Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

1

Abdallah, A. (2020). Axiomatic Six Sigma, A Simulation-Based Decision-Making Framework.  Journal of Mechanical Engineering Research and Developments,  43(7), 119-136.

Qualitative

Sample: Logistics companies in J.F. Kennedy hospital

Sample Size: 1

Setting: logistic company

The project results were 65% reduction in labor, 41% reduction in work in process and 55% reduction in average time packages spend at the station.

Use of simulation and a managerial decision making tool called "alternative evaluation tool”

Less sample size

11 A

2.

Al Harthi, M. K., Afifi, R. M., Tashkandi, M. A., Saad, A. E., & Afifi, Y. (2019). Role and Effectiveness of Simulation-based Training in Raising Family Medicine Residents’ Clinical Resuscitation and Critical Care Skills.  Modern Advances in Pharmaceutical Research Vol. 2, 125-142.

Quantitative

Sample: 28 and 72

Sample Size: 434 Residents

Setting: Six relevant studies

To assess the impact of a simulation-based procedural skills training on residents’ competence in the performance of critical resuscitation procedures.

All came to positive conclusions about the usefulness of simulated education in raising residents’ resuscitation handling skills.

All had limitations, mostly small sample size, except the Greek study. This may well affect study power and hence, minimize generalizability

11B

3

Sample: Third year pharmacy students. Data from two cohorts.

Sample Size: 165 participants but 90 were complete data sets.

Setting: at a single pharmacy school campus

· N/A

1. When comparing the matched responses for the presurvey and post-survey regarding attitudes, five items showed significant improvement (p<.05).

2. Students (N=90) demonstrated a statistically significant gain in knowledge regarding types of medication errors, investigation of medication errors, and reporting medication errors as seen in an increase in overall knowledge assessment scores (p<.01)

3. The mean pretreatment overall knowledge score was 81.5% (SD 7.4). The mean post-treatment overall knowledge score was 83.9% (SD 5.8

A modified Professionals Patient Safety Assessment instrument.

Reported: response rate, survey instrument, evaluation methods. The survey had no formal validation and reliability testing. Reliance on students self-reporting their perceived skills and behaviors.

Perceived: study performed at only one institution and may not represent the pharmacy field as a whole.

II B

4

Becnel, K. T. (2022).  Effectiveness of Simulation-Based Case Studies in Undergraduate Nursing Students (Doctoral dissertation, Teachers College, Columbia University).

Quantitative

Sample: 137 students

Sample Size:137 students

Setting: medical-surgical course

The findings from this study address a gap in the literature on the effectiveness of simulation-based classroom teaching strategies on the development of clinical judgment in undergraduate nursing students.

This dissertation has four specific aims that examined the effect of using simulation-based case studies in the classroom on clinical judgment, knowledge acquisition, and general self-efficacy in baccalaureate nursing students enrolled in a medical surgical course. It also examined relationships between student demographics and clinical judgment. Each specific aim is listed below with a corresponding research question or a hypothesis.

The use of a convenience sample from one regional, public university may limit the generalizability of the findings to other populations. In addition, a true randomized design where students were randomized to a treatment group was unable to be used

11B

Bryant, K., Aebersold, M. L., Jeffries, P. R., & Kardong-Edgren, S. (2020). Innovations in simulation: Nursing leaders' exchange of best practices.  Clinical Simulation in Nursing,  41, 33-40.

Qualitative

Sample: 15 Simulation specialists

Sample Size: 15 participants

Setting: At a summit

The summit was organized around three main topics: the future of simulation-based education, latest trends in simulation research, and linking simulation to improved patient safety outcomes.

The most common simulation outcomes measured to date regard participants’ perceptions; they show increased self-confidence and satisfaction with learning through simulation

Limited research work

11B

Bø, B., Madangi, B. P., Ralaitafika, H., Ersdal, H. L., & Tjoflåt, I. (2021). Nursing students' experiences with simulation-based education as a pedagogic method in low-resource settings: A mixed-method study.  Journal of Clinical Nursing.

Quantitative

Sample: nursing students

Sample Size:99 students

Setting: Nursing platform

This study provides knowledge and insight into nursing students’ experience with simulation-based education as a pedagogic method during their pre-service education.

This study introduced simulation-based education in nurse education programs in Tanzania and Madagascar and explored nursing students’ experiences with this pedagogic method as a mode of learning.

The results from the questionnaire show limited variation and hence the results may be questioned.

11B

2

Buckley, T., & Gordon, C. (2011). The effectiveness of high fidelity simulation on medical-surgical registered nurses' ability to recognize and respond to clinical emergencies.  Nurse education today,  31(7), 716–721. https://doi.org/10.1016/j.nedt.2010.04.004

Quantitative

Sample: Emergency Room Nurses.

Sample size: 164 clinical patient emergencies

Setting: Hospital Emergency room setting

 Participants reported a total of 164 clinical patient emergencies in the follow-up time period including: 46% cardiac, 32% respiratory, 10% neurological, 7% cardiac arrest and 5% related to electrolyte disturbances. The ability to respond in a systematic way, handover to the emergency team and airway management were identified as the skills most improved during patient emergencies following simulation. The most useful aspects of the simulation experience identified were scenario debriefing and assertiveness training. Participants with less years of clinical experience were more likely to report practicing team leader role and debriefing as the most useful aspects of simulation.

The aim of this study was to evaluate registered nurses' ability to respond to the deteriorating patient in clinical practise following training using immersive simulation and use of a high fidelity simulator.

The skills practised in simulation were highly relevant to participants practise in medical-surgical areas. Non-technical skills, including assertiveness skills should be considered in future emergency training courses for nurses.

II B

3

Chamberlain, J. (2017). The impact of simulation prebriefing on perceptions of overall effectiveness, learning, and self-confidence in nursing students. Nursing Education Perspectives, 38(3), 119-125.

Quantitative

Sample: 119 undergraduate nursing students

This design study compared outcomes among four groups of undergraduate students (n = 119) at two schools of nursing: no prebriefing, prebriefing with learning engagement and orientation activities, prebriefing with orientation activities, and prebriefing with learning engagement activities

: Self-report, direct observation, or clinical patient safety outcomes.

Perceptions of overall simulation effectiveness, learning, and self-confidence were significantly higher with prebriefing (p = .000) compared to no prebriefing. No significant distinction (p >.05) was found among the prebriefing activities.

II B

4

Dottin, R. L. (2018). The Effects of Simulation-Based Training on Critical Thinking.

Quantitative

Sample: Graduates

Sample Size: 10

Setting: Hospitals

This study aimed to investigate the effects of a simulation-based training experience on the critical thinking skills of 10 graduate medical education trainees to 15 understand the potential of simulation as an innovative tool to improve medical competencies among trainees in a graduate medical training program

There is a vast amount of medical education research that convey the positive aspects of incorporating simulation-based training in medical training programs

The major limitations of this study included the limited time period to conduct the simulation and the small size of study participants

11B

5

George, K. L., & Quatrara, B. (2018). Interprofessional simulations promote knowledge retention and enhance perceptions of teamwork skills in a surgical-trauma-burn intensive care unit setting.  Dimensions of Critical Care Nursing,  37(3), 144-155.

Qualitative

Sample: 1 patient

Sample Size: 1 patient

Setting: STBICU setting

The simulation required the team to use interventions to reduce elevated intracranial pressure and then perform cardiac resuscitation according to Advanced Cardiac Life Support guidelines. A semistructured debriefing guided by the TENTS tool highlighted important aspects of teamwork. 

Mean knowledge test and TSS scores both significantly increased after the simulation and remained significantly elevated at 1-month follow-up. Participants recommended retraining intervals of 3 to 6 months.

Less sample size.

11A

6

Lee, Yeung, K. C. Y., Clarke, C. L., & Yoo, J. (2019). Nursing Students’ Learning Dynamics and Perception of High-Fidelity Simulation-Based Learning.  Clinical Simulation in Nursing,  33, 7–16. https://doi.org/10.1016/j.ecns.2019.04.008

Quantitative

Sample: nursing students

This study constructed a theoretical model of HF-SBL dynamics, consisting of process and four influencing factors of HF-SBL. Moreover, the students' perception on a lack of psychological fidelity during HF-SBL was identified and highlighted

Constructivist grounded theory was adopted. Twenty-three semistructured interviews with memo writing were conducted with 16 undergraduate nursing students. All collected data were managed using NVivo 11.

NVivo 11 was used.

Through understanding of the model, nursing educators can improve their current simulation-based education and make it more relevant and realistic for students

II B

7

Morris, N. A., Czeisler, B. M., & Sarwal, A. (2019). Simulation in neurocritical care: past, present, and future.  Neurocritical Care,  30(3), 522-533.

Qualitative

Sample: Computer based stimulation

In this review, we will explore the historical origins of simulation-based medical education, its conceptual framework, current applications, and future directions especially as pertinent to neurosciences.

The study found that neurology and neurocritical care community has lagged behind in implementation of this pedagogy

High cost

11A

8

Nichols, Wiley, S., Morrell, B. L. M., Jochum, J. E., Moore, E. S., Carmack, J. N., Hetzler, K. E., Toon, J., Hess, J. L., Meer, M., & Moore, S. M. (2019). Interprofessional Healthcare Students’ Perceptions of a Simulation-Based Learning Experience.  Journal of Allied Health,  48(3), 159–166.

Quantitative

Sample: 31 nursing students.

Sample Size 31

· N/A

1: A total of 31 students completed both pre-SBLE and post-SBLE surveys. The majority of the participants were female (77.4%) and 38.7% had participated in an interprofessional simulation experience involving three healthcare professions held at the university the previous summer. Of the 31 participants, 15 (48.4%) were in the AT program, 5 (16.1%) in nursing, 4 (12.9%) in PT, 4 (12.9%) in psychology, and 3 (9.7%) in OT.

This paper describes a simulation-based learning experience (SBLE) designed to encourage students (n = 130) from six healthcare professions to learn more about interprofessional communication, roles and responsibilities of the healthcare team, and knowledge of interprofessional collaborative practice.

Data analysis showed statistically significant differences in participants' perceptions of roles/responsibilities for collaborative practice (p = 0.001) and the patient outcomes from collaborative practice (p = 0.002).

II B

9

Mitchell M, Newall F, Sokol J, Heywood M, Williams K. Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital. Adv Simul (Lond). 2020 Aug 12;5:21. doi: 10.1186/s41077-020-00139-9. PMID: 32817808; PMCID: PMC7425032.

Quantitative

Sample: 146 participants.

Sample Size: 146 participants

Setting: Acute Care hospital setting

·

1: Nine training days were conducted in 2017 for nursing, medical, allied health, education and security staff with a total of 146 participants (83% were acute care nurses). Two thirds (68%) of participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. 

The aim of this proof of concept study was to develop a simulation-based education session on aggression management for acute care paediatric staff based on best practice principles, to evaluate the acceptability of this training programme and to gain an understanding of the impact of the training on participants' perceived confidence in managing clinical aggression. Two separate simulation exercises were delivered as a 2-h component of a hospital management of clinical aggression (MOCA) training day. Participants completed a written survey immediately prior to, at completion of the simulation-based group training, and at 3-6 months following the simulation

Reported: 80% of all participants reported feeling more confident in managing clinical aggression, 47% reported a 1-point increase in confidence, whilst 33% of participants reported a 2- or 3-point increase. At 3-6 months post-training, 66% of respondents ( N = 44) reported continued confidence in managing aggression with 100% of participants stating they would recommend simulation training to colleagues.

Simulation training is an acceptable method of training and shows promise to improve staff-perceived confidence for managing behavioral emergencies in acute pediatric health care settings.

II A

10

Tortorelli, C., Choate, P., Clayton, M., El Jamal, N., Kaur, S., & Schantz, K. (2021). Simulation in social work: Creativity of students and faculty during COVID-19.  Social Sciences,  10(1), 7.

Qualitative

Sample: 163 Data base

Sample Size: 163 Data base

Setting: Database Research

A prel