Guest Poster

    With the sudden changes brought about by the COVID-19 pandemic, there was an unexpected disruption to nursing student clinical experiences. Instead of caring for patients in the clinical setting or in a simulation lab, students are providing care in screen-based simulation environments.

    The Clinical Learning Environment Comparison Survey (CLECS) was developed in 2007 to help understand how face-to-face simulation compares to clinical experiences. The original CLECS was used in the landmark National Council of State Boards of Nursing (NCSBN) simulation study. Now the research team, with co-principle investigators Kim Leighton, PhD, RN, CHSE, CHOSOS, ANEF, FAAN, and Colette Foisy-Doll, MSN, BScN, RN, CHSE have updated the CLECS to reflect screen-based simulation, and renamed it CLECS 2.0. The research team includes Dr. Suzie Kardong-Edgren, PhD, RN, ANEF, CHSE, FSSH, FAAN and Dr. Tonya Schneidereith, PhD, CRNP, PPCNP-BC, CPNP-AC, CNE, CHSE-A.

    Pocket Nurse reached out to Dr. Leighton with a few questions about the study. A link to the study is at the bottom of this article. The link will be open through June 30, 2020.

    PN: Why do you think this addition of screen-based simulation to the Clinical Learning Environment Comparison Survey (CLECS) was important at this time?

    KL: The original CLECS evaluated how well learning needs were met in traditional clinical environments versus in the simulation environment. At the time it was developed (2007), manikin-based simulation was fairly new. The discussion “can simulation replace clinical?” was just being initiated. Due to the decision to close schools, students lost their hands-on clinical experiences and their face-to-face simulation experiences, which led to the need to quickly create another type of experience.

    I realized that as a result of COVID-19, educators had to quickly determine how to continue experiential learning with students who could no longer go to traditional clinical and face-to-face simulation activities. As a result, many simulationists creatively figured out how to move simulation online. This looked different than simulation activities that have been provided online or in virtual reality previously. In the past, presumably a planning process that involved budgetary consideration and a degree of training were involved in using various products to enable virtual simulation.

    This time, simulationists were forced to quickly, and often without training, move simulation to the screen-based environment without training in how to teach or manage online education. We know it is not the same as teaching in the sim lab environment, but we don’t know how it is different. I felt it was important to learn how well the students perceived their learning needs were met in screen-based simulation and compare the three environments. The results will help educators to know more specifically where to focus future efforts in screen-based simulation.

    PN: Do you have any hypothesis about how COVID-19 will impact simulation learning for nursing students?

    Unfortunately, COVID-19 has removed the hands-on experiential face-to-face learning opportunities that we believe to be so valuable in healthcare education. However, many educators have become quite creative in how they facilitate learning online. I believe the impact will be the result of many factors, most notably the simulationists’ skill at teaching online, as it is very different than in a classroom or lab.

    Other variables include the students’ ability to learn online, such as their internal and external motivators, their living situation, and their own stress levels related to learning online but also stress about the world around them.

    My general hypothesis is that we will not initially see stellar results, in general. We shouldn’t expect perfection and shouldn’t expect that all the learning needs have been met. What we can do though, is use the results to guide us moving forward as screen-based simulation evolves.

    PN: In the call for participants, you explain you are using “snowball sampling strategy.” Can you explain what that means?

    Snowball sampling is a technique used when research participants might be hard to find in order to recruit. In this case, the students are no longer at their schools; they are learning from home. In snowball sampling, we rely on the “word traveling.” As people learn about the study, they share this with others.

    We hope that educators and clinicians will share with students, and that students will share with their friends. This allows us to recruit outside of the restrictions of a multi-site study and to reach a broader, more generalized sample that may be more representative of nursing students as a whole.

    We have all seen the effects of social media and what happens when a post “goes viral.” It can be seen by millions of people around the world in a very short time. We don’t expect to go viral but we do hope to reach many people!

    PN: This study focuses on nursing students. Do you think some of the results can be extrapolated to other healthcare professional such as paramedics or physical therapists?

    I do. The CLECS is designed on the basis of a typical clinical experience day for nursing students; however, there is overlap with other healthcare professions. For example, there are items such as ‘Preparing to care for patient,’ ‘Understanding rationale for patient’s treatment plan,’ ‘Identifying patient’s problems,’ that cross disciplines. Of the 29 items on the CLECS 2.0, I believe all but perhaps one define the learning needs of all healthcare students.

    This research study was approved by the Research Ethics Board of MacEwan University, where Mrs. Foisy-Doll is employed as Director of the Clinical Simulation Centre.

    For more information, please see Dr. Leighton’s LinkedIn page; or learn more about the study here.

    Dr. Kim Leighton is Executive Director of ITQAN Clinical Simulation and Innovation Center at Hamad Medical Corporation in Doha, Qatar. The Sim Center serves a multidisciplinary practitioner community and aims to expand services to the region and beyond. Dr. Leighton has spent the past 17 years facilitating learning with manikin-based simulation in undergraduate and graduate nursing, medicine, and allied health programs as well as for practicing clinicians in the public and private sectors. While president of the International Nursing Association for Clinical Simulation and Learning (INACSL), she led development of Standards of Best Practice: SimulationSM, endorsed by 20 interprofessional organizations, now in its third edition.

    Dr. Leighton’s research focuses on development and psychometric analysis of evaluation tools for simulation education, which have been disseminated through her website to simulation educators in 54 countries. Dr Leighton is co-editor of the award-winning book Simulation Champions: Fostering Courage, Caring, and Connection and assistant editor for Clinical Simulation in Nursing.