Introduction This case study has examined the functioning and effects of simulation training within the bachelor’s level nursing program at Copenhagen University College (KP). The study involved a range of data collection methods to better understand the various potential effects of simulation. The study was part of the Pathways to the Improvement of Quality in Higher Education (PIQUED) project, funded by the Danish Ministry of Higher Education and Science.

Research question

What are the effects of simulation training on knowledge gained, skills performance, critical thinking, and self-confidence for nursing students?

As simulation has become increasingly prevalent in nursing education, there has been a growing need for research on the effects of simulation (Mancini et al., 2019). A large number of studies have been conducted in the last 10-15 years, utilizing a range of qualitative and quantitative approaches (Hayden et al., 2014; Laschinger et al., 2008; Lapkin et al., 2010; Husebø et al., 2018; Yuan et al., 2012). However, the results of many of these studies have been unclear, often having small sample sizes, lacking control groups, and with some results pointing to positive effects of simulation while others fail to find any.

This study took an alternative approach, studying the effects of expanding simulation training for nursing students rather than using it as a substitute.

Methods The study conducted a controlled field experiment within the nursing program at the University College Copenhagen. 10 classes (approximately 40 students each) were block randomized into an intervention and a control group. The control group participated in a standard 5^th-semester program (including a 3-hour simulation program), while the intervention group participated in an extended 3-day simulation program including full-scale simulation scenarios, peer-to-peer (P2P) sessions, and SMART GOAL Debriefings. The intervention group also participated in an additional 2-day simulation program in the 6th semester, where students were undertaking clinical training.

Surveys were conducted both prior to and immediately after simulation training, and covered self-assessment of technical and non-technical skills, expectations, stress levels, and perceived outcomes (Fuglsang et al., 2022). Additional data were collected at the end of clinical training in the 6th semester to measure the persistence of any initial effects. Data on before (after the 4th semester) and after (end of 5th and 6th semester) differences in grade point averages was also collected (Fuglsang et al., 2022).

Results Students in the intervention group who received extended simulation training reported markedly higher levels of professional self-confidence immediately after training. This effect for confidence in technical skills was double the size of the effect for non-technical skills. The effects on self-confidence in technical skills persisted at the end of the following semester for those that received low-intensity clinical training (health cares in a non-hospital setting). Students in the treatment group gained a small (though statistically insignificant) relative increase in grade attainment after the 5th semester, though this difference dissipated over time.

The study indicates that simulation training has substantial positive short-term effects on the professional self-confidence of nursing students and appears to have smaller positive effects on knowledge acquisition. Most of these effects are crowded out by other factors over time (notably intensive clinical training), but might have long-term positive effects for those that receive less intensive clinical training experiences. These results thus provide an indication that simulation training as part of nursing education can be used as an effective tool to support the transition to clinical training and practice.

References

1. Fuglsang S, Bloch CW, Selberg H. Simulation training and professional self-confidence: a large-scale study of third year nursing students. Nurse Education Today 2022;108:105175.

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

3. Husebø SE, Silvennoinen M, Rosqvist E, Masiello I. Status of Nordic research on simulation-based learning in healthcare: an integrative review. Advances in Simulation.2018;3(1):1-20.

4. Lapkin S, Levett-Jones T, Bellchambers H, Fernandez R. Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing. 2010;6(6):e207-e222.

5. Laschinger S, Medves J, Pulling C, McGraw DR, Waytuck B, Harrison MB, Gambeta K. Effectiveness of simulation on health profession students’ knowledge, skills, confidence and satisfaction. International Journal of Evidence-Based Healthcare. 2008;6(3):278-302.

6. Mancini ME, LeFlore JL, Cipher DJ. Simulation and clinical competency in undergraduate nursing programs: a multisite prospective study. Journal of Nursing Education. 2019;58(10):561-568. https://doi.org/10.3928/01484834-20190923-02

7. Yuan HB, Williams BA, Fang JB. The contribution of high-fidelity simulation to nursing students’ confidence and competence: a systematic review. International Nursing Review. 2012;59(1):26-33.