Y. M. C. CHAN, H. B. YUAN
OPEN ACCESS
tions, and “read” the patient’s responses to the intervention.
This experience can help students to bridge the theory practice
gap by transferring cognitive learning into practical experience.
Health assessment skills were increased by assessment of the
relevant data, a logical interpretation and reasoning and accu-
rate judgments.
The reflections offered a unique way for students to critically
analyze their own performance. Students engaged in introspec-
tive learning to self-correct. The reflections focused on students’
primary misconceptions, anything they missed in report or oth-
er information they needed from report or the patient to act
more effectively, and what they should do differently the next
time while emphasizing what was correct, appropriate and safe.
It allows the student to clarify their thinking and link the simu-
lation to real situation while reinforcing specific knowledge,
and to discuss how to intervene professionally in complex clin-
ical situations (Gaberson & Oermann, 2010). In this case, stu-
dents learned from previous experience and paid close attention
to patients’ concerns. They assessed the relevant and important
data and explained them to the patient using understandable
wording as managing the contingencies and emergencies. They
presented better communication skills and patient education
across the time of simulation.
Previous studies reported the consistent findings. Kaddoura
(2010) reported that simulation prepared new nursing graduates
well to care confidently for critically ill patients, and helped
them learn to make sound clinical decisions to improve patient
outcomes. Zheng et al. (2010) found that students’ performance
was significantly improved in application of theoretical know-
ledge, health education and humanistic care after one-semester
of simulation. More than 95% of students agreed that feedback
sessions confirmed management of patients’ problems, helped
to develop rationale for actions (Wotton, Davis, Button, &
Kelton, 2010).
However, students indicated that the SimMan is not realistic
enough. The SimMan had its own inherent limitation. It may do
not duplicate the experience of working with a live patient. By
responding to a situation during the scenario, the “patient” pro-
vided instant feedback; through which students saw the out-
comes of their interventions. It was suggested that forthright
feedback from the facilitator was needed to enhance the realism
of the scenario with physical props and psychosocial interac-
tions (Birkhoff & Donner, 2010).
The interesting finding in this study was that second-year
students achieved higher overall scores of health assessment in
some sessions than third-year students. They presented better
physical examination in each simulation session, and better
communication and patient education in some sessions. It may
be caused by the different learning effort of students. The tutors’
comments showed that second-year students valued the newly
learned knowledge and applied it in the simulated scenarios.
They did good preparation for learning and engaged in group
learning, deep discussion and reflection. They try their best to
make the physical examination comprehensive while concern-
ing the patient’s response and providing the appropriate man-
agement. However, third-year students did not have a deep
memory and understanding of some knowledge that they
learned in their previous two years, and did not do a full know-
ledge review and a good skill preparation for the simulated
learning. Their assessment was not comprehensive while their
explanations to abnormal sign and symptoms were incorrect or
ambiguous. Sometime they could not recognize some severe
arrhythmias. Thereby, they got the lower scores in physical
examination, patient education and communication compared
with the second-year students. For ensuring the quality of learn-
ing, students should have good preparation for knowledge and
skills, be self-motivated and keep responsible for their own
learning. Tutors should promote students' intrinsic motivation
for learning and develop their potential efforts in learning dur-
ing simulation.
Limitations
The generalization of the findings was limited because a
small purposive sample was recruited from one research setting.
The new developed health assessment evaluation rubric was
only used in medical-surgical care; the generalizability of fur-
ther studies needs to be considered in other area of nursing care,
such as long-term care or community care. As a confounding
variable, the mixed role play of students (patients or family
members and nurse) may affect the effective “nurse-patient”
communication and thus influence the accuracy and scores of
health assessment.
Recommendations
The performance indicators of the health assessment evalua-
tion rubric require more research to address content and con-
struct validity in different nursing contexts in order to more
accurately reflect the current understanding of each aspect of
health assessment. As transfer of skill from the simulated envi-
ronment to the clinical setting is essential, follow-up studies
need to be concerned with the impact of using simulation on
students’ performance in clinical placement.
Conclusion
Simulation using a human patient simulator offered a realis-
tic learning environment for students to develop their health
assessment skills. Most of students appreciated that simulation
facilitated their knowledge application, assessment and com-
munication skills and group collaboration, but using manne-
quins did not replace working with live patients. Forthright
feedback from the facilitator was needed to enhance the realism
of the scenario . Tutors should promote students’ intrinsic mo-
tivation for learning and develop their potential and efforts in
learning. The questionnaire needed to be carried out to investi-
gate students’ perceptions about the impact of simulation expe-
rience on the development of health assessment.
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