Nursing Students Perceptions of the Use of High

Nursing Students Perceptions of
the Use of High-fidelity
Simulation in PBL/PBL
Joanna Pierazzo (PI), Mary Allan, Grace McLaren &
Dorothy Bâby
Funded by Nursing Education Research Unit, McMaster University
and Mohawk College of Applied Arts & Technology, Hamilton, ON
—  High
Fidelity Simulation (HFS) is a teaching
and learning tool using human like simulators
to re-create real life patient situations
—  In PBL, real-world care scenarios are used to
facilitate learning
—  Traditionally, Standardized Patients have been
used to enhance student learning…BUT this
cannot mimic physiological change in more
acute s
(Barrows, 1996; Gaba et al, 2001; Jeffries, 2007; Leigh & Hurst, 2008)
Literature Review
Research has primarily focused on the use of simulation
in professional practice
—  Few studies have explored the use of simulation in
nursing theoretical courses
—  Findings suggest:
1.  simulation enhances clinical reasoning and bridges
theory with professional practice
2.  students benefit from combined pedagogical approaches
3.  students demonstrate improved clinical performance
(Lasater, 2007, Liaw, Chen, Klaiilin, Brammer, O’Brien & Smarasekera, 2009 ; Murphy et al., 2011;
Ogilvie et al, 2011; Reilly & Spratt, 2006, Sinclair & Ferguson, 2009 ; Wong, Cheung, Chung, Chan
& Chan, 2008; Wotton et al., 2010)
Research Question
—  What
are nursing students’ perceptions of
the use of high-fidelity simulation in the
Level Two Nursing Concepts in Health and
Illness course?
Research Design
—  A
descriptive, qualitative research design,
specifically case study methodology by Stake
—  a case may be ‘simple or complex’….’a
child or a classroom’….or ‘an event, a
—  Instrumental Case = case of interest, being
examined to provide insight into an issue
—  The case is second year nursing students,
taking N2N04 and who have utilized High
Fidelity Simulation in PBL
(Stake, 2005)
—  Convenience
sample of 19 Level 2 BScN
students enrolled in a theoretical nursing
—  Have participated in a PBL scenario with
the use of HFS (adult with COPD and/or
older adult with delirium)
Data Collection
—  Three
focus groups conducted at 2 sites
of a Collaborative BScN program
—  Semi-structured interview guide was
developed and pilot tested
—  Moderator and field observer facilitated
each focus group
—  Sessions were audiotaped and transcribed
Data Analysis
—  Thematic
analysis using a categorical
aggregation was used to identify a
collection of ‘instances’ from the data
—  Triangulation was utilized to strengthen
insights and interpretations
(Stake, 2005)
Bridging theory and practice
“opportunity to connect how we can actually use PBL to
benefit our clinical practice”
“it was a really nice bridge for the gap between PBL
and clinical”
Integrating knowledge from other courses
“actual nursing interventions…. that you can pull from
clinical as well as research done in PBL and other courses”
“helpful in incorporating the pathophysiology of COPD
well as like pharmacology because we actually got to use
the treatments that we had wanted to implement …”
Findings (cont’d)
Enhancing confidence for practice
“more comfortable in the real life clinical setting…. we
can always take back what we did”
“confidence booster…I did this really well or where I
need a little more focus”
Learning together
“showed how difficult it is to communicate between 2 nurses
when you’re trying to perform a task…..
“good experience of working collaboratively with like others
and learning how to facilitate and delegate our individual
Findings (cont’d)
Learning in a safe environment
“our decisions are protected….we can always take back what
we did”
“ if you make a mistake you’re going to remember that
mistake…and you’re not going to harm anyone in the process of
learning what you’re doing”
Integrating HFS in a PBL classroom:
Enhances students' confidence when going to
professional practice settings
Helps students to make connections between theory
concepts and practice application
Allows students to be actively engaged in their own
Provides an opportunity for students to learn with and
from each other
Supports educator creativity in using HFS when
discussing acute patient care scenarios in PBL Limitations
—  Simulation
centre variability
—  Faculty expertise in integrating simulation
in PBL
Barrows, H. S. (1996). Problem-based learning in medicine and beyond: A brief overview. In L. Wilkerson &
H. Gilselaers (Eds.), Bringing problem-based learning to higher education: Theory and practice. San
Franscisco, CA: Jossey-Bass Inc. Gaba, D.M, Howard, S.K., Fish, K.J., (2001). Simulation-based training in anesthesia crisis
management (ACRM): A decade of experience. Simulation & Gaming, 2001; 32; 175-193.
Jeffries, P.R. (Ed.) (2007). Simulation in nursing education: From conceptualization to evaluation.
National League for Nursing: New York.
Lasater, Kathie. (2007). High fidelity simulation and the development of clinical judgment: students'
experiences. Journal of Nursing Education, 46(6), 269-275.
Liaw, S.Y., Chen, F.G., Klainin, P., Brammer, J., O’Brien, A., & Samarasekera, D.D. (2009). Developing
clinical competency in crisis event management: an integrated simulation problem-based learning
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Chapter 17, Qualitative Case Study, Sage Publications, Inc. Thousand Oaks: California.
Wong, F. K., Cheung, S., Chung, L., Chan, K., & Chan, A. (2008). Frame-work for adopting a problembased learning approach in a simulated clinical setting. Journal of Nursing Education, 47(11), 508-514.
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