Engaging Learners in Presimulation Preparation Through Virtual Simulation Games

Abstract

Background: With increased emphasis on technology, nurse educators must carefully assess learning outcomes associated with various components of clinical simulation. Presimulation preparation is a critical aspect of simulation education that has not been well-studied. Traditional presimulation activities include readings, lectures, and quizzes. Non-traditional activities include video lectures, online modules, and self-assessments. However, in our experience, learners may fail to adequately prepare for simulation when given traditional presimulation preparation activities. Research suggests that alternate presimulation activities improve learning outcomes. Thus, there is a need for innovative approaches to optimize learning during the simulation. Recently there has been an increase in the use of virtual simulation and gaming in medical and nursing education. To date we have not encountered the use of virtual simulation games (VSGs) as a presimulation preparation activity for clinical simulation. Over 30 validated clinical simulation scenarios have previously been developed by nurse educators from across Ontario for senior nursing students to enhance their transition to clinical practice. Each scenario is implemented with self-regulated pre-simulation preparation guided by a scenario-specific learning outcomes assessment rubric. The development of a series of VSGs aims to further enhance presimulation preparation for undergraduate nursing students participating in these scenarios. We propose that VSGs used for presimulation preparation will prove to be more engaging to learners, resulting in better preparation and improved performance during live simulations. Ultimately the use of virtual simulation for presimulation preparation may translate to improved performance in real clinical settings with a positive impact on patient safety and well-being. Objective: To describe the development and implementation of VSGs used to prepare nursing students prior to their experience in live simulation scenarios. Description of the Innovation: To further enhance learner preparation to participate effectively in live simulations, a virtual simulation game was developed for each of four live scenarios. Each game incorporated five decision points designed to promote critical thinking. The learning outcomes assessment rubric was also incorporated into the game as a pre/post assessment allowing learners to gauge their own readiness to participate in the live simulation scenario. The virtual games consisted of video clips filmed from the perspective of the nurse interacting with the patient. At regular intervals, learners were required to select the best of three nursing actions in response to the situation. Learners were provided with immediate feedback following selection of an incorrect response and are directed back to select another response. Following selection of the correct response, learners were also provided with the rationale before the game proceeds to the next decision point. Feasibility Testing: Following usability testing, each virtual simulation game was implemented in two of four participating Ontario schools of nursing. Successful implementation of the games demonstrated the feasibility of using VSGs for presimulation preparation. Preliminary learner and faculty perceptions of the usefulness of the game to prepare learners to participate in live simulation have been very positive. Learners reported that the game was easy to use, interactive, relevant, and engaging, and preferable to completing assigned readings prior to simulation. Learners appreciated that the rationale for each decision was provided as immediate feedback, which supported their learning, and reported that playing the game helped them to feel more prepared and less anxious to participate in the simulation lab. Faculty anticipated that learners would be more likely to complete presimulation preparation when it was presented in this interactive format. Conclusion: We anticipate the virtual simulation game will be an engaging pre-simulation preparation activity. The advantages to using virtual games for presimulation preparation could include the promotion of self-regulated learning, enhanced knowledge, decreased anxiety, and enhanced preparation and performance during a live simulation scenario. Additionally, we anticipate that standardized pre-simulation preparation will reduce faculty preparation time and student assessment time and may decrease instructional time in the simulation laboratory. Collaboration and sharing of VSGs across nursing schools will mediate the development costs and result in cost savings in the long-term. Funding: ECampus Ontario Research and Innovation Grant.