Prevalence and Use of Simulation in Undergraduate Nursing Education Institutions in South Africa

Thurling, Catherine Hilary

Purpose: The purpose of this presentation is to assess the prevalence, uses and practices of simulation as a teaching methodology in undergraduate nursing curricula in South Africa.

Methods: A survey of the prevalence and practices of simulation in South Africa was carried out as part of a situational analysis for the development of a simulation programme. The validated 2010 Simulation in Nursing Education Survey (Hayden, 2010) was used with permission from the original authors.

The researcher received ethics approval from the relevant university's Human Ethics Research Committee to conduct the study, prior to contacting potential participants.

The population selected to participate in this study were educators situated at either a University or Nursing College that offers an undergraduate four-year degree or diploma. The survey consisted of 28 questions, with both mixed Likert scale and open-ended questions being used. A total of 138 surveys were emailed to educators. Data was collected from December 2013 to December 2014, using SurveyMonkey®.

Results: Fifty one participants responded, reflecting a 36.95% response rate. Completed surveys were returned from 8 of the 9 provinces in South Africa, University = 34; College= 17. Low response rates could be due to the necessity for internet access, adequate computer literacy of respondents. In resource restricted areas in South Africa these issues may have made a significant contribution to coverage bias in this study. Alternative measures were put in place in an attempt to negate these anticipated difficulties. The measures included:

All selected Nursing Colleges and Universities were sent a letter via email by the researcher informing them of the study, and a copy of the survey.
The researcher was present at as many nursing functions and conferences as possible, in order to promote the study, and to ask interested nurse educators for their current email addresses as well of those of any potential contacts who might be interested in participating in the study.
All contacts were sent follow-up emails and a copy of the survey.
Where possible, emails were sent to both work and home email addresses.

Prevalence measures:

Non-manikin simulation - role playing was used by 90.91% of respondents followed by 54.55% who use standardised patients in their teaching. Computer-based simulation tools such as CD-ROMs and internet-based virtual programmes were only used by 43.18% and 20.45% of educators respectively.
High fidelity and medium fidelity simulators are most commonly used in midwifery (36.11% and 50.00% respectively)
Debriefing is not routinely performed after simulation experiences in South African Nursing Education Institutions. Of the participants who replied to the question, 43.59% debrief students while 56.41% do not accommodate debriefing.
Simulation is most commonly not graded (61.90%) and when it is graded, 26.32% of educators give an objective graded score and 28.95% give a pass/fail grade.
95.23% of respondents stated that they should be using more simulation with only 4.77% stating that they were using just the right amount of simulation in their programme,
The percentage of simulation hours substituted for clinical hours ranged from 1% to 30% with the average being 15.2%.
The biggest barrier to not using simulation was a lack of training in both simulation techniques and debriefing (75.00%)

Conclusion: It is not surprising that the midwifery curriculum has the highest use of simulation, as exposure to clinical emergencies may be infrequent. Therefore simulation-based learning has an essential role to play in the curriculum, to help a nurse gain the necessary confidence and knowledge needed to respond to a given emergency.

But the overall results of this study indicate that South African Nursing education Institutions are not using simulation in undergraduate nursing courses optimally, this may be due to limited access to high-fidelity simulator by educators as they are often expensive to buy and maintain but also, high-fidelity simulation is a relatively new technology in nursing education and nurse educators might not have been sufficiently trained in the methodology to feel comfortable using the technology, thus reinforcing the need to expand context specifi, hands-on simulation training programmes to both universities and colleges wanting to use simulation.