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

Title: The contribution of clinical simulation in the teaching and training of Advanced Nursing Practices.

1) Objective: Identify and evaluate the use of clinical simulation as a strategy for the teaching and/or training of advanced nursing practices.

2) Guiding question: How has clinical simulation been used for the teaching and/or training of advanced nursing practices?

3) Search strategies

3.1. Database

Database 1: Embase

Database 2: LILACS

Database 3: PubMed

Database 4: CINAHL

Database 5: Scopus

3.2. Search for descriptors and key words – executed in March 2018

Database 1: Embase

Advanced practice nursing (Emtree) AND simulation (Emtree) = 10 articles

Database 2: LILACS

Práticas avançadas em enfermagem (descriptors) AND simulação (descriptors) = 0

Práticas avançadas em enfermagem (words) AND simulação (words) = 0

Database 3: PubMed

Advanced practice nursing (Mesh Terms) AND simulation (Mesh Terms) = 0

Advanced practice nursing (Text words) AND simulation (Text words) = 26 articles

Database 4: CINAHL

Advanced practice nursing (Exact subject) AND simulation (Exact subject) = 0

Advanced practice nursing (Word in subject) AND simulation (Word in subject) = 18 articles

Database 5: Scopus

Advanced practice nursing (Index Terms) AND simulation (Index Terms) = 14 articles.

4) Inclusion criteria:

Population: people who used clinical simulation for the teaching and/or training of advanced nursing practices;

Intervention: use of clinical simulation for teaching and/or training of advanced nursing practices;

Comparison: use of other strategies for teaching and/or training advanced nursing practices;

Results: background for appropriate conducts and decision making;

Studies: original articles and theses presenting the use of simulation for teaching and/or training of advanced nursing practices;

5) Data extraction:

Two researchers fully read the selected studies, when information was extracted on the study design, participants, definition of advanced practice, context and clinical simulation.

The disagreements between the extracted results were solved by consensus, including the presence of a third researcher. The extracted information was arranged in a database.

6) Information synthesis:

Each study was analyzed to identify the use and contribution of clinical simulation to the teaching and/or training of advanced nursing practices. The goal is to evaluate how simulation is used in advanced nursing practices.

n	Reference	Design	Participants	Context	Contributions
1	Defenbaugh, Chikotas, 2016⁽²³⁾	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⁽³¹⁾	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⁽²⁴⁾	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⁽²⁸⁾	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⁽³⁰⁾	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⁽²⁷⁾	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⁽²⁹⁾	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⁽³²⁾	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⁽²⁵⁾	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⁽³³⁾	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⁽²⁶⁾	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.

[TFN1001] Source: Elaborated by the authors based on the considerations of The Joanna Briggs Institute, Reviewers’ Manual 2015.⁽²¹⁾

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

Abstract