Education for the future in a changing health landscape

The research project "Education for the future in a changing health landscape", examines different aspects of simulation as a pedagogical method and information seeking in clinical practice through four sub-studies. The first sub-study examines simulation-based education and the effect of repeated simulation on the nursing student's learning outcome and competence. It contributes to new knowledge about repeated simulation that can be used to develop students' competence that correspond with educational goals and the health service's requirements. A systematic literature study on repeated simulation in nursing education includes findings from 27 studies that are thematically classified into 1) time frame, 2) context and number of scenarios at each simulation day, 3) repetitive simulation related to clinical practice and 4) the student's learning outcome. Lack of randomized studies and few studies that map learning over time are also highlighted. A longitudinal randomized controlled study (over 3 years), examining nursing student's learning results from participation in repetitive simulation is also a part of the sub-study. Through questionnaires, participants report having flexible action competence throughout the study period. Students' self-confidence increases significantly over time, regardless of group affiliation (simulation with double or single scenarios). Predictive factors for third-year students' self-confidence after simulation participation have been investigated without showing a significant interaction effect. Most students prefer a concrete approach to learning and to reflect with others. The second sub-study examines how affective learning in simulation and the reflection part (debriefing) has an impact on students' learning process, as well as how the leader of simulation (facilitator) uses affective tools in simulation and debriefing. The study is based on principles from Interpretive Description. The results are presented in three scientific articles. The first article is a systematic review study that explores current knowledge about health professionals' emotions in simulation and debriefing and the importance of emotions for learning. The 16 included studies mainly map stress and anxiety as persistent and one-dimensional emotions throughout the simulation and are mainly examined quantitatively. Whether stress and anxiety promoted or inhibited learning in simulation is ambiguous. The second article presents the results from a study where students' emotions during a simulation sequence are explored. Data were collected by observing and videotaping simulation, including debriefs. Immediately after simulation, the student who had had the active role in the simulation saw the video and were interviewed about his or her experiences. The study showed that the students' emotions were nuanced and changed through the simulation. They experienced emotions that both promote and inhibit learning. The fact that students experience multiple negative and positive emotions in a short learning situation, contributes to an increased understanding of emotions importance for learning in simulation. Results from facilitator-interviews are presented in the third article and show attention and strategies to secure students in simulation, together with strategies to evoke emotional situations in scenarios that enable to improve students' in-depth learning in debriefing. The findings contribute to knowledge about simulations as an affective learning and teaching method. They also show that affective perspective must be emphasized in simulation and lay the foundation for reflection in debriefings. The project's third sub-study is a grounded theory study in which teachers' pedagogical theory related to simulation is investigated. Experienced and less experienced facilitators in nursing education have been interviewed. A theory has been developed that shows that their main concern is to maximize students' learning space in scenario-based simulation, but that this is affected by several factors. Legitimization of simulation as a method in the organizations, development of oneself as a facilitator and work on preparing and adapting simulation to the student group are key factors. A number of strategies are used to meet these. Sub-study 4 was carried out by a project participant who worked from the USA for a period. This was before the pandemic and supervising students digitally in informatio seeking and assessment of research was relatively new to this educational programme. The students who participated were in clinical practice. They should learn to work according to principles in evidence-based practice and use information literacy skills when working on their assignments. Teaching plans and interactive training modules were prepared. https://www.vid.no/forskning/nurseedufut/

Resultatene fra prosjektet som helhet vil kunne ha betydning for den pågående debatten knyttet til behovet for flere sykepleiere og utfordringer knyttet til praksisplasser. Pandemien har synligjort det økte behovet for sykepleiere, men at EU-direktivets krav til praksis (både omfang og kontekst) er en betydelig utfordring. Flere har tatt til orde for å se på simulering som erstatning for deler av praksis. I tillegg vil prosjektets emosjonsforskning ha overføringsverdi til andre opplæringskontekster der studenter eller elever bli eksponert. Den vil også bidra inn i forskningsfeltet som omhandler emosjoner og læring.

The society has a constantly increasing need for professional health workers, and nursing students must be able to meet future demands for health care. Hence, the nursing education must equip students with change competency, information seeking expertise and reflection skills. We therefore propose a project that address the students' need to develop key transferable skills in learning. In detail, we wish to explore ways in which the education can help students develop these skills that will be essential for their professional development as nurses. Nurses need training in facing unexpected situations in a safe environment (simulation), learn to reflect over their own challenges (active learning), and learn how to use and navigate information resources related to their clinical practice (information literacy). We wish to investigate the combination of simulation and information literacy in a clinical environment, and argue that simulation as a learning method will equip students with the ability to adapt to changes and enable them to work evidence based and stay updated. This will help them meet unanticipated situations as professional nurses. The project will deliver a portfolio of tools, methods, cases, scenarios, etc. that may be used in nursing education and clinical practice. Concretely, we will investigate how simulation as a learning method in clinical practice may bridge the theory-practice gap in nursing education, and how simulation may be studied from a pedagogical perspective. Further, we will develop tools that will secure the quality of simulation in clinical practice. We will also develop and evaluate toolkits related to e-learning and information literacy in order to support the students' active learning and reflective processes, also when they work with simulation. Tools and methods developed within the project will be disseminated at internal workshops and training sessions, and documented and shared to external users as well.