Kaminski-Ozturk Nicole, Martin Brendan
A Research Scientist, Research Department, National Council of State Boards of Nursing, Chicago, Illinois.
The Director, Research Department, National Council of State Boards of Nursing.
J Nurs Regul. 2023 Apr;14(1):21-29. doi: 10.1016/S2155-8256(23)00065-0. Epub 2023 Apr 5.
In the early stages of the COVID-19 pandemic, as clinical site restrictions were implemented, education programs leading to licensed practical nurse/licensed vocational nurse (LPN/LVN) degrees increasingly relied on virtual simulation-based experiences to provide clinical training to their students. However, scant evidence exists regarding the extent of this change and the various modalities employed by LPN/LVN programs across the United States.
We sought to identify the degree to which virtual clinical simulation was adopted by LPN/LVN education programs during the early stages of the COVID-19 pandemic to address clinical site restrictions. In addition, we hoped to identify the practices and activities that educators included under the broad umbrella definition of virtual clinical simulation.
All active U.S. prelicensure LPN/LVN nursing education programs were contacted in September 2020. Program leaders were asked to estimate the proportion of clinical hours completed in virtual clinical simulation before the pandemic and the proportion anticipated for the fall 2020 term. Descriptive statistics were generated, with repeated measures analysis of covariance applied to evaluate the average change in virtual simulation within programs stratified by reported clinical restrictions.
Representatives from 265 LPN/LVN programs in 44 U.S. jurisdictions responded to the survey. Responding programs significantly increased the proportion of clinical hours completed in virtual clinical simulation between fall 2019 ( = 10.7, = 15.3) and fall 2020 ( = 35.3, = 27.6, < .001). Furthermore, there was an interaction between clinical site restrictions and term, with a more pronounced uptick in virtual simulation usage among programs that indicated they found identifying clinical sites "very difficult" ( = 41.1, = 28.9) relative to those who found it "somewhat more difficult" ( = 23.9, = 18.8, < .001). Programs adopted a range of modalities, including simply watching videos and participating in virtual or augmented reality, online software packages, or other forms of screen-based learning.
As the adoption of virtual simulation increases, clear definitions of what constitutes clinical virtual simulation must be established. Additionally, rigorous inquiry to support evidence-based regulatory guidelines is needed.
在新冠疫情早期，由于实施了临床场所限制措施，培养执业护士/职业护士（LPN/LVN）的教育项目越来越依赖基于虚拟模拟的体验，为学生提供临床培训。然而，关于这一变化的程度以及美国各地LPN/LVN项目所采用的各种模式，现有证据很少。
我们试图确定在新冠疫情早期，LPN/LVN教育项目采用虚拟临床模拟以应对临床场所限制的程度。此外，我们希望确定教育工作者在虚拟临床模拟这一宽泛定义下所包含的实践和活动。
2020年9月联系了美国所有活跃的LPN/LVN预执照护理教育项目。项目负责人被要求估计疫情前在虚拟临床模拟中完成的临床学时比例以及2020年秋季学期预期的比例。生成描述性统计数据，并应用重复测量协方差分析来评估按报告的临床限制分层的项目中虚拟模拟的平均变化。
来自美国44个司法管辖区的265个LPN/LVN项目的代表回复了调查。回复的项目在2019年秋季（平均值 = 10.7，标准差 = 15.3）至2020年秋季（平均值 = 35.3，标准差 = 27.6，P <.001）期间，显著增加了在虚拟临床模拟中完成的临床学时比例。此外，临床场所限制和学期之间存在交互作用，表明发现确定临床场所“非常困难”的项目（平均值 = 41.1，标准差 = 28.9）相对于那些发现“有点困难”的项目（平均值 = 23.9，标准差 = 18.8，P <.001），虚拟模拟使用量的上升更为明显。项目采用了一系列模式，包括单纯观看视频以及参与虚拟或增强现实、在线软件包或其他形式的基于屏幕的学习。
随着虚拟模拟的采用增加，必须明确界定什么构成临床虚拟模拟。此外，需要进行严格的调查以支持基于证据的监管指南。
