| Objective: The aims of this study were to explore the application status of scenariobased simulation in Fundamentals of Nursing training course of undergraduate nursing colleges in China and analyze the existing problems and challenges through quantitative research method.The qualitative research method was adopted to clarify the learning needs of undergraduate nursing students for scenario-based simulation in Fundamentals of Nursing training course.By integrating the results of quantitative research and qualitative research,the scenario-based simulation program of Fundamentals of Nursing training course based on INACSL Standards of Best Practice: Simulation was constructed.By means of experimental research method,the effectiveness and feasibility of the simulation program were verified,so as to provide reference for the popularization and application of scenario-based simulation in undergraduate nursing education and the reform of nursing skills training education in China.Methods: A mixed-methods studyPart I: The application status of scenario-based simulation in Fundamentals of Nursing training course in undergraduate nursing collegesThis part of the study is a cross-sectional study design.Using convenience sampling,123 teachers who participated in Fundamentals of Nursing training course in domestic undergraduate nursing colleges were selected as samples.The research tool is a questionnaire on the application status of scenario-based simulation in Fundamentals of Nursing training course in undergraduate nursing colleges compiled by the researcher under the guidance of INACSL Standards of Best Practice: Simulation.SPSS21.0 software was used for statistical analysis of the data,and descriptive statistical analysis was used to understand the application status of scenario-based simulation in Fundamentals of Nursing training course.Part Ⅱ: Study on needs assessment of scenario-based simulation in Fundamentals of Nursing training course in undergraduate nursing collegesThis part of the study is a descriptive qualitative study design.Fourteen undergraduate nursing students and nine clinical supervisors from September 2019 to February 2020were selected by the purpose sampling method combined with maximum difference sampling strategy to conduct semi-structured interviews.Content analysis method was used to organize and analyze the transcribed text data.Part Ⅲ: The development of scenario-based simulation program of Fundamentals of Nursing training course based on INACSL Standards of Best Practice: Simulation This part combined the results of quantitative and qualitative research to clarify the overall outcomes,simulation modality and skills of the scenario-based simulation program.Under the guidance of NLN Jeffries simulation theory and INACSL Standards of Best Practice: Simulation,the elements of the simulation program were determined,and the specific contents of each element were refined by referring to the Fundamentals of Nursing textbook and the clinical practice guidelines of related skills.Then,the simulation program was initially constructed.Through expert meeting and pilot test,the simulation program was revised and improved.After evaluating the content validity of the simulation program and the inter-rater reliability of the evaluation tool,the final draft of the simulation program was formed.Content validity index was used to evaluate the content validity,intra-class correlation was used to evaluate the inter-rater reliability.SPSS21.0 software was used for statistical analysis of the data.Part Ⅳ: The verification of scenario-based simulation program of Fundamentals of Nursing training course based on INACSL Standards of Best Practice: Simulation This part of the study is an experimental study design.Sophomore nursing students were selected as the study subjects.By random sampling method,3 out of 5 classes of2019 cohort were selected to participate in the scenario-based simulation of scalp needle intravenous infusion,and 3 out of 5 classes of 2020 cohort were selected to participate in the scenario-based simulation of nasal feeding.The three selected classes were divided into traditional teaching group,directive feedback simulation group(simulation group 1)and debriefing simulation group(simulation group 2)by using the whole group random grouping method.The traditional teaching group were taught by demonstrations-practice-return demonstrations-directive feedback mode.Simulation group 1 were taught by demonstrations-practice-briefing-facilitationdirective feedback mode.Simulation group 2 were taught by demonstrations-practicebriefing-facilitation-debriefing mode.The research tools include: the general demographic questionnaire,knowledge questionnaire,nursing skills rubric,Student Satisfaction and Self-confidence in Learning Scale,Chinese Version of Critical Thinking Disposition Inventory,Simulation Design Scale.SPSS21.0 software was used for statistical analysis of the data,and descriptive statistical analysis and univariate analysis were used to verify the effectiveness of the scenario-based simulation program.In this study,P<0.05 was considered statistically significant.Results: Part I: The application status of scenario-based simulation in Fundamentals of Nursing training course in undergraduate nursing colleges123 teachers from 50 undergraduate nursing colleges were enrolled in the survey.Among the 123 teachers,64(52.0%)had not applied scenario-based simulation in the Fundamentals of Nursing training course,59(47.9%)had carried out or were carrying out scenario-based simulation;among the 59 teachers,the earliest year to carry out scenario-based simulation was 1998,and the latest year was 2019.Role-playing(91.5%)and task trainer(86.4%)were the most commonly used simulation modalities by nursing teachers.Only 5 teachers(8.5%)were familiar with and applied INACSL Standards of Best Practice: Simulation in the process of scenario-based simulation;4teachers(11.1%)used debriefing based on the theoretical model;7 teachers(11.9%)used evaluation tools with good reliability and validity.The design of standardized scenarios(61.0%),let students actively participate in scenario-based simulation(50.8%),and students keep silent during debriefing(47.5%)were the main difficulties encountered by teachers in the process of applying scenario-based simulation.Part Ⅱ: Study on needs assessment of scenario-based simulation in Fundamentals of Nursing training course in undergraduate nursing colleges1.Participant sociodemographic: 14 undergraduate nursing students,aged from 21 to24(21.93±0.82)years,were included in this part of the study.They were from 7different practice hospitals,and the practice time was 3～8 months.There were 9clinical supervisors,aged from 33 to 43(35.56±2.96)years,from 8 different departments of 6 hospitals,respectively.The work experience ranged from 10 to 24(12.67±4.44)years.The clinical supervision experience of undergraduate nursing students ranged from 5 to 10(6.56±1.81)years.2.The results of qualitative interview: after summarizing and refining the interview contents of undergraduate nursing students and clinical supervisors,five themes were obtained:(1)The impact of clinical real situation;(2)Problems existing in the implementation of nursing skills of undergraduate nursing students;(3)There is a gap between skills teaching and clinical practice;(4)Inconsistent clinical practice opportunities;(5)The importance of confidence.Part Ⅲ: The development of scenario-based simulation program of Fundamentals of Nursing training course based on INACSL Standards of Best Practice: Simulation1.This part of the study formed scenario-based simulation program of scalp needle intravenous infusion and nasal feeding,including 11 elements: learners,learning objectives,simulation modality,scenario,scenario setting,briefing plan,scenario running process,debriefing strategy,standardized patient training,rubric and reference.2.The results of the reliability and validity test of the simulation program: the content validity index of scalp needle intravenous infusion simulation program was 0.93,and the inter-rater reliability of the rubric was 0.81 ～ 0.98.The content validity index of the nasal feeding simulation program was 0.92,and the inter-rater reliability of the rubric was 0.89 ～ 0.98.Part Ⅳ: The verification of scenario-based simulation program of Fundamentals of Nursing training course based on INACSL Standards of Best Practice: Simulation1.Baseline comparison: there was no statistically significant in participant sociodemographic among the three groups(P>0.05),indicating comparability.2.The effect of scenario-based simulation on professional knowledge of undergraduate nursing students: there was no significant difference in professional knowledge scores before intervention among the three groups of scalp needle intravenous infusion and nasal feeding(P>0.05);after intervention,the scores in professional knowledge of nursing students within the three groups were significantly improved(P < 0.05).Comparison between groups,for nasal feeding,scores in professional knowledge were significantly higher in the simulation group 1 and simulation group 2 than those in the traditional teaching group [19.00(17.00,21.00)vs.16.00(14.00,18.50),20.00(15.75,21.25)vs.16.00(14.00,18.50),P<0.05].There was no significant difference in professional knowledge scores among the three groups of scalp needle intravenous infusion(P>0.05).3.The effect of scenario-based simulation on skills of undergraduate nursing students:after intervention,for scalp needle intravenous infusion,the difference in the skill scores of nursing students in the three groups was statistically significant(P<0.05).among them,the skill scores of simulation group 2 were significantly higher than those of the other two groups [92.00(89.00,95.00)vs.87.00(82.50,93.00),92.00(89.00,95.00)vs.88.50(83.00,92.75),P<0.05].There was no significant difference in skill scores among the three groups of nasal feeding(P>0.05).4.The effect of scenario-based simulation on satisfaction and self-confidence of undergraduate nursing students: after intervention,there were statistically significant differences in the average scores of satisfaction and self-confidence of nursing students in the three groups of scalp needle intravenous infusion and nasal feeding(P<0.05).For scalp needle intravenous infusion,the average scores of satisfaction of nursing students in simulation group 1 and group 2 was significantly higher than those in traditional teaching group [(4.47±0.41)vs.(4.13±0.57),(4.52±0.51)vs.(4.13±0.57),P<0.05],the average scores of self-confidence in simulation group 1 and group 2were significantly higher than those in traditional teaching group [(4.13±0.40)vs.(3.70±0.50),(4.19±0.60)vs.(3.70±0.50),P<0.05].For nasal feeding,the average scores of satisfaction of nursing students in simulation group 1 and group 2 were significantly higher than those in traditional teaching group [(4.46±0.47)vs.(3.93±0.40),(4.60±0.38)vs.(3.93±0.40),P < 0.05],the average scores of selfconfidence in simulation group 1 and group 2 were significantly higher than those in traditional teaching group [(4.20±0.64)vs.(3.59±0.45),(4.16±0.42)vs.(3.59±0.45),P<0.05].5.The effect of scenario-based simulation on critical thinking of undergraduate nursing students: before intervention,there was no significant difference in the total score of critical thinking and scores of all dimensions between the three groups of scalp needle intravenous infusion and nasal feeding(P>0.05);after intervention,for these two skills,there was no significant difference in the total score of critical thinking and scores of all dimensions within and between the three groups(P>0.05).6.The evaluation of scenario-based simulation design: the average scores of 5scenario-based simulation design features of scalp needle intravenous infusion and nasal feeding were higher than 4 points.Conclusion: 1.Scenario-based simulation is rarely used in Fundamentals of Nursing training course,which starts late and lacks the guidance of INACSL Standards of Best Practice: Simulation.Nursing teachers did not effectively practice the elements related to high quality simulation in the process of implementing scenario-based simulation.The main difficulties for nursing teachers are designing standardized scenarios and the lack of students’ participation during simulation.It is suggested that the future scenario-based simulation should follow the guidance of the best practice standard to ensure the effect of simulation.2.The undergraduate nursing students have clear learning needs for the scenario-based simulation of Fundamentals of Nursing training course.In the development of scenario-based simulation program,the learning needs of undergraduate nursing students can be effectively utilized to transform them into simulation learning objectives and guide the design of standardized scenarios.On this basis,a targeted scenario-based simulation program can be built.3.In this study,the scenario-based simulation program of Fundamentals of Nursing training course based on INACSL Standards of Best Practice: Simulation was constructed,including 11 elements: learners,learning objectives,simulation modality,scenario,scenario setting,briefing plan,scenario running process,debriefing strategy,standardized patient training,rubric and reference.It can provide reference for the application research of scenario-based simulation4.Scenario-based simulation can effectively improve the professional knowledge,skills level,satisfaction and self-confidence of undergraduate nursing students;however,it has no significant effect on critical thinking.Undergraduate nursing students have higher evaluation on the design of scenario-based simulation.The effect of debriefing on skills level of undergraduate nursing students is better than directive feedback.It is suggested that nursing teachers should use debriefing to guide nursing students to complete the reflection and discussion during the implementation of scenario-based simulation,so as to maximize the effect of scenario-based simulation. |
