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Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Agezegn Asegid
Agezegn Asegid
 und 
Nega Assefa
Nega Assefa
   | 21. Sept. 2021
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Article Category: Review
Online veröffentlicht: 21. Sept. 2021
Seitenbereich: 193 - 208
Eingereicht: 14. Juni 2020
Akzeptiert: 17. Juli 2020
DOI: https://doi.org/10.2478/fon-2021-0021
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© 2021 Agezegn Asegid et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Flow diagram showing the process of study identification and selection.
Flow diagram showing the process of study identification and selection.

Figure 2

Forest plot showing the effect size of individual studies.Note: CI, confidence interval.
Forest plot showing the effect size of individual studies.Note: CI, confidence interval.

Figure 3

Forest plot showing sensitivity analysis by one study remove method.
Forest plot showing sensitivity analysis by one study remove method.

Figure 4

Funnel plot showing publication bias among included studies.
Funnel plot showing publication bias among included studies.

Characteristics of included studies.

Study Interventions Study type, duration, sample size Scenario Outcome measures Result Effects
1 Aqel & Ahmed 2014, Jordan,27 RCT Training of participant over simulated case with cardiac arrest scenario and debriefing discussion. HFS, 25!90 CPR Direct observation using Checklist: mock codes were conducted over manikin over floor and evaluation using AHA checklist. The results revealed the existence of a significant difference in the post-test CPR knowledge as well as the CPR skills in favor of participants in the intervention group. Improved
2 Basak et al., 2016, Turkey,28, 29 Quasi, Single pre-post 45 min paper-based drug dose calculation simulation and debriefing session for discussion. LFS, 45!82 Actual physician prescription Rating: Drug dose calculation was evaluated from 100 points immediately after training and 1 month later. The difference between the mean pre-test score and the mean post-test score was statistically significant (t = 8.767, df = 89, P = 0.001) Improved
3 Basak et al., 2019, Turkey,30 RCT, equivalent control group 20 min simulation with 40 min debriefing and self-evaluation for 10 min generally 80 min discussion about teaching skill over SPs. SP, 80!71 Inhaler drug administration Direct Observation using Check list: Teaching skill measured by checklist consisted of 15 procedural steps developed and tested by principal investigators. Total patient teaching skill score for control group was 26.73 ± 5.63 and 39.08 ± 5.49 for SP group which causes a statistically significant difference (P ≤ 0.01) Improved
4 Bogossian et al. 2015, Australia,20 Quasi Single pre-post Interactive e simulation clinical scenario with video recording patient conditions, pop-up task, and respective response. VS, 24!367 Cardiac, shock, and respiratory Virtual skill performance A paired t-test showed a significant improvement in performance between the first and last scenarios (t = −8.037, df = 366, CI 2.05–1.24; P = 0.00). Improved
5 Bowling et al., 2015, USA,31 Quasi, equivalent control group 50 min respiratory distress simulated cased training and participant required to react to simulated case. MFS, 50!73 Respiratory distress OSCE with six station lasting 7 min and rater-based evaluations There was a significant difference for both groups in knowledge and skill performance (measured with a mini OSCE), but not between the groups Improved
6 Boyde M et al., 2018, Australia,24 Quasi, Single pre-post Innovative teaching of emergency management of patient using HF simulation with Jefferies simulation principles. HFS, Not mentioned, 50 Emergency patient Self-assessment: The self-efficacy in clinical performance scale was used to measure participant's assessment and handovepractice. The mean change in handover skill from 7.88 ± 1.76 to 8.79 ± 1.22 was statistically significant with t (41) = 3.41, P < 0.01 Improved
7 Chen et al., 2015, Canada,32 Quasi, equivalent control group Auscultation skills training using low and HF training. HFS, 40!54 Pneumothorax and a systolic murmur: Auscultation skills OSCE using Check list: Participants required to correctly identify 20 different sounds on simulators. There was no evidence that the HFS group performed better than the LFS group in clinical skills or in auscultation sounds recognition on HFS. No change
8 Durmaz et al., 2012, Turkey,33 RCT Intervention: Participants receive 4 h computer-based education simulation about pre-operative and post-operative patient management. VS, 4 h,82 Pre-post case OSCE for pre and post-operative management and deep breathing and coughing exercise: e. There was not a significant difference between the students’ post-education practical deep breathing and coughing exercise education skills (P = 0.867). Improved
9 Ismailoglu et al., 2018, Turkey,25 Quasi, equivalent control group IV training over virtual IV simulator VS, Not clear, 62 Encoded case Direct observation Check list: Intravenous catheterization Skill list performance evaluation. Mean psychomotor skills score of the experimental group 45.18 (33.73 ± 4.22) was higher than that of the control group 20.44 (26.53 ± 4.45) with Z = 5.294, P = 0.000. Improved
10 Jaberi et al., 2019, Iran,34 RCT Abdominal examination skill was tested after teaching student sing SP for 45 min. SP, 45!,87 Physical examination of abdomen OSCE using checklist: Six station OSCE were used with one rater for each station were assigned to evaluate performance over SPs. The mean score in intervention group changed from 5.35 ± 1.77 to 15.39 ± 3.2, while it was changed 4.98 ± 2.17 to 14.43 ± 3.93 in control group. There was a significant difference between the mean pre-test and post-test scores in each group (P < 0.05). Improved
11 Karabacak et al., 2019, Turkey,35 Quasi, Single pre-post A 12 h theory and laboratory-based training using SP on selected fundamental of nursing skills. SP, 12 h, 65 Fundamental of nursing issues Self-assessment: Proficiency self-assessment Form for proper communication with the patient, establishing a safe patient unit, safe patient transfer and act on body mechanics. No significant difference has been found between pre-scenario (7.05 + 9.17) and post-scenario (5.89 + 2.02) scores about self-assessment of safe patient transfer (t = 1.01; P = 0.32). No change
12 Keleekai et al., 2016, USA,36 RCT, equivalent control group Virtual based 3 h training to improve/decrease IV reinsertion VS, 3 h, 58 Peripheral IV securing Direct observation of virtual guided skill performance using Check list: Number of success and reinsertion of IV after demonstrating over IV arm model. Participants evaluated over 28-point check lists. The intervention was effective and resulted in several statistically significant improvements in knowledge, confidence, and skills both within and between study groups over time. Improved
13 Lee et al., 2019, Taiwan, China,37 Quasi, equivalent control group Integrating simulation-based teaching over advanced acute care adult scenario on shock, resuscitations for 90 min. HFS, 90!52 Shock and resuscitations Direct observation at clinical sites using Check list: Evaluated based on predesigned check list for clinical evaluation at actual practical setting. No significant difference in clinical performance was observed among groups. No change
14 Liaw et al., 2015 Singapore,38 RCT, equivalent control group The interactive web-based programmer 3 h training on patient identification, early recognition, vital sign monitoring, and management. VS, 3 h, 67 Deteriorating patients Direct observations using Check list: The simulation performance tool was adapted and modified from the original RAPIDS tool and used to assess specific and global rating scale. l. Two independent raters evaluated recorded video of performance. There was a significant change in Assessing and managing clinical deterioration in experimental group pre-test 18.17 (3.55), post-test 25.83 (4.79), and Reporting clinical deterioration pre-test 10.09 (2.31) post-test 12.83 (2.41). Improved
15 Lubbers et al., 2016, USA,39 Quasi, Single pre-post 1 h simulation, pre-post–simulation discussion. HFS, 3 h and 30!58 Not mentioned Self-assessment of Knowledge, confidence and performance. The Skill score, revealed significant increases from pre-test 2.25 to post-test 4.13, t = 21.21, P < 0.001). Improved
16 Meyer et al., 2011, USA,23 Quasi, equivalent control group Replacing 2 weeks (25%) of clinical work or rotation with simulation-based teaching in skill lab. VS, 24 h, 120 Various Direct observation using rating scale Clinical faculty assessment of student performance in clinical work and compared with control group who spent 100% in clinical rotations. Faculty rated students with patient simulation experience higher than those who had not yet attended simulation mean 1.74 (0.75), P = 0.02). Improved
17 Morton et al., 2019, USA,26 Quasi, Single pre-post Training using HFS portraying a patient with cardiac arrest. HFS, Not mentioned, 37 CPR Direct observation using Check list: Mock Code Evaluation Tool basically developed based on AHA (2015) guideline for basic life supports. There is no statistically significant difference in performance obtained following simulation-based training. No change
18 Sarmasogle et al. 2016, Turkey,40 Quasi, equivalent control group SP-based training of Arterial blood pressure and Subcutaneous injection, feedback, and discussion with SP. SP, 4 h, 77 Hypertension and acute pain Direct observation using Check list: Performance assessment using check list for arterial blood pressure measurements and subcutaneous injection by two raters. The mean performance score for the measurement of arterial blood pressure was 76 ± 7.6 for the control group and 83 ± 3.1 for the experimental group (P < 0.001). However, no significant difference was found between the groups’ performance scores on subcutaneous injection administration. Improved
19 Stayt LC, et al., 2015, UK,41 RCT 2 h clinical skill teaching; systematic ABCDE assessment and management process on medium fidelity patient simulator (ALS Simulator, made by Laerdal Medical) using a clinical scenario of an acutely unwell patient who is exhibiting signs of clinical deterioration. SP, 2 h, 98 Deteriorating patient OSCE using check list. The OSCE comprised of a check list of 24 objective performance criteria that evaluated participants’ performance of assessing and managing a deteriorating patient using a patient simulator. The results indicate that students who received simulation training performed a systematic ABCDE assessment and managed the deteriorating patient more effectively than those who received a didactic teaching approach. Improved
20 Sumner et al., 2012, USA,42 Quasi, Single pre-post Participants received the intervention by attending a 4-hour basic arrhythmia program on the second day of nursing orientation. MFS, 4 h, 138 Arrhythmia cases Self-assessment: post simulation self-report of caring and resource utilization in caring of patient with arrythmias patients. Following simulation there was transfer of knowledge to clinical practice. Improved
21 Toubasi S et al., 2015, Jordan,21 Quasi, Single pre-post Step by step simulation and debriefing of cardiac arrest scenario using AHA guidelines. MFS, 8 h, 30 Cardiac arrest Direct observation using Check list: Validated skill scenario testing tool which was developed by the AHA to assess performance according to the AHA 2010 guidelines. There is a significant mean difference of 2.9 in overall skill performance and BLS score after simulation (t = 7.4, df = 29, P < 0.01). Improved
22 Unver et al., 2013, Turkey,43 Quasi, Single pre-post 4 h training using SP SP, 4 h, 85 Medical administration OSCE: OCEF were used. There was a significant difference (30.26) in pre-test (24.02 ± 16.06) to post-test (54.28 ± 14.54) skill performance measurements (P < 0.01; t = 14.35). Improved
23 Vidal VL et al, 2013, Turkey,44 Quasi, equivalent control group Computer-based training with demonstration, return demonstration and verbal feedback regarding performance of phlebotomy. VS, 3 h, 73 Phlebotomy Direct observations using Check list: the skill checklist used by the mentors consisted of 21 items addressing the necessary steps for the completion of a phlebotomy procedure and 3 items related to overall performance. There is significant among the group in mean skill performance score in pain factor (P = 0.006), hematoma formation (P = 0.000), and number of reinsertions (P = 0.000). Improved
24 Woda et al., 2019, USA,22 Quasi, Single pre-post A 20 min training using HFS and debriefing about care of patient with type I DM. HFS, 20!233 Type one DM Direct observation of using Check list: Performance evaluated using 10 item evaluation rubrics by research assistance on major areas of DM care. Simulation did have a significant positive effect on performance change scores (P < 0.001; r = 0.28). The mean pre-test score on performance items was 0.73 (SD = 0.14), and the mean post-test score on performance items was 0.76 (SD = 0.12) Improved

Summary of effect size for subgroup analysis.

Comparison and Groups Numbers of studies Effect size (d) SMD, CI, P value I2, % Z value
All studies Groups 24 1.01 (CI [0.62, 1.41], P < 0.01) 93.9 5.13
  Single group 10 1.02 (CI [0.52, 1.50), P < 0.01) 95 4.46
  Double groups 14 1.00 (CI [0.56, 1.44], P < 0.01) 92.9 4.48
Simulator types
  HF 7 1.23 (CI [0.55, 1.93], P < 0.01) 94.8 3.5
  Medium fidelity 3 0.89 (CI [−0.14, 1.93], P = 0.09) 86.5 1.69
  LF 3 1.27 (CI [0.24, 2.29], P = 0.02 0 2.4
  SP 5 1.03 (CI [0.23, 1.84], P = 0.01) 96 2.5
  VSs 6 0.69 (CI [−0.04, 1.4], P = 0.06) 95.4 1.85
Types of participants
  Clinical staffs 3 1.08 (CI [0.43, 1.74], P < 0.01) 85.8 3.25
  Nursing students 8 0.98 (CI [0.61, 1.37], P < 0.01) 95 5.11
Regions (country)
  America 8 1.22 (CI [0.62, 1.82], P < 0.01) 94.6 4.02
  Europe 10 0.76 (CI [0.24, 1.29], P = 0.004) 95.3 2.85
  Middle East 6 1.17 (CI [0.48, 1.86], P = 0.001) 88.74 3.34
Design
  Quasi 17 0.96 (CI [0.57, 1.34], P < 0.01) 94.78 4.86
  RCT 7 1.14 (CI [0.54, 1.75], P < 0.01) 91.1 3.7
Types of scenarios
  Acute 12 1.07 (CI [0.73, 1.41], P < 0.01) 88.1 6.18
  Cold 12 0.92 (CI [0.35, 1.49], P < 0.02) 95.16 3.16
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