Date of Degree

6-2022

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor

Marianne R. Jeffreys

Committee Members

Eleanor T. Campbell

Anthony G. Picciano

Joanne K. Singleton

Subject Categories

Adult and Continuing Education | Educational Assessment, Evaluation, and Research | Educational Methods | Educational Technology | Other Nursing

Keywords

Nursing Education, Virtual Simulation, Synchronous Prebriefing, Synchronous Debriefing, Paired Prebriefing-Debriefing, Self-Efficacy, Virtual Simulation Performance, Myocardial Infarction Care

Abstract

Through the use of virtual simulations (VS) in nursing education, nursing students are exposed to a variety of clinical scenarios that may potentially improve their learning of competencies, increase their self-efficacy, and enhance their future clinical performance. Despite limited quantitative research incorporating evidence-based strategies such as prebriefing and debriefing as part of the VS experience, this educational technology continues to gain popularity. In 2020, the use of VS in the nursing curriculum exponentially increased when the global COVID-19 pandemic impacted traditional in-person clinicals, laboratory, and human patient simulation (HPS) experiences. Associate Degree Nursing (ADN) programs have benefited from the use of VS. Among the various types of programs that educate prelicensure nursing students, ADN programs prepare the greatest number of students, educate more culturally and academically diverse students, and are challenged to prepare competent nurse graduates within a short curriculum timeframe. The researcher aimed to explore the effect of the Virtual Simulation Paired Prebriefing-Debriefing (VSPPD) strategy on ADN students’ self-efficacy perceptions and VS performance concerning the care of patients experiencing a myocardial infarction (COPE-MI).

Guided by the National League for Nursing (NLN) Jeffries Simulation Theory (JST) and principles of Bandura’s self-efficacy theory, this quasi-experimental, two-group (intervention group and control group), pretest and post-test educational intervention study examined five research questions: 1) What is the effect of the Virtual Simulation Paired Prebriefing-Debriefing (VSPPD) strategy on Associate Degree Nursing (ADN) students’ self-efficacy perceptions concerning the care of patients experiencing an MI? 2) What is the effect of the VSPPD strategy on VS performance scores? 3) What is the correlation between students’ self-efficacy perceptions and VS performance scores? 4) What is the influence of selected demographic variables on students’ self-efficacy perceptions concerning the care of patients experiencing an MI? 5) What is the influence of selected demographic variables on students’ VS performance scores?

Implemented with a third-semester, five-credit, advanced medical-surgical nursing course in the ADN curriculum, the VSPPD strategy aimed to positively influence nursing students’ self-efficacy for performing cognitive, practical, and affective COPE-MI nursing skills and VS performance scores through students’ participation in a paired prebriefing-debriefing and repeated completion of the same VS scenario preceded and followed by structured briefing conversations. The VSPPD strategy was developed by the researcher based on the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, constructs of the JST, and the NLN vSim® for Nursing Curriculum Integration Guide for Faculty. The effectiveness of this educational strategy was measured by the Care of Patients Experiencing a Myocardial Infarction Self-Efficacy Tool (COPE-MI SET©), the Virtual Simulation Survey (VSS), and students’ VS performance scores.

Data analysis results for the five research questions support the effectiveness of the VSPPD educational strategy on students’ COPE-MI self-efficacy perceptions (in the cognitive, psychomotor, and affective domains) and VS performance scores. Results also support that there is a positive correlation between students' COPE-MI self-efficacy perceptions and VS performance scores. While sample size limitation was a concern, this study also provided evidence that the VSPPD strategy caused positive changes in students’ COPE-MI self-efficacy perceptions and VS performance scores regardless of students’ age, previous experience with video or computer gaming, or previous healthcare work experience.

This study fills a literature gap in the area of high-quality, multidimensional, synchronous VS educational intervention studies specifically utilizing sound evidence-based educational and evaluation strategies that were guided by theoretical frameworks, followed international simulation guidelines and standards, incorporated a structured paired prebriefing-debriefing, included and measured repeated VS performances, and measured self-efficacy outcomes using a valid and reliable measurement tool. Lastly, the study VSPPD strategy detailed implementation guidelines and evaluation tools can assist in directing future VS synchronous educational strategies and research studies focused on evaluating participants’ COPE-MI self-efficacy perceptions and VS performance.

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