Few studies have focused on evaluating nursing students' satisfaction with different types of simulation, and in particular using valid and reliable instruments. A descriptive, cross-sectional and retrospective post-test study was conducted to examine nursing students’ satisfaction with low-fidelity simulation (LFS) and high-fidelity simulation (HFS). Thirty-five 4th year nursing students who met the eligibility criteria completed the Satisfaction with Simulation Experience Scale (SSE) and a demographic questionnaire via Fluidsurvey. A paired t-test analysis revealed a significant difference in the CL subscale mean scores between LFS (M = 4.09) and HFS (M = 3.78), p = 0.008. The ranking question revealed that the opportunities to practice new skills, and to apply clinical reasoning and decision-making were among the top three ranked features for both LFS and HFS. Also included in the top three ranked items identified for LFS was the preparation of materials and orientation and for HFS was engagement and realism. / February 2016

Clinical simulation is a teaching strategy to assist nursing students to connect classroom knowledge to the clinical setting. Teaching clinical simulation requires special training, but many nursing faculty who teach clinical simulation do not receive clinical simulation training. The purpose of this study was to determine if the effects of formal versus informal simulation training impacted nursing faculty's self-ratings of their competency in facilitating simulation and identify areas for needed educational support. A quantitative descriptive approach was used and grounded in the National League for Nursing and Jefferies (NLN/JSF) theoretical framework. This framework focuses on the relationship between teacher, student, and educational experience. Data on 102 faculty members from prelicensure nursing programs in Maryland completed the Debriefing Assessment for Simulation in Healthcare (DASH-SV) survey. Data analysis using the independent-samples t-test revealed no significant difference in nursing faculty's perceptions regarding how they facilitate clinical simulation between nursing faculty who are formally trained to teach clinical simulation and those who are not. However, there was a significant difference in one element of the DASH-IV which measured the skill of helping students achieve or sustain good performance. The data will contribute to the nursing simulation literature by providing a better understanding of what faculty members perceive as their strengths and weaknesses in teaching clinical simulation. The findings of this study can influence positive social change in nursing by providing nursing administrators with information about faculty perceptions of clinical simulation and influence decisions on training of nursing faculty in using clinical simulation.

Purpose: The purpose of this pilot study was to describe situation awareness (SA) among licensed practical nurses (LPNs) working in direct patient care. Specific Aims: The specific aims for this study are 1) to examine SA scores, as measured by the Situation Awareness Global Assessment Technique (SAGAT), in LPNs working in direct patient care and compare to published data on SA in registered nurses (RNs), 2) to examine the relationship between SA scores and years of LPN experience, 3) to examine differences in SA scores by type of workplace setting and 4) to describe the relationship between levels of satisfaction with simulation, as measured by the Satisfaction with Simulation Experience Scale (SSES) and SA scores among LPNs. Framework: Situation Awareness Theory, as described by Endsley, was used as the framework for this study. Design: A cross-sectional, descriptive design using the Situation Awareness Global Assessment Technique was used to gather data from a convenience sample of LPNs. Results: LPNs (N=24) participated in the study and achieved an average SAGAT score of 72.6%. There were no differences in scores between those LPNs enrolled in an RN program and those who were not enrolled. Individual scores on the SAGAT were comparable or better than scores in a similar study of RNs. Conclusion: LPNs in this study demonstrated adequate situation awareness. Key Words: Situation awareness, licensed practical nurse, patient deterioration, clinical simulation

The focus of the research programme within this thesis is an investigation of scenario-based simulation training in undergraduate healthcare education. The aim of the main study was to determine the effectiveness of high-fidelity simulation training with adult branch nursing students. Their acquisition of knowledge and skills was tested using a 15-station Objective Structured Clinical Examination (OSCE) pre- and post- the simulation intervention with randomised control and experimental groups of volunteer students. The results show that simulation training is an effective learning method as students from the experimental group, who were given the opportunity to observe and take part in high-fidelity simulation training followed by debriefing, made significantly higher improvements between their two OSCE performances than students from the control group. The second study focused on interprofessional learning with a randomised control group investigation of the students’ knowledge of the roles and skills of other healthcare professions involved in the same simulation session. The results demonstrate that observing and taking part in multidisciplinary scenarios and their debriefings contributed to the students’ acquisition of knowledge about the roles and skills of other health professionals. The study also showed that students’ perception of multidisciplinary team working was significantly influenced by whether or not they had experienced interprofessional high-fidelity scenario-based simulation training. The main original themes emerging from the research work presented in this thesis comprise the implementation of high-fidelity scenario-based simulation training and debriefing with undergraduate students from a range of healthcare disciplines and the objective measure of the effectiveness of such learning opportunities. This work has now started to impact on simulation practice in undergraduate education within the University and beyond

Respiratory therapy graduate students are going to face a clinical environment that commands greater responsibility and culpability than in years past. Therefore, respiratory therapy educators must prepare graduates for the multidimensional demands of the workplace. PURPOSE: The purpose of this study was to explore the perception of the undergraduate respiratory therapy (BSRT) and integrated graduate respiratory therapy (MSRT) students in the implementation of simulation in the educational laboratory setting. METHODS: Data were collected through a descriptive survey. The survey was distributed to a convenience sample of first year BSRT and MSRT students attending an accredited respiratory therapy program at an urban public research university in the southeast United States. The survey consisted of 10 questions presented in a four-point Likert-type scale to obtain students’ perceptions regarding their simulation experience. The collected data were analyzed using descriptive statistics. RESULTS: Thirty-two students were surveyed, more than two-thirds of the participants were female. Approximately seventy-one percent of respondents were BSRT, females accounted for 87% and males 13%. Graduate MSRT were 28.1% of the total sample with 44.4% females and 55.6% males. More than two-thirds of MSRT students reported previous clinical experience while BSRT students reported less than one-quarter. Additionally, only two students from BSRT indicated that they have previous simulation experience, whereas more than half of MSRT students reported previous simulation experience. The study findings indicate BSRT and MSRT students’ overall perceptions are similar, however, both perceive the experience of nervousness differently. BSRT students indicated high agreement with the statement that they experienced nervousness during the simulation with mean = 3.52 (SD ± .51). MSRT students indicated high agreement with the statement that simulation was a valuable learning experience with mean = 3.33 (SD ± .70). Both of BSRT & MSRT students agreed that simulation should continue to be an integral part of the respiratory therapy program. MSRT students demonstrated higher agreement with mean = 3.55 (SD ± .72). Finally, the majority of responses to a debriefing session after simulation experience supported their understanding and reasoning were positive from both BSRT & MSRT students with means respectively = 3.39 (SD ± .65), and 3.55, (SD ± .52). CONCLUSION: Respiratory therapy educators continue to strive to enhance respiratory therapy students’ clinical reasoning, transference of theory to clinical practice, skills acquisition, and critical thinking. Use of simulation is essential to achieve these objectives. The results of this study support the implementation of simulation course in the curriculum as a mandatory requirement prior to clinical practice as evidenced by positive responses from students. Although students felt positively that simulation should be continued in the curriculum, they did not feel it should totally substitute for all clinical experiences.

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Dans l’optique de perfectionner l’utilisation de la simulation clinique, il importe de se questionner sur la qualité des débriefings et surtout sur la perception qu’en ont les étudiant(e)s. L’outil le plus utilisé à cet effet est le Debriefing Experience Scale (DES; Reed, 2012) qui évalue l’expérience et l’importance du débriefing selon les étudiant(e)s. Cet outil n’est pas disponible en français et il est essentiel qu’il soit adapté au contexte et à la population auprès de qui on souhaite l’utiliser. Le but de cette étude a été de traduire en français, adapter au contexte québécois et valider le contenu du DES (Reed, 2012). Selon les recommandations de Sousa et Rojjanasrirat (2011), le DES a été traduit en français et rétrotraduit en anglais pour obtenir une version française, le DES-FR. La pertinence et la clarté de ses énoncés ont été évaluées par 10 expert(e)s en simulation clinique. Un échantillon de convenance de 29 étudiant(e)s en sciences infirmières a été sollicité pour évaluer la clarté des énoncés de l’outil. Les résultats indiquent que le DES-FR a un indice de validité de contenu global (IVC-S) de 0,93 selon les expert(e)s, suggérant une bonne validité de contenu, ainsi qu’un indice de clarté global (IC-S) de 0,96, soutenant qu’il est dans son ensemble clair selon l’échantillon étudiant. Le DES-FR est le premier outil en français présentant une validité de contenu et adapté au contexte de formation québécois qui permettra d’obtenir des données sur la qualité des débriefings selon la perspective étudiante. / To further improve the use of clinical simulations, it is crucial to question the quality of debriefings, especially students’ perceptions of them. The most used tool for this purpose is the Debriefing Experience Scale (DES; Reed, 2012), which assesses the experience and importance of debriefing for nursing students. The DES (Reed, 2012) is not available in French, and it must be congruent with the context and population it is intended to be used. This study aimed to translate into French, adapt to the Quebec educational context, and validate the content of the DES (Reed, 2012). For the method, we followed Sousa and Rojjanasrirat (2011) guidelines. Thus, the DES (Reed, 2012) was translated into French and back-translated into English to obtain a French version, the DES-FR. Ten clinical simulation experts assessed the French version for item relevance and clarity. In total, 29 nursing students evaluated the DES-FR item clarity. According to the experts, the DES-FR has an overall content validity index (S-CVI) of 0.93, suggesting good content validity. The overall scale’s clarity index (S-CI) reached 0.96, supporting that the content of the DES-FR is clear according to nursing students. The DES-FR is the first content-validated French tool adapted to the Quebec educational context that will provide data on the quality of debriefings from the student perspective.

De nos jours, la simulation clinique haute-fidélité (SCHF) s’avère une stratégie pédagogique par excellence, étant de plus en plus adoptée par plusieurs établissements d’enseignement nationaux et internationaux en sciences infirmières, et ce, afin de préparer les étudiants à leur future pratique. En dépit des nombreux bienfaits associés à la SCHF, il appert que plusieurs étudiants peuvent ressentir un sentiment de stress, d’angoisse et d’humiliation s’ils ne reçoivent pas l’accompagnement nécessaire de la part de leur formateur dans ce contexte académique. Nonobstant que plusieurs chercheurs infirmiers mettent l’accent sur l’importance du rôle du formateur en contexte de simulation, leurs travaux n’ont pas étudié l’aspect de la relation formateur-étudiants. Pourtant, sa valeur ajoutée a été mise en évidence par de nombreux écrits scientifiques, mais dans d’autres contextes académiques, notamment en classe, en stage clinique et en ligne. De surcroît, ces études n’ont pas précisé la nature de la relation formateur-étudiants, ni l’ont exploré sous une perspective humaniste. Par conséquent, il s’est avéré judicieux d’ajouter le qualificatif « pédagogique » afin de souligner l’aspect éducatif de la relation et le qualificatif « caring » pour désigner son approche humaniste. À la lumière des écrits recensés et à notre connaissance, aucune étude en sciences infirmières n’a exploré ce type de relation en contexte de SCHF. Ainsi, cette recherche doctorale s’est intéressée à décrire et comprendre la signification de l’expérience vécue d’une relation pédagogique de caring (RPC) selon la perception d’étudiants infirmiers du premier cycle universitaire en contexte de SCHF. De plus, cette recherche phénoménologique descriptive a visé l’exploration des facilitateurs, des obstacles et des contributions associées à la RPC dans ledit contexte. L’Investigation Relationnelle Caring (Cara, 1997; Cara et al., 2017), méthode phénoménologique descriptive, a été choisie afin de répondre au but et aux questions de cette recherche. Des entrevues individuelles de type semi-structuré ont été réalisées auprès de 19 étudiants infirmiers, lesquels ont participé à une seconde entrevue visant la validation des récits synthèses issus des verbatim. Inspirée par la pédagogique émancipatoire relationnelle (Hills et Watson, 2011; Hills et al., 2021) comme perspective disciplinaire, l’analyse et l’interprétation des données recueillies ont permis aux cinq eidos-thèmes suivants d’émerger : (1) engagement authentique du formateur à l’égard des étudiants, (2) conscientisation du formateur quant aux barrières au développement de la RPC, (3) mise en œuvre d’un espace d’apprentissage sécuritaire pour les étudiants, (4) cocréation d’une collaboration empreinte de caring entre formateur-étudiants et, (5) nature pédagogique et caring de la relation contribuant à la transformation du processus d’apprentissage. Ces derniers ont favorisé l’émergence de la structure essentielle du phénomène étudié (RPC), laquelle correspond à : « un engagement authentique du formateur favorisant un espace académique sécuritaire dans le but de cocréer une collaboration humaniste avec les étudiants qui vise la transformation de leur processus d’apprentissage en contexte de simulation clinique haute-fidélité ». Cette recherche phénoménologique ajoute au corpus de connaissances en sciences infirmières une nouvelle description et compréhension de la signification de la RPC, mettant en évidence, ses caractéristiques, ses facilitateurs, ses obstacles, de même que ses contributions en contexte de simulation. Nos résultats révèlent que les formateurs jouent un rôle capital pour promouvoir des expériences d’apprentissage enrichissantes chez les étudiants dans ledit contexte. Diverses recommandations, découlant de nos résultats, ont été proposées dans différents domaines de la pratique infirmière, notamment la formation, la recherche, la clinique, la gestion et le volet sociopolitique. Enfin, ces dernières visent à offrir aux parties prenantes des pistes de solution concrètes pour concourir à l’avancement des apprentissages des étudiants et, plus largement, à l’humanisation de la formation infirmière en contexte de simulation. / Nowadays, the high-fidelity clinical simulation (HFCS) is an outstanding pedagogical strategy, which is increasingly being adopted by several national and international nursing institutions in order to prepare students for their future practice. Despite countless advantages pertaining to HFCS, it appears that many students may feel a sense of stress, anguish, and humiliation if they do not receive the necessary support from their educator in this academic context. Notwithstanding the fact that many nursing researchers emphasize the importance of the educator’s role within the context of simulation, their works did not study the aspect of the educator-students relationship. However, its added value has been highlighted by a large amount of scientific papers, but in other academic contexts, notably classroom, clinical and online environments. Moreover, these studies did not specify the nature of the educator-students relationship, nor did they explore it from a humanistic perspective. Consequently, it was appropriate to add the term “pedagogical” to emphasize the educational aspect of this relationship, and the term “caring” to refer to its humanistic approach. Based on the literature and to our knowledge, no nursing study has explored this type of relationship within the context of HFCS. Thus, this doctoral research was interested in describing and understanding the meaning of the lived experience of a caring pedagogical relationship (CPR) according to the perception of undergraduate nursing students in the context of high-fidelity clinical simulation. In addition, this phenomenological descriptive research aimed to explore its facilitators, barriers, as well as contributions from the students’ perspective. The Relational Caring Inquiry (Cara, 1997; Cara et al., 2017), a descriptive phenomenological method, has been selected to meet the purpose and questions of this research. Individual semi-structured interviews were realized with 19 nursing students, who also participated in a second interview to validate the narrative synthesis. Being inspired by the relational emancipatory pedagogy (Hills & Watson, 2011; Hills et al., 2021), as a disciplinary perspective, the analysis and interpretation of the data collected have allowed the following five eidos-themes to emerge: (1) authentic engagement of the educator toward students, (2) Educator’s conscientization regarding barriers to the development of the CPR, (3) implementation of a safe learning space for students, (4) cocreation of a caring collaboration between educator-students and, finally, (5) pedagogical and caring nature of the relationship contributing to the transformation of learning process. They subsequently facilitated the emergence of the essential structure of the studied phenomenon (CPR), which corresponds to: “an authentic engagement of the educator fostering a safe academic space in order to cocreate a humanistic collaboration with students to transform their learning process within the context of high-fidelity clinical simulation”. This research adds to the body of nursing knowledge a new understanding in regard to the meaning of the CPR by highlighting its characteristics, facilitators, barriers, as well as its contributions in the context of simulation. Our results show that educators play a vital role to promote enriching learning experiences among students in the aforementioned context. Various recommendations arising from our findings have been proposed in different domains of nursing, notably education, research, clinical, management, and sociopolitical. Finally, these aim to provide stakeholders with concrete avenues to advance students’ learning and, more broadly, to humanize nursing education in simulation settings.