Evidence to support virtual simulation as an effective pedagogy during the pandemic: Research and policy implications.

Cynthia Foronda, PhD, RN, CNE, CHSE, ANEF

Associate Professor of Clinical

University of Miami School of Nursing and Health Studies

Macy Faculty Scholar 2018-2020

President, International Nursing Association for Clinical Simulation and Learning

Disclaimers

• Statements may or may not represent the view of INACSL

• Served as a paid educational consultant of virtual simulation products in the past

• The activities reported here were supported (in part) by the Josiah Macy, Jr. Foundation, United States

Objectives

• Summarize the evidence associated with virtual simulation in nursing education

• Consider policy implications related to substituting virtual simulation for clinical practice hours

• Identify resources to assist nurse educators with the transition of providing clinical experiences virtually.

Objectives

• Summarize the evidence associated with virtual simulation in nursing education

• Consider policy implications related to substituting virtual simulation for clinical practice hours

• Identify resources to assist nurse educators with the transition of providing clinical experiences virtually.

Synthesis of Research

• Virtual simulation• Improved knowledge compared to

customary methods (Gu, Zou, Chen, 2017)

• Decreased time to skill achievement (Farra, et al., 2015)

• Increased retention of material over time (Farra, Miller, Timm, & Schafer, 2013)

• Fun/Satisfied (Foronda, et al., 2016; Liaw, et al, 2014; Sunnqvist, et al., 2016; Tilton, et al., 2015; Ulrich, et al., 2014; Verkuyl, et al, 2017).

Systematic Review

• Team of 5 individuals

• Reviewed articles from 1996-2018

• Applied PRISMA Guidelines

• Appraised articles using Melnyk and Fineout-Overholt’s (2015) Levels of Evidence

• “How does virtual simulation impact learning outcomes?”

Foronda, C.L., Fernandez-Burgos, M., Nadeau, C., Kelley, C.N., & Henry, M.N.

(2020, February). Virtual Simulation in Nursing Education: A Systematic Review

Spanning 1996-2018. Simulation in Healthcare, 15(1), 46-54.

Appraising the Evidence

Melnyk, BM, Fineout-Overholt, E. Evidence-based practice in nursing and

healthcare: A guide to best practice.3rd ed. Philadelphia: Wolters Kluwer

Health; 2015.

Results

Results

Results

Results

The majority of the evidence

(n=69 studies, 86%) suggested that the

intervention of virtual simulation resulted

in improved student learning outcomes.

Results

When looking at the 17 RCT’s, the majority (n=12, 70%) of studies demonstrated that virtual simulation led to statistically significant gains in learning outcomes when compared to traditional methods.

Conclusion

• The preponderance of evidence suggests

virtual simulation improves learning outcomes.

Evidence regarding debriefing virtual simulation

Objectives

• Summarize the evidence associated with virtual simulation in nursing education

• Consider policy implications related to substituting virtual simulation for clinical practice hours

• Identify resources to assist nurse educators with the transition of providing clinical experiences virtually.

Coronavirus

INACSL Standards of Best Practice: SimulationSM

• INACSL Standards can and should be applied to virtual simulation

Policy Implications

• Advocate that virtual simulation hours can be substituted for clinical practicum hours

Policy Implications

• If virtual simulation can be substituted, what ratio is allowed? • Hayden et al. (2014)/NCSBN study – up to 50% of manikin-based simulation could be

substituted• Sullivan, et al. (2019) study – suggests that manikin-based simulation can be substituted at a

2:1 clinical hour ratio• Evidence r/t clinical hour substitution with virtual simulation is lacking• Research is needed but we do not have the luxury of time

Hayden, J.K., Smiley, R.A., Alexander, M., Kardong-Edgren, S., & Jeffries, P.R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2S), S3-S64.

Sullivan, N., Swoboda, S. M., Breymier, T., Lucas, L., Sarasnick, J., Rutherford-Hemming, T., ... & Kardong-Edgren, S. S. (2019). Emerging evidence toward a 2: 1 clinical to simulation ratio: A study comparing the traditional clinical and simulation settings. Clinical Simulation in Nursing, 30, 34-41

Policy Implications

Recommendations

• Cautiously suggest allowing a 2:1 ratio of replacing clinical practicum hours with virtual simulation during the pandemic (1 hour of virtual simulation = 2 clinical hours)

• Ask Boards of Nursing/Policymakers for flexibility r/t limitations of clinical hours completed in simulated settings (i.e. > 25%, 50%*)

• *Remember that substituting with 50% or more statement is valid only when educators are adequately trained, using quality, vetted simulations to meet course objectives, along with standardized high level debriefing

Bradley, C., Johnson, B., Dreifuerst K., White, P., Conde, S., Meakim, C., Curry-Lourenco, K., & Childress, R. (2019, August). Regulation of Simulation Use in United States Prelicensure Nursing Programs. Clinical Simulation in Nursing, Volume 33, 17-25.

INACSL Simulation Regulations Committee. (2020, March 12). INACSL Simulation Regulation Map. Retrieved from https://www.inacsl.org/simulation-regulations/.

Policy Implications

• Recommendations

• Ask Boards of Nursing/Policymakers to include the terms “virtual simulation”, “screen-based simulation” or “computer-based simulation” in the interpretation of the verbiage of “interactive simulation”

• Advocate for both prelicensure and advanced practice

students to be able to substitute virtual simulation for clinical hours

• Support legislation to help educate and graduate nurses!

Objectives

• Summarize the evidence associated with virtual simulation in nursing education

• Consider policy implications related to substituting virtual simulation for clinical practice hours

• Identify resources to assist nurse educators with the transition of providing clinical experiences virtually.

Resources

• INACSL COVID-19 and Virtual Learning Resource List

https://www.inacsl.org/covid-19-update/resource-list/

• NLN Coronavirus Resource Center

http://www.nln.org/coronavirus-resource-center

• Society for Simulation in Healthcare Helpful Links

https://www.ssih.org/COVID-19-Updates/-Helpful-Links-and-Information

Key References

• Bradley, C., Johnson, B., Dreifuerst K., White, P., Conde, S., Meakim, C., Curry-Lourenco, K., & Childress, R. (2019, August). Regulation of Simulation Use in United States Prelicensure Nursing Programs. Clinical Simulation in Nursing, Volume 33, 17-25.

• Foronda, C.L., Fernandez-Burgos, M., Nadeau, C., Kelley, C.N., & Henry, M.N. (2020, February). Virtual Simulation in Nursing Education: A Systematic Review Spanning 1996-2018. Simulation in Healthcare, 15(1), 46-54.

• Goldberg, E. (2020, March 20). Coronavirus may keep California’s nursing students from graduating. Retrieved from https://www.nytimes.com/2020/03/20/health/coronavirus-nurses-healthcare.html?smid=em-share

• Hayden, J.K., Smiley, R.A., Alexander, M., Kardong-Edgren, S., & Jeffries, P.R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2S), S3-S64.

• INACSL. (2020, March 23). COVID-19 and Virtual Learning Resource List. Retrieved from https://www.inacsl.org/covid-19-update/resource-list/.

• The INACSL Standards Committee (2017, December). INASCL Standards of Best Practice: SimulationSM: Operations. Clinical Simulation in Nursing, Volume 13, 681-687.

• INACSL Simulation Regulations Committee. (2020, March 12). INACSL Simulation Regulation Map. Retrieved from https://www.inacsl.org/simulation-regulations/.

• National League for Nursing. (2020, March 23). Coronavirus Resource Center. Retrieved from http://www.nln.org/coronavirus-resource-center.

• Sullivan, N., Swoboda, S. M., Breymier, T., Lucas, L., Sarasnick, J., Rutherford-Hemming, T., ... & Kardong-Edgren, S. S. (2019). Emerging evidence toward a 2: 1 clinical to simulation ratio: A study comparing the traditional clinical and simulation settings. Clinical Simulation in Nursing, 30, 34-41

• Verkuyl M, Atack L, McCulloch T, et al. (2018). Comparison of debriefing methods after a virtual simulation: An experiment. Clinical Simulation in Nursing, 19, 1–7.

Questions, Comments, or Ideas

c.foronda@miami.edu