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NURSING MS C922_Roz Template _APA 7th edition (2) Virtual Simulation Technology Virtual Simulation Technology Rozlyn A. Peck Western Governors University College of Health Professions ... Executive Summary As technology continues to evolve, educational and nursing practices must also evolve to continue to provide safe effective care to the patients and communities they serve. The current technology of using simulated labs and onsite clinical experiences for students’ hands-on teaching no longer meets students' and educators' needs due to restrictions in place related to the recent COVID-19 pandemic. This proposal provides an explanation of the current gaps and why virtual simulation technology (VST) should be implemented. A literature review was conducted to uncover solutions for the gaps identified in the needs-gap analysis. The analysis process is explained along with the gaps that were revealed. A need for alternate means of clinical experiences for students was found to be the primary gap. The proposal includes a review of five sources that support the use of virtual simulation technology. The stakeholders and methods used for collaboration are discussed. Surveys found that faculty and students were open to the implementation of virtual simulation technology. The challenges arising from the sole use of simulation labs and onsite clinical experiences are reviewed. Recent closures of schools and student restrictions at healthcare facilities used for clinical experiences have created additional challenges that can be addressed using VST. A force- field analysis is also included, presenting the organization’s readiness for change. Forces for and against the proposed change and organizational factors that may facilitate or impede change are analyzed. Lewin’s change theory is reviewed and was chosen as the model to implement the virtual simulation technology. Keeping the learning institution’s technology options up-to-date creates multiple benefits. The use of virtual simulation technology to supplement nursing students' clinical experiences has increased in recent years and demonstrates numerous benefits to the learning process. This proposal explains why it is necessary to implement virtual simulation technology for clinical experiences and how it will benefit students, faculty, the learning institution, and the nursing profession. Virtual Simulation Technology Virtual simulation technology (VST) use has increased over the years and provides multiple benefits to students and educators. In healthcare, virtual simulations have been used to give students a safe environment to practice real-life clinical scenarios with interactive computerized patients in various immersive settings. Students can practice different skill sets, including but not limited to clinical decision making, communication skills, motor skills, and problem-solving. The recent COVID-19 pandemic has created new needs and challenges for nursing programs due to many clinical settings not allowing or limiting students and visitors. The recent pandemic has identified gaps in the institution's current technology, and research revealed virtual simulation to be a potential solution. Utilizing Lewin's change theory is a way to implement the changes need to incorporate VST into the curriculum. This proposal discusses the current gap and how VST can improve the "Role of the BSN Nurse in Promoting Community Health" course. Literature Review Refer to Table 1. Literature Review Summary Table. Summary of Sources A couple of themes emerged during the review of the literature concerning virtual simulation technology (VST). One identified theme was that VST has the potential to increase learning and critical thinking skills. When used in the clinical setting, VST creates learning by providing students with real-world scenarios, environments, and patient-centered challenges and allowing students to interact with a patient in a digital setting (Padilha et al., 2019). Students can utilize motor control skills, decision making, and communication skills on a computer using virtual patients in a wide range of clinical settings (Padilha et al., 2019). Several studies used pre and post-tests to assess knowledge before and after the intervention. In these studies, the scores assessing knowledge after the intervention were higher in the groups that used the VST. According to Turrise, Thompson, & Hepler (2020), critical thinking scores were slightly higher for the students using VST, while scores went down in the control group. A second theme identified was that students found the virtual simulation technology useful to their learning and increased confidence and satisfaction with learning. VST allows students to practice different skillsets and patient interactions in a safe environment before interacting with a real patient and has the potential for increasing satisfaction with learning in nursing students (Turrise et al., 2020). Several studies used questionnaires or surveys to assess satisfaction with the VST. In all of these studies, students reported increased confidence and higher satisfaction in the groups using the VST. In the study by Padilla et al. (2020), nursing students considered VST an important tool and facilitator for learning. Shin et al. (2019) show that VST may be an effective tool for increasing learner engagement and may be a useful resource for remote education or providing education to underserved areas. Needs Assessment Knowledge Gaps The recent COVID-19 pandemic has caused many nursing schools to close onsite classroom learning or limit the number of students in the classroom. These school site closures have also impacted students' ability to access onsite simulation labs they depend on for practice and training. Additionally, many healthcare facilities have stopped offering clinical experiences that nursing schools rely on for students' hands-on learning experiences. While the learning institution provides online versions of the nursing curriculum, educators noted a gap in the online clinical opportunities to build critical thinking, communication, and other necessary skills needed to meet learning objectives. According to Padilha et al. (2019), clinical virtual simulation responds to managing lab space difficulties and allows for a broader range of clinical scenarios students can use for training purposes. As the healthcare field and nursing education programs continue to face technological changes and challenges, nursing educators and students must adapt to new technologies to better meet the needs of the patients and communities they serve. The conducted research showed that digital and virtual simulation technology developments have helped to ease the way to recreate reality using virtual patients depicted on a computer screen the student can interact with (Padilha et al., 2018). VST allows the student to practice on patients in a safe environment before working with a real live person. Shin et al. (2019) pointed out that virtual nursing simulation allows learners to participate in a cycle of engagement and experience that helps drive them toward greater learning achievement. VST has some limitations. Instructors may be comfortable using the VST, impacting their ability to facilitate the students' correct use of the VST. While several studies indicated increased student satisfaction using the VST, many of the studies reviewed did not include the instructors' perspective. Another limitation is that students may not have immediate access to the instructor if using the VST remotely compared to having the instructor available in the simulation lab or onsite at the clinical setting. Despite these limitations, it was felt that VST would benefit the nursing faculty and student population as an alternate means of clinical instruction for students was identified as a gap. Need-Gap Analysis Gap Analysis Process The recent COVID-19 pandemic caused many schools to close on-campus classrooms and labs. Additionally, many teaching hospitals and other healthcare facilities used for students' hands-on clinical experiences have stopped allowing students, leading stakeholders to perform a needs assessment. The goal was to identify the areas needing improvement and the forms of technology available to address the identified gaps in current curriculum technology. Recent student feedback has also suggested that the current technology use is lacking in comparison to other institutions. A gap analysis was performed to help create an improvement plan (see Table 2.). There are several steps in the gap analysis process. The first step and second steps include identifying the need for change and analyzing the gap (Mitchell, 2013). The third step is planning the implementation of the change. The final step is evaluating the outcome of the change (Mitchell, 2013). Data to support the change was collected through student and faculty surveys and research on the nursing program's current technology. Next, stakeholders were identified and assigned a role. The gap analysis was used as a guide to determine how to change from the current process of using on-campus lab and healthcare facility clinical training sites to the new process of using updated technology to provide remote virtual simulation clinical and lab learning experiences during the COVID-19 pandemic. Table 2. Curriculum Technology Need-Gap Analysis Current Curriculum Technology Desired Curriculum Technology Need-Gap Action Steps to Meet the Need-Gap Learning institution simulation lab Hospital and other Virtual simulation technology for assessment skills and clinical scenarios Clinical experiences that can be observed from The current gap is the lack of virtual simulation technology for clinical experiences due to schools' closure and student restrictions on 1. Gap identification 2. Literature review 3. Stakeholder identification 4. Role designation for team members 5. Conduct needs health care facility clinical experiences anywhere onsite clinical settings due to the COVID-19 pandemic. assessment 6. Need-gap analysis 7. Identify a solution to the discovered need 8. Create an implementation plan 9. Evaluate plan effectiveness Asses for virtual simulation programming availability Determine cost and faculty training needs for virtual simulation technology to be used Assess the students' ability to access a computer and the internet Assess the students' ability to use the identified virtual simulation technology Stakeholders Stakeholders were identified to participate in the change process. The first stakeholder identified was the head of the Nursing Department. This person's role was to help determine other nursing institutions' outcomes in implementing virtual simulation technology in clinical settings. Some outcomes would include faculty and staff's ability to access the VST remotely, students' perceived ease of use, and improvement in students' critical thinking, assessment, and communication skills. Another role of this stakeholder was to determine faculty's educational needs and identify perceived challenges during the change. The second stakeholder identified was a representative from the clinical sites restricting student access due to COVID-19. These sites rely on the graduating students to fill needed positions and need to ensure that those students receive the highest level of training. This stakeholder's role was reviewing various VST and identifying those based on evidenced-based practice criteria providing various clinical scenarios and assessment opportunities. The third stakeholder identified was the IT Department head. This stakeholder is responsible for determining the VS technology to be used based on the second stakeholder's evidence-based research. Other responsibilities included assessing the potential costs and need for faculty training for the determined VS technology. The final stakeholder chosen was then the second-year nursing class. This group was given a survey to assist with the needs assessment process. The survey measured students' comfort level using computers and other simulation technologies, the variation of technology use between classes, and their satisfaction with the learning process using the virtual simulation technology. Methods of Collaboration The stakeholders used various collaboration methods during the needs assessment process to communicate findings and make decisions. One effective collaboration method was the use of Zoom meetings. Given many school closures and clinical site student and visitor restrictions, there has been a need to have meetings that do not require in-person face-to-face interactions. Zoom meetings allow immediate feedback as discussion takes place. The meetings are held weekly to gather input from all group members to make plans and analyze ideas. Another effective method used by the interprofessional team was email communication. Email is another type of communication that does not involve in-person face-to-face communication. It allows for a written dialogue between two or more people that can be retrieved as often as needed. This type of communication requires little time and is a convenient way to establish the group members, determine the designated roles in the process and the outlined plan, and provide progress updates to everyone. Email communication also includes the "reply all" function that allows for an easy response to all group members. Current/Emerging Technologies Today's classrooms have more options for emerging technologies than in the past. Two emerging technologies being used include lecture capture technology and high fidelity simulations. Lecture capture technology allows instructors to record their lectures, including documents and powerpoints that students can view at their convenience from anywhere (Groen et al., 2016). Students can stay caught up with lectures despite missing class due to illness. Having the option to watch difficult topics and skills multiple times may better prepare students for tests and patient care. A significant disadvantage of lecture capture technology is the removal of face to face interaction. Students will lack immediate feedback from the instructor, which can negatively impact skills vital for nurses. The educator would have to find other means to provide the communication and collaboration needed to prepare students to provide safe nursing care. Another emerging technology used in classrooms is high-fidelity mannequin nursing simulators. These simulators are used to create interactive experiences resembling various clinical situations in different settings and are equipped with technologies that resemble many body functions (Erlinger, Bartlett, & Perez, 2019). Benefits of this technology include students' ability to practice assessment skills and steps needed in critical situations before actually performing them on a patient or real situation. Having the ability to practice and learn from watching other students helps to reduce anxiety and increase learning. A major disadvantage of this technology is cost. This technology is expensive, requires space to set up and use. Simulators may have limitations on the number of clinical scenarios and assessment skill options available depending on the manufacturer. This type of technology also requires training of faculty and students and maintenance. Additional costs are involved if the hardware or software breaks down, and repairs or replacement is needed (Meurer, 2017). Learning institutions may be limited in the number of simulators available due to cost, limiting the amount of time students can use the simulator. Additionally, the COVID-19 pandemic has caused many schools to close or limit the number of students in the classroom, limiting or preventing access to the current technologies, creating a need to find other ways of providing opportunities for students to practices these skills. Anticipated Challenges With the recent COVID-19 pandemic, the current state of technology faces several challenges. The first challenge is the closure of schools or limitations to the number of students allowed in the class. These closures limit the instructor's ability to review materials needed to meet course objectives and learning outcomes. A second challenge due to school closures is students will lack the instructor's immediate feedback when attending class on campus. A third challenge with the current technology is that many healthcare sites used for clinical training do not allow nursing students, limiting their ability to practice hands-on communication and other skills needed to provide safe nursing care. This also limits the instructor's ability to provide training and feedback to prepare students to provide safe patient care. Overcoming Challenges Emerging technologies exist that can address the challenges with the current practice. Implementation of a system that allows students to view lecture material and practice communication, collaboration, critical thinking, assessment, and other clinical skills from anywhere combat the current inflexible technology. Students can review the material as many times as need to prepare for tests and clinical experiences. With virtual clinical simulations, students can safely practice needed skills in a safe, controlled environment from anywhere as many times as necessary. They also provide essential feedback to promote learning. Needs Assessment Summary of Findings The needs assessment revealed gaps and room for improvement with the current state of technology. Stakeholders found alternate means for onsite simulation lab and clinical experiences were needed for both faculty and students due to the recent closures and restrictions of schools and clinical sites related to the COVID-19 pandemic. Other reasons for this need include personal illness and unsafe driving conditions. Students expressed frustration with missed opportunities for hands practice with specific skills due to a lack of available patients and opportunities at clinical sites. Student surveys also revealed a lack of time to revisit difficult concepts at clinical sites due to the instructor having multiple students to supervise at clinical sites. The surveys also indicated that most students have a high comfort level using technology, and many have used virtual simulations in previous high school or college courses. Students that have used virtual simulation technology in the past reported it was beneficial to the learning process. The majority of faculty also reported high comfort levels using technology and willingness to adopt a new system. The research process revealed several emerging technologies used to fill in the identified gaps. A decision was made to utilize the virtual simulator Body Interact (http://bodyinteract.com/product/ ). This simulator gives students the ability to interact with a virtual patient in a clinical environment and utilize skills including but not limited to critical thinking, nursing diagnoses and interventions, assessment, and communication skills (Padilha et al., 2018). This technology also includes the ability to perform individual and group clinical activities and tracks their performance. The data collected on student performance can be analyzed on an individual and group level for learning management (Padilha et al., 2018). The data collected can also be accessed by both the student and the educator. This technology also allows students to review difficult material or skills from anywhere as often as needed in a safe environment before touching a live person. While this technology involves cost, the overall benefit and needs outweighed the cost. The group felt this technology would provide the best solution to the need. The group also felt this technology was easy to use for training staff and students quickly. Collaboration with Stakeholders The stakeholders met to review and discuss their research findings on the educational technology needs and potential options for change. The nursing department head researched other learning institutions' nursing programs throughout the country and spoke w/ their nursing faculty about their use of technology for clinical situations. The IT department head researched the overall costs, including program purchase cost, upgrades to computers, faculty and student training, technology resources for financially challenged students, and support costs. The second- year nursing students' were surveyed on their opinions and comfort level with using technology. Students were asked about any previous use of virtual simulation technology, perceived usefulness of technology in clinical situations. Most students reported a high comfort level with technology. Those students that reported prior use of virtual simulations for clinical experiences found it easy to use, beneficial to the learning process, and would recommend use in nursing programs. The nursing department faculty were also surveyed regarding their comfort with technology use, views on current technology state, and readiness for change. Many faculty acknowledged a need for alternate means for students' clinical opportunities because of closures and restrictions related to the COIVD-19 pandemic. However, some nursing faculty were resistant to change due to the additional time required to train and implement the new technology. Many staff were already stressed by training on technologies needed to continue classroom lectures remotely, in addition to their regular responsibilities, and are resistant to learning another one. Other faculty reported resistance to change related to a fear of students not showing up for onsite clinical experiences and opting only to use virtual simulations in the future when COVID-19 restrictions are lifted. Other concerns raised by staff were related to the amount of time required to help students learn the technology taking away from students learning the course material. Surprisingly student surveys also revealed a strong need for hands-on, face-to- face training to facilitate the learning process and skill development. Additionally, the group’s research revealed that RN-BSN online accelerated students value simulated clinical experiences that require them to practice decision-making skills, critical thinking skills, and clinical reasoning (Turrise et al., 2020). Further research indicated that students could access tutorials and online help twenty-four hours a day, seven days per week through the virtual program support, reducing the amount of time required by the instructor for training to focus on course material. Once the staff learned about the potential benefits to the students, the faculty was on board with using virtual simulation for clinical experiences. Force Field Analysis Assessment Refer to Table 3: Organizational Readiness for Curriculum Proposal Organizational Factors There are external and internal organizational forces that can influence the implementation of new technology. These forces can either facilitate or impede the process. Faculty staffing is one internal factor that can affect the implementation process. Having a fully staffed faculty open to change helps facilitate the implementation process. If faculty is resistant to change, additional time and resources may be needed to provide the required training. Availability of resources is another internal organizational factor impacting the implementation process. Ensuring there is enough in the budget to cover the costs of the proposed technology and resources available to implement the change will facilitate the process. The lack of available funds would impede the implementation process. One external factor impacting the implementation process is the closures and restrictions of schools and healthcare facilities related to students' clinical experiences. School closures and healthcare facility restrictions may remain in place for an extended period of time. If so, that could facilitate the implementation process as more attention can be focused on the new process for clinical experiences. If sites begin to open or allow students, that could impede the change process as the normal process will restart, and a new one will still need to be implemented. Competition with other surrounding nursing schools is another external factor that could impact the implementation process. According to Padilha et al. (2020), younger students are adopting the use of information and communication technologies as an essential component of their academic life. Many of these students will seek learning institutions that incorporate new technologies to meet their educational needs. A learning institution that realizes keeping available technology up-to-date and desirable to attract students. As the use of virtual simulations for clinical experiences in learning institutions increase, those that do not adopt this technology may lose potential students to competing schools. Forces for Integration Several forces promote the integration of VST into the nursing curriculum to benefit the “Role of the BSN Nurse in Promoting Community Health” course. One force is the presence of faculty and student interest. Surveys of faculty and students revealed an interest in using virtual simulation for clinical experiences, facilitating implementation. A second force is minimal upgrades needed to existing hardware and software as it facilitates the implementation process by reducing costs and the amount of time required for set up. A third force is an increased rate of teaching progess. Students will be able to practice clinical training scenarios multiple times students to practice at their own pace. Additionally, faculty can monitor students' progress in the simulations to assist with areas needing more attention and provide a more individualized learning experience. All of these forces facilitate the transition to virtual simulation technology for clinical experiences for students and faculty. Challenges to Integration Several forces can impede the implementation of VST for the “Role of the BSN Nurse in Promoting Community Health” course. One force that could impede the implementation is cost. If there are not enough funds to purchase the technology or cover the cost upgrades to existing technology and training costs, this significantly hinders the implementation process. Faculty resistance to change is another force that impedes the implementation process. If staff are resistant, it will take more time and potentially additional resources to implement the changes needed, thus impeding the process. A third force that can impede the implementation process is concerns for absenteeism. Many faculty feel students will only utilize the virtual simulation for their clinical experiences when COVID-19 restrictions are lifted. This concern can impede the process as additional attention will be needed to ensure the technology is used to supplement the learning and not replace hands-on learning in clinical settings. Identification of Change Theory In nursing, change theories are used to implement change. The use of unstructured methodology can cause implementation failure (Mitchell, 2013). There are multiple theories to choose from to implement the needed changes. Lewin’s change model, often used by leaders, consists of three stages: unfreezing, moving, and refreezing, and consists of a force-field analysis (Mitchell, 2013). Lewin’s change model and force-field analysis will decrease the chances of problems during virtual simulation technology implementation. Justification of Change Theory Lewin’s change theory was agreed upon to implement the virtual simulation technology for clinical experiences. This change theory also includes a force-field analysis framework for planned change and will be used in the implementation process. While Lewin’s change theory has been criticized for being a top-down approach, the group felt the technology would be best implemented in this manner (Mitchell, 2013). The stages of unfreezing, moving, and refreezing will provide the needed structure to initiate and adapt to the new technology. All efforts will be made to increase driving forces for change, but the virtual simulation technology will be implemented regardless of staff resistance. Potential Resistance to Change There may be resistance to the proposed technology change for many reasons. Faculty may be resistant as it requires additional time and resources to learn the new technology. They may also not find aspects of the virtual simulation technology appealing, causing them to be resistant to change. Another reason for faculty resistance is a concern for increased absenteeism for clinical experiences when COVID-19 closures and restrictions are lifted at schools and healthcare facilities. It is vital to present research findings that do not validate this concern. The examined studies support that virtual simulation technology is most often used as a supplement to clinical experiences as a complementary strategy to the learning experience (Padilha et al., 2018; Padilha et al., 2019; Seiki et al., 2020; Shin et al., 2019; Turrise et al., 2020). Student surveys revealed a value in the new technology to support the learning process and indicated a strong need for continued hands-on clinical experiences. A barrier to the change process would be students lacking the necessary hardware and internet access. Students lacking access to these needed resources prevents learning and hinders change as the new technology is a computer- based virtual simulation. Ensuring students have the necessary resources is crucial to the successful implementation of the change. Plan to Implement Change Theory Lewin’s change model will be used to implement the virtual simulation technology for clinical experiences in the nursing curriculum. The first step is unfreezing, which includes examining the current clinical opportunities for students, identifying the need for change, and completing a force-field analysis. Also, in the unfreezing stage, stakeholders will be identified and the faculty made aware of the findings to support the needed change. The moving stage will include planning details and the implementation of the virtual simulation technology. Education and assigning of tasks to staff related to the change will take place. The VST will also be tested to confirm it is ready for use. Refreezing is the final stage in the change process. This stage includes continued management of the implementation and tech support to encourage consistent and correct use of the technology. This stage also includes establishing rewards and consequences to ensure faculty and students comply with the new process. Rationale and Purpose of Proposal This proposal aims to understand the current state of technology, identified needs, and a potential improvement plan. Through the research process, virtual simulation technology was noted for becoming a more frequently used tool in higher education and has proven to be beneficial. Implementing virtual simulation technology for clinical experiences will benefit students, faculty, and the learning institution in multiple ways. One benefit includes practicing clinical scenarios, communication, and critical thinking skills in a controlled, safe environment. This proposal was created to support and illustrate the potential value of virtual simulation technology and why it should be implemented in the “Role of the BSN Nurse in Promoting Community Health” course. Filling the Curriculum Gap The need-gap analysis identified opportunities for improvements to the curriculum. Students needed an alternate means and supplement to clinical experiences given restrictions in place at clinical sites due to the COVID-19 pandemic. A literature review revealed VST to be a potential solution. This proposed technology will provide students with various clinical experiences and opportunities to use the communication and critical thinking skills needed to meet course objectives and learning outcomes. Another benefit to this technology is that students can practice as many times as needed to learn the material safely in a controlled setting. Faculty can monitor student progress and provide a more tailored learning experience for students. The technology improvement will also allow the learning institution to stay competitive with other nursing programs available to students. While there will be additional costs involved, the overall benefits and need outweighed the costs, and funds are available to cover the anticipated costs. Importance and Impact of the Proposal There are several drawbacks with the current state of technology, given school closures and healthcare facility restrictions on students due to the recent COVID-19 pandemic. Nursing students and faculty would benefit from an updated system. There is also an increasing demand for well-qualified nurses across the United States, putting increasing pressures on learning institutions to fill the needs. Enhanced learning from VST has positively impacted students’ critical thinking, decision making, and communication skills, leading to more proficient nurses entering the workforce. There is a constant need for nurses to adapt to change and remain knowledgeable about new technologies. The learning institution should offer up-to-date technology in the classroom and clinical experiences to better prepare students for the workforce. Virtual simulation technology use is increasing in post-secondary education and demonstrates multiple benefits. This proposal explains why it is necessary to implement virtual simulation technology for clinical experiences and how it will benefit students, faculty, the learning institution, and the nursing profession. References Erlinger, L.R., Barglet, A., & Perez, A. (2019) High-fidelity mannequin simulation versus virtual simulation for recognition of critical events by student registered nurse anesthetists. AANA Journal Online 87(2), 105-109. Retrieved from https://nurseanesthesiology.aana.com/high-fidelity-mannequin- simulation-versus-virtual-simulation-for-recognition-of-critical-events- by-student-registered-nurse-anesthetists Groen, J. F., Quigley, B., & Herry, Y. (2016). Examining the use of lecture capture technology: Implications for teaching and learning. The Canadian Journal for the Scholarship of Teaching and Learning, 7(1). http://dx.doi.org/10.5206/cjsotl-rcacea.2016.1.8 Meurer, J. (2017). The disadvantages of simulation in nursing programs. Retrieved from https://advocatesearchgroup.com/disadvantages-simulation-nursing-programs/ Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37. Retrieved from http://home.nwciowa.edu/publicdownload/Nursing%20Department %5CNUR310%5CSelecting%20the%20Best%20Theory%20to%20Implement %20Planned%20Change.pdf Padilha, J.M., Machado, P.P., Ribeiro, A.L., & Ramos, J.L. (2018). Clinical virtual simulation in nursing education. Clinical Simulation in Nursing, 15, 13-18. https://doi.org/10.1016/j.ecns.2017.09.005 Padilha, J., Machado, P.P., Ribeiro, A., Ramos, J., & Costa, P. (2019). Clinical virtual simulation in nursing education: Randomized Controlled Trial. Journal of Medical Internet Research, 21(3), N.PAG. https://doi.org/10.2196/11529 Seki, N., Moross, J., Hiromi, O., Sunaga, M., Naito, M., Kondo, K., Shinada, K.,…& Kinoshita, A. (2020). Dental hygiene learning outcomes obtained through computer-assisted simulation modules. Journal of Dental Hygiene, 94(1), 32-38. Available from https://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=5&sid=6308a862-dd21- 4b53-9ab2-156eb1a3919d%40sessionmgr4006 Shin, H., Rim, D., Kim, H., Park, S., & Shon, S. (2019). Educational characteristics of virtual simulation in nursing: An integrative review. Clinical simulation in nursing 37, 18-28. https://doi.org/10.1016/j.ecns.2019.08.002 Turrise, S., Thompson, C.E., & Hepler, M. (2020). Virtual simulation: Comparing critical thinking and satisfaction in RN-BSN students. Clinical Simulation in Nursing 46, 57-61. https://doi.org/10.1016/j.ecns.2020.03.004 Table 1. Literature Review Summary Table First Author (PubYear) Title Purpose Context Findings Relevance Strength of Evidence Padilha (2019) Clinical virtual simulation in nursing education: randomized controlled trial To evaluate the effect of clinical virtual simulation on knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students Randomized controlled trial consisting of a pretest and two post-tests with 42 Portuguese nursing students enrolled in the course "Corporal Body Responses 1” Clinical virtual simulation improves knowledge retention, initial clinical reasoning over time (2 months) and improves student satisfaction with learning. The study supports that virtual simulation technology can be a useful tool for students Level II Randomized Control Trial Strengths: Randomized controlled trial with pretest and two post- tests Prospective and analytical study Weaknesses: Small sample size (42 students) Only second-year nursing students were used for the study Only used a single course with context related to the respiratory process. Follow-up time was too short to evaluate knowledge retention over time. Staff not included Padilha (2018) Clinical virtual simulation in nursing education To assess the ease, usefulness, and intention of pregraduate nursing students to use a clinical virtual simulator Four hundred twenty-six pregraduate students from a Portuguese nursing school. Exploratory, descriptive, and cross-sectional study using a quantitative approach through a questionnaire based on the Technology Acceptance Model. Students revealed perceived ease, usefulness, and intention to use CVS as an important complementar y strategy for their nursing programs. The study supports that students find CVS useful and easy to use. Level IV Non- Experimenta l Exploratory Descriptive Cross- sectional Strengths: Large sample size (426 students) Weaknesses: Staff not included One method of data collection used Seki (2020) Dental hygiene learning outcomes obtained through computer- assisted simulation modules To evaluate the learning outcomes and practicality of interactive simulation modules developed for a computerized learning system in dental hygiene education Twenty-nine Japanese fourth- year dental hygiene undergraduate students Pre- and post- test and a questionnaire were used to measure knowledge gained and receive learner's feedback. State the key findings that relate to your proposal. Post-test scores were significantly higher in the study group than those in the non-study group. Post- test scores were also higher than the pretest scores in the study group. Questionnaire results indicated that students considered the Summary of how this article is relevant to your proposal The study demonstrate s students find virtual learning modules useful and beneficial Level IV Non- experimental Strengths: Multiple data points collected Weaknesses: Small sample size (twenty-nine students) Staff not included in the study virtual modules convenient and beneficial Shin (2019) Educational characteristic s of virtual simulation in nursing: An Integrative Review To identify educational characteristic s of virtual simulation in nursing education Using Whittemore and Knaft's (2005) integrative review method and searching in PubMed, Medline, and CINHAL 40 studies met the inclusion criteria. General and virtual specific characteristics of virtual simulation were identified. Virtual simulation may be an effective strategy to increase learner satisfaction and improve knowledge The study supports that virtual simulation as a beneficial learning strategy. Level I Integrative Review Strengths: multiple studies reviewed Multiple forms of data collection Weakness: A small sample size of studies reviewed Staff not included in the studies Turrise 2020 Virtual simulation: Comparing critical thinking and satisfaction in RN-BSN students Compare the outcomes of critical thinking, confidence, and satisfaction with digital clinical experiences (intervention) compared to written case studies (control) Twenty-seven RN-BSN students enrolled in a seven-week pathophysiology -pharmacology online accelerated course Students using the digital clinical experiences had higher confidence and satisfaction scores compared to those in the control group Critical thinking scores increased for the intervention group and decreased for the control group, but no statistically significant differences pre The study supports that virtual simulation can improve confidence, satisfaction, and critical thinking in nursing students Level IV Non- experimental design Strengths: A pilot study used as a randomized, controlled, pretest, post- test design Weaknesses: Small sample size (twenty- seven students) A seven- week course may be too short a time frame for to post-test. learners to improve critical thinking skills. Staff not included Table 3. Organizational Readiness for Curriculum Proposal Implement virtual clinical simulation technology to provide students and educators flexibility for clinical training experiences due to closures and restrictions related to the COVID-19 pandemic Virtual simulation technology allows students to practice various skills in a safe, controlled virtual environment from anywhere at any time. Clinical scenarios and assessment criteria can be revisited as often as needed by the student to develop the skills required to provide safe patient care. [Show More]

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