Effect of Realistic Simulation and Digital Educational Platforms for Learning Nursing Student

Effect of Realistic Simulation and Digital Educational Platforms for Learning Nursing Student: Randomized Clinical Trial

Teaching modalities that integrate digital educational technologies, such as educational games, dummies and simulated environments, develop critical thinking in students, the absorption of significant learning and the consequent reduction in the exposure of patients to the damage associated with health care. Thus, this study will evaluate the effectiveness of simulation strategies and digital educational platforms in the teaching-learning process, in self-confidence and its implications for the physiological variables and stressful feelings of undergraduate nursing students. Our hypothesis is that students submitted to the use of digital platforms will present lower levels of self-efficacy, capacity for clinical judgment and retention of knowledge when compared to those who were submitted to the simulation strategy.

Study Overview

• Status: Not yet recruiting
• Conditions: Educational Technology
• Intervention / Treatment: Other: Educational digital platforms

Detailed Description

The study will be carried out in the simulation laboratory of two Higher Education Institutions, one public and the other private in the city of Brasília, Brazil. The sample will consist of 100 students randomized into an experimental group (n=50) and a control group (n=50). Students enrolled in the undergraduate nursing course, aged 18 years or over, will be eligible; have minimal approval in a discipline related to the content of "Nursing Care for Adult Patients". Students who work actively in the scenario of patient care in critical and risk situations will be excluded; members of the Academic League of Realistic Health Simulation and those with prior training in the health field. It is expected that nursing students, through active and innovative strategies, will be able to obtain and retain greater knowledge, raise levels of self-efficacy and clinical judgment, for their performance in clinical practice.

• Study Type: Interventional
• Enrollment (Anticipated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marcia CS Magro, PhD; Phone Number: 5561982690888; Email: marciamagro@unb.br
• Study Contact Backup: Name: JANE WS NOGUEIRA, Master; Phone Number: 5561999666669; Email: janewalkiria@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Aged over 18 years;

Students approved in the discipline related to nursing care for adult and elderly patients.

Exclusion Criteria:

Students who actively work in the scenario of patient care in critical and risk situations; Members of the Realistic Health Simulation League; Students with previous training in the health area (nursing technicians, firefighters, among others) ; Participants who for some reason are absent from one of the project stages.

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Educational digital platforms; Nursing students from the Experimental Group (GE), will participate in educational activities made available on digital platforms on "nursing care for patients with signs and symptoms of sepsis"	Other: Educational digital platforms; The digital educational platforms will be implemented through games of questions and answers, simulated cases sent via google forms about the nurse's performance in a critical care unit facing the patient with signs and symptoms of sepsis. The questions in the games will aim to develop clinical judgment and quick decision-making in nursing students in order not to compromise the health care of the patient in sepsis.
Active Comparator: High-Fidelity Simulation; Nursing students in the Control Group (GC) will be exposed to high-fidelity simulation in the intensive care setting, where they must solve situations and procedures related to the nurse's performance in recognizing the signs and symptoms of sepsis.	Other: Educational digital platforms; The digital educational platforms will be implemented through games of questions and answers, simulated cases sent via google forms about the nurse's performance in a critical care unit facing the patient with signs and symptoms of sepsis. The questions in the games will aim to develop clinical judgment and quick decision-making in nursing students in order not to compromise the health care of the patient in sepsis.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cognitive Performance (Baseline)	Application of a questionnaire with ten multiple choice questions to assess the knowledge of nursing students about signs and sepsis symptoms	Applied before the intervention
Cognitive Performance (Post-Test)	Application of a questionnaire with ten multiple choice questions to assess the knowledge of nursing students about signs and sepsis symptoms	Applied immediately after the intervention
Cognitive Performance (Retention over time)	Application of a questionnaire with ten multiple choice questions to assess the knowledge of nursing students about signs and sepsis symptoms	Applied thirty days after the intervention
Cognitive Performance (Retention over time)	Application of a questionnaire with ten multiple choice questions to assess the knowledge of nursing students about signs and sepsis symptoms	Applied sixty days after the intervention
Clinical Judgment (Baseline)	Evaluation of the development of clinical reasoning of nursing students. The instrument Lasater clinical Judgment Rubric (LCJR)- Brazilian Version will be used. It assesses 11 dimensions at four levels of clinical judgment (recognition, interpretation, response, reflection). The total score ranges from 11 to 44, where the "initial" level generates one point, the "in development" level generates two points, the "proficient" level generates three points and the "exemplary" level generates four points.	Applied before the intervention
Clinical Judgment	Evaluation of the development of clinical reasoning of nursing students. The instrument Lasater clinical Judgment Rubric (LCJR) - Brazilian Version will be used. It assesses 11 dimensions at four levels of clinical judgment (recognition, interpretation, response, reflection). The total score ranges from 11 to 44, where the "initial" level generates one point, the "in development" level generates two points, the "proficient" level generates three points and the "exemplary" level generates four points .	Applied immediately after the intervention
Clinical Judgment	Evaluation of the development of clinical reasoning of nursing students. The instrument Lasater clinical Judgment Rubric (LCJR) - Brazilian Version will be used. It assesses 11 dimensions at four levels of clinical judgment (recognition, interpretation, response, reflection). The total score ranges from 11 to 44, where the "initial" level generates one point, the "in development" level generates two points, the "proficient" level generates three points and the "exemplary" level generates four points.	Applied thirty days after the intervention
Clinical Judgment	Evaluation of the development of clinical reasoning of nursing students. The instrument Lasater Clinical Judgment Rubric (LCJR) - Brazilian Version will be used. It assesses 11 dimensions at four levels of clinical judgment (recognition, interpretation, response, reflection). The total score ranges from 11 to 44, where the "initial" level generates one point, the "in development" level generates two points, the "proficient" level generates three points and the "exemplary" level generates four points .	Applied sixty days after the intervention
Self-efficacy (Baseline)	Assessment of satisfaction, learning, individual performance after educational actions. A self-efficacy scale will be used. IT'S self-applicable and has 13 items related to beliefs about their own abilities, motivation for action, coping with obstacles, predisposition to challenge, openness to experience, resilience in the face of failures, the influence of initial success on the the final success of an activity and the history of previous successes. These items are represented by a Likert-type scale of agreement, containing five points, in which 1 represents the participant's total disagreement and 5 the total agreement. Scores above 2.5 indicate that participants feel very capable.	Applied before the intervention
Self-efficacy	Assessment of satisfaction, learning, individual performance after educational actions. A self-efficacy scale will be used. IT'S self-applicable and has 13 items related to beliefs about their own abilities, motivation for action, coping with obstacles, predisposition to challenge, openness to experience, resilience in the face of failures, the influence of initial success on the the final success of an activity and the history of previous successes. These items are represented by a Likert-type scale of agreement, containing five points, in which 1 represents the participant's total disagreement and 5 the total agreement. Scores above 2.5 indicate that participants feel very capable.	Applied immediately after the intervention
Self-efficacy	Assessment of satisfaction, learning, individual performance after educational actions. A self-efficacy scale will be used. IT'S self-applicable and has 13 items related to beliefs about their own abilities, motivation for action, coping with obstacles, predisposition to challenge, openness to experience, resilience in the face of failures, the influence of initial success on the the final success of an activity and the history of previous successes. These items are represented by a Likert-type scale of agreement, containing five points, in which 1 represents the participant's total disagreement and 5 the total agreement. Scores above 2.5 indicate that participants feel very capable.	Applied thirty days after the intervention
Self-efficacy	Assessment of satisfaction, learning, individual performance after educational actions. A self-efficacy scale will be used. IT'S self-applicable and has 13 items related to beliefs about their own abilities, motivation for action, coping with obstacles, predisposition to challenge, openness to experience, resilience in the face of failures, the influence of initial success on the the final success of an activity and the history of previous successes. These items are represented by a Likert-type scale of agreement, containing five points, in which 1 represents the participant's total disagreement and 5 the total agreement. Scores above 2.5 indicate that participants feel very capable.	Applied sixty days after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Student stress (Baseline)	Assessment of the intensity of stress among nursing students caused by pedagogical strategies: high-fidelity simulation and digital educational platforms. The questionnaire will be applied. It consists of 31 items and the answers are Likert type, scored from 0 to 3, depending on the degree of concern it generates for the student, as follows: nothing (0), a little (1), a lot (2) and extremely ( 3).	Before the intervention
Student stress	Assessment of the intensity of stress among nursing students caused by pedagogical strategies: high-fidelity simulation and digital educational platforms. The questionnaire will be applied. It consists of 31 items and the answers are Likert type, scored from 0 to 3, depending on the degree of concern it generates for the student, as follows: nothing (0), a little (1), a lot (2) and extremely ( 3).	Applied immediately after the intervention
Student stress	Assessment of the intensity of stress among nursing students caused by pedagogical strategies: high-fidelity simulation and digital educational platforms. The questionnaire will be applied. It consists of 31 items and the answers are Likert type, scored from 0 to 3, depending on the degree of concern it generates for the student, as follows: nothing (0), a little (1), a lot (2) and extremely ( 3).	Applied thirty days after the intervention
Student stress	Assessment of the intensity of stress among nursing students caused by pedagogical strategies: high-fidelity simulation and digital educational platforms. The questionnaire will be applied. It consists of 31 items and the answers are Likert type, scored from 0 to 3, depending on the degree of concern it generates for the student, as follows: nothing (0), a little (1), a lot (2) and extremely ( 3).	Applied sixty days after the intervention

Collaborators and Investigators

• Sponsor: University of Brasilia
• Investigators: Principal Investigator: Marcia CS Magro, PhD, University of Brasilia

Publications and helpful links

General Publications

• Basak T, Unver V, Moss J, Watts P, Gaioso V. Beginning and advanced students' perceptions of the use of low- and high-fidelity mannequins in nursing simulation. Nurse Educ Today. 2016 Jan;36:37-43. doi: 10.1016/j.nedt.2015.07.020. Epub 2015 Jul 29.
• Silveira MS, Cogo ALP. The contributions of digital technologies in the teaching of nursing skills: an integrative review. Rev Gaucha Enferm. 2017 Jul 13;38(2):e66204. doi: 10.1590/1983-1447.2017.02.66204. English, Portuguese.
• Cogo ALP, Lopes EFDS, Perdomini FRI, Flores GE, Santos MRRD. Building and developing realistic simulation scenarios on safe drug administration. Rev Gaucha Enferm. 2019 Jan 10;40(spe):e20180175. doi: 10.1590/1983-1447.2019.20180175. English, Portuguese.
• Valentin B, Grottke O, Skorning M, Bergrath S, Fischermann H, Rortgen D, Mennig MT, Fitzner C, Muller MP, Kirschbaum C, Rossaint R, Beckers SK. Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients. Scand J Trauma Resusc Emerg Med. 2015 Apr 8;23:31. doi: 10.1186/s13049-015-0110-6.
• McGuire K, Lorenz R. Effect of Simulation on Learner Stress as Measured by Cortisol: An Integrative Review. Nurse Educ. 2018 Jan/Feb;43(1):45-49. doi: 10.1097/NNE.0000000000000393.
• Fraser K, McLaughlin K. Temporal pattern of emotions and cognitive load during simulation training and debriefing. Med Teach. 2019 Feb;41(2):184-189. doi: 10.1080/0142159X.2018.1459531. Epub 2018 Apr 24.
• Nieto Fernandez-Pacheco A, Castro Delgado R, Arcos Gonzalez P, Navarro Fernandez JL, Ceron Madrigal JJ, Juguera Rodriguez L, Perez Alonso N, Armero-Barranco D, Lidon Lopez Iborra M, Damian ET, Pardo Rios M. Analysis of performance and stress caused by a simulation of a mass casualty incident. Nurse Educ Today. 2018 Mar;62:52-57. doi: 10.1016/j.nedt.2017.12.016. Epub 2017 Dec 15.
• Mohammadi G, Tourdeh M, Ebrahimian A. Effect of simulation-based training method on the psychological health promotion in operating room students during the educational internship. J Educ Health Promot. 2019 Sep 30;8:172. doi: 10.4103/jehp.jehp_106_19. eCollection 2019.
• de Sena DP, Fabricio DD, da Silva VD, Bodanese LC, Franco AR. Comparative evaluation of video-based on-line course versus serious game for training medical students in cardiopulmonary resuscitation: A randomised trial. PLoS One. 2019 Apr 8;14(4):e0214722. doi: 10.1371/journal.pone.0214722. eCollection 2019.
• Blanie A, Amorim MA, Meffert A, Perrot C, Dondelli L, Benhamou D. Assessing validity evidence for a serious game dedicated to patient clinical deterioration and communication. Adv Simul (Lond). 2020 May 27;5:4. doi: 10.1186/s41077-020-00123-3. eCollection 2020.
• Fonseca LM, Aredes ND, Fernandes AM, Batalha LM, Apostolo JM, Martins JC, Rodrigues MA. Computer and laboratory simulation in the teaching of neonatal nursing: innovation and impact on learning. Rev Lat Am Enfermagem. 2016 Oct 10;24:e2808. doi: 10.1590/1518-8345.1005.2808.

Study record dates

Study Major Dates

• Study Start (Anticipated): September 1, 2021
• Primary Completion (Anticipated): March 1, 2022
• Study Completion (Anticipated): September 1, 2022

Study Registration Dates

• First Submitted: June 17, 2021
• First Submitted That Met QC Criteria: June 17, 2021
• First Posted (Actual): June 25, 2021

Study Record Updates

• Last Update Posted (Actual): June 28, 2021
• Last Update Submitted That Met QC Criteria: June 25, 2021
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Keywords: Nursing; Active Learning; Educational Technology; Learning Curve; Simulation Training; "Learning"
• Other Study ID Numbers: 28233120.4.0000.0030

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No