Human patient simulation (HPS) improves nursing students competence in providing nursing care to older adult experiencing acute stroke : a randomized controlled trial

Background Stroke is commonly experienced among older adults. Mortality, complications and disabilities experienced from stroke could be alleviated if effective and efficient treatment was received during acute stroke. Nurses are the first healthcare professionals that patient will interact while seeking medical advice. Present Traditional Lecture-based (TLB) education shows limitation in enhancing nursing competence. Human Patient Simulation (HPS) was explored for its effectiveness to improve nursing students learning. Objectives The aim of this research study was to evaluate HPS in improving nursing students’ competence (knowledge acquisition, critical thinking and clinical judgement) in providing nursing care to older adult experiencing acute stroke. HPS was also evaluated in enhancing learning experience, scenario design, satisfaction and self-confidence in learning using translated Chinese version National League Nursing (NLN) HPS evaluation scales. Methods This research study was implemented in four phases. In the first phase, cultural adaptation and psychometric analysis of Chinese version of NLN HPS evaluation scales was performed. In the second phase, older adult acute stroke scenario was designed. In the third phase, a pilot study was carried out to check the feasibility of the study. In the last phase, Randomized Controlled Trial (RCT) was performed. Results Four translators and nine experts in HPS from China, Hong Kong and Taiwan were involved in the translation process. 300 nursing students with Traditional Chinese as written dialect. Chinese (traditional Chinese) version of NLN Educational Practices Questionnaire (EPQ-C), Simulation Design Scale (SDS-C) and Student’s Satisfaction and Self-Confidence in Learning (SSCL-C) were developed. Cronbach’s alpha (α) of the three scales ranges from 0.78 to 0.95. Most of the factors loading in the scales was ≥ 0.40. Interclass Correlation Coefficient (ICC) of the scales was above 0.80. The three scales demonstrated a high reliability and validity. Scenario design team composing of two clinical nurses, a physician and educators commented on the scenario in order to reflect the most current clinical situation and the most updated management of older adult experiencing acute stroke. Pilot study was used to test the feasibility of the research and Teaching Assistants teaching skills who was implementing the intervention. It was marked that the participants could have different predisposing knowledge on acute stroke which may hinder the results of the study not solely affected by the intervention. Therefore, a pre-intervention educational session on acute stroke was provided. A randomized controlled trial (RCT) was conducted to assess the primary outcome (knowledge acquisition) and the secondary outcome (critical thinking, clinical judgement, learning experience, scenario design, satisfaction and self-confidence in learning). 200 nursing students demonstrated that HPS was significant (p < 0.05) in improving knowledge acquisition, critical thinking and clinical judgement. HPS was also significant (p < 0.05) in enhancing learning experience, scenario design, satisfaction and self-confidence in the learning. Conclusion HPS was more effective than TLB in improving competence of nursing students in providing nursing care to older adult experiencing acute stroke and HPS was more effective in enhancing learning experience, scenario design, satisfactions and self-confidence in learning.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph