The design and development of a programme for simulation best practices in South African nursing education institutions

Thurling, Catherine Hilary
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Although simulation has been part of health care education for the last 40 years, there appears to be some resistance to embedding the education methodology in both nursing and medical curricula. Possible reasons for this lack of integration could be the educators’ fear of technology, organizational barriers, such as time for integration, and a lack of support for educators wanting to introduce simulation. In South Africa at present, simulation is only being used in pockets at universities and nursing colleges, with no formal contextually relevant training programme in place, specifically for nursing education, despite evidence that simulation improves student’s outcomes and critical thinking. Nurse educators have expressed anxiety and bewilderment and seem uncertain about the use of simulation. The purpose of this study was to develop a best practice simulation programme for nurse educators wanting to use simulation in their undergraduate nursing curricula. A multi-method design within a pragmatic paradigm was used for this study. The process was divided into four phases. Phase one involved data collection, using the National Council of State Board of Nursing (NCSBN) survey: Use of Simulation in Nursing Education (Hayden, 2010), to describe the prevalence and use of simulation in both university and college undergraduate curricula. Phase two consisted of two parts, conducted consecutively: a scoping literature review to determine simulation best practices in nursing and medical education, followed by a Delphi Study to elicit the perceptions of educators in South Africa regarding simulation and best practice. In the scoping literature review the question asked was: What does the literature identify as simulation best practices in nursing and medical education? Four best practices emerged from the literature, namely the importance of debriefing, identifying learner objectives, the integration of simulation into the curriculum and the inclusion of deliberate practice. A Delphi Study was then conducted to elicit the judgement and perceptions of simulation educators, working in the South African context, of the identified best practices. Phase three was the design of a conceptual framework and the development of a constructivist blended learning programme, using the Assessment, Design, Development, Implementation and Evaluation (ADDIE) instructional design method. The goal of the programme was: Participants will be able to apply simulation knowledge and skills to meet the learning needs of their undergraduate nursing students. The four best practices and the National League of Nurses/Jeffries Simulation Framework guided the programme. The resultant programme was developed in seven Modules building towards the completion of a simulation scenario, including planning for the scenario and post simulation debriefing. Phase four was an expert review of the programme, from an e-learning specialist, nurse educators and a simulation expert. Both an expert review guideline for a written report and interviews were used for evaluation and refinement of the programme, prior to the programme being rolled out to nurse educators. Results: Simulation in South African nurse education institutions is predominantly at a task training level and has been developed into complex patient scenarios using higher fidelity simulations. The programme was well received by the experts as relevant to simulation education in South African undergraduate nursing curricula, either in a university or nursing college educational environment. Limitations: The limitations to the study include the small sample sizes in the data collection phases, due to simulation in South Africa being relatively new in nursing education. Universities were predominantly represented in the data collection findings, despite the researcher reaching out to nursing colleges for their perspectives and inputs. There is a dearth of South African simulation literature and none on best education simulation practices in South African Nursing Education Institutions (NEIs), and therefore the researcher relied on international literature in the scoping review. Conclusion: The blended education simulation programme is based on the needs of nurse educators wanting to include simulation in their education environment, based on their resources, and allows them to work through the programme in their own work space and time.
A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements of the degree of Doctor of Philosophy Johannesburg, 2017.
Thurling, Catherine Hilary (2017) The design and development of a programme for simulation best practices in South African nursing education institutions, University of the Witwatersrand, Johannesburg, <>