A comparison of educational strategies for the acquisition of nursing student’s

performance and critical thinking: simulation-based training vs. integrated training

(simulation and critical thinking strategies)

Pengarang: Nahid Zarifsanaiey, Mitra Amini, dan Faridah Saadat.

Tahun Terbit: 2016
Latar Belakang:
Technical and treatment advancements and rapid changes of political, social and
cultural factors demonstrate the need to use new active training strategies in medical
and nursing education. The nursing students should be actively trained in order
for them to sufficiently under- stand real clinical situations and gain the learning in a real
context. Deubel stated that the use of an educational theory and subsequent use of a
teaching model alone is not sufficient to advance learning and in order to design active
courses and create the ground for learners to think, educational spectrum and teaching
models must be inte- grated. The integration of these practices such as simula- tion and
critical thinking strategies will improve the effectiveness of training programs and will
help students gain Nursing skills.
There is a close correlation between the simulation-basedlearning, critical thinking
strategies and the principles of constructivist and collaborative learning. Furthermore, the
integration of these strategies will strengthen learning, because students focus on problems
in real clinical situa- tions that could strengthen their understanding of concept. In most
reviewed studies, the integrated simulation training was investigated only with
Problem based learning and the use of other critical thinking strategies (problem
solving-based on group discussion) is less studied. The importance and necessity
of this study is clear with respect to the special status of teaching the critical thinking
skills, the sensitivity of teaching the clinical skills. In this way, we can empower
nurses by adopting new techniques and strategies of active learn- ing. Therefore, the
aim of this study is to compare the effects of integrated training (simulation and critical
thinking strategies) and simulation-based training on the performance level and the
critical thinking ability of students in 2014 in Shiraz
Desain Penelitian: Quasi Experimental research with non-equivalent group pretest post test
design.
Populasi: The study samples include all first-year nursing students studying in the second
semester of the academic year of2014–2015 (n = 40) who were selected applying
census method.
Sample: The sample size is equal to the size of the population studied.
Teknik Sampling: All students who took the 2-credit course of principles and practical
nursing skills and wished to participate in the study were included. Students who were
enrolled as guest students at the semester and had no desire to participate in the research
were excluded. All the study subjects were divided into two groups according to age,
sex, place of residence as the experimental group (n = 20) and the control group
(n = 20).
Analisa Data:
Implementation stages of the research:
1. Before the training, the level of critical thinking skills of both groups was investigated.
2. Two teaching techniques were carried out in each group. The experimental and
intervention groups were trained using the integrated and simulation- based techniques,
respectively.

Experimental group The experimental group was trained for ten 2-h sessions
using critical thinking strat- egies along with simulation. The critical thinking strategies
in this research include problem based learning with small group discussion. At each
session, hypothetical scenarios of clinical conditions related to the subject matter, prepared
utilizing patient records in hospitals and reference books containing clinical setting and
strategic questions, were discussed. Then, the solution to the problem was determined by
students in small group discussion after changing the learning environment and the manner
of seats arrangement in the lab in a U shape. At this stage, the instructor was used as a
facilitator and provided students with the necessary instructions and tried to encourage
all students to participate in the discussion.
2- Simulation stage (role-playing and mannequins) Then the students were taught the
basic instruction by the instructor through role-playing, and they were also encouraged
by the instructor to practice in groups of ten on the mannequins (Fig. 1). Control group
The simulation method alone was used in the control group in such a way that the related
instructor taught the subject matter of the same session on the mannequins through role-
playing, without any clinical background and students practiced in groups of 10. 3. At the
end of the program, both groups participated in the critical thinking skills test and
Objective Structured Clinical Examination (OSCE) test in order to measure their
performance. OSCE test was carried out by planning 10 stations.

Data collection tool

The tool used in measuring the critical thinking ability was the California Critical
Thinking Skills Test Form B (CCTST). This tool was developed to measure students
critical thinking skills and it contains 34 multiple-choice questions, designed in five
areas of cognitive skills of critical thinking, which include analysis, inference, in- ductive
reasoning, deductive reasoning and evaluation. Each person was awarded one score
for each question which was answered correctly in the questionnaire and the total of
correct answers constitutes the total score, the minimum and maximum of which
were 0 and 34. Scores obtained in each section of the test was between the range of 0
and 16, such that in the analysis, inference, evaluation, inductive reasoning and deductive
reasoning sections, 9, 11, 14, 16 and 14 scores were considered, respectively Objective
Structured Clinical Examination (OSCE) test questions were utilized as a tool to assess
the students' performance. This test was selected from 10 stations, including measuring
blood pressure, dressing change, measuring body temperature, colostomy care, wound
care clinical scenario, clinical bowel care scenario, pres- sure ulcer care, oxygen therapy,
vital signs scenario, identifying devices by consulting with nursing team members.

Intervensi:

Integration cycle of the simulation and critical thinking strategies

 Correlations between Clinical Judgement and Learning Style
Preferences of Nursing Students in the Simulation Room

Pengarang: Karin Hallin, Marie Häggström, Britt Bäckström & Lisbeth Porskrog Kristiansen.
Tahun terbit: 28 September 2015
Latar Belakang:
Becoming a skilled practitioner as a nurse requires first and foremost knowledge,
competence and patient-safe environments, but also opportunities for reflection, reflection-
in-action and/or reflection-on-action (Schön, 1987). John Dewey’s (1964) philosophical and
theoretical thoughts on education as integrated unities of theory and practice are summarized
in the concept of ‘learning by doing’. Reasoning and problem-solving in practical situations
are performed in open, unstructured and perhaps also ambiguous situations, which can in one
way or another be difficult to understand, cope with or resolve.

Learning style theories assume that all human beings learn in different ways and
at different levels, which requires the ability to reflect on how students adapt teaching
methods to their needs. This area of education is comprehensive and addresses students at
both individual and group level, but also affects organizations as a whole (Beischel, 2011;
Wheelan, 2009). It is apparent that the less academically successful the student, the more
important it is to accommodate learning style preferences, and the stronger the preference,
the more important it is to provide compatible strategies (Griggs et al., 1994). Researchers
have identified a lot of areas that may influence students’ learning, one of which is the Dunn
and Dunn Learning Style Model.

Desain Penelitian: A descroptive cross-sectional quantitative.

Populasi: 241 nursing students, were in final semester of a three year Bachelor of Science
Nursing Programme

Sampel: 173 nursing students (138 female and 35 male)

Tekning Sampling: Convenience sampling was used with 60 teams with 173 nursing
students in the final semester of a three-year Bachelor of Science in nursing programme. Data
collection included questionnaires of personal characteristics, learning style preferences,
determined by the Dunn and Dunn Productivity Environmental Preference Survey, and
videotaped complex nursing simulation scenarios. Comparison with Lasater Clinical
Judgement Rubric and Non-parametric analyses were performed.
Analisa Data:
Quantitative analysis methods were used in this study. The nursing students’ characteristics,
the demographic data, were analysed using descriptive statistics while the hypotheses were
tested using non parametric rank correlation.
Intervensi:

The Dunn and Dunn Learning Style Model, with its questionnaire, the ‘Productivity
Environmental Preference Survey’ (PEPS) focuses on elements that are crucial for learning
new and difficult information, but should not be confused with psychological models and
tests. The model is built on fifty years of worldwide quantitative and qualitative research,
which indicates that the model and the PEPS are very applicable to direct learning situations
and the education of health professionals (Dunn & Griggs, 1998; 2007).

The PEPS focuses on 20 variables and yields information concerning the following:

 Environmental preferences: ‘Sound’, ‘Light’, ‘Temperature’, and ‘Furniture design’,

 Emotional preferences: ‘Motivation’, ‘Adjustability’, ‘Persistence’, the need for
externally imposed
‘Structure’ or the opportunity to do things independently
 Sociological preferences: ‘Authoritative person present’, ‘Variation/several ways’,
‘Learning alone, in pairs or as a part of a team’
 Physiological preferences: perceptual strengths such as ‘Auditory’, ‘Visual’, ‘Tactile” or
‘Kinesthetic’,
‘Time-of-day energy levels’, need for ‘Intake’ and/or ‘Mobility’
 CAPTURING JUDGEMENT STRATEGIES IN RISK ASSESMENTS WITH
IMPROVED QUALITY OF CLINICAL INFORMATION: HOW NURSES’
STRATEGIES DIFFER FROM THE ECOLOGICAL MODEL

Pengarang: Hulqin Yang, Carl Thompson

Tahun Terbit: 2016
Latar Belakang:
Nurses use their judgement to identify patients at risk of deterioration in acute care.
Critical care outreach systems - often nurse-led - have been implemented as a means of
improving the quality of these judgements. Critical care outreach systems are usually
initiated by track and trigger systems based on routine observations of airway adequacy,
breathing and circulatory systems. Adverse observations trigger intervention and
management, often in the form of expertise - such as that offered by the critical care
outreach team.
In order to ensure prompt identification of patients at risk of clinical deterioration the
National Institute for Health and Clinical Excellence (NICE) suggests that all hospital adult
patients should receive a minimum set of physiological observations and a clear written
monitoring plan at the time of admission or initial assessment. These routine observations
are often carried out by ward or emergency department nursing staff and they should be
monitored at least every 12 h. Early recognition of changes to physiological parameters is
crucial to timely intervention and reducing the chances of critical events and mortality. As
up to 62 % of cardiac arrests are potentially avoidable the evidence is that this system of
identification and intervention, based largely on clinical judgement, could perform better.
Desain Penelitian: Correlation
Population: Nurse
Sample:
Nurse Senior and Nurse student
Teknik sampling:
Acak
Analisa data:
The findings from this study suggest that a mismatch between nurses’ judgement strategies
and a pertinent ecological model may explain suboptimal judgement performance. Our
findings highlight the importance of appropriate attention being paid to patients exhibiting
physiological abnormalities, and correct recognition of patients at risk of acute
deterioration. When making risk assessments in practice, nurses should pay more attention
to important cues such as respiration rate, consciousness level and systolic blood pressure.
Clinical simulations recreating real patient cases have advantages over paper based
traditional approaches to simulation. These simulations and the awareness they provide can
allow nurses to refine their judgement behaviours with opportunities for reflection and
correction. The report by the National Patient Safety Agency [48] has revealed that
insufficient training to understand the relevance of observations is one common factor
contributing to patient deterioration incidents not being recognised or acted upon.
Approaches such as cognitive feedback could enhance understanding of the relationship
between clinical information and ecological criteria (for example, physiological signs and
symptoms and true underlying risk of a critical event); it may also help nurses appreciate
more about the nature of uncertainty in the probabilistic relationships that make up the
provision of healthcare.
Intervention: Improving the quality of information by clinical simulations significantly
impacted on nurse’ judgement policies of risk assesments.