Simülasyona Dayalı Öğrenmenin Felsefesi ve Kuramsal Altyapısı
Özet
Simülasyona dayalı öğrenme (SDÖ), hemşirelik eğitiminde yeterliliğe dayalı ve aktif öğrenmeyi destekleyen, öğrencilerin bilgi, beceri ve tutumlarını hasta güvenliğini tehlikeye atmadan geliştirmelerine olanak tanıyan önemli bir stratejidir. SDÖ süreci ön bilgilendirme, klinik senaryonun uygulanması ve sürecin temel taşı olan çözümleme oturumlarından oluşur. Öğrenme ve bellek ilişkisi bağlamında, deneyime dayalı bu simülasyonlar bilgilerin örtük ve açık bellekte kalıcı şemalar oluşturmasına yardımcı olmaktadır. Eğitim felsefesi açısından realizm kökenlerine dayanan realist değerlendirme modeli; simülasyonun kimin için, hangi koşullarda ve neden işe yaradığını analiz eder. SDÖ tasarımları; davranışçı teoriler, bilişsel yük teorisi, Jeffries simülasyon çerçevesi, Kolb'un deneyimsel öğrenme teorisi, Bandura'nın sosyal öğrenme teorisi, Tanner klinik yargı modeli ve yapılandırmacılık gibi çeşitli kuramsal temellere dayandırılmaktadır. Bu teoriler, öğrencilerin öz yeterliklerini, yansıtıcı düşünme becerilerini ve klinik karar mekanizmalarını güçlendirerek teori ile klinik uygulama arasındaki boşluğu kapatmayı ve nihai olarak hasta bakım kalitesini artırmayı amaçlar.
Simulation-based learning (SBL) is a crucial strategy in nursing education that supports competency-based and active learning, allowing students to develop their knowledge, skills, and attitudes without compromising patient safety. The SBL process consists of pre-briefing, clinical scenario execution, and the debriefing session, which is considered the cornerstone of the experience. In the context of the learning-memory relationship, experiential simulations help form permanent schemas in implicit and explicit memory. From an educational philosophy perspective rooted in realism, realist evaluation analyzes for whom, under what conditions, and why simulation works. SBL designs are grounded in various theoretical foundations in nursing literature, including behaviorist theories, cognitive load theory, Jeffries' simulation framework, Kolb's experiential learning theory, Bandura's social learning theory, the Tanner clinical judgment model, and constructivism. These theories aim to bridge the gap between theory and clinical practice by strengthening students' self-efficacy, reflective thinking, and clinical judgment, ultimately enhancing the quality of patient care.
Referanslar
Ege Üniversitesi Hemşirelik Fakültesi. Hemşirelikte Rol, Yetkinlik ve Yeterlik Belirleme Çalıştayı İzmir: Ege Üniversite Hemşirelik Fakültesi 2022 (01.07.2022 tarihinde https://egeduyuru.ege.edu.tr/dosyalar/20220225-hems-program.pdf. Adresinden ulaşılmıştır)
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. 2010;376(9756):1923-58. doi:10.1016/S0140-6736(10)61854-5
Holmboe ES, Sherbino J, Long DM, et al. The role o f assessment in competency-based medical education. Med Teach. 2010;32:676-82. doi:10.3109/0142159X.2010.500704
Lavoie P, Michaud C, Belisle M, et al. Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review. Journal of Advanced Nursing. 2018;74(2):239-50. doi:10.1111/jan.13416
Abelsson A. Learning through simulation. Disaster and Emergency Medicine Journal. 2017;2(3):125-8. doi:10.5603/DEMJ.2017.0027
O'Shea M-C, Palermo C, Rogers G, et al. It Is Time to Link theory to practice in simulation-based learning: lessons from learning theories. Journal of the Academy of Nutrition and Dietetics. 2022;122(3):508-18. doi:10.1016/j.jand.2021.06.011
Jeffries P. Simulation in nursing education: from conceptualization to evaluation. Second Edition ed: Lippincott Williams & Wilkins; 2012.
Barry Issenberg S, Mcgaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher. 2005;27(1):10-28. doi:10.1080/01421590500046924
Oh P-J, Jeon KD, Koh MS. The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis. Nurse Education Today. 2015;35(5):e6-e15. doi: 10.1016/j.nedt.2015.01.019
Kaldheim HKA, Bergland Å, Ølnes MA, et al. Use of simulation-based learning among perioperative nurses and students: A scoping review. Nurse Education Today. 2019;73:31-7. doi: 10.1016/j.nedt.2018.09.013
Sarfati L, Ranchon F, Vantard N, et al. Human‐simulation‐based learning to prevent medication error: A systematic review. Journal of Evaluation in Clinical Practice. 2019;25(1):11-20. doi: 10.1111/jep.12883
La Cerra C, Dante A, Caponnetto V, et al. Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis. BMJ Open. 2019;9(2):e025306. doi:10.1136/bmjopen-2018-025306
Fey MK, Gloe D, Mariani B. Assessing the quality of simulation-based research articles: A rating rubric. Clinical Simulation in Nursing. 2015;11(12):496-504. doi:10.1016/j.ecns.2015.10.005
Dönmez A. Psikiyatri hemşireliği eğitiminde öğretim yöntemleri. Türkiye Klinikleri. 2021;1:9-12
Siegel DJ. Memory: An overview, with emphasis on developmental, interpersonal, and neurobiological aspects. Journal of the American Academy of Child & Adolescent Psychiatry. 2001;40(9):997-1011. doi:10.1097/00004583-200109000-00008
Siegel DJ. Pocket guide to interpersonal neurobiology: An integrative handbook of the mind (norton series on interpersonal neurobiology). First Edition ed. New York, United States: WW Norton & Company; 2012.
Siegel DJ. Toward an interpersonal neurobiology of the developing mind: Attachment relationships,“mindsight,” and neural integration. Infant Mental Health Journal. 2001;22(1‐2):67-94. doi:10.1002/1097-0355(200101/04)22:1<67::AID-IMHJ3>3.0.CO;2-G
Siegel DJ. The developing mind: How relationships and the brain interact to shape who we are. Second Edition ed. Grand Haven, United States: Guilford PublicationsBrilliance Corporation; 2020.
Birhan, S. Eğitim Felsefesi. Birinci Baskı ed. Ankara Ankara Üniversitesi Eğitim Bilimleri Yayınları; 1991.
Parker BC, Myrick F. A critical examination of high-fidelity human patient simulation within the context of nursing pedagogy. Nurse Education Today. 2009;29(3):322-9. doi: 10.1016/j.nedt.2008.10.012
Department of Health. Safer medical practice: machines, manikins and polo mints. 2008 (01.07.2022 tarihinde 2008.http://webarchive.nationalarchives.gov.uk/20130105045455/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_096227.pdf. adresinden ulaşılmıştır)
Graham AC, McAleer S. An overview of realist evaluation for simulation-based education. Advances in Simulation. 2018;3(1):1-8. doi:10.1186/s41077-018-0073-6
Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. Jama. 2011;306(9):978-88. doi: 10.1001/jama.2011.1234
Okuda Y, Bryson EO, DeMaria Jr S, et al. The utility of simulation in medical education: what is the evidence? Mount Sinai Journal of Medicine. 2009;76(4):330-43. doi:10.1002/msj.20127.
Sevdalis N. Simulation and learning in healthcare: moving the field forward. BMJ Simulation & Technology Enhanced Learning. 2015;1(1):1. doi: 10.1136/bmjstel-2014-000003
Nestel D. Open access publishing in health and social care simulation research - advances in simulation. Advance in Simulation. 2016;1:2. doi: 10.1186/s41077-015-0002-x
Wong G, Greenhalgh T, Westhorp G, et al. Realist methods in medical education research: what are they and what can they contribute? Medical Education. 2012;46(1):89-96. doi:10.1111/j.1365-2923.2011.04045.x
Ogrinc G, Batalden P. Realist evaluation as a framework for the assessment of teaching about the improvement of care. Journal of Nursing Education. 2009;48(12):661-7. doi: 10.3928/01484834-20091113-08
Riesenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. American Journal of Medical Quality. 2019;34(5):446-54. doi:10.1177/1062860619873200
Zigmont JJ, Kappus LJ, Sudikoff SN, editors. Theoretical foundations of learning through simulation. Seminars in perinatology; 2011: Elsevier.
Bingölbali E, Arslan S, Zembat İÖ. Bloom taksonomisi. In: Bingölbali E, Arslan, S., Zembat, İ.Ö., (ed). Matematik Eğitiminde Teoriler. Birinci Baskı. Ankara: Pegem Akademi; 2016. p. 839-60.
Abdulghani HM, Shaik SA, Khamis E.A. Research methodology workshops evaluation using the Kirkpatrick’s model: translating theory into practice. Medical Teacher. 2014;36(1):S24-S9. doi: 10.3109/0142159X.2014.886012
Johnston S, Coyer FM, Nash R. Kirkpatrick's evaluation of simulation and debriefing in health care education: a systematic review. Journal of Nursing Education. 2018;57(7):393-8. doi:10.3928/01484834-20180618-03
Marchal B, Van Belle S, Van Olmen J, et al. Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research. Evaluation. 2012;18(2):192-212. doi:10.1177/1356389012442444
Eckert E, Bell A. Invisible force: Farmers' mental models and how they influence learning and actions. Journal of Extension. 2005;3(4).
Sheckley B, Kehrhahn M, Bell S, et al. (eds.). Trio: an emerging model of adult professional learning. Proceedings of the 49th Annual Adult Education Research Conference; 2008: University of Missouri, St. Louis.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 2000;55(1):68. doi: 10.1037//0003-066x.55.1.68
Rigby RR, Mitchell LJ, Hamilton K, et al. The use of behavior change theories in dietetics practice in primary health care: a systematic review of randomized controlled trials. Journal of the Academy of Nutrition and Dietetics. 2020;120(7):1172-97. doi: 10.1016/j.jand.2020.03.019
Ross S. Simulation-based learning: from learning theory to pedagogical application. Internet Journal of Allied Health Sciences and Practice. 2021;19(4):15. doi:10.46743/1540-580X/2021.2056
Nestel D, Kelly M, Jolly B, Watson M. Healthcare simulation education: evidence, theory and practice: John Wiley & Sons; 2017.
International Nursing Association of Clinical and Simulation Learning (INACSL). INACSL standards of best practice: aimulation(SM) simulation design. Clinical Simulation Nursing. 2016;12:5-12.
Ertmer PA, Newby TJ. Behaviorism, cognitivism, constructivism: comparing critical features from an instructional design perspective. Performance Improvement Quarterly. 2013;26(2):43-71. doi:10.1002/piq.21143
McGaghie WC, Harris IB. Learning theory foundations of simulation-based mastery learning. Simulation in Healthcare. 2018;13(3S):S15-S20. doi:10.1097/SIH.0000000000000279
Rutherford-Hemming T. Simulation methodology in nursing education and adult learning theory. Adult Learning. 2012;23(3):129-37. doi:10.1177/1045159512452848
Iskander M. Simulation training in medical education—an exploration through different theoretical lenses. Medical Science Educator. 2019;29(2):593-7. doi:10.1007/s40670-019-00696-3
Türkoğlu S, Çetin FH, Tanır Y, ve ark. Çalışma belleği ve nörogelişimsel hastalıklar. Çocuk ve Gençlik Ruh Sağlığı Dergisi. 2019;26(2):52-62.
Van Merriënboer JJ, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Medical Education. 2010;44(1):85-93. doi:10.1111/j.1365-2923.2009.03498.x
Chow M, Conway AR. The scope and control of attention: Sources of variance in working memory capacity. Memory & Cognition. 2015;43(3):325-39. doi:10.3758/s13421-014-0496-9
Jeffries PR, Rizzolo MA. Designing and implementing models for the innovative use of simulation to teach nursing care of ill adults and children: a national, multi-site, multi-method study. New York: National League for Nursing; 2006.
O'Donnell JM, Decker S, Howard V, et al. NLN/Jeffries simulation framework state of the science project: Simulation learning outcomes. Clinical Simulation in Nursing. 2014;10(7):373-82. doi:10.1016/j.ecns.2014.06.004
Feeler A. A Systematic review of the effectiveness of the nln jeffries simulation framework. Walden Dissertations and Doctoral Studies. 2019.
Al Khasawneh E, Arulappan J, Natarajan JR, et al. Efficacy of simulation using NLN/Jeffries Nursing Education Simulation Framework on satisfaction and self-confidence of undergraduate nursing students in a Middle-Eastern country. SAGE Open Nursing. 2021;7:23779608211011316. doi:10.1177/23779608211011316
Poore JA, Cullen DL, Schaar GL. Simulation-based interprofessional education guided by Kolb's experiential learning theory. Clinical Simulation in Nursing. 2014;10(5):e241-e7. doi:10.1016/j.ecns.2014.01.004
Zenios M. Educational theory in technology enhanced learning revisited: A model for simulation-based learning in higher education. British Journal of Educational Studies. 2020.
Franklin AE, Lee CS. Effectiveness of simulation for improvement in self-efficacy among novice nurses: a meta-analysis. Journal of Nursing Education. 2014;53(11):607-14. doi: 10.3928/01484834-20141023-03
Cant RP, Cooper SJ. Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today. 2017;49:63-71. doi: 10.1016/j.nedt.2016.11.015
Kardong-Edgren S. Bandura's self-efficacy theory… something is missing. Clinical Simulation in Nursing. 2013;9(9):e327-e8. doi:10.1016/j.ecns.2013.07.001
Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. Journal of Nursing Education. 2006;45(6):204-11. doi:10.3928/01484834-20060601-04
Lasater K. Clinical judgment development: using simulation to create an assessment rubric. Journal of Nursing Education. 2007;46(11):496-503. doi:10.3928/01484834-20071101-04
Akalın A, Şahin S. Simülasyona dayalı hemşirelik eğitiminde kuramlar. Sağlık Bilimleri ve Meslekleri Dergisi. 2019;6(1):136-43. doi:10.17681/hsp.409068
