Evaluation of the Instructional Design of High-Fidelity Simulation By the Third Year Undergraduate Nursing Students

Purpose:

Simulation as a learning strategy integrates clinical skills, content knowledge, teamwork, inter-professional communication, physical assessment, nursing therapeutics and critical thinking within a non-threatening environment (Levett-Jones et al., 2011:706). In order to reach these competencies through the use of simulation, the School of Nursing at the University of the Free State has been using simulation as a teaching and learning strategy in the undergraduate and postgraduate programs since 2010. In the first four years of using simulation, it has been a growing experience through continuous efforts to address short-falls and improving each simulation scenario. However, the question arises whether the simulations we do, comply with the standards set out for quality simulation experiences on an international level.

The aspects of authenticity, scaffolding, alignment and constructivism are built into a template that the facilitators implement during the design and running of high-fidelity simulation sessions. Authenticity forms a major concern when performing simulation, despite of the increasingly sophisticated technology (Dunnington, 2014:21).

Instructional scaffolding organizes and structures scattered information and concepts to students during a simulation session to assist them in knowing where to focus their attention on a given scenario (Lin, Hou, Wu, & Chang, 2014:55).

Constructive alignment ensures the students meet the necessary outcomes and competencies set out per simulation session. Significant positive relations between the simulation design and learning outcomes have been confirmed through other studies (Ahn & Kim, 2015:711).

Constructivism is the philosophical theory of choice used at the institution. This allow individuals to construct new knowledge for themselves through interaction with their environment (Meakim et al., 2013:S5). It is a process of personal discovery, when learners learn to understand issues within a realistic setting. However, it is only through the combination of the student’s interaction during the high fidelity simulation and debriefing that the aims of constructivism are met (Neill, Hons, Tesol, & Wotton, 2011:162).

Pamela Jeffries’ publication “A Framework for Designing, Implementing, and Evaluating Simulations Used as Teaching Strategies in Nursing” conceptualized practices concerning the planning and running of simulations as a teaching tool (Jeffires, 2005). The framework describes the five major constructs namely: educational practices, teacher, students, simulation design characteristics and outcomes.

The aim of the study is to describe the instructional design of high-fidelity simulation from the third year nursing students’ perspective in the School of Nursing regarding design characteristics and criteria of the Jeffries simulation model.

Methods:

A quantitative, non-experimental, cross-sectional descriptive design was used (Grove, Burns, & Gray, 2013:24). Students completed the 20 item Simulation Design Scale (SDS) instrument which was designed by the National League for Nursing (NLN), aimed at evaluating the five design characteristics of Jeffries’ simulation model. It is a self-report instrument using 5-point Likert scales and provides the option for participants to select Not Applicable as a response (Thidemann & Söderhamn, 2013:1602).

Descriptive statistics namely frequencies and percentages for categorical data, means and medians and percentiles for continuous data were calculated. The association between the adherence and importance of design characteristics will be described by means of 95% confidence intervals for the median differences for paired data. The analysis was done by a biostatistician from the Department Biostatistics.

The population in this study included most of the third year undergraduate nursing students (30 students) in the four year Baccalaureus nursing programme at the University of the Free State. 

Results:

The relationship between the adherence and importance of the design characteristics are described by means of 95% confidence intervals for the median differences for paired data. The results confirm the importance of each design characteristic within high fidelity simulation session. From this study we can see that the students could identify all five design characteristics within their high fidelity scenario.

The median results indicate that the students rate the objectives and information provided to them as the most important design principle, followed shortly by problem solving. Feedback and debriefing were seen as the third most important design criteria by the students.

Conclusion:

Findings of this study confirm the importance of applying design principles when planning high-fidelity simulation sessions for undergraduate nursing students. The students evaluated and rated the five design characteristics and confirmed the presence and importance of each as fundamental foundations for designing and performing high-fidelity simulation scenarios. Further research needs to determine the role these five characteristics have on attaining learning outcomes, learning transfer, the duration of the effect as well as translational impacts. Furthermore there is a need to determine the relationship between the design characteristics in relation to the level of the learner, the level of patient care as well as systems outcomes (Groom, Henderson, & Sittner, 2014:343).