Search

This paper describes the rapid conversion of a face-to-face interprofessional (IP) disaster simulation to an online format in response to COVID-19 campus closures. The online disaster simulation utilized internet-based tools allowing real-time collaboration between IP students. Team exercises involved disaster triage, disease outbreak investigation, and disaster response. Surveys measuring self-assessment of various IP skills and simulation learning outcomes (SLOs) were compared with responses from previous face-to-face simulations. Results indicated mean scores for IP skills were higher for online students when compared with in-person simulations, and all SLOs were met. The online disaster simulation provided an effective, innovative IP educational opportunity.

Background To facilitate inclusive healthcare and increase cultural capabilities, health professions students require authentic interprofessional learning experiences that challenge their social, professional, and historical positioning. Tag Team Simulation (TTS) is an innovative approach to develop students’ interprofessional collaboration and cultural competency for working with Aboriginal people. Method Co-designed and delivered by Aboriginal people and an interdisciplinary team of health professions academics, this pilot aimed to: (a) evaluate the effect of TTS on students’ self-rated cultural capabilities (Cultural Capabilities Measurement Tool) and interprofessional attitudes (Interprofessional Attitude Scale), and (b) explore students’ simulation learning experience. Results Students’ respect, communication, and safety and quality scores on the Cultural Capabilities Measurement Tool were significantly higher post simulation, as were their Interprofessional Attitude Scale scores. Students experienced the simulation as authentic and effective in advancing their communication skills and cultural understanding. Conclusions This co-designed interprofessional simulation improved health professions students’ self-rated cultural capabilities and interprofessional attitudes. Coupled with positive student feedback, results indicate that TTS is an innovative simulation method for building cultural competence in health professions students across disciplines.

Background and problem In Australia, interprofessional education has been embedded into pre-registration course accreditation standards. Little is known about Australian midwifery and medical students experiences of interprofessional learning when the focus is on emergency scenarios during birth. Aim This study aimed to evaluate student experience of Interprofessional Simulation-Based Learning workshops focused on emergency scenarios with midwifery and medical students. Methods This was a descriptive, exploratory study of an educational activity designed to enhance inter-professional and collaborative learning between Bachelor of Midwifery students and Bachelor of Medicine students at a Simulation Centre in Sydney, Australia. A pre and post survey design enabled data collection before and after the 6-h simulation-based workshop. Findings A total of 45 students attended two interprofessional simulation learning days, 14 were midwifery students and 31 medical students. Students disclosed a level of apprehension in the pre workshop survey and ambivalence towards the values of collaborative simulation-based learning. Following the workshop students reported that the workshop enhanced their ability to work collaboratively in practice. Both student cohorts commented on a perceived power imbalance and a sense of each profession having to ‘prove’ their knowledge levels. Students stated that learning to work together in a safe environment allowed them to develop an appreciation for each other’s scope of practice and responsibilities in an emergency situation. Conclusion This form of collaborative learning has the potential to improve new graduate experience in the workplace, especially during emergency situations, and ultimately improve care for women and babies.

Postpartum hemorrhage (PPH) is a medical emergency that is the primary cause of nearly one-quarter of all maternal deaths worldwide. Prelicensure nursing students are often underprepared to respond to obstetrical emergencies, such as PPH, due to a lack of exposure in the clinical setting. Simulation is used to aid students in developing knowledge, skills, and attitudes in clinical learning and emergency scenarios. The purpose of this pilot study was to evaluate student knowledge before and after participation in a high-fidelity simulation of a patient experiencing PPH. Student confidence and satisfaction after the experience was also assessed. Findings demonstrated that high-fidelity simulation significantly increased student knowledge related to PPH nursing care (p = 0.001). Student perceived confidence and satisfaction were also aggregately rated at 95% after the simulation experience. The PPH scenario utilized is described, and implications of implementing simulation in prelicensure nursing programs are discussed.

The global impact of COVID-19 forced nursing education to provide an alternative for scheduled clinical experiences during the Spring and Fall of 2020. Many programs selected the pre-packaged, web-based solutions at the onset of the pandemic due to the uncertainty and recommendation of social distancing. Clinical and simulation faculty began to look for educational alternatives to provide meaningful learning experiences that more closely replicated clinical learning because students expressed displeasure with the asynchronous web-based options. This article outlines how an innovative partnership between clinical faculty, simulation faculty, and the Theatre Department modified an in-person simulation activity designed for groups of two students into a web-based “clinical” experience that included the assigned clinical faculty, eight nursing students, and one simulated patient. This active learning strategy was able to meet the course objectives, required little additional resources, and most importantly, underwent positive evaluation by the weary, screen-based learners.

For many industry contexts, the implementation of Artificial Intelligence (AI) has contributed to what has become known as the fourth industrial revolution or “Industry 4.0” and creates an opportunity to deliver significant benefit to both businesses and their stakeholders. Robot arms are one of the most common devices utilised in manufacturing and industrial processes, used for a wide variety of automation tasks on, for example, a factory floor but the effective use of these devices requires AI to be appropriately trained. One approach to support AI training of these devices is the use of a “Digital Twin”. There are, however, a number of challenges that exist within this domain, in particular, success depends upon the ability to collect data of what are considered as observations within the environment and the application of one or many trained AI policies to the task that is to be completed. This project presents a case-study of creating and training a Robot Arm Digital Twin as an approach for AI training in a virtual space and applying this simulation learning within physical space. A virtual space, created using Unity (a contemporary Game Engine), incorporating a virtual robot arm was linked to a physical space, being a 3D printed replica of the virtual space and robot arm. These linked environments were applied to solve a task and provide training for an AI model. The contribution of this work is to provide guidance on training protocols for a digital twin together with details of the necessary architecture to support effective simulation in a virtual space through the use of Tensorflow and hyperparameter tuning. It provides an approach to addressing the mapping of learning in the virtual domain to the physical robot twin.

Background Prebriefing research and evidence has been emerging over the past ten years; however, controversy has existed on how much information to provide to learners and on the best strategies to prepare learners. An adult learning and Benner's Novice to Expert Framework are used to support this work. Method The purpose of this article is to discuss the historical aspects of prebriefing research and study from its infancy to the current body of work. A prebriefing model of preparing students for simulation is described, as well as its development through simulation literature, research, and experience in facilitation practice. Results A three-phase prebriefing model was developed that includes planning, briefing, and facilitating. An active engaged preparation strategy called Know: Do: Teach is provided, as well as the background for how it was developed according to literature surveillance, research, and simulation practice and experience. Conclusion Prebriefing strategies may be one way to transition students from knowledge to the clinical thinking required for nursing practice. This model shows promise for the development of engaged student learning before simulation, as well as a guide for novice simulation educators to develop prebriefing activities.

Oral and Maxillofacial Surgery (OMFS) is underrepresented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school. This can result in clinicians having problems recognising emergency presentations, and referrals being made inappropriately. OMFS trainees delivered an educational simulation course on common OMFS pathologies to medical students, with theory and hands-on, high-fidelity simulations that covered anatomy, emergency presentations, and the training pathway. Delegates were assessed immediately before, immediately after, and six-weeks after the course. There were significant improvements in knowledge six weeks after the course, with mean scores improving by 23% for knowledge of anatomy (p

Background A psychologically safe environment is defined as one where individuals feel comfortable to take risks without fear of negative consequences. When an individual feels psychologically safe in simulation, they are more likely to engage in the experience and reflect on their own and others’ performance. Despite this, little is known about what creates this type of environment from the learner perspective. Methods A qualitative descriptive study was conducted to explore prelicensure nursing students’ perceptions of psychological safety as it exists within the prebrief, scenario, and debrief phases of a simulation learning experience. Data were collected using a series of open-ended questions through an online survey tool. Three researchers independently, then collaboratively, reviewed the data, identifying themes and patterns across each phase. Results Eighty-six prelicensure nursing students completed the online survey. Across the three phases, five themes emerged: (1) faculty presence; (2) learning without fear; (3) working together; (4) setting expectations; and (5) positive conversations. Conclusions Our findings support much of the current literature on psychological safety in simulation but also highlight unique findings, including bullying, learner control and not being rushed.

Background The rarity of perianesthetic catastrophic events creates a challenge in training support staff in the treatment of emergencies such as local anesthetic systemic toxicity (LAST). Simulation learning offers a unique venue in which to safely encounter rare events. Aims This study aimed to evaluate knowledge retention regarding LAST in perianesthetic nursing staff using high-fidelity simulation and a short didactic session. Design Nurses were recruited from perioperative locations to participate in a simulated scenario of LAST and engage in a short didactic session. Settings Simulation and education occurred in the high-fidelity simulation center at the University of Wisconsin Hospital. Participants/Subjects Thirteen nurses from the preoperative, post-anesthesia, and block nursing teams participated in the study. Methods Participants completed a pre-test before participating in the simulation, followed by a formal debrief and short lecture. They then completed post-tests and a short survey focused on self-efficacy and review of the simulation experience. Results Test scores, compared to the pre-test, improved significantly on the immediately-post, 1-month, and 3-month assessments. Participants felt more equipped to handle crisis scenarios. Conclusions Experiential learning often results in significant knowledge acquisition and retention. Participants in this study improved their test scores regarding LAST and increased their sense of self-efficacy and ability to handle crisis scenarios after taking part in a high-fidelity simulation.

Background This article reports the development and psychometric testing of the Global Interprofessional Therapeutic Communication Scale© (GITCS©), an instrument designed to measure culturally appropriate provider-patient communication, giving formative and summative evaluation for multiple health professionals. Method Using DeVellis' (2016) eight-step instrument process, the 44-item GITCS© was developed with input from a team of interprofessional experts and tested with 592 unique crowd source viewers using International Nursing Association Clinical and Simulation Learning Standards of Best Practice–based videos to evaluate the Likert-type scale. Psychometric reliability (coefficient alpha) and validity (confirmatory factor analysis) were tested using R. Results The second-order model contained a single latent variable representing overall quality of the therapeutic relationship and three lower level constructs: Factor 1: trust and rapport building (23 items); factor 2: power sharing (9 items); and factor 3: empathy (9 items). Two items were excluded based on experts' opinion, and one item was deleted because it was repetitive. Conclusion The GITCS© demonstrates initial reliable measurement of therapeutic communication with strong statistical support of its underlying factors. It has the potential to facilitate faculty teaching and assessment of student's therapeutic communication skills, in both simulation and clinical settings. It needs further testing to demonstrate the multifaceted conceptualization of reliability in simulated, clinical, and virtual environments by faculty, health professionals, and students.

Smart learning environments (SLEs) are spaces that incorporate technology to improve students learning outcomes. This growing body of literature typically examines day-to-day learning, but very little research considers the use of these environments for formative and summative assessment. We investigate how SLEs can be used to conduct successful real time simulations for summative assessment, using an innovative crisis management simulation in a unique smart learning environment at the University of South Wales. Using a PLS SEM methodology, this research demonstrates that the psychological factors of social support and career relatedness show significant positive effects upon perceived learning. Surprisingly, the perceived ease of use of the technology does not significantly affect perceived learning. This research contributes a valuable understanding of simulation learning within SLEs, and its relationship to positive outcomes in students' perceived learning. Implications for both academics and practitioners are discussed, and suggestions for future research are given.

Research Objectives To co-develop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Design An interpretive descriptive qualitative approach involving two 2.5 hour focus group discussions to co-design an online simulation tool. Setting Pediatric rehabilitation hospital, Toronto, Ontario. Participants A purposive sample of ten rehabilitation health care providers. Interventions Not applicable. Main Outcome Measures Focus group discussions with participants. Results Two main themes arose from our analysis of co-developing a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it; to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (i.e., included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions Our online gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was co-created with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with a disability. Author(s) Disclosures None.

Background Being in a flow state during simulation-based education enables students to achieve successful learning by concentrating on their activities. Methods After experiencing simulations, both junior and senior nursing students participated in a questionnaire survey. The questionnaire included six types of scales to measure each component of the research framework. The collected data were analyzed using t-tests, analysis of variance, Pearson correlations, and multiple regressions. Results Students’ school years, preferred learning styles, perceived levels of support, problem-solving opportunities, and perceived levels of fidelity were identified as factors influencing the flow experience during simulation-based education. Conclusions To increase the effectiveness of learning, educators should consider factors that influence the flow experience when designing simulation learning environments.

Background Objective structured clinical examinations can be used to understand students' care skill performance and to evaluate courses. Thus, identifying antecedents to improved skill performance in these examinations is crucial for improving students' future care ability. Objectives This study examined the antecedents of clinical skill performance in nursing students and determined whether perceived task load and anxiety mediate the relationships between task characteristics and skill performance. Methods A quantitative approach was conducted. The questionnaire for this study was comprised of five measures: Simulation Learning Effectiveness Scale, Task Characteristic Subscale, Task Cognitive Loading Scale, State-Trait Anxiety Inventory, and a clinical practice examination. Finding Structural equation modeling revealed that students' simulation learning effectiveness was positively associated with three task characteristics (task autonomy; task variety, identity, and significance; and task feedback) during clinical examinations. Further, the effect of learning effectiveness on task feedback was greater than on task autonomy, variety, identity, and significance. In addition, task load mediated the relationship between task variety, identity, and significance and clinical examination performance, whereas anxiety mediated the relationships between all three task characteristics and clinical examination performance. Conclusion Promoting nursing students' simulation learning effectiveness is crucial for improving feedback in regard to the task. Further, those who perceived the task as having more variety, identity, and significance were more likely to perceive the task as having a higher cognitive load and to experience anxiety, which, in turn, led to poorer performance. Interventions should, therefore, managers' aim to reduce students' perceived load and anxiety before they participate in clinical skill examinations.

This paper deepens in the study of the appropriateness of virtual learning environments through the use and value of social networks by college students, considering the reliability, confidence and experience of the Internet. The study develop a comprehensive structural equation model conducted among 381college students of different Social Sciences degrees of the University of A Coruna (Spain). The results show that both topical social network and the Internet have a significant influence on college students’ virtual learning environment assessment, regardless the area of study. The analysis also discloses the potential utility of the above interactions on virtual learning environments in terms of downloading of material, improvement in learning efficiency and usefulness of contents, functions and supplement of other learning ICT tools. Findings reveal that the implementation of educational policies that allow adapting virtual learning environments to college students’ preferences are required.

Background: Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear. Aim: To describe the current use of simulation in tertiary nursing education programs leading to nurse registration Australia and New Zealand, and determine whether investments in simulation have improved uptake, quality and diversity of simulation experiences. Methods: A cross sectional electronic survey distributed to lead nursing academics in programs leading to nurse registration in Australia and New Zealand. Findings: 51.6% of institutions responded and reported wide variation in allocation of program hours to clinical and simulation learning. Simulation was embedded in curricula and positively valued as an adjunct or substitute for clinical placement. While simulation environments were adequate, staff time, training and resource development were barriers to increasing the quality, amount and range of simulation experiences. Quality assurance and robust evaluation were weak. Discussion: Simulation program hours are inconsistently reported and underutilized in terms of potential contribution to clinical learning. Benefits of capital investment in simulation physical resources have been realised, but barriers persist for increasing high quality simulation in nursing programs. Conclusion: Transitioning components of clinical education from the clinical to tertiary sectors has resource implications. Establishment of sustainable, high quality simulation experiences requires staff training, shared resources, best practice and robust evaluation of simulation experiences in nursing curricula. Refereed/Peer-reviewed

Background Nursing students are increasingly participating in simulation-based learning experiences. The psychological safety of these environments has an effect on learning. Clarity surrounding antecedents, attributes and consequences of this concept can assist nurse educators in providing an optimal simulation learning environment. Design Using the Walker and Avant method, a concept analysis of psychologically safe learning environment in simulation was conducted. Results Psychological safe learning environments in simulation contain three defining attributes. 1) ability to make mistakes without consequences; 2) the qualities of the facilitator and; 3) foundational activities such as orientation, preparation, and objectives and expectations. Conclusion This concept analysis provides a clear definition of psychologically safe learning environments in simulation and will facilitate the application of this concept in simulation-based learning activities.

Immersive virtual reality is applied in many human activities. This virtual reality can be used as a training tool for thinning operations in forests. The aim of this study is to describe the complex solution of Thinning Trainer, that we developed. This system uses the SIBYLA growth model for predicting forest-growth development. The model, based on Virtual Reality Modeling Language, was chosen as a virtual reality environment. The CAVE Automatic Virtual Environment was implemented as a hardware tool for the Thinning Trainer, offering an immersive virtual reality of the forest for the users. Mutual connection of hardware, virtual reality and the SIBYLA growth model is established using a software solution called Caveman. Fully automatic system provides users with the possibility to interact and experiment with a virtual forest.

In this article, we have proposed an educational model using virtual reality on a mobile platform by personalizing the simulated environments as per user actions. We have also proposed an evolutionary learning algorithm based on which the user learning path is designed and the corresponding simulated learning environment is modified. The main objective of this study is to create a personalized learning path for each student as per their calibre and make the learning immersive and retainable using virtual reality. Our proposed model emulates the innate natural learning process in humans and uses that to customize the virtual simulations of the lessons by applying the evolutionary learning technique. A quasi-experimental study is conducted by taking different case studies to establish the effectiveness of our learning model. The results show that our learning model is immersive and gives long term retention while enhancing creativity through reinforced customization of the simulations.

HealthCAST (Collaboratively Acted Simulation Training), a simulated patient program developed between a university's nursing and theatre programs, models how multiple departments collaborated to create an interprofessional, simulated-patient program. HealthCAST had two goals: 1 Provide opportunities for skill acquisition and feedback for health care and theatre students. 2 Apply basic quality management principles (measurement, assessment, improvement) to continuously improve the process (simulation learning) and outcomes (knowledge and skills acquisition) for participants. This article describes the process used to create the program, including an analysis of the program's results. The quality management process supported the use of HealthCAST to provide interprofessional education for students in health care and theatre. Lessons learned from the development and evaluation of the program included: (1) engage local partners; (2) use a simulated-patient model; (3) articulate expectations; (4) bridge professions; (5) debrief using open-ended questions; and (6) evaluate often, using mixed methods.

Simulation has played an important role in health professional education for over 50 years but is relatively new to osteopathy. Simulation provides an opportunity to control some of the variables in clinical education such as adequate patient numbers and case mix exposure and provide a meaningful contribution to the students' clinical education. Simulation learning (SL) is a process where the learner practices a procedure or routine in a simulated learning environment. SL has recently been investigated as a valid part replacement of traditional clinical placements in physiotherapy. This case study endeavours to provide osteopathy educators with a framework to develop, implement and evaluate simulated learning in osteopathic education. This case study outlines simulated learning activities that part replaced clinical placements in osteopathy education and provides an overview of costs and resources required. Student feedback obtained throughout the project suggests structured simulated learning activities may build critical practice skills and be used as an acceptable clinical learning tool.

Debriefing is a critical conversation following simulation to reframe the context of a situation, facilitate students' reflection, assess critical thinking, evaluate learning, and improve future performance. However, there is a significant gap in the literature regarding how to effectively debrief following immersion in virtual simulation. The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM Debriefing (2016) were developed to support effective simulation and learning when incorporated with design and development; yet, debriefing for virtual simulation may not have been fully conceptualized when the standards were established. Alternative debriefing methods specifically aimed at debriefing virtual simulation must be explored and implemented in order to "enhance learning and heighten participant self-awareness and self-efficacy" (INACSL Standards Committee, 2016, p. S21). This article provides an example of how a synchronous, Web-based Internet conferencing platform was used to conduct debriefing sessions following immersion in an asynchronous virtual learning environment with family nurse practitioner students in an online graduate program. The lessons learned and recommendations are generalizable for all simulation populations.

In this article we report our study of objectivation in the conversation of a design team. Objectivation is the practical work in which groups engage to produce social objects that facilitate orderly collaboration. We observed how design team members came to agree on specific details about an educational simulation they were designing, as they treated simulation features like independent social facts that could be affected by and have effects on other simulation features, and that had discrete benefits that made them an asset within the product. In our report we describe patterns of objectivation in their conversation that produced these results. We conclude by discussing how our study relates to, and enriches, the findings provided by prior design research.

The design of blended learning environments brings with it four key challenges: (1) incorporating flexibility, (2) stimulating interaction, (3) facilitating students' learning processes, and (4) fostering an affective learning climate. Seeing that attempts to resolve these challenges are fragmented across the literature, a systematic review was performed. Starting from 640 sources, 20 studies on the design of blended learning environments were selected through a staged procedure based on the guidelines of the PRISMA statement, using predefined selection criteria. For each study, the instructional activities for dealing with these four challenges were analyzed by two coders. The results show that few studies offer learners control over the realization of the blend. Social interaction is generally stimulated through introductory face-to-face meetings, while personalization and monitoring of students’ learning progress is commonly organized through online instructional activities. Finally, little attention is paid to instructional activities that foster an affective learning climate.

Background Little is known about the effectiveness of students' transfer of simulation learning to "real-world" contexts. This study was an initial exploration of third-year nursing students' perceptions regarding the transfer of high-fidelity simulation learning to clinical practice. Method A series of semistructured focus group discussions were undertaken with final year undergraduate nursing students (n = 25). Result Three themes emerged from the analysis of data: But it's not the same on "real" clinical practice, Having opportunities to apply what we've learned, and Making better connections. Conclusions The findings highlight that transfer of simulation learning to practice should not be assumed, particularly when students' clinical placements are in settings that are dissimilar to the high-fidelity simulation scenarios they have experienced.

Use of high fidelity simulation has become increasingly popular in nursing education to the extent that it is now an integral component of most nursing programs. Anecdotal evidence suggests that students have difficulty engaging with simulation manikins due to their unrealistic appearance. Introduction of the manikin as a 'real patient' with the use of an audio-visual narrative may engage students in the simulated learning experience and impact on their learning. A paucity of literature currently exists on the use of audio-visual narratives to enhance simulated learning experiences.This study aimed to determine if viewing an audio-visual narrative during a simulation pre-brief altered undergraduate nursing student perceptions of the learning experience.A quasi-experimental post-test design was utilised.A convenience sample of final year baccalaureate nursing students at a large metropolitan university.Participants completed a modified version of the Student Satisfaction with Simulation Experiences survey. This 12-item questionnaire contained questions relating to the ability to transfer skills learned in simulation to the real clinical world, the realism of the simulation and the overall value of the learning experience. Descriptive statistics were used to summarise demographic information. Two tailed, independent group t-tests were used to determine statistical differences within the categories.Findings indicated that students reported high levels of value, realism and transferability in relation to the viewing of an audio-visual narrative. Statistically significant results (t=2.38, p0.02) were evident in the subscale of transferability of learning from simulation to clinical practice. The subgroups of age and gender although not significant indicated some interesting results.High satisfaction with simulation was indicated by all students in relation to value and realism. There was a significant finding in relation to transferability on knowledge and this is vital to quality educational outcomes.

The effectiveness of simulation learning and the effects of anxiety in the simulated situation have been understudied. In addition, research on the association between learning effectiveness and students' clinical care performance in the hospital setting is very limited in Taiwan. The aim of this study is to examine the mediating effect of self-reflection and simulation learning effectiveness on the clinical nursing performance of nursing students. A Prospective, longitudinal, and correlational design was used. The study was conducted from December 2014 to July 2015. Participants were 293 nursing students in southern Taiwan. A structural model was specified and tested using partial least squares structural equation modeling to examine the relationships between the variables. The results revealed that the model was robust in terms of its measurement quality (reliability, validity, and goodness of fit), with the data's explaining 38.3% of variance in nursing competence. As self-reflection and learning effectiveness were added into the structural model, the effect of anxiety on nursing competence was still significant, but the regression coefficient (β) estimate of -0.41 (p

Background Simulation learning outcomes and learner satisfaction may be influenced by the facilitation methods employed. This mixed-methods study explored differences between instructor-led simulation with in-scenario feedback and postscenario debriefing and student-led simulation with postscenario debriefing only. Methods Novice nursing students experienced both facilitation methods and completed (a) Health Assessment Educational Modality Evaluation Simulation Subscale, (b) Facilitation Style Preference Survey, and (c) multiple choice quiz, and provided qualitative feedback on what they liked/disliked about each facilitation style. Results Novice learners preferred instructor-led to student-led simulation ( p Conclusion Instructor-led simulation is the preferred facilitation method for novice nursing students; however, a progression from instructor-led to student-led simulation may enhance learning by providing increased autonomy as knowledge and confidence grow.

Facilitating a simulated clinical experience for prelicensure nursing students requires skills. Frequently, the experience is planned, presented, and debriefed by an educator assigned as the facilitator. The International Nursing Association for Clinical Simulation and Learning (INACSL) Best Practice Standards℠ provide the goals for all simulation experiences. This article identifies challenges frequently experienced by the novice facilitator in meeting the standards. A table with the acronym CLEAR has been developed to identify challenges and strategies to assist the novice facilitator to meet the INACSL Best Practice Standards: Simulation Standard V: Facilitator℠ recommendations. The strategies provide the facilitator innovative ways to promote successful simulation learning experiences.

Virtual reality simulators are becoming an essential part of modern education. The benefits of Virtual reality in dentistry is constantly being assessed as a method or an adjunct to improve fine motor skills, hand-eye coordination in pre-clinical settings and overcome the monetary and intellectual challenges involved with such training. This article, while providing an overview of the virtual reality dental simulators, also looks at the link between virtual reality simulation and current pedagogical knowledge. Keywords: Virtual reality, Dental education, Dental simulators

Background New nursing graduates have revealed that they perceive a gap between theory and practice with reference to their education and the real workplace setting. Additionally, many nurses experience a reality shock when they participate in clinical practice. Purpose The purpose of this study was to develop and test the effects of a scenario-based simulation training program on new graduate nurses' competency, critical thinking dispositions, and interpersonal communication skills. Method This pilot multi-site study used a pretest-posttest control group design. It was conducted at four sites of a university-affiliated simulation center in Korea. Participants were recruited utilizing a convenience sample from four tertiary hospitals in Korea. Twenty-four new graduate nurses participated in this study. Results At the three-month follow-up, the levels of communication skills used in practice among the intervention group were statistically significantly higher than those of the control group participants (U = 151.50, p = .005). However, there were no significant differences between the groups in changes in nursing competency (U = 287.50, p = .992) or critical thinking disposition scores (U = 269.50, p = .702). The participants' mean rating scores concerning the objectives, intentions, and recommendations for other nurses were positive and high. Conclusion The involvement of current practicing of nursing in certain scenarios and the implementation of simulation learning could enhance the readiness of new graduate nurses.

This paper describes the use of Reinforcement Learning in Immersive Virtual Reality to make a person move to a specific location in a virtual environment. Reinforcement Learning is a sub-area of Machine Learning in which an active entity called an agent interacts with its environment and learns how to act in order to achieve a pre-determined goal. The Reinforcement Learning had no prior model of behaviour and the participants no prior knowledge that their task was to move to and stay in a specific place. The participants were placed in a virtual environment where they had to avoid collisions with virtual projectiles. Following each projectile the agent analysed the movement made by the participant to determine paths of future projectiles in order to increase the chance of driving participants to the goal position and make them stay there as long as possible. The experiment was carried out with 30 participants, 10 were guided towards the leftmost part of the environment, 10 to the rightmost area, and 10 were used as control group where the projectiles were shot randomly throughout the game. Our results show that people tended to stay close to the target area in both the Left and Right conditions, but not in the Random condition. HighlightsWe used of Reinforcement Learning in Immersive Virtual Reality to make a person move to a specific place.The Reinforcement Learning agent had no prior knowledge of human behaviour.People tended to stay near the target area.Reinforcement learning can be used to predict the movements of the people.

Based on the experience of teaching online to masters and PhD groups in social economy and non-governmental organizations for collectives in different parts of the world, the need arose to create communication spaces to prevent the isolation that course participants experienced. This system of work facilitates the learning of the course contents and also enables the various participants to contact each other and exchange ideas and experiences. This study provides a general perspective of the new practical approaches in e-learning, focusing on the social components of learning that enable communication similar to that achieved in traditional classrooms. The creation of a virtual community or either the use of the social networks, were the tools used to motivate a communal living of a group of young students from three different countries who have created personal and professional links.

Information and communication technology (ICT) enriched learning in many ways and made the knowledge of the society accessible to everyone at any time and everywhere through the Internet. Learning represents a life-long ongoing activity that allows innovation of processes by establishing new ways of execution in organizations. By introducing dynamics and interactivity, education and acquisition of new knowledge became more attractive. Virtual reality (VR) enables dynamic forms of learning by creating artefacts in virtual environment with activities triggered by learner’s interaction. This paper analyzes current state of VR applications in education of employees in various economy sectors in Slovak Republic based on conducted survey.

Prebriefing is the introductory phase of the simulation process, however, little nursing education research is available on this aspect of simulation. Reflection theory and concept mapping informed a model-based structured prebriefing activity to prepare students for meaningful simulation learning.The aim of this study was to examine the intervention of structured prebriefing for its effect on nursing students' competency performance, clinical judgment and their perceived prebriefing experience.An experimental group-randomized design was used in this study; the intervention group who received structured prebriefing was compared to the control group.The study was conducted at a university school of nursing in Canada.Baccalaureate nursing students (N=76) enrolled in a fourth-year medical-surgical course participated in this study.Competency performance, clinical judgment, and the perception of the prebriefing experience of those participants receiving structured prebriefing and those receiving traditional prebriefing activities, were compared. The relationship between simulation performance and students' self-rated prebriefing experience was also examined. Scores from the Creighton Competency Evaluation Instrument and the Prebriefing Experience Scale were analyzed using parametric and non-parametric statistics.A statistically significant difference was demonstrated between groups for competency performance (p0.001), clinical judgment (p0.001) and prebriefing experience (p0.001). No relationship was found between perception of prebriefing experience and students' simulation performance.Theory-based, structured prebriefing can impact nursing student competency performance, clinical judgment and perceptions of prebriefing, and may enhance meaningful simulation learning.

The paper presents a new approach to creating interactive simulations for testing tactile interaction with the user, which involves use of a low-cost device. The role of the haptic (touch) device and its functionality is achieved by using a manipulator with a parallel kinematic structure (Delta robot). This required the development of methods of integrating a robot with the selected Virtual Reality (VR) systems. Therefore, a new element was introduced into the virtual environment - a device to simulate real objects. In the Virtual Environment (VE), user interacted with a simulated object, and the task of the Delta robot was moving into a position which enabled the interaction. In this way, VE has become more responsive because it corresponded to the behavior of the user, who can move and interact with digital objects and directly experience their physical properties (e.g. size, shape). According to the authors, this type of application will be able in the future to support the effectiveness of virtual training, with particular emphasis on educational simulation (e.g. to perform procedural tasks).

Virtual maintenance, which is widely used in aerospace, automobile, military equipment, etc., has been given abroad attention among equipment life-cycle including concept definition, system design, component production, daily operation, troubleshooting, and so on. Virtual maintenance has been given many different definitions and lot of technologies for implementation, but there is no clear systematic conclusion on the both. Based on the review of the current achievements, the elements of virtual maintenance are extracted, the technologies are systematically explored, and the applications are developed. Meanwhile, the future perspectives of virtual maintenance are discussed associated with virtual reality and augmented reality, multi-person collaboration, remote assistance, as well as artificial intelligence.

Today's young gamers are tomorrow's students who expect more immersion from their online learning experiences. Teachers and administrators, however, must ask are some students at a disadvantage in such a class and does gender play a role? We examine the degree to which gaming experience and gender influence sense of presence in a virtual world learning classroom. Feelings of presence are key to involvement in virtual worlds. Participants, 348 undergraduates, interacted within a custom designed virtual world classroom focusing business negotiation skills. Results reveal that while gaming experience gives a slight advantage, lack of previous software ownership and gender do not put learners at a disadvantage. This finding shows that non-gamers and females can equally participate in a virtual world classroom, relieving concerns of adoption. Display Omitted Students without gaming experience are not significantly disadvantaged when in virtual world instruction.Gender does not influence feelings of presence in a virtual world classroom.Experience of software ownership does not influence feelings of presence.Teachers can confidently implement virtual world learning environments without concern.

Due to changes in health care nurses are achieving more responsibilities. Globally nurses are trained at different educational levels to become registered nurses. All nurses should be able to implement clinical reasoning in chronic and acute patient care. There is uncertainty in health care institutes about the level of performance of clinical reasoning in the intermediate nurses.This cross-sectional study aimed to assess the level of clinical reasoning in intermediate nursing students in different education years. Furthermore, we explored whether the level of clinical reasoning can be explained by years of education and numbers of internship days in different healthcare settings.All second, third and fourth year (n = 151) nursing students of one nursing school in the Netherlands were invited to participate in this study. Levels of clinical reasoning were assessed using the Dutch Lasater Clinical Judgment Rubric (D - LCJR).Twelve experienced nurses assessed the students during two days at the beginning of their education year in an educational simulation setting. Following the assessment protocol, the Rubric was scored in an interview after the students saw their patient.We assessed 119 students. Fourth-year students scored on a significant higher level of clinical reasoning compared to the second - and third-year students (p 0.001). Forty five percent of them reached an accomplished level of clinical reasoning. Second- and third-year students scored similar in their level of clinical reasoning (p = 0.61). In addition to education year an internship in the hospital care also explained the variation in level of clinical reasoning. Together they explained 38% (p 0.001).Intermediate nursing students were successfully assessed on their level of clinical reasoning in an education environment. The level of clinical reasoning could be explained by education year and number of days internship in the hospital care.

The proliferation of hand-held devices offers educators new opportunities to reach students. This paper reviews the current literature on video and online learning as an instructional medium in academia, often created by librarians. Topics examined include distance learning, learning theory, user preference, student motivation, and learning efficiency.

This review evaluates simulation learning experiences of final-year nursing students. Given that a high-fidelity simulation assessment occurs in the topic, this article evaluates the establishment of an unstaffed redo station following simulation debrief as a scaffolded learning strategy. A total of 230 participants of a total cohort of 431 undergraduate final-year nursing students. Likert ratings and open-ended responses in the end-of-topic feedback survey enabled a content analysis of participant experiences with the simulation redo station. Answers from the high number of responses provided interesting insights for why students agreed that the redo station improved their learning experience. The redo station was perceived by students as a positive tool to enhance their own learning. Use of a staffed redo station may further enable student-focused learning. Future exploration of this learning and clinical reasoning in regards to deteriorating patients is warranted.

Simulation for nursing students has gained national attention, but literature does not exist to support planning for activities that take into account prior experience as a health care provider. This phenomenological study explored perceptions of students with prior health care experience about simulation learning within their Associate degree of Nursing (ADN) program. A purposive sample of 19 ADN students who were licensed practical nurses or paramedics was recruited. Qualitative analysis of tape-recorded interviews revealed 7 primary themes about simulation and its importance to these students. Results of the study demonstrated that prior health care experience should be accounted for when planning simulation activities. Nursing students would prefer challenging simulation scenarios building on prior knowledge and skills. In addition, licensed practical nurse (LPN) and paramedic students need assistance with identifying and enacting the role of registered nurse within simulation scenarios.

Background The demand for home health care services is rapidly increasing and is driving a need for additional trained home health care professionals (HHPs). HHPs need effective training for managing personal health and safety hazards encountered when providing health care services in the home environment. The purpose of this article was to describe the process used for developing and evaluating an interactive virtual simulation training system (VSTS) to educate HHP. Sample Sixty-eight HHPs, including nurses, home health aides, occupational and physical therapists, administrators, and health and safety educators, participated in the study. Methods A mixed methods design that included an interdisciplinary, participatory design methodology was used to develop a VSTS to train HHP to identify and manage health and safety hazards in the home using a gaming simulation learning approach. Results This approach has yielded a training package that includes modules addressing electrical and fire hazards; environmental hazards; and lift, slip, and trip hazards routinely encountered by HHP. Conclusions Participatory methods are a useful and effective way to design a VSTS that is interactive, engaging, and informative.

Aim The aims of this qualitative descriptive study were to 1) explore and define radiographers' competence in intravenous pharmacotherapy before and after a simulation-based education, 2) examine radiographer's perceptions of transfer of learning into clinical practice. Method Sixteen diagnostic radiographers in one hospitals' Clinical Radiology Unit were individually interviewed before a multidisciplinary simulation-based pharmacotherapy education intervention in 2012 and fourteen were re-interviewed after the intervention 6–7 months later. Data were analyzed using qualitative content analysis. Results Before education the participants reported uncertain competence in pain management during imaging procedures and acute situations. These weak competence areas identified were strengthened and self-confidence grew. The intervention improved the domains of pharmacotherapy-related patient safety; teamwork development and communication skills. In addition, the radiographers indicated that the iv. pharmacotherapy knowledge from simulation learning was transferred to routine work. Conclusion The results of this study suggest simulation-based education is suitable for radiographers' pharmacotherapy learning. Adequate pain measurement and management are essential during invasive procedures and these skills can be realistically learned in simulations and transferred to clinical practice.

The pressure on the ability of training to teach useful and applied knowledge is growing, as society becomes more competitive and more information consumer. The aim of this research is to show whether the application of a project-based task in virtual groups has led to a greater significant knowledge to participants. Forty teachers who were studying a master program at a fully online institution participated in the study. Teachers worked in groups of 4 or 5 members through forums where they exchanged messages and files during four weeks. They had to carry out a project on how to integrate technology in schools and classes. Three types of knowledge were analyzed: academic, professional and applied. The results of our analysis show significant improvement in all three types of knowledge. Teachers were able to use more ideas, propose more actions and place them in a given context. Our results support project-based learning in virtual environments to foster meaningful learning.

Background Over the past 10 years, simulation-based learning (SBL) has developed as a viable strategy to prepare students for clinical reasoning; however, very little is known about the specific components of the SBL experience and how they affect student learning. Currently, there is a gap in the simulation literature regarding prebriefing and the best strategies for preparing students for SBL. Method A three round modified electronic Delphi design was used to seek consensus from simulation experts about the prebriefing component of SBL. Initial qualitative responses of round one led to the creation of quantitative prebriefing item statements for consideration in rounds two and three. Expert panel members used a Likert scale to indicate agreement with each prebriefing statement. A 70% level of consensus was set as the benchmark. Results An expert panel of Certified Healthcare Simulation Educators reached consensus (>70%) on 83 statements about prebriefing. Findings suggest that prebriefing is an important three-phase process of SBL composed of planning, briefing, and facilitating. Conclusions The panel participants agreed that the simulation educator plays a vital role in preparing simulation participants for a successful SBL experience; however, further clarification of the prebriefing terminology is necessary. Findings of this study may be used to develop guidelines for simulation educators, administrators, and SBL learners to prepare for a successful SBL experience.

The paper reports on the development and evaluation of a virtual reality system to support training in on-line programming of industrial robots. The system was evaluated by running training experiments with three groups of engineering students in the real, virtual and virtual augmented robot conditions. Results suggest that, the group with prior training in the virtual reality system augmented with cognitive/perceptual aids clearly outperformed the group that executed the tasks in the real robot only. The group trained in the non-augmented virtual reality system did not demonstrate the same results. It is concluded that the cognitive/perceptual aids embedded in the augmented virtual reality system had a positive effect on all task performance metrics and on the consistency of results across participants on the real robot. Virtual training environments need not be designed as close as possible to the real ones. Specifically designed augmented cognitive/perceptual aids may foster skill development that can be transferred to the real task. The suggested training environment is simple and cost effective in training of novices in an entry level task.

Background The topics of inclusivity, diversity, and cultural awareness are difficult to adequately explore in a traditional classroom setting. The use of the virtual platform of Second Life® afforded a unique opportunity to use virtual role-play simulation to experience what it is like to walk in another's shoes. Method Fifteen graduate nurse educator students enrolled in a course titled "Inclusivity in Nursing Education" were randomly assigned a customized avatar, representing a marginalized person for use in a role-play simulation in the virtual world of Second Life®. Two written assignments regarding the learning experience were evaluated using a simple qualitative analysis. Results Students indicated that they increased their own capacity to understand, appreciate, and relate to people different from themselves. Conclusion Although future research is needed to determine the full extent to which virtual platforms can be used effectively in nursing education, this case study demonstrated that valuable learning regarding complex topics can take place in the virtual world.

This study is conducted in terms of research and development aiming for developing blended learning model using project-based learning via virtual science laboratory in a science classroom for students in secondary schools. The model could lead students to understand sciences lessons easier and enable to do experiments in lesser time, and encourage them to create new further experiments with curiosity. In addition, the model combines face-to-face learning and learning on online network to optimize the advantages of both methods. The research process is divided into 2 phases: 1) the development of blended learning model using project-based learning via virtual science laboratory, and 2) the affirmation of blended learning model using project-based learning via virtual science laboratory. The research samples are five experts selected by purposive sampling. The research instruments are the model of blended learning model using project-based learning via virtual science laboratory, and the evaluation of the model's appropriateness analyzed by means and standardized deviations statistically. The research result shows that: 1. There are five modules in the model which are 1) Student Module 2) Instructor Module 3) Blended Learning Module from Project-Based Learning and Active learning for students to conducting science projects and to check how much they understand what they have learned 4) Virtual Laboratory Module and 5) Assessment Module. 2. The five experts assessed the instruction model, and pointed out that the developed instruction model is highly appropriate. This shows that the developed instruction model can be used for enhancing analytical thinking skills and evaluation of ability in conducting science projects for secondary students.