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

Surgical nurses´experiences with intrinsic work motivation: a focus on autonomy, competence and relatedness

Fostering employee well-being and creating positive workplace culture provides important competitive advantages for recruiting workers. The key factor influencing well-being at work is theintrinsic motivation experienced by employees. Ryan and Deci’s self-determination theory onhuman motivation distinguishes intrinsic and extrinsic motivation. Three basic psychological needs that must be satisfied to foster intrinsic motivation are autonomy, competence, and relatedness. The aim of the study was to describe surgical nurses’ experiences with their intrinsic work motivation. A descriptive qualitative study was conducted at a single Finnish hospital. For data collection, 12 nurses participated in three focus-group interviews. Deductive and inductive content analyses were used. The experience with autonomy refers to the possibility of having influence and a sense of control over one’s work. The experience with competence arises from meaningful work tasks, self-efficiency and feedback. The experience with relatedness relates to doing good for others and feeling a sense of community and an appreciation of one’s profession on a social level. Making managerial appreciation visible in workplace communities and developing methods for daily feedback could improve opportunities for nurses to experience intrinsic motivation and thus increase well-being at work.</p

Perceived quality of surgical care in association with patient-related factors and correlation to reported postoperative complications in Finland: a cross-sectional study

Objective To study if patient-related factors are associated with patient-evaluated quality of care in surgery. To examine if there is an association with postoperative complications and patient-evaluated low quality of care. Design A correlation cross-sectional study, in addition, a phone call interview at 30 days postoperatively to examine complications. Setting The data on patients admitted for non-cardiac general and orthopaedic surgery at a central hospital in Southwestern Finland were collected in two phases during an 8-month period. Participants 436 consecutive consenting and eligible in-ward non-cardiac general surgery and orthopaedic surgery adult patients. Ambulatory, paediatric and memory disorder patients were excluded. 378 patients completed the questionnaire (Good Nursing Care Scale for Patients (GNCS-P)). Methods Perceived quality of care was examined by the GNCS-P questionnaire. Patient-related factors were obtained from electronic patient records and questionnaire. A telephone interview related to postdischarge complications was conducted 30 days after discharge. Main outcome measures Patient evaluation of quality of care at discharge, its association with patient-related factors and patient-reported postdischarge complications. Results The overall quality was evaluated high or very high by the patients. The lowest overall quality of care rate was assessed by surgical patients living alone (p=0.0088) and patients who evaluated their state of health moderate or poor (p=0.0047). Surgical patients reporting postoperative complications after discharge evaluated lower overall quality of care (p=0.0105) than patients with no complications. Conclusion Patient demographic factors do not seem to influence the perceptions of the quality of care. Instead, subjective state of health and living conditions (living alone) may have an influence on the patient experience of quality of care. The perceived quality of care in healthcare staff technical and communication skills may have an association with reported postoperative complications.</div

Graduating nursing students' user experiences of the immersive virtual reality simulation in learning : A qualitative descriptive study

Aim: To describe nursing students' user experiences' (UX) regarding highly immersive virtual reality (VR) simulation with head mounted display used for learning. Design: Qualitative descriptive study. Methods: Graduating nursing students (n = 41). Individual interviews were held right after VR simulation. The usability was assessed using System Usability Scale (SUS). Results: User experiences emphasized three themes about the highly immersive VR simulation: nursing care in the immersive VR simulation, technology in the immersive VR simulation, and learning nursing in the immersive VR simulation. Usability was evaluated as fair (SUS score 62.3 out of 100). Scores revealed that the VR simulation was easy to use. The support of a technical person was highlighted. Conclusions: This study supports strongly the use of highly immersive VR simulation for nursing education. VR simulations should replicate the most authentic nursing care. Technical assistance is crucial when adopting new technologies in education. The results highlighted the importance of UX in an education context.publishedVersionPeer reviewe

Learning Clinical Reasoning Through Gaming in Nursing Education : Future Scenarios of Game Metrics and Artificial Intelligence

The COVID-19 pandemic has challenged healthcare professionals’ clinical reasoning, which can have serious consequences for patients. So far, the use of artificial intelligence (AI) in nursing education has been limited. Artificial intelligence (AI) is one solution for ensuring quality decision-making in demanding clinical situations in two ways. First, AI applications can support healthcare professionals’ clinical decisions. Second, AI techniques can be used to support learning clinical reasoning (CR) in healthcare education and training. This chapter focuses on the potential of exploiting AI through game metrics in nursing education. Previously, simulation games have proven effective for learning clinical reasoning skills. However, game metrics have not been commonly utilized in nursing simulation games, although research in other disciplines has shown that game metrics are suitable for demonstrating the achievement of learning outcomes. This chapter discusses the possibilities of using game metrics to develop adaptive features for nursing simulation games. Personalization and adaptivity in simulation games can enable meaningful learning experiences and enable nursing students to achieve good CR skills for their future work in constantly challenging clinical situations.publishedVersionPeer reviewe

The effectiveness of a simulation game on nursing students’ self-evaluated clinical reasoning skills: A quasi-experimental study

Good learning outcomes can be achieved in clinical reasoning using gamified simulations; however, research on the effectiveness of learning clinical reasoning skills through simulation games is still very limited. The purpose of this study is to evaluate the effectiveness of a simulation game on nursing students’ clinical reasoning skills. This study uses a quasi-experimental, one group, pre-post-test design with one-week interventions that consist of playing five surgical patient scenarios in a simulation game. The data were collected at three universities of applied sciences in Finland (1.3.2018–31.5.2019). The participants (n=376) filled out the Clinical Reasoning Skills Scale before and after playing the game. Descriptive and multivariable analyses were used. Statistically significant differences were found between the background variable categories when examining gaming activity and self-evaluated clinical reasoning skills. The participants rated their clinical reasoning skills as significantly better after playing than before playing the simulation game.&nbsp

The effectiveness of simulation game on nursing students’ surgical nursing knowledge : —a quasi-experimental study

Student nurses need diverse learning experiences throughout their studies to learn surgical nursing. Interactive virtual simulations for hybrid education in the COVID-19 postpandemic era provide new opportunities to learn knowledge through practical patient scenarios. The aim of this study was to evaluate the effectiveness of a simulation game on nursing students’ surgical nursing knowledge. A quasi-experimental design was used, including a pre- and post-test and experimental (simulation game) group (n = 140) and a control (theoretical self-study material) group (n = 136). The level of surgical nursing knowledge was assessed with the surgical nursing knowledge (SNK) test. The data were collected in three universities of applied sciences in Finland. Both groups had better surgical nursing knowledge after the intervention than before. The change of surgical nursing knowledge was greater in the experimental group than in the control group. The simulation game was an effective approach to learning surgical knowledge. Simulation games as an interactive and motivating tool may add value in hybrid education by combining theoretical pre- and postoperative nursing care content and practical skills.Peer reviewe

Developing and testing transferability and feasibility of a model for educators using simulation-based learning - A European collaboration.

Background: There is a pragmatic and often inconsistent approach of embedding simulation-based learning into nursing programmes. This paper details a European collaboration that designed a model for educator facilitation for educators utilizing simulation-based education. Objectives: The objectives of the study were to develop a model to educate the educators who deliver simulation based learning and to test to which extent this model could be transferred to education providers in different national settings. Methods: This model, its transferability and feasibility, was tested across three European countries. Educators from three Schools of Nursing participated in the study. Design-based Research was used as an overall methodology. Data were collected by the use of pre- and post-programme questionnaires and focus groups. Results: The content of the NESTLED model is consistent with the needs of the participants. The testing also demonstrated that the model is transferable across-countries. Additionally, the participants' preferences regarding amount of time and pre-reading for the different sessions vary depending on the background and level of seniority of the individual participant. Conclusion: The testing of the NESTLED model demonstrated that participants gained confidence and knowledge from undertaking the programme. Delivering the NESTLED model across-countries was found to be feasible, but flexibility is required in terms of logistical delivery of the programme

Patients Receiving Palliative Care and Their Experiences of Encounters With Healthcare Professionals

The study aimed to explore experiences of encounters with health care professionals among patients receiving palliative cancer care in specialist palliative care inpatient units. A qualitative explorative study design was conducted in a specialist palliative care inpatient setting. Data collection was implemented using semi-structured individual interviews (20 palliative care cancer patients) and analysed with inductive content analysis. Palliative care patients experienced both meaningful and disrespectful encounters with healthcare professionals. The meaningful encounters encompassed authentic and supportive experiences, while the disrespectful encounters included indifferent and inadequate experiences. Caring for a patient receiving palliative care requires care beyond tending to a patient’s physical needs. Patients should be encountered holistically and as equal human beings without highlighting their roles as patients. The healthcare professionals and the organisations should also acknowledge the importance of time and effort spent for encounters and conversations with the patients instead of concentrating resources mainly on physical care.publishedVersionPeer reviewe