Purpose: Nurse educators in China are slowly gaining an understanding of the use of simulation in education and are increasing their knowledge of simulation development and implementation. The primary investigator, an American nurse educator, three Chinese nurse educators, and three additional U.S. nurse educators collaborated to design two studies to evaluate their collaborative work involving the engagement of Chinese nurse educators in simulation workshops. A subsequent study will be implemented in March 2019 to explore the implementation of simulation in two Chinese baccalaureate nursing programs.
The review of literature revealed two Chinese simulation-based experience studies. Wang et al., (2013) reported positive outcomes in one Chinese school of nursing with student satisfaction significantly greater with the utilization of moderate-fidelity to high-fidelity simulation. Findings of this study also suggested that the high-fidelity simulation provided a strong means of implementing “best practice” for simulation design concepts. Zhang (2017) utilized a qualitative descriptive approach to examine Chinese nursing student’s perception of simulation and noted three themes: students found simulation to be engaging, students reported needing clearer and more concise preparatory guidelines, and students desired faculty to provide a more positive learning environment. Stayt et al., (2015) reported student satisfaction and improved clinical performance from a randomized control study of two nursing schools in England. Khalaila (2014) reported on a quantitative descriptive study regarding simulation-based education in Israel, with findings of decreased student anxiety, increased self-confidence, and enhanced ability to care.
Methods: Research Study One: Five Chinese nursing schools and four Chinese clinical settings. Research Study Two: Two Chinese nursing schools.
The goals of these two research studies were: 1) to examine the knowledge and identify the perceived barriers of Chinese nurse educators regarding development and implementation of simulation-based learning experiences, and 2) to gain an understanding of Chinese nurse educators’ and nursing students’ perceptions of simulation implementation.
The first research study was a descriptive quantitative design implemented by the primary investigator in China and consisted of a presentation, “Overview of Simulation”, given to both didactic and clinical nurse educators. Upon consent, attendees completed a demographic profile, an author approved adapted version of King (2018) pretest and post-test “Knowledge of Simulation”, and a “Barriers to Simulation” survey.
The second study, a descriptive quantitative design will be implemented in March of 2019 with two Chinese schools of nursing whose faculty were involved in a multi-day “Step by Step” simulation design workshop in Fall of 2018 by the primary investigator. This workshop was based on INACSL Standards of Best Practice: SimulationSM (2017 & 2016a-h) and Bambini (2016). Data to be collected will focus on the perceptions of the nurse educators and nursing students involved in simulation scenarios designed during the Fall 2018 workshop.
Results: The preliminary analysis for research study one, (N=377/Pre-test, N=277/Post-test: 1 school of nursing and 3 clinical sites). Based on the Pre-test, the findings suggested that nurse educators had a strong theoretical knowledge base (all correct pretest answers > 80%) with noted areas of strengthening in simulation scenario development (all correct answers < 80% except for pre/post debriefing >87%) and debriefing goals and techniques (< 50%; < 30%, respectively). The barrier survey (N=277) indicated that nursing educators valued simulation and desired to incorporate simulation into their courses (N=234; N=239 respectively). The areas identified as needing assistance were, integration into course and increased understanding of simulation design (N=235; N=235, respectively). Research Study Two, to be implemented March 2019, will examine the perceptions of nursing faculty and students involved in simulation-based experiences designed during the Fall 2018 workshops.
Conclusions: Results of these two studies will be utilized to guide the ongoing work of this research team in development and implementation of simulation design methods, including techniques needed to successfully incorporate simulation into Chinese healthcare education. The primary investigator will be returning in the Spring of 2019 to assist Chinese research colleagues in conducting the follow-up study.