Clinical simulation and training for Advanced Nursing Practices: an integrative review

Ribeiro, Vanessa dos Santos; Garbuio, Danielle Cristina; Zamariolli, Cristina Mara; Eduardo, Aline Helena Appoloni; Carvalho, Emilia Campos de

doi:10.1590/1982-0194201800090

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Acta Paulista de Enfermagem

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Integrative Review • Acta Paul Enferm 31 (6) • Nov-Dec 2018 • https://doi.org/10.1590/1982-0194201800090 copy

Clinical simulation and training for Advanced Nursing Practices: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Analyze the contribution of clinical simulation use as a teaching and training strategy of advanced nursing practices.

Methods

An Integrative Review was undertaken through a search in the databases Embase, LILACS, PubMed, and e Scopus, using the descriptors and key words Advanced practice nursing AND simulation.

Results

Sixty-eight articles were identified; after the exclusion of repeated articles and studies that did not answer the guiding question, 11 articles were analyzed. The data evidenced that simulation permitted an in-depth investigation to assess the students’ performance in advanced practice nursing, concerning the approach of the patient and leadership; this method helped the student to take responsibility in decision making, to guide patient care, direct the team, Interact with the family, besides demonstrating leadership, prioiritization, delegation, collaboration and professionalism.

Conclusion

The studies analyzed evidenced that clinical simulation contributed to the teaching of advanced practice nursing, enhancing the clinical awareness and competency building for advanced clinical management, leadership and teamwork skills; most studies involved postgraduate students.

Simulation training; Simulation; Teaching; Advanced practice nursing

n	Reference	Design	Participants	Context	Contributions
1	Defenbaugh, Chikotas, 2016⁽²³23. Defenbaugh N, Chikotas NE. [The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students]. Nurse Educ Pract. 2016;16(10:176-81.⁾	Qualitative study	Master’s students in an APN course (n=15).	Assessed the impact of simulations with actors and facilitators specialized in communication in APN teaching.	The use of simulations with actors permitted learning in a safe and supported environment, improved clinical awareness and communication skills.
2	Benbenek, Dierich, Wyman, Avery, Juve, Miller, 2016⁽³¹31. Benbenek M, Dierich M, Wyman J, Avery M, Juve C, Miller J. Development and Implementation of a Capstone Objective Structured Clinical Examination in Nurse Practitioner and Nurse-Midwifery Programs. Nurse Educ. 2016;41(6):288–93.⁾	Methodological	Nurses studying APN.	Developed, applied and assessed a tool (C-OSCE) to assess training during three years of APN training.	The C-OSCE showed to be a valuable assessment method for clinical competency building and permitted identifying weaknesses in the APN training curriculum.
3	Kowitlawakul, Chow, Salam, Ignacio, 2015⁽²⁴24. Kowitlawakul Y, Chow YL, Salam ZH, Ignacio J. Exploring the use of standardized patients for simulation-based learning in preparing advanced practice nurses. Nurse Educ Today. 2015;35(7):894–9.⁾	Qualitative, descriptive, exploratory study	Master’s students in an Acute Care Program (n=7).	Assessed the students’ perception on the use of actors and mannequins in simulation.	Simulation involving actors contributed to realistic development, data collection, communication; but was limited to provide the patients’ signs and symptoms when compared to simulations using mannequins.
4	Kesten, Brown, Meeker, 2015⁽²⁸28. Kesten KS, Brown HF, Meeker MC. Assessment of APRN Student Competency Using Simulation: A Pilot Study. Nurs Educ Perspect. 2015;36(5):332–4.⁾	Pilot study (effectiveness/feasibility)	Students from a specialization course in critical care with at least two years of clinical experience.	Assessed the feasibility and effectiveness of simulating complex cases in advanced practice competency assessment. The simulation involved mannequin use.	Simulation using complex cases and mannequins permitted improvements in clinical management competencies, use of scientific evidence, patient safety, leadership skills, communication, cooperation and professionalism.
5	Blackburn, Harkless, Garvey, 2014⁽³⁰30. Blackburn LM, Harkless S, Garvey P. Using failure-to-rescue simulation to assess the performance of advanced practice professionals. Clin J Oncol Nurs. 2014;18(3):301–6.⁾	Descriptive study	Advanced practice professionals in oncology (n=14).	Assessed the best method to measure the professionals’ performance of APN in specific oncology situations. Used simulations and practicums.	The simulation demonstrated benefits in knowledge gaining, skills and teamwork, but is limited; although mannequins are easy to use, expertise is required and implementation costs are high.
6	Walton-Moss, O’Neill, Holland, Hull, Marineau, 2012⁽²⁷27. Walton-Moss B, O’Neill S, Holland W, Hull R, Marineau L. [Advanced practice nursing students: pilot test of a simulation scenario]. Collegian 2012];19(3):171-6⁾	Pilot study	Newly graduated nurses in APN in the specialties: Primary Health Care and Adult/Elderly Health Care (n=6).	Described the construction, elaboration of a pilot test of a simulation scenario for clinical assessment of adult patient with chest pain and preliminary tests in this scenario.	Simulation permitted encouraging the students to describe the lessons learned before actual patient care practices, granted conditions to develop a clinical history focused on the problem, identification/distinction of clinical changes based on physical examination focused on complaint; development of clinical reasoning and clinical judgment; promotion of patient safety, infection control and effective communication.
7	Jeffries, Beach, Decker, Dlugasch, Groom, Settles, O’donne, 2011⁽²⁹29. Jeffries PR, Beach M, Decker SI, Dlugasch L, Groom J, Settles J, et al. Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses. Nurs Educ Perspect. 2011;32(5):316–22.⁾	Quasi- experimental	APN students in cardiology (n=36).	Assessed a curriculum based on simulation for postgraduate nursing students in cardiology from four schools, which use simulation for cardiovascular skills training and assessment of cardiovascular skills using OSCE.	The APN students were able to accomplish precise cardiovascular assessments after completing the simulation-based curriculum. Self-confidence increased, as well as technical skills. The strategy was considered important for technical and diagnostic reasoning skills.
8	Corbridge, Robinson, Tiffen, Corbridge, 2010⁽³²32. Corbridge SJ, Robinson PF, Tiffen J, Corbridge TC. Online Learning versus Simulation for Teaching Principles of Mechanical Ventilation to Nurse Practitioner Students. Int J Nurs Educ Scholarsh. 2010;7(1):1–9.⁾	Experimental pre and post-test	APN students in adult health, geriatrics and acute care (n=20).	Verified the difference in knowledge gained and satisfaction of APN students about mechanical ventilation using two educational method, high-fidelity simulation and an online class with PowerPoint presentation.	The study appointed that learning was equivalent, independently of the teaching method, but simulation offered greater satisfaction with the learning experience.
9	Richardson, Resick, Leonardo, Pearsall, 2009⁽²⁵25. Richardson L, Resick L, Leonardo M, Pearsall C. Undergraduate students as standardized patients to assess advanced practice nursing student competencies. Nurse Educ. 2009;34(1):12–6.⁾	Qualitative study	Undergraduate nursing students (n=22) and postgraduate students (n=20).	High-fidelity simulation with standardized actors for clinical skills assessment of APN students through OSCE. The objective was for nursing students to discover the benefits of being a standardized patients. The scenarios consider the competencies for data collection, diagnostic skills and communication.	The study highlighted that the students, as standardized patients, and APN students presented development in the cognitive and psychomotor domains. Being a standardized patient allowed the students to understand what nursing practice and the activities of APN are like.
10	Tiffen, Graf, Corbridge, 2009⁽³³33. Tiffen J, Graf N, Corbridge S. Effectiveness of a Low-fidelity Simulation Experience in Building Confidence among Advanced Practice Nursing Graduate Students]. Clin Simul Nurs. 2009;5(3):113–7.⁾	Experimental before and after	Nurses studying APN (n=32).	Assessed the use of low-fidelity simulators for teaching heart and lung assessment skills.	The simulation experience increased the confidence and improved the health assessment skills in the group of nursing students in advanced practice training.
11	Aronowitz, Aronowitz, Mardin-Small, Kim, 2017⁽²⁶26. Aronowitz T, Aronowitz S, Mardin-Small J, Kim B. Using Objective Structured Clinical Examination (OSCE) as Education in Advanced Practice Registered Nursing Education. J Prof Nurs. 2017;33(2):119–25.⁾	Experience report	Undergraduate nursing students enrolled in APN course.	Assessed the use of OSCE to teach communication skills at a medical institution in the USA, in teaching nursing undergraduates enrolled in APN course.	The OSCE showed to be a tool with benefits for advanced practice teaching and assessment, promoted effective learning with situations similar to clinical practice; training in stations reduced anxiety about reality. In addition, it appointed that the implementation starts with basic cases and evolves with increased complexity, which permitted better critical thinking.

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[1] Corresponding author. Emilia Campos de Carvalho https://orcid.org/0000-0003-0738-0539 E-mail: ecdcava@usp.br