As societal needs change, the education of students must evolve to meet current needs. The Institute of Medicine (2011), in its Future of Nursing report, challenged educators to envision and embrace new ways to prepare future nurses. One way education has changed has been through the formation of academic-practice partnerships involving universities and hospitals. These partnerships are advantageous because they allow a combination of resources, the formation of relationships, and an alignment of educational and clinical strategies (Dobalian et al., 2014).
Simulation is one resource that is being used collaboratively to refine skills, promote teamwork, and improve communication between disciplines (Dobalian et al., 2014). With simulation, students are placed in safe clinical situations and asked to demonstrate the skills needed to prepare them for the future. A faculty member observes the students during the experience, and a debriefing is conducted. Research supports the use of simulation in helping students connect classroom learning to clinical experiences (Stroup, 2014).
The location of simulation centers varies, with a significant number of centers housed in university settings, much like a laboratory (Quaas & Bjorklunk, 2012). More recent hospital-based programs are emerging, yet literature on the scope and use of these centers is limited (Senger, Stapleton, & Gorski, 2012). Traditionally, hospital-based programs have served the needs of hospital staff, with the simulation-based education of students taking place off site. As the number of partnerships and the use of collaborative practice increases, the idea of working together in simulation becomes increasingly viable (Senger et al., 2012).
This article reports the initial evaluation results for learning and confidence for junior- and senior-level nursing students following simulation experiences in a hospital-based simulation center. Students completed the Simulation Effectiveness Tool (SET). Their responses allowed faculty to make changes in the early stages of implementation of the partnership between the school of nursing and the hospital and provided an outline for future use of the hospital-based center.
BACKGROUND
In 2010, discussion between the Eastern Michigan University School of Nursing and St. Joseph Mercy Hospital led to the establishment of a shared simulation space for a new physician assistant program. This space was designed to provide simulation experiences for hospital staff and Eastern Michigan University students from both the physician assistant and nursing programs. Existing space in the hospital was renovated for the simulation center.
Personnel were hired by the hospital to direct and run the simulations and by the university to facilitate the student groups. Facilitators consisted of university faculty in the school of nursing, the physician assistant program, and hospital employees hired for their area of expertise. For example, a nurse currently working in obstetrics at the hospital facilitated obstetrics simulations for students. Training for facilitators included introductory videos on simulation and an orientation to the environment.
Since its opening in May 2014, the simulation center has served more than 10 different health care groups including nurses, patient care technicians, anesthesia providers, respiratory therapists, patient companions, and students in both nursing and medicine. Approximately 4,217 nursing student learner hours took place between July 2014 and May 2016 (H. Buza, personal communication, May 11, 2016).
METHOD
In 2014, 160 traditional junior (72) and senior (88) nursing students were scheduled to participate in three experiences at the hospital-based simulation center. Students completed the SET, which measured learning skills or knowledge from the simulated experience and confidence (Cordi, Leighton, Ryan-Wenger, Doyle, & Ravert, 2012). Questions on the SET generated information regarding knowledge gained, decision-making skills, preparedness, and the debriefing process. Previous studies have shown that the 13-item scale is a reliable instrument for measuring simulation effectiveness with high internal consistency (Cronbach's alpha = .91). Further studies identified Cronbach's alphas for the subscales of learning (.87) and confidence (.84; Cordi et al., 2012).
The SET evaluation tool was given to the students after debriefing. Participation was not mandatory so attendance varied. However, all students participating in simulation completed the SET questionnaire after their experience. Students were allowed privacy and time to complete the tool and add comments. Percentages were completed and tallied for each group independently, to see if results were affected by class level, and then collectively. Comments were grouped according to theme. Institutional review board approval for the study was obtained from Eastern Michigan University prior to data collection; the study was considered exempt.
RESULTS
Students ranged in age from 18 to 61 years old (N = 188). Almost all of the students strongly agreed or somewhat agreed with all 13 statements. The greatest number of students strongly agreed on the following statements: "The instructor's questions helped me think critically" (97 percent of juniors, 99 percent of seniors); "Debriefing and group discussion were valuable" (91 percent of juniors; 96 percent of seniors); and "I was challenged in my thinking and decision-making skills" (85 percent of juniors, 90 percent of seniors). Juniors and seniors were tallied separately.
The fewest strong agreements had to do with the following statements: "I developed a better understanding of the medications that were in the simulated clinical experience (SCE)" (49 percent of juniors, 60 percent of seniors) and "My assessment skills improved" (53 percent of juniors, 60 percent seniors). A small percentage of students (up to 3 percent) did not agree with these statements.
Qualitative comments made by students provided valuable feedback. Several students requested that they be provided with additional information about the case and an orientation to the simulation center prior to beginning the simulation exercise. Students also asked if simulation could replace their clinical day and requested a more realistic charting system for the experience. Specific comments reflected overall positive themes, with students "feeling it was helpful and informative" and "wanting more simulations throughout the semester."
DISCUSSION
This study focused on assessing the students' perception of the effectiveness of the simulation experience in a new hospital-based simulation center. The data were used to provide preliminary information to improve the simulation process for future experiences and to compare the score of junior and senior students. Only a few studies have discussed the benefits of the hospital and university simulation partnership, such as resource and knowledge sharing, improved teamwork, communication, and role clarification (Metcalfe, Hall, & Carpenter, 2007; Senger et al., 2012). This study focused on the effectiveness of the student's experience.
The results showed that most students somewhat or strongly agreed on all 13 statements, indicating that the simulation was a useful learning experience. There were no significant differences found between the junior and senior students. Both groups scored the items similarly, suggesting that the simulations were appropriate at both levels in the program. However, the study revealed areas to improve on, as evidenced by lower percentages of students strongly agreeing that the simulation increased their knowledge about medications and assessment skills.
Feedback from the comments was used by instructors to focus future simulations on assessment skills and greater discussion of medications in the debriefing process. Initial results provide support of benefits to simulation, but more research is needed to show if the effectiveness is related to the hospital-based setting and its shared resources.
CONCLUSION
Simulation has been increasingly used in nursing education as a teaching innovation. Its effectiveness in learning and student confidence has been demonstrated using tools such as the SET in academic settings (Cordi et al., 2012). This study compared the use of simulation between junior and senior nursing students within a unique partnership setting, with similar results between the groups and most students providing positive feedback. Previous partnerships have shown stakeholder benefits but lack substantial evaluative data.
Use of the SET tool has been seen in the literature, primarily in academic settings. This particular partnership is unique and advances the literature by providing a cost-effective and resource-sharing model, giving students access to high-fidelity simulation experiences in a hospital-based simulation center. Future research studies are needed to evaluate if hospital-based simulation centers are an effective and resource-sharing alternative to the university-based centers and to promote the development of partnerships between universities and hospitals.
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