Outcomes of a simulation-based nurse residency program

ChristianaCare, NewarkDelaware. Copyright notice. Images are NOT covered under the Creative Commons license and are the property of the original photographer or company who supplied the image. Abstract A review and discussion of creating nurse residency programs employing the recommendations from accrediting bodies to demonstrate organizational value.

Open in a separate window. Figure 1. References 1. World Health Organization. Retrieved from: www. Institute of Medicine. The Future of Nursing: Leading change, Advancing health. Bureau of Labor Statistics, U. Department of Labor. Occupational Outlook Handbook, registered nurses. Goode, C. Requiring a nurse residency for newly licensed registered nurses. Nursing Outlook , 66 3 , — Blegen, M. Newly licensed RN retention: Hospital and nurse characteristics.

The Journal of Nursing Administration , 47 10 , — Park, S. Comparison of reasons for nurse turnover in Magnet and non-Magnet hospitals. The Journal of Nursing Administration , 46 5 , — Ulrich, B. Improving retention, confidence, and competence of new graduate nurses: Results from a year longitudinal database. Nurs Econ , 28 6 , — Chesak, S.

Sood, A. Stress management and resiliency training in a nurse residency program. Journal for Nurses in Professional Development , 35 6 , — Lin, P. Well designed quasi-experimental studies are needed. As a major nursing education redesign, NRPs could be used to test the principles, concepts and strategies of organizational transformation and experiential-interactive learning theory.

By focusing on fiscal outcomes, current administrators of NRPs are missing the opportunity to implement an organizational strategy that could improve workplace environments. Healthcare organizations need to envision NRPs as a demonstration of positive clinical learning environments that can enhance intra- and interprofessional education and practice.

Disagreement on the inclusion or exclusion of articles was resolved by consensus. Of the potentially relevant articles, screening of the title and abstracts resulted in relevant studies. After a review of these articles, 96 studies were retained and three articles included additionally via hand search. These 99 full-text articles were reviewed systematically to confirm their eligibility Fig. The CASP appraisal tool was designed to facilitate systematic thinking about educational studies.

This tool contains 11 questions in three sections: 1 Are the results of the trial valid? Any disagreement that arose between the reviewers was resolved through discussion and consensus with a third reviewer. The inclusion criteria for this review were as follows:. This study sampled pre-licensure nursing students, licensed nurses, or nurse practitioners. We defined simulation-based educational intervention as education involving one or more of the following modalities: partial-task trainers, standardized patients SPs , full-body task trainers, and high-fidelity mannequins.

Study outcomes included learning and reaction outcomes. Learning outcomes were categorized into three domains: cognitive, psychomotor, and affective. The level of fidelity was determined by the environment, the tools and resources used, and other factors associated with the participants [ 8 ].

However, as to debriefing, a few selected studies do not indicate the method of debriefing they had used, making it difficult to categorize and discuss the effects of each debriefing method. Thus, we categorized fidelity level according to the physical equipment used. Fidelity level was coded as low, medium, or high according to the extent to which the simulation model resembled a human being, hybrid, or SP.

LFSs were defined as static models or task trainers primarily made of rubber body parts [ 9 , 10 ]. Medium-fidelity simulators MFSs were full-body manikins that have embedded software and can be controlled by an external, handheld device [ 10 ]. HFSs were life-sized computerized manikins with realistic anatomical structures and high response fidelity [ 11 ].

We also considered hybrid simulators, which combined two or more fidelity levels of simulation. As SP is a person trained as an individual in a scripted scenario for the purposes of instruction, practice, or evaluation [ 12 ], the use of SP was considered because of the different types of fidelity responses, such as body expressions and verbal feedback, which cannot be perceived in other simulation models. The extracted data were coded by two researchers. A coding manual was developed in order to maintain the reliability of coding.

The manual included information regarding effect size calculations and the characteristics of the study and the report. Differences between coders were resolved by discussion until a consensus was achieved. Fixed effects models assume that the primary studies have a common effect size. In contrast, random effects models attempt to estimate the distribution of the mean effect size, assuming that each primary study has a different population [ 13 ].

A test for heterogeneity of the intervention effects was performed using the Q statistic. As the results of the test for heterogeneity was statistically significant, we used the random effects models to accommodate this heterogeneity for the main effect and sub-group analyses. The planned subgroup analyses were conducted on evaluation outcomes. We identified potentially relevant articles using the search strategy described above, of which 40 met the inclusion criteria.

The characteristics of the 40 studies included in this meta-analysis are listed in Table 1. Twenty five of the 40 studies Half of the studies compared education using high-fidelity simulators with a control group. Learners at various levels of training were represented. The overall effect size for the random effects model was 0. The possibility of a publication bias was minimal because the funnel plot appeared symmetrical.

Studies using HFSs 0. The results of the sub-group analysis for reaction outcome according to fidelity level are shown in Table 4. The results of the sub-group analysis for learning outcomes according to fidelity level are shown in Table 4.

For cognitive outcome, which is a sub-domain of learning, the effect size was the highest for HFS 0. Regarding affective outcome, HFS 0.

MFS 1. The present study provided meta-analytical data for evidence-based education through a comprehensive analysis of simulation-based nursing education with diverse backgrounds and characteristics.

Through this process, 20 Korean papers were included additionally and half of papers were Korean. This could cause different result compared to previous one. In addition to including a reaction outcome according to fidelity levels, effect sizes based on outcomes and fidelity level were identified. A systematic search of the literature resulted in 40 published studies that were eligible for inclusion in this meta-analysis.

These primary studies provided evidence of the effects of simulation-based nursing education in various evaluation and learning environments. Random assignment studies accounted for The medium-to-large effect size 0.

This is consistent with the findings of a study on health professional education [ 16 ], which reported that technology-enhanced simulation training produced moderate to large effects.

Regarding simulator fidelity level, HFS 0. This result supports the findings of a previous meta-analysis of simulation in health professions, showing that HSF offers benefits over LFS [ 17 ]. However, these findings should be interpreted with caution.

Recent studies suggest that the degree of realism required of a simulation is a function of the learning task and context, and can therefore vary widely for different areas of educational outcomes [ 17 ]. Satisfaction levels are high among students participating in simulation learning that utilizes human simulators or SP [ 18 ].

Considering that problem-based learning PBL lessons were found to enhance student attitudes more than traditional lectures [ 19 ], student participation and actual activity appear to have positive effects on satisfaction and learning attitudes.

In the sub-group analysis for learning outcome according to fidelity level, the effect size was the largest for psychomotor outcome, followed by affective and cognitive outcomes.

This result differs somewhat from the meta-analysis on the effects of PBL [ 19 ], in which effect sizes were the largest for psychomotor outcomes, followed by the cognitive and affective domains. Specifically, the effect size of cognitive outcome was the largest for HFS 0. In the psychomotor domain, the order was MFS 1. These results demonstrate that HFS and SP are effective in producing cognitive and affective outcomes; however, to achieve psychomotor learning outcomes, technical training using MFS would be more helpful, which concurs with the lack of positive association between fidelity and process skills [ 17 ].

However, the present study has the limitation of not considering learning-related factors in the analyses based on the fidelity level of simulators. Even though debriefing has become more crucial in simulation-based learning and the methods have diversified over the years, a few selected studies do not indicate the methods of debriefing they had used, making it difficult to categorize and discuss the effects of each debriefing method.