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© Borgis - New Medicine 2/2013, s. 55-61
*Eszter Borján1, Zoltán Balogh1, Judit Mészáros2
Evaluating the effectiveness of two simulation courses for midwifery students
1Department of Nursing, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Department: Zoltán Balogh, PhD
2Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Dean of the Faculty of Health Sciences: Prof. Judit Mészáros, PhD
Summary
Aim. The aim of this study was to evaluate the effectiveness of two simulation courses for midwifery students.
Material and methods. There were 30 midwifery students enrolled in the study at Semmelweis University, the Faculty of Health Sciences between February and May 2011. The descriptive study examined the effectiveness of a common compulsory course: “Clinical simulation” and a special course following it: “Case studies in simulation” using the METI Simulation Effectiveness Tool (SET). Students completed the SET after the common compulsory course and also after the special course, by rating its statements. Results were compared by the authors.
Results. The common compulsory course: “Clinical simulation” was effective. After the special course: “Case studies in simulation” we realized remarkable improvement in assessment skills, in the skill of critical thinking and self-confidence.
Conclusion. METI SET is a useful tool for evaluating our students’ perception; however, more objective assessment tools should be used for the evaluation of our students’ development in simulation.
INTRODUCTION
The worldwide use of high-fidelity human patient simulators in nursing and midwifery education programs has increased in the past ten years. Universities are faced with increased student intakes, decreased clinical placements and a shortage of patient availability (1, 2). Nevertheless students require innovative and successful learning strategies in order to be prepared for real clinical practice in a more effective way. Simulation is an efficient method because it provides multiple learning objectives in a realistic clinical environment without harming patients (1).
We started to integrate simulation into the curriculum in 2008 when we received our first METI (Medical Education Technologies, Inc.) Emergency Care Simulator (ECS). Since 2011 we have also obtained a METIman Nursing and a METI Baby Sim.
The curriculum development has been a four-year long process we have not finished yet. Simulation has been integrated into the curriculum for all undergraduate students. Each of our students has the opportunity to practice basic assessment and technical skills with a simulator. The name of the common compulsory course is: “Clinical simulation”. This course includes elementary level scenarios for all students in different fields of health care. The prerequisite of this course is to cover the subject: “Basics of Health Sciences” which provides general knowledge and practice in the fields of nursing (3). After completing the “Clinical simulation” course the nursing and midwifery students have more possibilities to practice on the simulator by using the METI PNCI (Program for Nursing Curriculum Integration) learning package (4). We have developed two special programs for nursing and midwifery students. The name of this special course is: “Case studies in simulation”. Although we don’t have a special birth simulator yet we can use the METI ECS and METIman Nursing simulators for midwifery students as well. As we were planning the simulation program for midwifery students we chose the most appropriate scenarios (simulated clinical experiences – SCEs) from the METI PNCI learning package considering the midwife’s role in different clinical fields (tab. 1). The prerequisite of this course is to cover the subject: “Basics of Nursing” which includes the basic knowledge and skills for nursing and midwifery students.
Table 1. Scenarios from the METI PNCI learning package.
Title of the scenarioReasons for the choice of scenarios
Hyperemesis Gravidarumobstetric scenario
Pregnancy Induced Hypertensionobstetric scenario
Postpartum Hemorrhageobstetric scenario
Amniotic Fluid Embolismobstetric scenario
Postop Ileuscommon complication after operation
Postop DVTcommon complication after birth or operation
While using human patient simulators we have experienced most of the advantages of this new teaching and learning strategy but we have also realized that we have to measure the effectiveness of our work in order to ensure the best way of teaching our students. We can find many evaluation instruments in literature but in most cases their validity and reliability is unknown. Further use and development of simulation evaluation instruments are of highest importance (5).
AIM
The first aim of this study was to evaluate the effectiveness of the special simulation course for midwifery students by comparing the results measured after a common compulsory course: “Clinical simulation” with the ones measured after the special course: “Case studies in simulation”. The second aim of this study was to analyse the fields of students’ development after the two courses. For the comparison we used the METI Simulation Effectiveness Tool (SET).
The research questions of this study were as follows:
1. Was the common compulsory “Clinical simulation” course effective?
2. Did we experience any improvement after the special course?
3. Can we improve all fields of knowledge and all skills during one course?
MATERIAL AND METHODS
This descriptive study examined the effectiveness of the two courses by using the METI Simulation Effectiveness Tool (SET)*. This multi-item tool is a valid and reliable instrument developed by the experts of METI including 13 statements and measuring three aspects of learning outcome: skills or knowledge gained as a result of the simulated cases, confidence level and satisfaction attitudes. The 13 statements are shown in table 2.
Table 2. Evaluation of the two courses by midwifery students.
Statements of METI SETAfter the common compulsory course: “Clinical simulation” After the special course: “Case studies in simulation”
N = 30 = 100%Do Not AgreeSomewhat AgreeStrongly AgreeNot ApplicableDo Not AgreeSomewhat AgreeStrongly AgreeNot Applicable
1. The instructor’s questions helped me to think critically 53%47%  13%87% 
2. I feel better prepared to care for real patients 33%60%7% 33%64%3%
3. I developed a better understanding of the pathophysiology of the conditions in the SCE 33%67%  40%60% 
4. I developed a better understanding of the medications that were in the SCE16%70%14% 13%74%13% 
5. I feel more confident in my decision making skills10%67%23% 3%67%30% 
6. I am more confident in determing what to tell the healthcare provider6%47%37%10%10%40%47%3%
7. My assessment skills improved6%37%57%  16%84% 
8. I feel more confident that I will be able to recognize changes in my real patient’s condition 57%37%6% 33%67% 
9. I am able to better predict what changes may occur with my real patient13%53%24%10%3%70%27% 
10. Completing the SCE helped me understand classroom information better 30%70%  27%73% 
11. I was challenged in my thinking and decision making skills 54%40%6%3%40%57% 
12. I learned as much from observing peers as I did when I was actively involved in caring for the simulated patient23%57%14%6%13%70%14%3%
13. Debriefing and group discussion were valuable 13%76%10% 16%80%3%
There were 30 midwifery students enrolled in the study at Semmelweis University, the Faculty of Health Sciences between February and May 2011. All of them were before the real clinical practice, at “Novice” level. Students completed the SET after the common compulsory course: “Clinical simulation” by rating the statements of the tool. The same students completed the SET again after the special course: “Case studies in simulation”. Results of the two courses were compared by the authors.
The data analysis was performed by using the statistical program SPSS for Windows version 15.0.
RESULTS
Research Question 1: Was the common compulsory “Clinical simulation” course effective?
Students evaluated the 13 statements of METI SET after the common compulsory course. High percentage of students agreed somewhat or strongly with all of the statements (tab. 2). The most remarkable results are: Statement 2: “I feel better prepared to care for real patients”, 60% of the students strongly agreed. Statement 3: “I developed a better understanding of the pathophysiology of the conditions in the SCE”, 67% of participants strongly agreed. Statement 7: “My assessment skills improved”, 57% of students strongly agreed. 70% of participants strongly agreed with Statement 10: “Completing the SCE helped me understand classroom information better.” 76% of the students strongly agreed with Statement 13: “Debriefing and group discussion were valuable.”
Research Question 2: Did we experience any improvement after the special course?

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otrzymano: 2013-05-08
zaakceptowano do druku: 2013-06-03

Adres do korespondencji:
*Eszter Borján
Semmelweis University, Faculty of Health Sciences, Department of Nursing
1085 Budapest, Vas u. 17, Hungary
tel.: +36 (1) 4865930; fax: 4865931
e-mail: eborjan@gmail.com

New Medicine 2/2013
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