Background: Pre-licensure nursing education has a long history of using low- and medium-fidelity simulation. High-fidelity simulation has more recently been incorporated into nursing curricula, for the purposes of improving students’ clinical competence and confidence. The growing body of literature in this area reveals variable effectiveness of simulation technologies. There is however an absence of theoretical frameworks and wide variation in the quality and character of the evidence, which raises concerns about its applicability and transferability. A rigorous literature review was needed to answer specific questions about the types, timing, and level of simulation experiences that facilitate optimal learning, skill development, and confidence among nursing students.
Objectives: To 1) use a realist literature review to address the question: “what simulation experiences are most effective for which pre-licensure students, in what circumstances, and how?” and 2) identify directions for future research.
Method: Electronic searches of CINAHL Plus with full text; MEDLINE; and ERIC were conducted. Searches were limited to published articles and grey literature written in the English language. Grey literature included Proquest Dissertations and Theses database; Conference Papers Index; Knowledge Utilization Database; and GreySource. We also searched websites and reports from educational and nursing organizations and government documents. Titles and abstracts of retrieved articles were reviewed to ensure that they met inclusion criteria. Team members independently reviewed and appraised the remaining articles using Critical Appraisal Skills Programme tools. Relevant information about the author(s), study setting, sample size, research question/purpose, and the main findings/outcomes were summarized.
Results: The initial search yielded 1217 articles; 368 of these were discarded in the preliminary review. The remaining articles (n = 849) were reviewed.
Contributions: The findings provide decision support for questions concerning the development, effective use, levelling, and evaluation of simulation technologies in pre-licensure nursing education, and guide future research in this area.
Funding was provided by the University of Alberta, Faculty of Nursing, Edmonton, Alberta, CANADA.
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