Discussion and Conclusion Chapter Order Description My topic is The Impact of High-Fidelity Simulation on Anxiety Levels and Self-Efficacy of Undergraduate Nursing Students: Systematic review. for discussion chapter I am confused because I have 2 outcomes which are anxiety and self efficacy I am not sure if you need to make it as separated out come and discuss each outcome in separate or you need to make it together also you need to compare my results the 11 studies with other studies. the instruction for this chapter are : 1.4 introduction: need to write brief introduction for this chapter and which information included in this chapter. 2.4 compendium of the result you need to start with general information: simulation in nursing education has received a lots of attention in recent years. therefore, there are number of systematic review and meata analysis has been done. However, this is the first review until now that has measure the anxiety level and self efficacy level on undergraduate nursing students before and after the HFS. Although the study design RCT has better effect to investigate the effect of HFS, the studies non RCTs has large number of citation on this review the studies were found fro database and other search strategy were 713. Studies was excluded after read the abstract was 575. And because the abstract of some studies doses not provide information about the types off intervention therefor 60 studies was included by reading full text before excluded by abstract this review focus on the impact of HFS on students’ anxiety level and self efficacy skill on undergraduate nursing students because these outcomes has a greater impact on student ability to deliver high quality of care for patients which could effect on patient outcomes Here I am not sure should I separate the outcomes in different sub headings such as (2.4.1 anxiety and 2.4.2 self efficacy or need to make it together in the discussion please what is better for this section the need to included the following points: 1- Need to illustrate all studies that measure the anxiety as outcome and self efficacy studies give examples of these studies. Then, discus the result of each study and provide a critical comment on this result this id the most important point in this section. also need to mentions which studies has no statically differences. In mean score =for anxiety and provide examples of these studies form included studies in result chapter (…) and on self efficacy ( ) for example the lack of significant of findings related to anxiety level and self efficacy were not surprising result scenic students anxiety level and self efficacy measures only on one context either after class room learning or after simulation students anxiety level and self efficacy after any teaching would naturally anxiety be reduced and self efficacy increased if they perceived they met the learning objectives of the class. Mentions which studies indicate increase self efficacy (give example of these study) and decrease the level of anxiety (give example of these study). Provide critical comment for these result such as use HFS could reduce anxiety because the students have opportunity to make mistake and learn from them in safe environment and HFS build confidence in ability to perform specific task since they start over again if the experience requires. Mentions how the quality of evidence effect on the results by provide different result in mean score. Durations of simulation experiment and different evaluation tools used between the studied could effect on studies and give example if possible. Small sample size and non RCTs could effect on studies and give example if possible Different participant characrtisitc and give example if possible. Academic preparation or (orientation for students before enrolled in simulation intervention) could affect on students results on anxiety and self efficacy level and give example if possible. You need to mention if any study not directly measure the anxiety and self efficacy as primary outcome ( and give example od this study). context of simulation and control condition take place and give example if possible. For example, anxiety and self efficacy after HFS depend on context of simulation or nursing courses. students cloud has low self efficacy on psychomotor skills after simulation because simulation simulation commonly included cognitive, affective and psychomotor and behavioural domains of learning. All these factors that affect on the result you need to write about it but you need to focus on the 11 studies that included on result chapter and see what appropriate to these studies. 2- The second important points in this chapter comparison my result with other review I will provide you with theses studies form excluded studies because low quality evidence, different methodology, qualitative and if you have studies has an expert opinion need to compare it with my result. I will upload for you word file named References fro included studies in the discussion section this file includes 34 studies you need to compare it with my result and you need to provide a critical comet if these studies have the same result or have different results. For example, although excluded studies such as (…..) because low quality have similar result and provide comment , or have different result and write comment why has different result it could because its low quality evidence or has other causes from factors that illustrated above. I wrote for you some factors that could effect on results between studies please see which is more appropriate foe my work . Other important points in this chapter is 3- Implication of simulation in clinical nursing education. This review presents evidence to suggest that the use of HFS significantly improves learning outcomes related to anxiety level and. self efficacy skills level among undergraduate nursing students In addition, results indicate high student satisfaction with HFS experiences. This therefore illustrates that HFS, if integrated appropriately, can be used in academic settings as an active learning methodology. Without comporting patient safety, students can practice different clinical skills in certain clinical situations and develop some clinical skills. However, there is a lack of unequivocal evidence of the effectiveness of using HFS in the teaching of clinical reasoning skills to undergraduate nursing students. In addition to the challenges about the cost of this technology, not totally realistic and operating this technology it could be sophisticated because high advanced level (need reference for this information). therefore, nursing educators need to practice or training and experience to acquired knowledge and skills how to use and operate this technology an d use it as teaching strategy and develop realistic cases seniors included objectives of class. Then how to apply it in my home country KSA context and propose how its done ( aculatty we have a plane for producing the simulation lab in my work place but until now we do not have it yet. ) Please you need to write some information here to apply simulation in my home county context. Also how the result of this review help me to introduce the simulation as learning strategy in KSA context and change in nursing curriculum in future. 4-Last things is summary for this chapter and you need to relate it with he next chapter which is conclusion chapter . please read it carefully and if you have any questions pleas ask me. for this chapter I will upload for the instruction and the references for included studies in discussion section this file include 34 studies you need to included in discussion section the studies could have low quality , different methods, participant and you found some studies has confidence as outcomes if these studies mention the confidence in ability to perform specific skills you must included but if the study just assess the confidence in general you can excluded. 2- The second part is the chapter 5 conclusion chapter the instruction for this chapter are : 5.1 conclusion you need to write a conclusion for all chapters of this review include how nursing education has changes and challenges faced include aim and objectives of this review. The main findings or result of this review and how it is important to implication of HFS as teaching strategy. 5.2 Strengths and limitation of this review limitation could include the following points: inexpert of the reviewer included studies that has been previously published. For example, in tis review that possibly estimate the effect of HFS on anxiety and self efficacy that could adjust with included unpublished studies. in addition to studies in English language included and other language is excluded which could cause language bias methodological shortcoming small size of sample could make insufficient power to detect the effect on of HFS on the indicated outcomes Generalisation of the findings No formal measurement tools to evaluate HFS on anxiety and self efficacy Use different measuring tools which could cause problem of validity and there is inconsistent evidence for determining the best instrument to use and methodological quality of studies Time limitation to conduct this review Strengths: This review was based on different groups of undergraduate nursing students and different nursing courses Litrucher search for different databases and unrestricted by time Explicit inclusion criteria included broad range of undergraduate students, studied designs, methodological quality. 5.3 Recommendation for future research this review provides a guide for future priorities research. need to conduct high quality research such as RCTs with large sample size to determine the effect of HFS on student’s anxiety and self efficacy in addition to need to more research included different outcome of learning to illustrate the effect on HFS on 3 domains of learning (cognitive, affective, psychomotor skills). The only way to advance the science is use experimental methods to compare the effect of the effect of HFS versus other educational strategy. That means the influence of the HFS on self efficacy and anxiety come from experimental analysis. More research needs to be conducted to examine the trainability of the simulation experience into real clinical situations. Need to produce or development the reliable and valid tools outcomes that can directly measure self efficacy and anxiety. Recommend to implement well design and organised simulation scenarios into nursing curricula before clinical placement for students. The most important point is to include research that considered the cost effectiveness of using HFS technology to teach nursing students. 5.4 implication for advanced clinical practice Here you need to use the East Midlands Advanced Clinical Practice Framework, I will upload for you the files for this framework. You need to discuss and explain the 4 Pillars of advanced clinical practice role this include clinical, Education, Research and Management Leadership you need to provide picture for this pillars. then you need to related each pillar to my personally experience to my work. I am woking on nursing school to teach students clinical skills laboratory and to supervise and asses’ students in clinical settings such as hospitals and primary care centres. Also I am a member on Laboratory, Equipment and Management Committee, and Clinical Experience Training Committee. For example, need to do research on education to determine best available evidence about clinical skills and teaching strategies for practical education. Also how this pallier related to advance clinical practice in my home country and how it will effect on development of nursing education in my country which related to my work experience. For leadership management, how to be changed agent and I could be a leader for developing simulation laboratory in my country especially n my work place for future implication. 5.5 Reflection on learning process here you need brief introduction about what is the reflection on teaching and learning process ant its important of reflection (need to support this information with reference). You need to use Gibbs reflective cycle 1988 and provide picture fro this Moodle. You need to explain each step of this Moodle and provide the following information and put it in appropriate place in each step of Moodle. Because of socio-cultural factors affect the image of nursing profession in KSA, newly graduated nurses tend to be employed in roles that are highly respected by society, such as in clinical teaching. ( Aldawsari, Babenko-Mould and Andrusyszyn, 2016). Therefore, most novice clinical teachers have not benefitted from front-line nursing experience or formal preparation as educators therefore, the nursing school provide a chance for newly hired clinical teachers to go abroad to pursue graduate degree as I work in nursing school after graduation I got this chance for scholarship and I enrolled in MSc Advance nursing course to improve my personally experice and my role as educator professionally and academically. Deciding the dissertation topic and methodology was not easy process. According to my work experice I worked for 2 years as nursing educators (clinical teacher) for clinical laboratory skills and supervise students in hospital. I decide to chose the topic that related to my work such as introduce the new teaching strategies to improve clinical education for undergraduate students to become competent for future work and improve patient outcomes as well as meet the challenges of practical education settings. In addition, through search about clinical teaching strategies and attend the last lecture on advanced nursing module (TPN) about simulation used as teaching and learning strategy not for students but also for nursing staff. I saw the simulation labs and equipment provide by university of nottingham and because there are increased number of research on simulation as teaching strategy. I decide to do systematic review about advance technology of this approach which is HFS. As I have not experience in systematic review I found it difficult and challenges in terms of expeince and time to conduct this review although working on the others modules to complete this course. I learned form this experience identifying the evidence based practice and its significant in health care profession and education, understand the reaarch methods evaluate and critique the research, make sense of findings and indication of my personal and professional development. Moreover, the most important point I learned is to assess methodological quality for studied to decide its reliable and valid articles to included it. However, the decision was difficult to included studies. Although there is a inclusion criteria to included studies that measure the anxiety and self efficacy as indicated outcomes for this review, during reading the full text I found some studies that measure the ability to performed specific skills without mentions to measure self efficacy and some studied used self confidence, satisfaction inchargibly with self efficacy outcomes where as some studies deal with self confidence and satisfaction as separated or deferent outcomes. I was confusing to include theses studies or excluded. Through the time and more focus on eligibility criteria I take descions to excluded theses studied because my outcomes clearly indicate self efficacy and the included studied use tools to evaluate the self efficacy. And included these studies in discussion chapter to compare it with my result as a wide review. After conducting this review, the most important thighs I gained it from this process is improve my ability to undertake nursing research and assessing my educators’ colleagues to carrying out and utilizing of research especially, in my home country because there is little attention on nursing education and clinical educating in the KAS. Its anticipated that the finding of this review will influence the development and implication of simulation lab in my work place at Tabuk university In the KSA. Also, I feel has benefit me in terms of advanced my research skills and advanced mu clinical practice. Need to mention if repeat this process again which changed could happen. for the reflection part I wrote for you the most important point you must included it in this part also you must use the Gibbs reflection model and explain each steps, also some information in (recommendation and strength and limitation and reflection ) I take it from pervious example you need to write it in your own word to avoid plagiarism I will upload for you the instruction for this chapter and Advanced Clinical Practice framework for implication part of this chapter please pleas if you have any question just Ask and write it for master level.
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