Nurse Educators Perceptions Using Simulation in Teaching - Literature review Example

Chapter 2: Literature Review Introduction The literature review in this chapter is based on a multitude of sources, primarily current research studies from peer-reviewed journals. The following databases were used: CINAHL, Proquest, Academic Search Premier and PsychInfo as the data bases to gather the necessary data and information needed. History of simulation, simulations, high fidelity simulation, nursing education, teaching strategies, faculty perceived stumbling blocks and facilitators to high fidelity simulations, extrinsic and intrinsic motivation, human patient simulator, technology, motivation at work, self determination theory, technological readiness and change theory, and instructional strategies were the search terms used. The background information was aided by a number of these articles reviewed, two national reports, websites, three dissertations, as well as textbooks. Theoretical Perspective (Theoretical Lens) The discussion of the paper will focus on Self-Determination Theory (SDT) as noted by Deci & Ryan (2000) to illustrate inspirational strategies that can be adopted to influence Nursing Educators to recognize and implement Simulation in their teaching strategies being incorporated into their curriculum. Motivational levels that can be attached to educators to aid in acquisition of technology will form a significant aspect of the research (Bauman, 2013, p. 134).  Self-Determination Theory (SDT) This theoretical framework was established by Deci and Ryam (2000) aimed to present a platform in which motivational types and levels are measured. It is founded on five mini theories: (Cognitive Evaluation Theory (CET), Causality Orientation Theory (COT), The Basic Psychological Need Theory (BPNT), Goals Content Theory (GCT) and The Organismic Integration Theory (OIT), with each involving around a particular motivational element informed by the need to illustrate motivational situations arising from the research. The Organismic Integration Theory (OIT) This revolves around extrinsic motivation and its associated features, and, on the other hand, looks at the consequences and factors affecting OIT. It particularly focuses on educator’s behavioral outcomes and advocates for increasing extrinsic motivation via autonomy and relatedness multipliers. Goals Content Theory (GCT) This theory emerged in order to draw clear lines of distinctions between intrinsic and extrinsic goals and the associated effects on motivation and wellness alluded to (‘Self Determination Theory’, 2011). The Causality Orientations Theory (COT) This is based on the need to illustrate how individuals’ behavioral actions are framed and regulated based on control, autonomy, and impersonal or Amotive Orientations. Amotive Orientation is pegged at anxiety arising from the incompetency. Approvals and rewards are illustrated by control orientation while interest-based actions executed by individuals as well as phenomenon valuations are studied in Autonomy Orientations. The Basic Psychological Needs Theory (BPNT) This analyzes the interconnection between psychological health and needs for well-being. It is founded on the notion that optimal functioning traces its route on relatedness, autonomy, and competence. (Baard, Deci, & Ryan, 2004, p. 134). Nursing faculty attached-researches identifies technological fear as a barrier to acquisition and implementation of HFS leading to discomfort and insecurity and these barriers are thus weeded out via motivation. Ryan & Deci (2000) sum up that; motivational orientation is based on set goals and attitudes culminating into particular actions. Technological readiness is intrinsic-motivated and embedded on innovativeness as well as optimism as one takes specific interest-driven actions founded on joy and interest (Parasuraman & Colby, 2000). Intrinsic motivation strongly attaches to relatedness, autonomy and urge for competency.Hunger for competency is beneficial to nursing-patient relationships as it has led to increased effectiveness in handling patients by nurses while relatedness has also become impactful as nurses are driven by own desire to be connected while adding experience and caring for patients based on increased urge for interaction (Deci & Vansteenkiste, 2004). Ryan and Deci (2000) attach intrinsic motivation to increased well-being, performance and persistence of one’s life cycle which is beneficial to how nursing students employ the HFS to better the performance and increase patients and self-well-being saves to the deeply-rooted inclination to remain steadfast and interested in novelty. Extrinsic motivations compliments or substitutes intrinsic motivation as some phenomena are best approached via extrinsic mechanism Historical Context of the Study This was based on the history of simulation as the driving force behind the research. The research reveals that, Ed Link invented the first flight simulator that had its fundamental feature as ground-based. Revelations are that; Mr. Link was inspired by his love for flying despite the difficulties to meet the rising and expensive costs (lessons and plane rentals) associated with flight. This explains why Mr. Link spent greater part of his leisure time developing a pilot trainer culminating into a multi-billion dollar industry of simulation. This has seen a simulation continued application in military and airline industry, a strategy that has ensured pilots’ performance skills being in total control and particularly at emergencies. Automobile, nuclear power and space program industries have also remarkably benefited from this innovation as it has presented a cheaper platform for executing tests that would be termed multi-billion if it were to be conducted in the real world. Nursing industry would not be exceptional and subsequently, the first patient simulator, ‘Mr. Chase’, life-sized mannequin embedded in moveable joints was developed. This has, however, been upgraded to incorporate modern hairstyle and various orifices of the body. Mr. Chase trained nursing students in several fields; positioning and performing nursing procedures, as well as bathing. The harvey model simulator, that mimicked cardiac status was established in 1974 and has since remained operational, is used for studying lung and heart sounds following its updates. The mid 1990s saw several technological advances ushering in the current computerized High-Fidelity Simulator that presents a platform in which life-like physiological indices are made possible. Various conditions have thus been represented based on particularly developed scenarios enabling nursing students to approach every rare and high-risks scenarios without fear and despondency. Confidence as HFS (High Fidelity Simulation) Implementation Factor Motivation is a major factor that must be considered in relation to high fidelity simulations. Blum, Borglund, and Parcells (2010) considered this factor in relation to a multitude of components involved in study self-confidence. This research involved a quantitative study regarding elements related to studying self-confidence among students. This research considered that self-confidence among entry-level nursing students. The study specifically involved 53 students who were enrolled in a traditional or simulation based laboratory. The quantitative results indicated that there was an overall improvement in self-confidence throughout the semester. Notably, however, the simulation did not specifically improve the students’ caring attributes throughout the semester. This research was significant in that it demonstrated that teachers needed to develop strategies that would promote the transfer of self-confidence from the laboratory to the clinical setting. Yuan, Williams, and Fang (2011) similarly examined the connection between high fidelity simulation in nursing and its impact on student confidence and competence. While Blum, Borglund, & Parcells (2010) had carried out quantitative research, this study instead implemented a qualitative research approach. The qualitative research design involved eighteen English and six Chinese students who were examined in this study. The research showed that among these research participants there was only a slight reason to believe that they had a tangible impact on improving confidence and competency among students. Simulation as a Strategic Approach to Teaching Nursing Students Dissenting arguments have emerged between opponents and proponents of the simulation adoption and implementation strategy for teaching nursing students based on its pros weighed against cons. Proponents hold the view that vast gains have been recorded for those institutions that have simulation as a compliment to other teaching methodologies based on its fundamental feature of a ‘learning by doing’ approach (Schlairet & Pollack, 2010, Fero, et al., 2010). However, conflicting accounts have emerged that have situated high fidelity simulation as an ineffective solution to improving nurse outcomes (Yuan, Williams, & Fang, 2011). Radhakrishnan, Roche & Cunningham, 2007, Ravert, 2008 and Horan, 2009). Such arguments are all research based and this makes each side strongly believe in their position; however, lack of standard HFS evaluation tools and randomization, methodological differences in measuring gained knowledge, and the use of small samples sizes have been conventionally agreed across the board as stumbling blocks leading to such variations in findings. Perception of Nursing Students to High-Fidelity Simulation (HFS) A significant amount of studies examined nursing students’ perceptions of high-fidelity simulation. Leonard and Chen (2010) indicated that a lack of studies have been carried out that have examined nursing students’ perceptions of using high-fidelity simulation. This study implemented a quantitative research design to examine the link between nursing students’ perceptions. In this study, 48 BSN students were placed in intra-professional teams. Each team had one student from each nursing level. The nursing students were instructed to manage the clinical scenario based on their level of competence and education. The students responded to a satisfaction survey about their perceptions of learning within this learning team. The study results found that the “intraprofessional educational experiences provide rich learning opportunities for both third-year and fourth-year nursing students” (Leonard & Chen, 2010). The research study also suggested that the simulations provide a means to support intraprofessional nursing student education. Guhde (2011) extended the examination of these perceptions through analyzing the link between nursing student perceptions on the impact that this learning method had on critical thinking, assessment, and learner satisfaction in simple vs complex high fidelity simulation scenarios. This research demonstrated that while no significant different was found between the simple and complex assignments, in both instances the research attested to the simulations having a positive impact on the nursing students’ abilities in the different nursing roles. While Leonard & Chen (2010) and Guhde (2011) examined the connection between high-fidelity simulations and nursing student perceptions, Partin, Payne, and Slemmons (2011) extended this analysis by examining the perceptions of nursing student teachers. This study specifically implemented a qualitative research design that required students to describe the self-perceptions of their learning experience in relation to their teaching of obstetrics. The students were required to attend simulation experiences in obstetrics and spend clinical time in a hospital. After these learning experiences the students were required to audiotape their perceptions and reflections on the experience. This research found that three themes emerged: “the nonthreatening environment, enhancement of learning, and feeling prepared for practice” (Partin, Payne, & Slemmons, 2011, p. 186). Perception of Nurse Educators to High-Fidelity Simulation (HFS) to weed the earlier stumbling blocks reported by Nehring and Lashley culminating into sixty two percent of 21 nursing schools further attaching the laxity to technological adoption on inadequacy of training as 73% of faculty had never engaged in HFS educational training. Qualitative open-ended-based questionnaires revealed greater lack of confidence to use HFS and negative attitude towards the technology cut across the faculty recipients.Kardong-Edgren (2008) employed diffusion of innovation theory in Washington. Enthusiasm and interest establishments within the faculty were the driving forces behind this study as this approach was attached to the platform where HFS utilization and acceptability would be greatly enhanced. According to Halstead, Phillips , Hardin, Porter and Dwyer (2011), descriptive exploratory study of nursing faculty, results that were published circumvented around establishment of consortium aimed at achieving a specific objective, collaboration enhancement as well as definition of best practices. The main outcomes were the fact that nurses had a deeply-rooted belief that development of nursing students’ clinical decisions was strongly founded on simulation. They further revealed that huge fiscal resources time as a factor in determining application of High-Fidelity Simulation in the faculty programs and that such factors pose greater threats in the rate of the technology adoption despite positive attitudes of the faculty stakeholders. A recommendation was successfully arrived at eyed at formation of a working partnership between practice institutions and academia, a strategy projected to greatly impacted faculty by enhancing efficient and effective utilization of the available scarce resources. The partnership would be embedded in a consortium model that would translate reduced unfair competition emptying into increased harmonious collaborations and mutual relationships between academia and faculty schools. Besides Partnership as a facilitator to drive simulation adoption, highly- rated training levels, support from collages, self-interest in technology was earmarked as the incentives to drive an elaborate adoption and utilization of HFS in the faculty (Adamson 2010; and Halstead et al., 2011).. Jansen, Johnson, Larson, Berry & Brenner (2009); and Adamson (2010 have also incorporated time constraints, staffing, funding a further supported the notion of space inadequacy and lack of training as erected obstacles to HFS adoption and utilization in the Nursing faculty. Besides these elements,, difficulty with respect to operation of complex simulators equipment, knowledge of blending simulation within curriculum, much committed time and technology fear have also remained projected as escalating downfalls based on the findings (Jansen, Johnson, Larson, Berry & Brenner (2010). Jansen, Johnson, Larson, Berry & Brenner (2010) held the view that faculty interest was the bedrock in determining whether to adopt HFS as bringing it underfoot was so a hardpan. The National Council of State Boards of Nursing (NCSBN), conducted a survey in 2010 that was eight questions questionnaire-based framed in a manner to unearth opinions with respect to simulation and programs (1,729 programs) utilization of simulation. An encouraging response was felt with 81 percent of the respondents opting for incorporation of simulation as a teaching strategy in the faculty. A major challenge arose with respect to simulation vendors that were not experts in the faculty hence could not provide the necessary and sound training required to implement HFS hence recommendation on more strategies to approach training, increased utilization of disposable equipment as well increased funding for further academic studies were inevitable. According to Anderson, Bond, Holmes, & Cason (2012), held that fact that a descriptive study of nurse educators during the simulation conference was majorly focused on simulation users. Practice with feedback with someone already endowed with simulation skills emerged at 52% as the overriding learning approach while observations stood at 7% for the acquisition of simulation in the nursing faculty. Linking simulation to course objective was rated at 74%, while 67% linked simulation activities to program objectives and 71% rated simulation to managing simulation experience out of the reported percentage of 95% using simulation. The report also revealed that less proficiency was recorded in writing scenarios (57%) and 33% having a challenge on programming scenarios. Weaver (2011) conducted a review of the impact that high fidelity nursing simulations had within nursing undergraduate education. This research demonstrated that these simulations had positive benefits on nursing students through their impact on knowledge, realism, and learner satisfaction. However, they argued that findings were not as strong in terms of knowledge transfer and stress. Burns, ODonnell, and Artman (2010) also examined the use of high fidelity simulation in undergraduate education. This study considered the potential impact that it had on facilitating the understanding of 1st-year nursing students’ learning of problem-solving skills. The research indicated that among the population sample, “All students (114) showed a significant positive difference for multiple attitudinal items, including critical thinking skills, overall nursing knowledge, confidence, and communication” (Burns, ODonnell, & Artman, 2010, p. 87). In these regards, the research findings both confirmed and rejected those established by Weaver (2010). Specifically, Burns, ODonnell, & Artman (2010) disagreed with Weaver (2011) regarding the extent that the simulations truly had a positive impact on student confidence levels. Other research established further tangible connections and impacts of these studies. Gates, Beth Parr, and Hughen (2012) recognized the impact that nursing simulations had on improving student outcomes. The research showed that the simulations not only improved student test scores, but can also be an effective substitute for the traditional forms of clinical experience. Not all accounts focused on the positive aspects of high fidelity nursing simulations. Neill (2011) raised a significant argument surrounding impact of this in relation to debriefing. In these regards, simulation debriefing was a significant process with regards to the impact of simulations and the argument was that further research needed to be conducted that examined the link between simulations and debriefing. Rourke, Schmidt, and Garga (2010) examined the degree to which theory-based research has contributed to individuals’ understandings of the use of high-fidelity simulations in nursing education. The research indicated that only 10% of the studies made consistent use of theory regarding the simulations; although 45% did make minimal use. These research findings suggest that a greater amount of theory-based research needs to be incorporated into the study of and the use of simulations in nursing education. Harder (2010) systematically identified and reviewed 23 2003-2007 publications (health care practitioners conducted 10 articles and 13 were nursing students oriented) with an 16 article focusing on nursing faculty on a an overall perspective based on healthcare education particularly, on the effectiveness of HFS as an approach to education strategy for clinical performance and skills. Simulation was unique in approaching education as it was characterized by computer-based programs, lecture classes, and psychomotor skills laboratory sessions with task trainers aimed at enhancing student’s clinical skills, unlike traditional learning strategies. Slight differences were spotted by three studies between simulation and traditional teaching methodologies, but a limitation of the Harder study was on the silent on diminishing in simulation lot. In 2010, Lapkin, Levett-Jones, Bellchambers, & Fernandez executed a study on focused on a review of Human Patient Simulation Mannequins (HPSMs) to determine its efficiency and effectiveness as a teaching strategy to reasoning ability of undergraduate nursing students. Inclusion criterion was met by nine articles seeing a deduction made that HPSMs had greatly enhanced three outcomes (critical thinking, ability to identify deteriorating patients and knowledge acquisition), fundamentally significant to clinical reasoning. The study also revealed silence on direct measurement of clinical reasoning methodologies. Simulation was also attached to significant strategy in facilitating the transition of graduate students to staff as revealed by McCaughey and Traynor (2010). This research concluded that simulation was vital in linking theory to real-life practice based on promising agreement by student’s response that SLE experience greatly enhanced their preparedness for transition to qualified experts in the nursing industry based on 72% positive response to sample size of 67 students questioned with 92.5% of sample size of 86 students attaching their increased confidence in simulation. Synthesis of the Findings Simulation has greatly contributed to increased safety of patients as errors have been eliminated. Critical reasoning is one of the fundamental features of HFS which has translated into increased adoption and implementation of the technology. Many researches conducted with respect to nursing faculty have revealed more pros than cons arising from the adoption of HFS. Motivation is found to have played a pivotal role in enhancing technological readiness based on the reduced fear of HFS adoption culminating into increased benefits as simulation have successfully been incorporated into a teaching strategy to nursing students. Barriers identified to illustrate the reason behind slow rate of HFS adoption have subsequently been addressed ranging from high initial costs of implementation where grants are being diverted to nursing schools, a phenomenon that was not executed in earlier teaching strategies. Increased ease of scenario development which can explain real-life situation have been felt making nurse educators and students to follow what is taught as a platform is presented where experiments and tests are proactively undertaken with minimal consequences for patients. Based on enhancement of transition from students to qualified nursing experts, simulation was reported to be the major contributor in shaping and ensuring preparedness of professionals to engage in real practice. Many respondents positively held the view that simulation help translates theoretical knowledge on a practical basis culminating into increased reasoning and great care when nurse students execute their duties. Besides, several challenges have also been associated with simulation based on lack funding for continuous nursing education, time constraints, fear of technological adoption but these challenges have only presented a platform for further research, culminating in increased understanding of weaknesses and strengths of the previously conducted research. This translates into better approaches based on readjustments of existing teaching strategies. Identification of Gaps and Limitations of the Literature The researcher unearths several gaps in the literature; sample sizes used were either small that might have not yielded tangible findings, measurability of impacts of motivation was also silent and never illustrated, the need for huge financial expenses and time commitments required was not proactively questioned based on whether HFS benefits warranted such undertakings. The literature only focused on motivation as the sole factor influencing HFS adoption by educators and nursing institutions but was silent on other elaborate and effective factors that could culminate to increased utilization of HFS. The literature reviewed failed to unearth the primary role of simulation, and loose ends arise as to whether simulation is focused on high-stakes evaluation or as teaching strategy. = Lack of standard HFS evaluation tool and randomization, methodological differences in measuring gained knowledge, use of small samples sized have been conventionally agreed across the board as limitations leading to dissenting arguments with respects to impacts attributable to incorporation of High-Fidelity Simulation into Nursing Education Curriculum . Financial support remains the greatest limitation of the research as it was quite interesting to note the college campuses got more grants as compared to nursing schools. Reference Adamson, K. (2010). Integrating human patient simulation into associate degree nursing curricula: Faculty experiences, barriers, and facilitators. Clinical Simulation in Nursing. Baard, P., Deci, E., & Ryan, R. (2004). 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