Clinical simulation for nursing competence development in cardiopulmonary resuscitation: systematic review

Nascimento, Juliana da Silva Garcia; Nascimento, Kleiton Gonçalves do; Oliveira, Jordana Luiza Gouvêa de; Alves, Mateus Goulart; Silva, Aline Roberta da; Dalri, Maria Celia Barcellos

doi:10.1590/1518-8345.4094.3391

Juliana da Silva Garcia Nascimento Corresponding author: Juliana da Silva Garcia Nascimento, E-mail: mestradounesp28@yahoo.com.br

Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

http://orcid.org/0000-0003-1118-2738

Kleiton Gonçalves do Nascimento

Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

http://orcid.org/0000-0002-2717-6837

Jordana Luiza Gouvêa de Oliveira

Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0001-5905-8993

Mateus Goulart Alves

Universidade de Franca, Franca, SP, Brazil.

http://orcid.org/0000-0003-0680-6817

Aline Roberta da Silva

Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0001-8214-5534

Maria Celia Barcellos Dalri

Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0002-8173-8642

Corresponding author: Juliana da Silva Garcia Nascimento, E-mail: mestradounesp28@yahoo.com.br

Associate editor: Maria Lúcia Zanetti

Questions	Bruce, et al.⁽²²22 Aqel AA, Ahmad MM. High-fidelity simulation effects on CPR knowledge, skills, acquisition, and retention in nursing students. Worldviews Evid Based Nurs. 2014 Dec;11(6):394-400. doi: 10.1111/wvn.12063 https://doi.org/10.1111/wvn.12063... ⁾	Ackermann⁽²³23 Tawalbeh LI, Tubaishat A. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan. J Nurs Educ. 2014 Jan;53(1):38-44. doi: 10.3928/01484834-20131218-01 https://doi.org/10.3928/01484834-2013121... ⁾	Akhu-Zaheya, et al.⁽²⁴24 Bruce AS, Scherer YK, Curran CC, Urschel DM, Erdley S, Ball LS. A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest. Nurs Educ Perspect. [Internet]. 2009 Jan-Feb [cited Jan 13, 2019];30(1):22-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19331035 https://www.ncbi.nlm.nih.gov/pubmed/1933... ⁾
1. Is it clear in the study what the “cause” and “effect” are, that is, is there no confusion which variable comes first?	Yes	Yes	Yes
2. Do the participants included in the groups have similar characteristics for comparison?	Yes	Yes	Yes
3. Did the participants included in the groups receive similar treatment in the intervention of interest?	Yes	Yes	Yes
4. Was there a control group?	Yes	Yes	Yes
5. Were there multiple measurements of the pre- and post-intervention/exposure outcome over time?	Yes	No	No
6. Was the follow-up complete and, if not, were the differences between the groups properly described and analyzed?	Yes	Yes	Yes
7. Were the participants’ results, in any comparisons, measured in the same way?	Yes	Yes	Yes
8. Were results measured reliably?	Yes	Yes	Yes
9. Were appropriate statistical analyzes used?	Yes	Yes	Yes

Questions	Aqel, et al.⁽²⁵25 Ackermann AD. Investigation of Learning Outcomes for the Acquisition and Retention of CPR Knowledge and Skills Learned with the Use of High-Fidelity Simulation. Clin Simul Nurs. 2009 Nov-Dec;5(6):e213-e222. doi: 10.1016/j.ecns.2009.05.002 https://doi.org/10.1016/j.ecns.2009.05.0... ⁾	Tawalbeh, et al.⁽²⁶26 Akhu-Zaheya LM, Gharaibeh MK, Alostaz ZM. Effectiveness of Simulation on Knowledge Acquisition, Knowledge Retention, and Self-Efficacy of Nursing Students in Jordan. Clin Simul Nurs. 2013 Sep;9(9):e335-e342. doi: https://doi.org/10.1016/j.ecns.2012.05.001 https://doi.org/10.1016/j.ecns.2012.05.0... ⁾
1. Was the randomization used to allocate participants to treatment groups?	Yes	Yes
2. Was the researcher responsible for allocation to the treatment groups blinded?	It is not clear	It is not clear
3. Were the treatment groups similar?	Yes	Yes
4. Were the participants blinded in allocating treatment?	It is not clear	It is not clear
5. Were those responsible for providing treatment blinded?	It is not clear	It is not clear
6. Were the outcome assessors blinded regarding the allocation of treatment?	It is not clear	It is not clear
7. Were the treatment groups treated in the same way as the intervention of interest?	Yes	Yes
8. Was the follow-up completed and, if not, were the differences between the groups in terms of follow-up properly described and analyzed?	Yes	Yes
9. Were the participants analyzed in the groups to which they were allocated?	Yes	Yes
10. Were the results measured in the same way for treatment groups?	Yes	Yes
11. Were the results measured reliably?	Yes	Yes
12. Was appropriate statistical analysis used?	Yes	Yes
13. Was the study design appropriate, and was there any deviation from the standard RCT^* * RCT = Randomized clinical trial design in conducting and analyzing?	Yes	Yes

Domains	Bruce, et al.⁽²²22 Aqel AA, Ahmad MM. High-fidelity simulation effects on CPR knowledge, skills, acquisition, and retention in nursing students. Worldviews Evid Based Nurs. 2014 Dec;11(6):394-400. doi: 10.1111/wvn.12063 https://doi.org/10.1111/wvn.12063... ⁾	Ackermann⁽²³23 Tawalbeh LI, Tubaishat A. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan. J Nurs Educ. 2014 Jan;53(1):38-44. doi: 10.3928/01484834-20131218-01 https://doi.org/10.3928/01484834-2013121... ⁾	Akhu-Zaheya, et al.⁽²⁴24 Bruce AS, Scherer YK, Curran CC, Urschel DM, Erdley S, Ball LS. A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest. Nurs Educ Perspect. [Internet]. 2009 Jan-Feb [cited Jan 13, 2019];30(1):22-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19331035 https://www.ncbi.nlm.nih.gov/pubmed/1933... ⁾	Aqel, et al.⁽²⁵25 Ackermann AD. Investigation of Learning Outcomes for the Acquisition and Retention of CPR Knowledge and Skills Learned with the Use of High-Fidelity Simulation. Clin Simul Nurs. 2009 Nov-Dec;5(6):e213-e222. doi: 10.1016/j.ecns.2009.05.002 https://doi.org/10.1016/j.ecns.2009.05.0... ⁾	Tawalbeh, et al.⁽²⁶26 Akhu-Zaheya LM, Gharaibeh MK, Alostaz ZM. Effectiveness of Simulation on Knowledge Acquisition, Knowledge Retention, and Self-Efficacy of Nursing Students in Jordan. Clin Simul Nurs. 2013 Sep;9(9):e335-e342. doi: https://doi.org/10.1016/j.ecns.2012.05.001 https://doi.org/10.1016/j.ecns.2012.05.0... ⁾
Study design	Non-randomized: 2 points	Non-randomized: 2 points	Non-randomized: 2 points	Randomized study: 3 points	Randomized study: 3 points
Sample (number of centers where the study was conducted and response rate)	A single institution: 0.5 point 50%-74% response rate: 1 point	A single institution: 0.5 point >75% response rate: 1.5 point	A single institution: 0.5 point 50%-74% response rate: 1 point	A single institution: 0.5 point >75% response rate: 1.5 point	A single institution: 0.5 point >75% response rate: 1.5 point
Data type/evaluation	Subjective evaluation: 1 point Objective evaluation: 2.0	Objective evaluation: 2.0 points	Objective evaluation: 2.0 points	Objective evaluation: 2.0 points	Objective evaluation: 2.0 points
Validity of the evaluation instrument	Internal structure, content, relations with other unreported variables: 0 point	Internal structure and reported content: 1 point Relations with other unreported variables:0	Internal structure and reported content: 1 point Relations with other unreported variables:0	Internal structure, content, relations with other unreported variables: 0 point	Internal structure and reported content: 1 point Relations with other unreported variables:0
Data analysis	Appropriate for study design: 1 point In addition to the descriptive analysis: 2 points	Appropriate for study design: 1 point In addition to the descriptive analysis: 2 points	Appropriate for study design: 1 point In addition to the descriptive analysis: 2 points	Appropriate for study design: 1 point In addition to the descriptive analysis: 2 points	Appropriate for study design: 1 point In addition to the descriptive analysis: 2 points
Results	Knowledge and skills: 1.5 points Satisfaction, attitudes, perceptions, opinions, general facts and confidence: 1 point	Knowledge and skills: 1.5 points	Knowledge and skills: 1.5 points Satisfaction, attitudes, perceptions and confidence: 1 point	Knowledge and skills: 1.5 points	Knowledge and skills: 1.5 points Satisfaction, attitudes, perceptions and confidence: 1 point
Total score	11.0	12.5	13	11.5	14.5

Author, year and country	Objectives	Method	Results/conclusion	Evidence level
Bruce, et al.⁽²²22 Aqel AA, Ahmad MM. High-fidelity simulation effects on CPR knowledge, skills, acquisition, and retention in nursing students. Worldviews Evid Based Nurs. 2014 Dec;11(6):394-400. doi: 10.1111/wvn.12063 https://doi.org/10.1111/wvn.12063... ⁾ 2009, United States of America	To compare the effectiveness of clinical laboratory simulation and a virtual computer game, regarding the development of competence for CPR^* * CPR = Cardiopulmonary resuscitation in nursing students	Quasi-experiment. Undergraduate nursing course at an American university. The control group had clinical simulation on-site; the experimental group had a virtual computer game for CPR	The scores for cognitive knowledge were significant in both teaching strategies (p=0.000), while post-simulation confidence scores were not statistically significant (p=0.177). The use of virtual simulation in CPR is effective, but on-site simulation is necessary to develop confidence in students	3
Ackermann⁽²³23 Tawalbeh LI, Tubaishat A. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan. J Nurs Educ. 2014 Jan;53(1):38-44. doi: 10.3928/01484834-20131218-01 https://doi.org/10.3928/01484834-2013121... ⁾ 2009, United States of America	To compare the effectiveness of clinical CPR simulation for nursing students with a traditional CPR teaching strategy	Quasi-experiment. Undergraduate nursing course (65 American students). The experimental group had classes, skills training and clinical simulation in CPR; the control group had classes and skills training	The experimental group proved to be statistically more significant in the development of clinical competence in CPR when compared to the traditional strategy. Teaching CPR through clinical simulation is effective for nursing	3
Akhu-Zaheya, et al.⁽²⁴24 Bruce AS, Scherer YK, Curran CC, Urschel DM, Erdley S, Ball LS. A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest. Nurs Educ Perspect. [Internet]. 2009 Jan-Feb [cited Jan 13, 2019];30(1):22-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19331035 https://www.ncbi.nlm.nih.gov/pubmed/1933... ⁾, 2013, Jordan	To examine the effectiveness of clinical simulation for CPR regarding knowledge acquisition, retention and self-efficacy of Jordanian nursing students	Quasi-experiment. Undergraduate nursing course in Jordan (110 students). The experimental group (n=52) had PowerPoint classes, skills training and clinical simulation, while the control group (n=58) had PowerPoint classes and skills training	The experimental group achieved higher scores for knowledge acquired and retained in CPR and greater perception of self-efficacy. Nursing students should be educated with more realistic technologies, such as simulation	3
Aqel, et al.⁽²⁵25 Ackermann AD. Investigation of Learning Outcomes for the Acquisition and Retention of CPR Knowledge and Skills Learned with the Use of High-Fidelity Simulation. Clin Simul Nurs. 2009 Nov-Dec;5(6):e213-e222. doi: 10.1016/j.ecns.2009.05.002 https://doi.org/10.1016/j.ecns.2009.05.0... ⁾, 2014, Jordan	To examine the effectiveness of clinical CPR simulation for competence development and retention in nursing students	Randomized experiment. Undergraduate nursing course in Jordan (90 students). The experimental group had PowerPoint classes and clinical CPR simulation, and the control group had PowerPoint classes and CPR skills training	Significant differences were identified in favor of the experimental group in the development of competence for CPR. The results of this study favor the use of simulation for nursing education	2
Tawalbeh, et al.⁽²⁶26 Akhu-Zaheya LM, Gharaibeh MK, Alostaz ZM. Effectiveness of Simulation on Knowledge Acquisition, Knowledge Retention, and Self-Efficacy of Nursing Students in Jordan. Clin Simul Nurs. 2013 Sep;9(9):e335-e342. doi: https://doi.org/10.1016/j.ecns.2012.05.001 https://doi.org/10.1016/j.ecns.2012.05.0... ⁾, 2014, Jordan	To examine the effect of clinical simulation on cognitive knowledge, knowledge retention and nursing students’ confidence in CPR	Randomized experiment (100 students). Undergraduate nursing course in Jordan. The experimental group (n=50) had CPR simulation, PowerPoint presentation and skills training. The control group had PowerPoint classes and CPR skills training	The experimental group had greater knowledge about CPR and confidence, compared to the control group. Simulation is significantly more effective than traditional training for teaching nursing students	2

[1] Corresponding author: Juliana da Silva Garcia Nascimento, E-mail: mestradounesp28@yahoo.com.br

Brasil

Brasil

Clinical simulation for nursing competence development in cardiopulmonary resuscitation: systematic review

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