Virtual Simulation in an Accelerated On-Line RN-BSN Pathophysiology-Pharmacology Course

Purpose: The National League for Nursing’s research priorities call for innovative approaches to learning that improve clinical reasoning and judgement (NLN, 2016). Simulation is a technique that uses a situation or environment that is created to allow individuals the opportunity to experience a representation of a real event for practice, learning, or to gain understanding of systems or human actions (http://sirc.nln.org/). While simulation in nursing education is not a new concept and has a solid body of evidence to support its use and effectiveness (Hayden, Smiley, Alexander, Kardong-Edgren & Jeffries, 2014; Cant & Cooper, 2010), virtual simulation is an emerging technology (Foronda et al., 2016). The proliferation of online education (Allen & Seaman, 2013) has amplified the demand for ways to deliver simulation experiences virtually (Foronda & Bauman, 2014). Virtual simulation programs have emerged and have been increasing in availability and use by healthcare educators (Hansen, 2008). While the evidence in simulation has supported its effectiveness, evidence for the use of virtual simulation is still evolving and requires further investigation (Foronda, Godsall & Trybulski, 2013). The aims of this study were to investigate the effectiveness of digital clinical experiences (DCEs) to improve critical thinking in accelerated online RN-BSN students enrolled in a pathophysiology-pharmacology class and determine student satisfaction and confidence with learning using DCEs.

Methods: This pilot study utilized a randomized, controlled, pre-test/post-test design with participants randomly assigned to one of two groups, an intervention group (use of DCE in addition to coursework) or a control group (coursework as usual without DCE). Students were enrolled in an online RN-BSN program in Southeastern North Carolina. Participants in the intervention group had required assignments in the ShadowHealth™ pharmacology DCEs. Participants in the control group received education as usual, which included readings, quizzes and written case analysis assignments. At baseline students were asked to complete a demographic questionnaire and the Health Sciences Reasoning Test (HSRT). At course completion, students completed the NLN satisfaction with learning tool and retook the HSRT. Additionally, students provided qualitative feedback at course midpoint via survey inquiring about their experiences with the DCE and again at course end using their normal course evaluation process.

Results: Using one-way repeated measures ANOVA, there was no statistically significant difference in critical thinking scores using the HSRT exam in the control group, Wilks’ Lambda = .991, F(1, 12)=.108, p=.748 nor the intervention group Wilks’ Lambda = .997, F(1, 13)=.034, p=.856 from pre-test to post-test. There was no statistically significant difference between groups on HSRT post scores Wilks’ Lambda = .999, F(1, 25)=.019, p=.892. While the intervention group which used ShadowHealth was more satisfied and more confident with learning (M= 20.78 for control, and 22.46 for intervention for satisfaction and M= 33.85 for confidence in control and 35.61 for intervention), the difference was not significant. In the mid and final course surveys learners reported changes in their practice that they attributed to using the DCEs.

Conclusion: There were no statistically significant differences in clinical reasoning, student satisfaction or student confidence with learning between those learners who used virtual simulation compared to those that did not. While virtual simulations did not improve critical thinking in this sample of RN-BSN students it may have improved safety in the clinical setting as learners reported changes in their practice due to the DCEs. This requires further study.