Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy.
Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy.
Nurse Educ Today. 2024 Aug;139:106231. doi: 10.1016/j.nedt.2024.106231. Epub 2024 Apr 30.
This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students.
Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results.
Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies.
The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias.
Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported.
The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.
本伞式综述旨在整合高保真模拟对本科护理学生知识和技能的影响的证据基础。
对汇总效应大小进行伞式综述，并对纳入的系统评价中的原始研究进行额外的元分析，排除重叠结果。
截至 2023 年 8 月，在 PubMed、Embase 和 Cochrane Library 中进行了系统检索。我们纳入了比较高保真模拟与其他学习策略的综述。
对纳入的系统评价（ROBIS 工具）和原始研究（ROB 2 或 ROBINS-I 视情况而定）进行偏倚风险评估。对高保真模拟对知识和技能的影响进行汇总效应的随机效应元分析。对原始研究进行进一步的随机效应元分析，并排除重叠研究（12%）。进行亚组分析，以更全面地分析结果。进行修剪和填充分析以调整潜在的发表偏倚。
纳入了 6 项系统评价，涵盖了 133 项原始研究（知识方面涉及 2767 名参与者，技能方面涉及 3231 名参与者）。知识（SMD=0.877，95%CI：0.182 至 1.572）和技能（SMD=0.738，95%CI：0.466 至 1.010）的调整后的汇总效应与从知识（SMD=0.980）和技能（SMD=0.540）的原始研究中进行元分析得到的效应大小非常吻合，两者都显示出高度的统计异质性。传统讲座是更常见的比较。亚组分析显示，在地理位置、主题、控制类型和干预措施报告方式等方面，效应大小存在显著差异。
结果提供了强有力的证据，支持将高保真模拟纳入本科护理课程，以提高学生的知识和技能。高异质性可能归因于研究背景或方法的差异。未来的研究应探索在不同的教育和文化背景下高保真模拟的最佳应用。
