Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis

Carmen La Cerra, Angelo Dante, Valeria Caponnetto, Ilaria Franconi, Elona Gaxhja, Cristina Petrucci, Celeste M Alfes, Loreto Lancia, Carmen La Cerra, Angelo Dante, Valeria Caponnetto, Ilaria Franconi, Elona Gaxhja, Cristina Petrucci, Celeste M Alfes, Loreto Lancia

Abstract

Objective: The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes.

Design: A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

Data sources: PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references.

Study selection: To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis.

Review method: Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria.

Synthesis method: For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI.

Results: Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected.

Conclusions: Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.

Keywords: education; high fidelity simulation training; learning; nursing; students.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Search and selection strategy Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-chart. HFPS, high-fidelity patient simulation.
Figure 2
Figure 2
Effect of high-fidelity patient simulation on nursing students’ knowledge.
Figure 3
Figure 3
Effect of high-fidelity patient simulation on nursing students’ performance.
Figure 4
Figure 4
Effect of high-fidelity patient simulation on nursing students’ satisfaction.
Figure 5
Figure 5
Effect of high-fidelity patient simulation on nursing students’ self-confidence.
Figure 6
Figure 6
Effect of high-fidelity patient simulation on nursing students’ self-efficacy.

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