Research Questions: How effective is videotape training versus face to face instruction in preparing senior nursing students to respond to ‘real-life’ emergency clinical situations?

Purpose: This study is the third phase of a multi-phase, multi-site evaluation of clinical simulation in Schools of Nursing in Ontario. The purpose of this sub study was to examine the effectiveness of simulation in preparing senior nursing students to respond to critical incidents in the simulated clinical environment.

Method: An experimental design was utilized to answer the research question. Fourth year nursing students (n=36) were randomly assigned to one of three groups. Both intervention groups participated in a 1/2-hour teaching session involving a critical incident (pending cardiac arrest). The first group received instruction via videotape and the second group engaged in ‘hands on’ experience using a high-fidelity simulator (SimMan). The third group (control) received no instruction and relied on their previous clinical knowledge and skills. All groups received a general orientation to the equipment and how to use it. Students were evaluated using an Objective Structured Clinical Examination (OSCE) involving a high-fidelity simulator and incorporated a standardized patient to reflect a ‘life-like’ clinical setting. Students moved through three 20-minute OSCE stations (patient rooms) involving a different critical incident, each requiring the students to respond by providing safe patient care which required them to transfer their knowledge from one station to the next. Students had a multidisciplinary team available to them, and could access them when they felt that they did not have the knowledge or skill to deal with the situation. The time spent at each station included a 5-minute debriefing session. Students also completed pre and post-tests to determine the effect of simulations on their self-perceived levels of confidence, competence, their ability to collaborate with other members of the health care team, to make clinical decisions, to assess, communicate, and manage a crisis situation. These scores were later compared to the actual OSCE scores.

Results: Analysis of the data revealed a statistically significant difference between the control group and the interactive (p= .007) and the control group and the video instruction group (p= .035). No statistical difference could be found between the low and high-fidelity groups. Results from the pre-test/post-test revealed a negative correlation between the OSCE scores and the students’ self-assessment in all areas except collaboration.

Conclusion: Simulation technology is an effective tool in teaching students to respond to critical incidents in the clinical setting. It provides a safe area where students can be given constructive feedback and praise. More research needs to be completed to determine whether or not high-fidelity simulators are the most effective in teaching clinical skills or whether these skills could be gained through less expensive teaching approaches.