Knowledge Acquisition Through Simulation in Nursing Education: A Meta-Analysis

Abstract

Nursing education is the process whereby students are guided, assisted and provided with means which enable them to learn the professional knowledge so that they can apply it to nursing care of people. Simulation is a learning method to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The use of simulation as an educational tool is becoming increasingly prevalent in nursing education. Objective: The objective of systematic review was to provide available evidence on the effect of high-fidelity simulation on knowledge acquisition. Method: The computerized searches from 2000-2010 in CINAHL, Medline, Chinese Academic Journal (CAJ) etc were performed. Primary empirical studies determining the effect of high-fidelity simulation on knowledge acquisition in nursing education were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Results: Only eleven studies were retrieved. They included three randomized controlled trials (RCTs) with a Jadad quality score of 3, five RCTS with a Jadad quality score of 2, one nonrandomized controlled trial with a convenience sample, and a quasi-experimental study with one group pretest-posttest design. The result of meta-analysis indicated that high-fidelity simulation increased the standardized mean score of knowledge exams by 0.69 point (95% CI for Standardized Mean Difference with random effect model 0.29 ~ 1.09, P=0.0007). Conclusion: The high-fidelity simulation did enhance the scores on knowledge exams, but the majority of reviewed RCTs were of low methodological quality. There was lack of formal measurement tools available to evaluate simulations. Clearly, it is necessary to develop measurement tools particularly for high-fidelity simulation, and conduct additional high quality RCTs with larger sample sizes to determine the effect of high-fidelity simulation on knowledge acquisition among different student groups.