The purpose of this study was to investigate the effects of the use of high-fidelity patient simulation in nursing education. Studies were identified by searching EMBASE, MEDLI, Cochrane Library CENTRAL, CINAHL and Korean databases (KOREAMED, KMBASE...
The purpose of this study was to investigate the effects of the use of high-fidelity patient simulation in nursing education. Studies were identified by searching EMBASE, MEDLI, Cochrane Library CENTRAL, CINAHL and Korean databases (KOREAMED, KMBASE, RISS, KISS, and NAT) (up to Feb 2014). In addition, a search of the Google Scholar database and a manual review of reference lists of identified studies were carried out. Thirty studies (2 randomized and 28 non-randomized design) involving 3,146 participants met the inclusion criteria for meta-analysis. Methodological quality was assessed using the seven-item scale of Cochrane's Risk of Bias for Randomized studies and eight items from the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). The data were analyzed by RevMan 5.3.3, a software program for meta-analysis. To verify the homogeneity of studies prior to integrating the effect sizes of each study, the Chi-square test and I2 statistics were performed. It was determined to produce the effect size by fixed effects model if studies were homogeneous, and by random effects model for non-homogeneous studies. The criteria of Cohen (1988) were utilized to interpret the effect size.
The results of this study are as follows:
1. Among 30 studies which met inclusion criteria, 70% of the studies were a nonequivalent control group, non-synchronized design. The total number of participants was 3,146 students with an average of 53.1 students in the experimental groups, and 51.7 for the control group. The range of intervention duration was 1 day to 7 months, with a mean of 3.1 sessions.
2. For the cognitive domain outcomes, knowledge, critical thinking, problem solving, clinical judgment and communication skill were evaluated. For the affective domain outcomes, self-efficacy and satisfaction were evaluated. For the psychomotor domain outcome, clinical competence was evaluated. The result to analysis of cognitive domain outcomes, the effect size was 0.58(p<.001) for knowledge, -0.75(p<.001) for critical thinking, -1.27(p=.008) for problem solving and -1.72(p<.001) for clinical judgment. However, there was significant heterogeneity (I2 =72-95%). On the other hand, there was no significant effect in the communication skill. Additionally, the self-efficacy and satisfaction of affective domain outcomes showed no significant effect. The effect size for clinical competence of the psychomotor domain was –0.89(p<.001).
The limitations of this study are 1) this study did not include studies published in languages other than English or Korean; therefore, some studies might have been missed, resulting in a possible publication review bias; 2) the variation of assessment instruments (self-developed instruments) may have caused problems of validity. Based on the instruments used in evaluation of outcomes in the reviewed studies, evidence for determining the best instrument was clearly inconsistent.
Despite some limitations in this study, a tentative conclusion can be reached, that the use of HPS (High-fidelity Patient Simulator) might have beneficial effects on cognitive outcomes (problem solving competency, critical thinking, and clinical judgment) and clinical skill acquisition. However, the effectiveness of using HPS on affective outcomes (self-efficacy and learning satisfaction) appeared to be inconclusive. Conduct of further longitudinal studies with a large sample will promote better understanding of whether HPS has a late effect on self-efficacy, communication skills, and learning satisfaction.
The findings of the current study suggest that the use of HPS could enable students to learn and practice formative skills in a less threatening and controlled environment. Therefore, based on the results of this study, the HPS educational approach, if integrated appropriately, can be used in academic settings as an effective learning methodology.
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