Faculty of Health Sciences (ETDs)
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Item A Framework for Integrating Simulation into the Bachelor of Nursing Science Programme in Eswatini(University of the Witwatersrand, Johannesburg, 2024) Shongwe, Sithembile Siphiwe; Armstrong, Susan J.Background: Simulation-based education is a required pedagogical method for preparing undergraduate students to become nurses. Its ultimate goal is to develop practice-ready professionals rather than introduce the latest technology into training. In Eswatini, simulation is used; however, no framework guides nursing education institutions on how to integrate simulation into their educational programmes to enhance clinical teaching and learning effectively. Purpose: The aim of this study was to develop a framework for integrating simulation into the Bachelor of Nursing Science programme in Eswatini. Research methods: A mixed methods approach utilising multilevel designs guided the inquiry process. Inferences drawn from the various strands of the mixed methods data were integrated to address the study problem. Phase one was a scoping review conducted to explore best practices of simulation-based education in the educational preparation of undergraduate nursing students locally (sub-Saharan Africa) and internationally. A Joanna Briggs Institute methodological approach guided the research process. Sixty articles were included in this scoping review. Phase two was a survey study conducted to assess the state of simulation use in the educational preparation of Bachelor of Nursing Science Students in Eswatini through auditing four (4) simulation laboratories (Study A) and a survey with (n=46) nurse educators, a census (total) sampling technique was used to select the study participants. Phase three used an iterative process together with simulation experts (n=2) to develop the framework and to identify activities to consider when integrating simulation in Eswatini. These were sourced from tabulated lessons learned or inferences drawn based on the findings of phases 1 and 2. The NLN Jeffries simulation theory guided the development of the framework. In phase four, Eswatini nurse educator experts (n=16) evaluated the framework’s utility in a Delphi study completed in two rounds. Findings: In phase one, best practices principal to simulation-based education emerged. The study findings were inductively developed, resulting in four core codes, namely: (i) lecturer preparation, (ii) student elements, (iii) designing simulations and (iv) innovations in simulation. Ninety-five per cent (95%) of the literature was from international settings compared to 5% from the African context. Phase two: Eswatini nursing education institutions were somewhat ready for simulation; this status was attributed to the lack of trained educators in simulation principles, a lack of financial and resource planning and limited infrastructure and equipment for supporting simulation-based education. Phase three: a framework with the following five domains was developed to guide the process of integrating simulation into the Nursing Education programme in Eswatini: Training or preparation of educators; Integration of simulation into the nursing/midwifery programme; Simulation equipment; Simulation infrastructure; and Student/simulation participants. Phase four: Eswatini nurse educators found the framework relevant and suggested feasible strategies for the Eswatini nursing education context. The strategies included sensitising management to increase simulation-based education support and sourcing funding for procuring equipment and infrastructure development. Conclusion: The framework for integrating simulation into the Bachelor of Nursing Science Programme was designed to allow a step-by-step implementation approach due to existing contextual challenges. The challenges include a lack of trained educators/lecturers on simulation-based education principles, an absence of simulation champions, insufficient equipment, infrastructure inadequacies, fiscal constraints and dwindling management support. The framework can potentially guide the successful integration of effective simulation into Eswatini nursing education institutions. Recommendations: There is a need for the current nurse educators to be trained in the simulation teaching and learning strategy to ensure the effective use of simulation-based education. Nursing education institutions must develop financial plans for funding the required simulation resources (educators’ training, equipment and infrastructure) to ensure the sustainability of simulation-based education