Sammendrag
This doctoral thesis examines simulation-based education, the effect of multiple simulation sessions on nursing students’ competence. The article-based thesis consists of three independent research articles and a synopsis. The synopsis includes a discussion of research on nursing competence and the use of simulation-based education in nursing education, an overview of the study’s theoretical perspective, a description of the applied methodology, and a summary of the three research articles. Finally, the synopsis ends with a discussion of the implications of the study’s main findings along with study limitations and potential for further research.
Paper 1, a mixed study systematic review, included in total, 27 studies based on inclusion and exclusion criteria. Four themes were identified; 1) students participated in multiple simulation sessions, over weeks to years, 2) which included 1–4 scenarios in various nursing contexts, 3) simulations were used to prepare for, or partly replace, students’ clinical practice, and 4) learning was described in terms of knowledge, competence, and confidence. The review presents few studies of multiple simulations experienced over more than a year, and there are few randomized studies.
Paper 2 is a longitudinal randomised controlled trial, collecting data four times throughout a 3-year nursing program; at the beginning of the second semester as a baseline and at the end of each of the following academic years. Students experienced either a single (control) or a double (intervention) set of simulation scenarios in four simulation days, including several simulation scenarios for each session. The effect was assessed by analysis of covariance and linear regression, with the measure at the end of the third academic year depending on the group adjusted for the measure at baseline; pre-test scores were the covariates. The results showed no significant differences between double vs single scenario sessions on clinical decision-making score or self-confidence score. However, the overall self-confidence scores increased significantly over time.
Paper 3 is part of a more extensive study (paper 2) examining the effect of simulation-based education, aiming to examine and describe predictors of self-confidence among nursing students attending multiple simulation-based education sessions during a bachelor program. The predictors were the background variables age, gender, former education and work experience, former experience in simulation-based education, and student’s learning mode. The corresponding baseline value was used as the predictor of overall score, as well as all subscales of self-confidence. The student’s preferred learning style at baseline and the end of the educational program were also analyzed. No significant interaction effects were found between the students’ self-confidence at the end of the educational program and predictive factors favoring a double set of simulation scenarios. A majority of participants preferred a concrete learning mode at baseline.
The main contribution of the thesis is increased knowledge about multiple simulation sessions and the effect on nursing students’ competence. Multiple simulation sessions impact nursing students’ competence, implemented in various time frames, over weeks, months, semesters, and years. Longitudinal studies in educational research are a challenge, due to drop out, not mandatory interventions and several pedagogical interventions affecting the competence of graduating students’ Multiple simulation sessions is one of the strategies. By implementing multiple simulation sessions throughout the bachelor program, the student learning with peers, develops the competence corresponding with the expectations of the health care services, ensuring patient safety.
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