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Year : 2017 | Volume : 5 | Issue : 2 | Page : 63 - 67  


Original Articles
Competency and satisfaction level of high and medium fidelity simulation in drug administration teaching and learning practice: A comparative study

Mohd Said Nurumal1, UmmuHananiHaji Hashim2, KhinThandarAung3

1Dean, Faculty of Nursing, 2Faculty of Nursing, 3Lecturer/Head, Critical Care Nursing Department, Faculty of Nursing, International Islamic University, Malaysia

Corresponding Author:

KhinThandarAung

Email: khin_ta@iium.edu.my

ABSTRACT:

Background: Nowadays, the simulation practice is becoming more popular in nursing education and that can improve the nursing students clinical skills and soft skills. Moreover, it allows the students from conductive simulated environment to the real-like situation that they may experience later in their clinical attachment period. Due to little current information of issues pertaining to the relevant type of simulation that is able to create the students competency and satisfaction, therefore, a thorough comparison between the effectiveness of high fidelity and medium fidelity simulation is needed.

Objective: The aim of this study was to compare the effectiveness of medium and high fidelity simulation towards developing students competency skill in drug administration via oral, subcutaneous, intramuscular and intravenous route and also to identify the students satisfaction level towards high and medium fidelity simulation.

Methods: A comparative cross-sectional study was conducted in Kulliyyah of Nursing, International Islamic University Malaysia (IIUM) at Jalan Hospital Campus, Kuantan. First year nursing students who match including criteria were recruited as a compulsory class (N= 54) and the students were divided into two groups using simple random assignment sampling. The students were assessed during the simulation using rubric checklist and completed Likert scale after finished each simulation sessions. Data analysis involved Wilcoxon signed rank test using PASW Statistic 18.

Results: The findings on the competency level (technical skills and non-technical skills) showed statistical significant improvement of mean score (p< 0.05) in high fidelity simulation compared to medium fidelity simulation in both groups. The students satisfaction levels towards simulation were significant increased statistically for both groups (p< 0.05) in second session of simulation regardless of the type fidelity simulation.

Conclusion: The high fidelity simulation was able to prepare better technical and non-technical skills as compared to medium fidelity simulation. However, the students satisfaction did not associate with the type of fidelity simulation but showed improvement after repeated or sequential simulation. More research is required to compare and to explore more about the simulation fidelity.

Keywords: High fidelity simulation, Medium fidelity simulation, Competency, Satisfaction, Nursing simulation

INTRODUCTION:

Nursing is a career that using knowledge-based supported by critical thinking and the intelligent application of knowledge into practice as its core. Thus, the nursing institution which is the main producer of nurses also takes part in producing future nurses that accommodate to the demands. One of the innovations in nursing education is simulation practice. Wilford & Doyle (2006) 1 stated that the simulation practice was firstly used in military and aviation about 40 years ago and a nursing school in the UK is the first institution that used simulation to teach physical assessment in their education curriculum. Simulation brings abundance benefits in terms of knowledge and skill acquirement and still being used as a teaching strategy that have increased credibility and popularity. 2, 3

In addition, simulation can provide development of the students clinical and cognitive skills, communication and also critical thinking proficiently. 4 Moreover, several studies found that simulation-based learning is an effective learning style that is able to reduce the medication errors compared to in-class lecture. 5, 6

Levett-Jones et al 7 stated that human patient simulation is being used extensively in nursing education, however the effectiveness of simulation in terms of teaching non-technical skills are still not clear. Since, the simulation is being used innovatively and it is believed that can reduce medication administration errors, it is important that the actual outcome of the simulation needs to be measured. Therefore, it is crucial to measure the actual effectiveness of simulation towards the improvement of technical skills and non-technical skills for administering drugs in undergraduate nursing programs and the students satisfaction towards high fidelity simulation and medium fidelity simulation.

This study intended to provide the actual measurement of the effectiveness of simulation in developing technical skills and non-technical skills in drug administration using simulation practice in undergraduate nursing programs. Moreover, the nurse educators able to decide which type of simulation that is needed to be approached first in order to develop the appropriate nursing skills within their students.

MATERIAL & METHODS:

Study Design: A comparative design involving first year nursing students from Kulliyyah of Nursing, IIUM who are in pharmacology module was used and then these participants were divided into two groups; high-fidelity group and medium- fidelity group using simple random assignment. The study was conducted on April 2015 after getting approval from Kulliyyah of Nursing Research Committee (KNRC), International Islamic University Malaysia Research Ethics Committee (IREC) and Clinical Skills Centre (CSC), Kulliyyah of Nursing, IIUM. Total 54 first year nursing students were involved and modified checklist for the transferability of the technical and non-technical skills (competency) was used as research instruments. To assess the students satisfaction in simulation practice using the Likert scale. The internal consistency of rubric checklist was tested by using two different assessors (inter-observer reliability) and internal consistency of the Likert Scale was tested using Crohnbach alpha. The result of interpreter reliability using intra-class correlation coefficients showed 0.894 while the Crohnbach alpha for Likert scales internal consistency showed 0.873.The validity of the instruments that used was obtained using content validity index (CVI) by showing the instruments to the expert to review. The data were analyzed using PASW Statistic 18. Descriptive and inferential analysis was used to investigate the competency score and satisfaction levels of high-fidelity group and medium- fidelity group. Alpha value of 0.05 was used to indicate the significance. Wilcoxon signed rank test was used to measure the competency score and satisfaction levels of respondents fewer than two different conditions (high and medium fidelity simulation).

RESULTS:

More than half of respondents were female students (73.3%) while others (26.7%) were male students. Competency level of high fidelity respondents and medium fidelity respondents as shown in Table 1.The high-medium group showed significant decrease in technical score while for the medium-high group showed significant improvement. In the non-technical score, the high-medium group performed poorly in medium simulation level thus showed significant declines of the score. For medium-high group performed significant improvement of scoring in non-technical skills from medium simulation to high simulation.

The Wilcoxon signed rank test was used to compare the difference of the mean of technical skills and non-technical skills between high-medium group and medium-high group in each simulation. It showed the different level of simulation elicit a statistically significant decreased change (z= -2.485, p-value= 0.013 < α= 0.05) for technical skills between high fidelity simulation and medium fidelity simulation. However, the difference of the non-technical mean score did not significant statistically as the z= -0.491 and p-value= 0.624 (> α= 0.05) but only significant decline descriptively.

In addition, the medium-high group participants demonstrated that the difference between the fidelity was significant improved statistically with z= -2.234 and p-value= 0.026 (< α= 0.05). The non-technical skills of medium-high group of students proved that the z= -2.753 and p-value= 0.006 (< α= 0.05) that implied that the difference between simulation was statistically improved significantly. (Table 2)

Table 3 presented the satisfaction level of the respondents toward the simulation immediately after finishing the procedure in different level of fidelity. The 5 points-Likert scale was scaled as 1-strongly agree, 2- agree, 3- neutral, 4- disagree and 5- strongly disagree. The mean score of satisfaction near to 1 implies that the respondent very satisfied towards the simulation while the increasing score toward 5 indicates that respondent very unsatisfied of simulation. The elements of respondents satisfaction towards simulation are the preparation of the simulation, the time allocated for each simulation, the lesson that able to learn during simulation, the inclination of confidence level after the simulation and the willingness to participate in the next simulation. In high-medium simulation, there are diminutions of the satisfaction score in medium level as compared to high level simulation. In other hand, for the group of medium-high simulation there are increments of satisfaction score in medium level simulation as compared to high level simulation.

The comparison between satisfaction levels toward the simulation of high-medium group and medium-high group was shown in Table 4.

DISCUSSION:

Most of the respondents were female and others were male. This was due to the distributions of genders in nursing profession was mostly dominated by female.

From the both groups of high-medium and medium-high, the mean score for the technical skills implied that the respondents able to perform better in high fidelity simulation setting rather than medium fidelity simulation setting regardless which type of simulation they experience first. In fact, the students that performed in high fidelity simulation in the first session obtained a lower mean score in his or her technical skills in the medium fidelity simulation setting which was their second session. This significant difference (p < 0.05) reflects that the high fidelity simulation is better and more effective in developing technical skills in drug administration among the nursing students. This result supported with the study conducted on high-fidelity simulation by Lasater 8 that found high-fidelity simulation allowed the assimilation of the theory that the students learnt in the class and a student said that he or she needs to actively participate in the simulation and assimilate all the knowledge they gain during class.

The result compared to the mean score of non-technical skills of respondents between high-medium group and medium-high group showed that they gained higher mean score in high fidelity simulation setting compared with medium fidelity simulation setting despite of the sequence of their simulation. The insignificant improvement in non-technical skills for high-medium group can be explained by the readiness of the students in the second session, which was medium-fidelity simulation, because they have already got exposure in the first session (high-fidelity simulation) and able to transfer it in second session resulting good score in the second session. In contrast, the medium-high group has better exposure in the second session (high-fidelity simulation) thus they are able to gain more score on the second session.

The study by Shinnick & Woo 9 found that there were no significant changesin statistically, but there were improvement in knowledge acquisition for the students undergone high-fidelity simulation as there were learning process occurs during the simulation. Besides, the ability of two-way interaction with high-fidelity simulation encourage the students to involve in the conversation thus enable them being alert for every detail that often being missed during the teaching and learning activities that was taught in the class. 8.

The satisfaction level of the respondents towards the preparation of simulation, the time allocation for each simulation, the lesson learn after the simulation, the increment of confident level after simulation, and the willingness to participate in future simulation between high-medium group and medium-high group resulted as there are no constant result between high fidelity simulation setting as well as medium fidelity simulation setting. Both of the fidelity had increment in mean score of the satisfaction whenever the students rated it in the second session. In addition, the satisfaction of simulation preparation showed significant difference between high-medium group and medium-high group had improvement in mean score that significant statistically (p< 0.05). On other satisfaction, only the time allocation and the increment of confident level in medium-high group showed a statistic significant difference (p< 0.05) while the other satisfaction between high-medium group and medium-high group not produced a significant difference of the mean score.

In this study, the satisfaction of the respondents did not follow with the different type of simulation. The respondents satisfaction increased with the repetitive simulation regardless of the high fidelity or medium fidelity simulation that was in the second session. Thus, the satisfaction for the simulation can be attainable in higher score after the few cycles of practice.

LIMITATION:

This study was conducted in a small population of nursing students at one university only. Ideally, a bigger sample would have enabled the researcher to compare the effectiveness of high fidelity simulation and medium fidelity simulation and to compare the satisfaction of the respondents toward respective simulation.

CONCLUSION:

This study found that most respondents have better mean score in high fidelity simulation for technical skills and non-technical skills regardless of the session of simulation compared to medium fidelity simulation. In this study, it reflects that the steps in teaching and learning activities such as introduce the students with the less difficult fidelity simulation first, followed by difficult fidelity simulation that is able to bring greater impact towards the students skills acquisition. For instance, medium fidelity simulation have the ability to prepare the students with the minimum skills before they engage in a high fidelity simulation then later on in real clinical settings.

REFERENCES:

  1. Wilford A, Doyle TJ. (2006) Integrating simulation training into the nursing curriculum. British Journal of Nursing; 11;15(17):926-30. DOI:12968/bjon.2006.15.17.21907.
  2. Brown RA, Guinea S, Crookes PA, McAllister M, Levett-Jones T, Kelly M, Reid-Searl K, Churchouse C, Anderson P, Chong N, Smith A. (2012) Clinical simulation in Australia and New Zealan: Through the lens of an advisory group. Collegian; 19(3):177-86. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23101352.
  3. Wolf L, Dion K, Lamoureaux E, Kenny C, Curnin M, Hogan M, Roche J, Cunningham H. (2011). Using simulated clinical scenarios to evaluate student Nurse Educator; 36(3):128-34. DOI:10.1097/NNE.0b013e318216120b.
  4. Becker KL, Rose LE, Berg JB, Park H, Shatzer JH.(2006).The teaching effectiveness of standardized patients. Journal of Nursing Education; Apr;45(4):103-11. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16629278.
  5. Buykx P, Cooper S, Kinsman L, Endacott R, McConnell-Henry T, Cant R. (2012). Patient deterioration simulation experiences: Impact on teaching and learning. Collegian; 19(3):125-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23101346.
  6. Ford DG, Seybert AL, Smithburger PL, Kobulinger LR, Samosky JT, Kane-Gill SL. (2010). Impact of simulation-based learning on medication error rates in critically ill patients. Intensive Care Medicine; Sep;36(9):1526-31. doi: 10.1007/s00134-010-1860-2..
  7. Levett-Jones T, Lapkin S, Hoffman K, Arthur C, Roche J. (2011). Nurse Education in Practice Examining the impact of high and medium fidelity simulation experiences on nursing students knowledge acquisition. Nurse Education in Practice; Nov;11(6):380-3. doi: 10.1016/j.nepr.2011.03.014.
  8. Lasater K. (2007). High-fidelity simulation and the development of clinical judgment: Students experiences. Journal of Nursing Education; Jun;46(6):269-76. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17580739.
  9. Shinnick MA &Woo MA. (2013). the effects of human patient simulation on critical thinking and its predictor in prelicensure nursing students. Nurse Education Today; Sep;33(9):1062-7. doi: 10.1016/j.nedt.2012.04.004.

Table 1: Technical and non-technical skills mean score between high-medium and medium-high groups

Simulation

Mean (μ)

Standard Deviation (SD)

High medium

Mtechnical

56.13

+15.09

Mnontechnical

62.53

+25.36

Htechnical

67.93

+18.10

Hnontechnical

67.20

+22.88

Medium high

Mtechnical

50.27

+20.35

Mnontechnical

57.20

+25.83

Htechnical

69.67

+15.37

Hnontechnical

78.00

+14.33

* Mtechnical: Technical skills in medium fidelity simulation.

*Mnontechnical: Non-technical skills in medium fidelity simulation.

*Htechnical: Technical skills in high fidelity simulation.

*Hnontechnical: Non-technical skills in high fidelity simulation.

Table 2: Technical and non-technical skills Z score and p-value between high-medium and medium-high groups

Simulation

Z score

P value (α= 0.05)

High medium

Htechnical-Mtechnical

-2.485

0.013

Hnontechnical-Mnontechnical

-0.491

0.624

Medium high

Htechnical-Mtechnical

-2.234

0.026

Hnontechnical-Mnontechnical

-2.753

0.006

* Mtechnical: Technical skills in medium fidelity simulation.

*Mnontechnical: Non-technical skills in medium fidelity simulation.

*Htechnical: Technical skills in high fidelity simulation.

*Hnontechnical: Non-technical skills in high fidelity simulation.

Table 3: Satisfaction levels toward the simulation

Simulation

Mean (μ)

Standard deviation (SD)

High medium (medium)

Preparation

1.67

0.90

Time

1.87

0.91

Lesson

1.27

0.79

Confidence

1.67

1.11

Future participation

1.60

0.98

High medium (high)

Preparation

2.60

0.82

Time

2.47

0.91

Lesson

1.73

1.10

Confidence

2.07

1.22

Future participation

2.00

1.25

Medium high (medium)

Preparation

2.27

0.88

Time

2.40

0.82

Lesson

1.53

1.12

Confidence

2.20

1.08

Future participation

1.93

1.10

Medium high (high)

Preparation

1.47

0.64

Time

1.67

0.72

Lesson

1.13

0.35

Confidence

1.40

0.63

Future participation

1.60

0.73

*High-medium (medium): Medium fidelity simulation in high-medium group.

*High-medium (high): High fidelity simulation in high-medium group.

*Medium-high (medium): Medium fidelity simulation in medium-high group.

*Medium-high (high): High fidelity simulation in medium-high group.

Table 4: Z score and p-value of satisfaction levels toward the simulation of high-medium group and medium-high group

Simulation

Z score

p-value (α= 0.05)

High medium

Preparation

-2.648

0.008

Time

-1.811

0.070

Lesson

-1.725

0.084

Confidence

-1.140

0.254

Future participation

-1.222

0.222

Medium high

Preparation

-3.051

0.002

Time

-2.598

0.009

Lesson

-1.289

0.197

Confidence

-2.326

0.020

Future participation

-0.877

0.380

*High-medium (medium): Medium fidelity simulation in high-medium group.

*High-medium (high): High fidelity simulation in high-medium group.

*Medium-high (medium): Medium fidelity simulation in medium-high group.

*Medium-high (high): High fidelity simulation in medium-high group.

ACKNOWLEDGEMENT(S): First and foremost, were highly appreciated to the first year nursing students who are studying in International Islamic University, Malaysia (IIUM) for giving their time and effort to participate in simulation practice for this study. Next, our appreciation also goes to our friends for all supports, advises and technical assistance provided by them from the start until the end of this research process. Finally, we special thanks to all members in our faculty for giving full support throughout the study.





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