Clinical simulation practice and associated factors among nurse and midwife educators working at teaching institutions in Bahir Dar, Ethiopia: a mixed methods study

Simulation is defined as "the processes by which we are trying to achieve results approximating clinical practice as closely as possible". It is a technique for replacing or completing real-life experiences with guided experiences, which are faithful imitations of the real world in a fully interactive way [1]. Simulation is a novel method of teaching psychomotor abilities because it allows students to integrate knowledge from all three learning domains while practicing the skill [2]. Simulation is a teaching and learning strategy that is increasingly used in nursing education to prepare students for the clinical workplace. It has existed in nursing education in many forms, and the first healthcare simulation manikins were introduced in the early 1960s [3]. Simulation is a technique or device that attempts to create the characteristics of a real-world situation. Simulation allows the educator to control the learning environment through the scheduling of practice and providing feedback [4].

Simulation is a technique or device that attempts to create characteristics of the real world. Simulation and debriefing methods were utilized to increase the participant’s awareness of their own knowledge, skills in ethics, and provide an opportunity for reflection on useful teaching strategies in applied ethics during clinical instruction [5].

Simulation learning is an integral component of many undergraduate nursing programs throughout the United States of America. Similar practices in simulation learning are being implemented in Ethiopia. Experiential learning through simulation allows students to improve their cognitive, affective, and psychomotor skills [6].

Schools of nursing are required to provide students with both theory and clinical opportunities relative to the scope of nursing. Nurse educators who teach in baccalaureate programs foster critical thinking and communication skills through didactic and clinical instruction, as well as learner activities such as simulation [7]. Simulations vary in type and the technology utilized. Simulations range in technological complexity from low-fidelity, consisting of case studies or written patient scenarios where students engage in problem-based learning, to high-fidelity, where high-tech mannequins are utilized to generate highly realistic scenarios [8]. Competent nurses are able to consistently transfer knowledge into appropriate action. To do this, nurses must be able to obtain patient data, make accurate decisions based upon their interpretation of the data, and take appropriate action based upon the information and the situation [9]. The use of clinical simulation as a teaching technique has become widely encouraged due to its ability to provide active learning mechanisms, construction of knowledge, critical understanding of reality and favor the acquisition of technical and non-technical skills, such as crisis management, teamwork, leadership, clinical reasoning, and decision-making [10].

Addis Ababa University has embraced simulation-based medical education (SBME) as part of the solution to fill the gap. Simulation in medical education is an educational modality that replicates or imitates a real clinical environment. It provides healthcare professionals the opportunity to acquire and master key skills and behaviors in a risk-free environment. Simulation-based medical education is widely used in the developed world as a result of the demand for patient safety, the rapid development of new medical technology and management modalities, the need for training in specific presentations and diagnoses to fulfill educational objectives, and insufficient clinical training opportunities with actual patients [11]. Clinical simulation may be used for assessment and evaluation of students’ skills, as a teaching strategy in clinical nursing courses, and an opportunity for students to practice clinical skills. Clinical simulations, most educators believe, foster and enhance critical thinking skills through the practice of psychomotor skills and therapeutic communication techniques [12].

Simulation is an instructional tool and procedure that has been proven to be effective. Simulation encourages students to work together and form bonds, as well as to follow a routine for mastering a skill. It is built on a scenario in which learning becomes interactive, allowing for feedback between the educator and other team members, and encourages clinical reasoning and critical thinking among the team members [13].The purpose of this study was to evaluate the use of simulation to impact the Development of clinical self-efficacy in junior- and senior-level nursing educators.

The main purpose of this research was to examine the overall practice and associated factors for nurse and midwife educators’ regarding clinical simulation education. There have been few studies in both the national and international contexts that specifically aim to assess the existing practice of nurse and midwife educators towards clinical simulation education; this study attempted to address this by assessing the level of practice and towards clinical simulation and identifying factors associated with clinical simulation. The study showed that 43% at (95% CI:36% −50%) of participants had poor practice, Accordingly, the odds of having poor simulation practice for a male instructor are less likely as compared with a female. It is also shown that teaching experience and the poor practice of clinical simulation have a direct correlation. Those with less than five years of teaching experience have a 21% lower simulation practice than those with more than ten years of experience. This study is supported by a study conducted in America [19].

The present study showed that those who said cost affects the implementation of clinical simulation were 37% less likely to practice as compared to those who said cost has no effect. It is also supported by our qualitative analysis. Most of the participants reported shortages of skill lab equipment, classrooms, and modules affected their performance in clinical simulation practice. Previous studies [20‐22]supported the effect of cost, teaching experience, and other related factors on the practice of simulation.

The quantitative analysis clearly showed that a teacher with sufficient training was more effective in clinical simulation than those who had not received training. The majority of respondents had no continuous training in the institution, according to the qualitative research that also supports this finding. Students were unable to learn effectively utilizing simulation instruments due to a lack of training and unknown instrumentation. This result is in line with a Chinese study that showed how simulative training can greatly increase students' competence in comparison to no-gain training [23].

The majority of interviewees stated that simulation-based classes are successful, but they are ineffective in their context. Basically, they have reasoned that the shortage of simulation equipment, the slow purchasing process, and large class size are dominantly affecting the implementation of simulation classes. This finding is in line with a report by [24, 25].They specifically reported that the prospective benefit of increased competence and safe practice of practitioners following exposure to simulation was specifically reported. There is an indication that the skills acquired during simulation exercises will be transferred to the clinical setting to the advantage of patient care. Although there was some ambivalence regarding the realism of the simulator and the case scenarios, overall the simulated learning was considered to be an authentic learning experience.

Furthermore, simulation classes will be effective if they are supported with the preparation of a session plan and syllabus. Accordingly, these materials have a direct impact on the effectiveness of simulation-based classes. Similar findings were compiled by [23, 25]. Which specifically disclosed that simulation-based nursing educational interventions were effective with particularly large effects in the psychomotor domain?

Finally, regarding the evaluation of students during simulation classes, the participants of this study have indicated that they evaluate students using a checklist at the middle and end of the session. Similarly, the report by [25].The study has figured out that for nurse educators, clinical simulation experiences offer an opportunity to assess and measure a student’s integration of multiple professional competencies. A thoughtful and informed evaluation plan is necessary to maximize the individual student learning experience and improve the effective application of simulation as a teaching and learning strategy. We investigated the usefulness of clinical simulation practice in the qualitative section. The majority of the participants indicated that their performance has been impacted by the lack of skill lab equipment, classrooms, and modules under the theme of infrastructure and educational resources. The efficiency of clinical simulation is greatly influenced by staff, student readiness, and human resources in general, and staff and student readiness in particular. The majority of respondents said there are not enough skilled laboratory assistants. The manager's support is generally decent, and we occasionally attend training. Most of the respondents said they utilize a checklist and assess pupils halfway through and at the end of the class. Since the activity is repeated by the students, the evaluation lasts the entire class period. A handful of them said they evaluated the pupils at the conclusion of the exercise.