Original Article
Exploring the learning experiences of neonatal nurses with in-situ and off-site simulation-based education: A qualitative study

https://doi.org/10.1016/j.jnn.2018.05.007Get rights and content

Abstract

Background

The setting (in-situ or off-site) in neonatal simulation-based education and its effect on perceptions and learning experiences of neonatal nurses.

Methods

Single focus group interview lead by two interviewers. Seven participants (all neonatal nurses). Hand-held recording device (audio only). Interview transcript analysed using thematic analysis by three researchers.

Results

No consensus among nursing staff regarding preference for simulation setting. In-situ simulation was more difficult to engage with due to preoccupation with ward patients and reduced staff numbers, however was more realistic, which directly influenced the experience of the simulation. Off-site simulation provided separation from the ward and greater engagement with simulation. Debriefing was key to both types of simulation and important in the learning experience of participants.

Conclusion

Overall, simulation-based education was well accepted by most participants. In-situ simulation provided the most realistic simulation environment. Issues regarding participant distraction and concerns about short staffing need to be addressed.

Introduction

Simulation-based education is an important resource for health professionals to learn teamwork skills and improve their performance in emergency settings, whilst protecting patients from unnecessary risks. It involves ‘devices, trained persons, lifelike virtual environments, and contrived social situations that mimic problems, events, or conditions that arise in professional encounters’ (Issenberg et al., 2005)(pg.5). As simulation training is a vital tool in medical education it is important to explore how it can be best conducted. One aspect of simulation design is the setting. In situ simulation involves simulation-based education in the actual patient care unit. Off-site simulation, on the other hand, involves training in facilities outside the patient care unit (Walker et al., 2013). The question of how the simulation setting (in situ simulation versus off-site simulation) affects learning is an unresolved issue.

Simulation training often aims to replicate varying aspects of real clinical practice (Judd et al., 2016). The appeal of simulation is in its capacity to do this in a safe environment (Moule, 2011). A potential factor influencing the effectiveness of simulation is realism, or likeliness to the real-life situation. Realism can be described as involving physical components (the degree to which the simulation correlates to the actual clinical environment) and psychological components (the degree to which the trainee perceives the simulation to be an authentic representation of the real clinical setting) (Sørensen et al., 2013). In-situ simulation is believed to increase the fidelity of the simulation experience as learning takes place in a clinical setting. The rationale behind this is that in-situ simulation provides the greatest amount of faithfulness to the real-life situation and therefore provides the better learning environment (Grierson, 2014). The literature states that psychological fidelity is the most important aspect of team training, and it is likely that in-situ simulation is able to best provide this for participants (Meurling et al., 2014).

In the context of a recent change in how simulation training was conducted by the neonatal simulation (NeoSim) team of a tertiary level neonatal unit of a large public University hospital in Australia, we were interested in staff perceptions and experiences of the previously used off-site simulation compared to the current in-situ simulation. Our objective was to explore attitudes towards the two types of simulation and draw conclusions about the advantages and disadvantages of each type of training to guide future simulation-based medical education.

This study aimed to address the research question: How does the setting in simulation based medical education (in-situ or off-site simulation) affect the perceptions and learning experiences of neonatal nurses?

Section snippets

Design

The study design chosen was a qualitative study using a focus group. Focus groups, which can be defined as “a form of group interview that capitalises on communication between research participants in order to generate data,”(Kitzinger, 1995)(pg.1) are useful for exploring people's knowledge and attitudes. Focus groups allow for researchers to tap into group dynamics that often reveal more information than conventional data collection.

Setting and participant recruitment

The focus group interview was conducted on site at Monash

Identification of themes

The text was analysed and four major themes and two subthemes were identified (Table 2). The overall research question addressing the setting of simulation (in-situ or off-site simulation) provided a structure for establishing the following themes.

Theme 1: Ability to engage with the simulation

All participants identified the ability to engage with the simulation as important to their overall learning experience. The nurses reported that they were rostered to in-situ simulation during their shift and could therefore not fully engage with the

Discussion

Simulation based education is seen as constructive to medical training (Sorensen et al., 2015). One meta-analysis on the effectiveness of simulation-based nursing education showed particularly strong educational effect with regards to psychomotor skills (Kim et al., 2016). All participants accepted simulation as an important tool to aid in communication between team members as well as playing a role in self-reflection and effective learning. This is the first qualitative study to our knowledge

Conclusions

Overall, simulation education is well accepted by most participants. It appears that in-situ simulation provides the most realistic simulation setting. However, the timetabling convenience of off-site simulation increases engagement with simulation and therefore the learning experience of participants. It is important the simulation equipment is appropriate and the environment of the simulation room is as faithful to the real-life scenario as possible. Furthermore, concerns with short staffing

Author contribution

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (17)

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    In-situ simulation occurs in the actual clinical environment (Patterson, Blike, & Nadkarni, 2008), whereas off-site simulation involves workshops outside the patient care unit (Walker et al., 2013). We have previously shown that in-situ simulation provided a more realistic environment compared with off-site simulation training through a focused group interview, but we had not investigated quantitative clinical neonatal outcomes post–NRS training (Kosanam, Stewart, Wallace, & Malhotra, 2018). NRS training has been shown to improve practitioner confidence (Bruno et al., 2016; Mileder, Urlesberger, Szyld, Roehr, & Schmolzer, 2014; Rakshasbhuvankar & Patole, 2014) and knowledge (Bruno et al., 2016; Jabir, Doglioni, Fadhil, Zanardo, & Trevisanuto, 2009), with trainees feeling a high level of satisfaction (Halamek et al., 2000) and improving their technical skills and resuscitation performance ability (Bruno et al., 2016; Rubio-Gurung et al., 2014; Sawyer et al., 2011).

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    However, the vast majority of studies describe the use of in-situ simulations in relation to continuing education and staff training in various traditional clinical contexts (Dowson et al., 2013; Lavelle et al., 2017; Villemure et al., 2016). Among health care professionals, in-situ simulations are considered more realistic than off-site simulations (Kosanam et al., 2019; Sørensen et al., 2015). It is reasonable to assume that nursing students will also benefit from in-situ simulations, as they take training out of the safe environment of the university into more realistic settings.

1

Hospital Intern, Bendigo Health, 71 Forest Street, Bendigo Australia 3550.

2

Consultant Neonatologist, Monash Children's Hospital, 246 Clayton Road, Clayton Australia 3168.

3

Clinical Nurse Educator, Monash Children's Hospital, 246 Clayton Road, Clayton Australia 3168.

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