Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence
Authors: MacKinnon Karen , Marcellus Lenora , Rivers Julie , Gordon Carol , Ryan Maureen , Butcher Diane 
Published: November 2017

EXECUTIVE SUMMARY

Background
Although maternal-child care is a pillar of primary health care, there is a global shortage of maternal-child health care providers. Nurse educators experience difficulties providing undergraduate students with maternal-child learning experiences for a number of reasons. Simulation has the potential to complement learning in clinical and classroom settings. Although systematic reviews of simulation are available, no systematic reviews of qualitative evidence related to maternal-child simulation-based learning (SBL) for undergraduate nursing students and/or educators have been located.

Objectives
The aim of this systematic review was to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate nursing students and nursing educators in educational settings to inform curriculum decision-making. The review questions are:i. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?ii. What are the experiences of educators delivering undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?iii. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators?

Inclusion criteria Types of participants
Pre-registration or pre-licensure or undergraduate nursing or health professional students and educators.

Phenomena of interest
Experiences of simulation in an educational setting with a focus relevant to maternal child nursing.

Types of studies
Qualitative research and educational evaluation using qualitative methods.

Context
North America, Europe, Australia and New Zealand.

Search strategy
A three-step search strategy identified published studies in the English language from 2000 until April 2016.

Methodological quality
Identified studies that met the inclusion criteria were retrieved and critically appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) by at least two independent reviewers. Overall the methodological quality of the included studies was low.

Data extraction
Qualitative findings were extracted by two independent reviewers using JBI-QARI data extraction tools.

Data synthesis
Findings were aggregated and categorized on the basis of similarity in meaning. Categories were subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings.

Results
Twenty-two articles from 19 studies were included in the review. A total of 112 findings were extracted from the included articles. Findings were grouped into 15 categories created on the basis of similarity of meaning. Meta-synthesis of these categories generated three synthesized findings.

Synthesized finding 1 Students experienced simulated learning experiences (SLE) as preparation that enhanced their confidence in practice. When simulation was being used for evaluation purposes many students experienced anxiety about the SLE.

Synthesized finding 2 Pedagogical practices thought to be appropriate and meaningful included: realistic, relevant and engaging scenarios, a safe non-threatening learning environment, supportive guidance throughout the process, and integration with curriculum.

Synthesized finding 3 Barriers and enablers to incorporating SLEs into maternal child education were identified including adequate resources, technological support and faculty development. Students and educators recognized that some things, such as relationship building, could not be simulated.

Conclusions
Students felt that simulation prepared them for practice through building their self-confidence related to frequently and infrequently seen maternal-child scenarios. Specific pedagogical elements support the meaningfulness of the simulation for student learning. The presence or absence of resources impacts the capacity of educators to integrate simulation activities throughout curricula.