a web-based cross-sectional survey was used to gather information from Australian and New Zealand universities offering nursing, pharmacy or medical programs. Responses were received from 31 of the 43 (72%) target universities. Eighty percent of the participants indicated that they currently offer IPE experiences, but only 24% of these experiences met the accepted definition of IPE. Of the participants who offer IPE as defined by Center for the Advancement of Interprofessional Education, only 50% use it to teach medication safety. Timetabling restrictions and lack of appropriate teaching and learning resources were identified as the main barriers to implementation of IPE. All participants reported that staff development, multi-media and e-learning resources would be beneficial to IPE initiatives and the teaching of medication safety. Innovative approaches will be needed to overcome the barriers and facilitate the uptake of quality IPE more broadly. Web-based and e-learning options promise a possible way forward, particularly in the teaching of medication safety to nursing, pharmacy and medical students

The creative use of masks to promote quality teaching and learning of safe medication practices for nurses

Background: The educational preparation of nursing students to become safe and effective clinicians is both challenging and costly (Levett-Jones, 2008). The teaching of critical content such as quality use of medicines (QUM) can be particularly difficult in the ‘artificial’ on-campus university environment (Bellchambers & McMillan, 2007). Research into medication safety highlights the need for more engaging, interactive and authentic learning experiences (Reid-Searl et al, 2008). To undertake this in current economic constraints call for creative and innovative strategies. Outline of the work: This paper showcases an innovative simulation project; the result of a collaboration between two universities, that enhances nursing students’ learning about medication safety in a cost effective way. The project employs the creative use of commercially prepared latex masks and other ‘props’ to bring unpredictable characters (such as ‘Cyril Smith’, ‘Dudley Dawes’) to life in the clinical laboratory setting. The ‘characters' (academics with rich story telling ability) model ‘typical’ patient responses and behaviours. Together with other academics, role plays that focus on medication assessment, administration and monitoring of (non)therapeutic outcomes, are conducted. The simulations can be conducted in real time within the classroom or alternatively captured on DVD or CD-ROM for revision or reviewing at remote locations. Costly manikins and standardised patients (actors) certainly have their place in nursing education; however simulation strategies such as those described in this project are a feasible and sustainable alternative

The reading room : exploring the use of literature as a strategy for integrating threshold concepts into nursing curricula

In addition to acquiring a solid foundation of clinical knowledge and skills, nursing students making the transition from lay person to health professional must adopt new conceptual understandings and values, while at the same time reflecting on and relinquishing ill-fitting attitudes and biases. This paper presents creative teaching ideas that utilise published narratives and explores the place of these narratives in teaching threshold concepts to nursing students.Appreciating nuance, symbolism and deeper layers of meaning in a well-drawn story can promote emotional engagement and cause learners to care deeply about an issue. Moreover, aesthetic learning, through the use of novels, memoirs and picture books, invites learners to enter into imagined worlds and can stimulate creative and critical thinking. This approach can also be a vehicle for transformative learning and for enhancing students’ understanding and internalisation of threshold concepts that are integral to nursing.Guided engagement with the story by an effective educator can help learners to examine taken-for-granted assumptions, differentiate personal from professional values, remember the link between the story and the threshold concept and re-examine their own perspectives; this can result in transformative learning. In this paper, we show how threshold concepts can be introduced and discussed with nursing students via guided engagement with specific literature, so as to prompt meaningful internalised learning

Interprofessional education for the quality use of medicines : designing authentic multimedia learning resources

It is claimed that health care students who learn together will be better prepared for contemporary practice and more able to work collaboratively and communicate effectively. In Australia, although recognised as important for preparing nursing, pharmacy and medical students for their roles in the medication team, interprofessional education is seldom used for teaching medication safety. This is despite evidence indicating that inadequate communication between health care professionals is the primary issue in the majority of medication errors. It is suggested that the pragmatic constraints inherent in university timetables, curricula and contexts limit opportunities for health professional students to learn collaboratively. Thus, there is a need for innovative approaches that will allow nursing, medical and pharmacy students to learn about and from other disciplines even when they do not have the opportunity to learn with them.This paper describes the development of authentic multimedia resources that allow for participative, interactive and engaging learning experiences based upon sound pedagogical principles. These resources provide opportunities for students to critically examine clinical scenarios where medication safety is, or has the potential to be compromised and to develop skills in interprofessional communication that will prepare them to manage these types of situations in clinical practice

The viewing room: A lens for developing ethical comportment

Healthcare is dynamic and complex, and against this background, nursingstudents must negotiate the transition from lay person to healthcare professional.Diverse life experiences and learning styles can further complicate this journey oftransformation. The contemporary role of the nurse includes caring for and makingclinical decisions about patients based on ethical principles. Learning about andintegrating ethical comportment as part of the transformative journey requires nurseeducators to create and implement learning experiences that challenge nursingstudents to think deeply and broadly about the experiences they encounter, to questiontheir previous assumptions and prejudices, to consider the world of healthcare througha new lens, and to reflect on and learn from the process. The judicious use of film hasthe potential to assist students to recognize and develop ethical comportment as theyprepare for real-world clinical practice experiences. In this paper, we present three filmexemplars and related teaching strategies designed to facilitate transformative learningand development of ethical comportment

Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students : a systematic review

Abstract: Human patient simulation manikins (HPSMs) are being used extensively in the education of health professionals, but their effectiveness in the teaching of clinical reasoning skills to undergraduate nursing students is not clear. The aim of this systematic review is to identify the best available evidence for their effectiveness in this regard. The review included all English-language randomized controlled trials from 1999 to 2009 that assessed the effectiveness of high-fidelity HPSMs in educating undergraduate nursing students. The results indicate that the use of HPSMs improves knowledge acquisition and critical thinking and enhances students’ satisfaction with the learning. There is a lack of unequivocal evidence of the effectiveness of using high-fidelity HPSMs in the teaching of clinical reasoning skills to undergraduate nursing students. Further research is required to ascertain the effectiveness of the use of HPSMs as an educational strategy to improve the clinical reasoning skills of undergraduate nursing students

Student evaluation of simulation in undergraduate nursing programs in Australia using quality indicators

Student evaluation of the implementation of evidence-based quality indicators for simulation experiences in undergraduate nursing programs in 2012 was explored in this study. The evaluation instrument used five specific measures derived from quality indicators. Students evaluated 10 simulation learning experiences in the first and second years of undergraduate nursing programs at two universities in Australia. Overall, students (n = 85) reported that simulation contributed to their achievement of objectives, but they did not always feel supported in these sessions. Student preparation and orientation was scored lower than other components of the simulation experience. Students reported very good scores for perceived realism and fidelity of simulation sessions, particularly the silicone mask and high-fidelity sessions, which implies that learning from simulation is transferable into the clinical practice setting. However, patient charts and other clinical documents were not always considered to be realistic. Debriefing was scored very highly overall and for both approaches used for debriefing. The student-evaluation instrument was an effective means of measuring student-related quality indicators across a range of simulation sessions. It identified areas for the improved delivery of simulation sessions

The implementation of Mask-Ed : reflections of academic participants

This paper profiles the findings from a study that explored the perspectives and experiences of nurse educators who implemented a novel simulation approach termed Mask-Ed. The technique involves the educator wearing a silicone mask and or body parts and transforming into a character. The premise of this approach is that the masked educator has domain specific knowledge related to the simulation scenario and can transmit this to learners in a way that is engaging, realistic, spontaneous and humanistic. Nurse educators charged with the responsibility of implementing Mask-Ed in three universities were invited to participate in the study by attending an introductory workshop, implementing the technique and then journaling their experiences, insights and perspectives over a 12 month period. The journal entries were then thematically analysed. Key themes were categorised under the headings of Preparation, Implementation and Impact; Reflexivity and Responsiveness; Student Engagement and Ownership; and Teaching and Learning. Mask-Ed is a simulation approach which allows students to interact with the ‘characters’ in humanistic ways that promote person-centred care and therapeutic communication. This simulation approach holds previously untapped potential for a range of learning experiences, however, to be effective, adequate resourcing, training, preparation and practice is required

Reshaping curricula: Culture and mental health in undergraduate health degrees

© 2017 Australian College of Mental Health Nurses Inc. country rich in cultural diversity, with Indigenous Australians having specific cultural values and a variety of spoken languages. In addition, the increasing number of people from migrant and refugee backgrounds requires that health professionals be able to communicate effectively with people from a wide range of cultural backgrounds. This is particularly relevant when undertaking a mental health assessment, because members of diverse communities often face the dual vulnerability of marginalization and stigmatization. This paper reports on the development and evaluation of a virtual teaching and learning resource that prepares health students to be culturally competent in mental health assessment. Four online interprofessional learning journeys were developed. Evaluation of the learning resources was conducted across three participating Australian universities. Quantitative evaluation involved pre- and post-testing using an empathy scale, the Mental Health Nursing Clinical Confidence Scale, and the Cultural Competence Questionnaire informed by the theory of planned behaviour. Qualitative data from focus group interviews explored participants' experiences of using the guided learning journey. Participants reported changes from pretest to post-test in their empathy and attitudes towards culturally and linguistically diverse consumers with significant positive changes in cultural competence, empathy, and attitudes. There was strong satisfaction with the learning materials, indicating that participants valued this 'real world' learning experience. Results require cautious interpretation, given recruitment difficulties in the evaluation phase. However, these learning journeys appear to have potential to be an effective way to challenge attitudes and perceptions, as well as increase cultural competence towards culturally and linguistically diverse consumers. Australia is