Abstract
Aim
The aim of the study was to describe the knowledge and practice of simulation among health tutors with a view to promoting the use of simulation in health training institutions in the Northern and Upper East Regions of Ghana.
Design
The study was quantitative research that utilized a descriptive cross‐sectional survey to describe the knowledge and practice of simulation in teaching.
Methods
A structured questionnaire was used to collect data from 138 health tutors who were enumerated through the census for the study. The return rate was 87%, representing 120 health tutors who finally completed the study. The data were presented by means of descriptive statistics.
Results
The findings of the study revealed that few participants had adequate knowledge of simulation. The study also found that a slight majority of the participants practiced simulation in teaching. The study further found that there was a positive correlation between health tutors' knowledge and the practice of simulation. Indicating that an increase in the health tutors' knowledge of simulation is associated with an increase in their practice of simulation.
Keywords: knowledge of simulation, nursing education, practice of simulation, quantitative description
1. INTRODUCTION
A proficient nurse or midwife is critical to the health and well‐being of the population. To be a proficient nurse or midwife requires the mastery of skills, knowledge and attitude for professional practice during training (Sanchez‐Garcia et al., 2019). The teaching strategies utilized by health tutors play a key role in fostering the acquisition and mastery of these skills by student nurses and midwives. Additionally, changes in the training of nurses and midwives coupled with changes in the health system necessitate the use of active teaching strategies to enhance experiential learning (Billings & Halstead, 2015). The role of simulation as an evidence‐based teaching strategy used to equip students with the requisite competencies required for practice is well documented. However, it appears the use of simulation is limited to a very few tutors, who sometimes struggle to use this strategy in teaching. The purpose of this study was therefore to describe the knowledge and practice of simulation in health training institutions in the Northern and Upper East Regions.
2. BACKGROUND
With the complex, fast‐paced health care environment and the demands of high‐quality health care among the nursing and midwifery workforce, nurse educators are responsible for preparing nursing graduates to provide safe and competent quality care (Jeffries, 2021). As such, the acquisition of practical skills forms a greater part of the training of nurses and midwives, so that the expected ‘readiness’ for work among graduates will not be lacking after training. To develop competent nurses, educators are responsible for preparing nursing students for complex clinical practice environments and developing student‐centred active learning methods (Karacay & Kaya, 2020). Nursing and midwifery students are normally taught practical skills in the skills laboratory following exposure to theoretical concepts of patient care in the classroom. However, the ability of students to practice the desired skills is dependent, to some extent, on the teaching strategies employed by the health tutor. Several teaching methodologies are employed by health tutors in teaching practical skills in health training institutions.
Most tutors employ traditional methods of teaching such as lectures, presentations, and demonstrations to teach students practical skills (Eraut, 2012). Nevertheless, the use of such methods has its shortcomings, as they do not provide the opportunity for the majority of the students to have adequate hands‐on experience and to be actively involved in the teaching and learning process. Hence, tutors need to utilize teaching and learning strategies that offer experiential learning with the opportunity for feedback while ensuring patient safety when teaching practical skills. In line with this, the World Health Organization (2013) has strongly recommended the use of simulation by health educators in order to modify and increase health professional education and training to meet contemporary health care needs. The Nursing and Midwifery Council (N&MC) also requires health tutors to use learner‐centred teaching strategies such as simulation to help students integrate theory, practical lessons and clinical experience so as to produce competent nurses who are capable of thinking critically and also able to make good clinical judgement during patient care (N&MC, 2020).
In health training institutions (students) and among healthcare practitioners (nurses and midwives) in the developed world, learner‐centred methods such as simulation have been shown to promote the acquisition of key skills (Ayed & Khalaf, 2018), improve competencies, and better assist in the development of patient assessment and management skills. In resource‐limited regions, Ayed and Khalaf (2018) and Alamrani et al. (2018) also catalogue the benefits of simulation, and key among is the ability of simulation to rapidly prepare nursing and midwifery students for practice and also facilitate career development opportunities. In Ghana, a study on simulation in health training institutions was conducted by Okantey (2017) at the Cape Coast Nursing and Midwifery Training College. Her study focused on students' satisfaction and self‐confidence with simulation, and it was found that students were satisfied with simulation. Muniru (2016) also undertook a study on simulation in medical education at the University of Ghana Medical School. She also focused on medical students' experiences of teaching and learning practical skills in the simulation centre. It was established in her studies that students had positive learning experiences using simulation to learn practical skills. Literature has supported simulation as a major tool in clinical education regarding positive outcomes for students and learning (Roberts et al., 2019).
Simulation as a strategy is guided by standards and calls for the need to assess the tooling of health institutions, skillset, and attitudes of tutors with regards to the use of stimulation in teaching. Utilizing simulation technology is ground‐breaking and challenging and forces professors to analyse teaching methodologies in order to modify them accordingly (Beroz et al., 2020). For instance, the International Nurses' Association of clinical simulation learning (INACSL) espouse that the needed infrastructure, tutor knowledge (on design, implementation and evaluation to ensure a successful session) and willingness to utilize simulations appear to be primary to its integration in teaching methods (Hernandez‐Acevedo, 2021; INACSL Standards Committee, 2016). Unlike a lecture, simulation is technical and requires the health tutor to have adequate knowledge on how to effectively deliver the session (Jeffries, 2021).
The knowledge of health tutors about utilizing simulation to achieve successful learning outcomes for students in practical skills appears to be underexplored. Nurse educators teaching diploma nursing programmes reported a lack of knowledge in managing technological issues, simulation facilitation procedures, and conducting scenarios (Akhter et al., 2021). Most empirical studies on simulation in nursing and midwifery education have focused on high fidelity simulation (Mak, 2019), with other studies focusing on students' experiences (Muniru, 2016; Tosterud et al., 2014), satisfaction in using simulation (Okantey, 2017) and student nurses' and midwives' perceptions of simulation (Chukwu, 2017).
Most of the studies neglected the health tutors' knowledge and use of simulation, whether low, medium, or high fidelity, as a teaching strategy. This is because if the health tutor is well‐grounded in the use of simulation in teaching, the ripple effect will be increased student satisfaction and enhanced learning. Additionally, a number of the quantitative studies also utilized a relatively small sample size (Sanli et al., 2022; Teni & Gebretensaye, 2019) with the exception of Dudding and Nottignham (2018), Nye et al. (2018) and this might have a bearing on generalizability. Lastly, most of these studies also employed a purposive sampling technique, which exposes the study to research biases and also limits the use of certain statistical analyses. This study, therefore, sought to assess the level of knowledge and practice of simulation among health tutors in teaching practical skills in health training institutions in the Northern and Upper East Regions of Ghana.
3. METHODS
3.1. Study design
A descriptive cross‐sectional survey design was used in this study. The design was chosen because data on the use of simulation in teaching was collected at one point in time during the data collection period. The design was also preferred because it helped describe the level of knowledge of simulation tutors and the practice of simulation in health training institutions. The following hypotheses were proposed to be tested by the study:
H 0: There is no statistically significant relationship between tutors' knowledge of simulation and their practice of simulation in teaching.
H 1: There is a statistically significant relationship between tutors' knowledge of simulation and their practice of simulation in teaching.
3.2. Study setting
The study was conducted in nine health training institutions in the selected regions of Ghana, and they included the Bawku Nursing and Midwifery Training College, Bolgatanga Midwifery Training College, Bolgatanga Nursing Training College, Navrongo Community Health Nursing Training College, Zuarungu Nursing and Midwifery Training College, Tamale Nursing and Midwifery Training College, Tamale Community Health Nursing Training College, Yendi College of Health and Gushegu Midwifery Training College. These health training institutions run diploma and certificate programmes in nursing and midwifery.
3.3. Population, sampling technique and sample size
The population for this study was health tutors who teach courses in the Registered Midwifery (RM), Registered Community Health Nursing (RCN), and Registered General Nursing (RGN) programmes in Health Training Institutions (HTIs) in the Northern and Upper East Regions. The population for the study was 138 health tutors enumerated through the census. All tutors who teach nursing and midwifery courses were selected because of the low number of tutors in the selected HTI who teach more than one course in a semester (Alhassan et al., 2017). Hence, these tutors would most likely teach a course with a practical component in a semester. However, 120 participants completed the study. The distribution of HTIs and the population used for the study are presented in Table 1.
TABLE 1.
Distribution of tutors used for the study.
| Name of HTI | Population of tutors |
|---|---|
| Bolgatanga NTC | 13 |
| Bolgatanga MTC | 10 |
| Bawku NMTC | 16 |
| Zuarungu NMTC | 18 |
| Navrongo CHNTC | 12 |
| Tamale NMTC | 25 |
| Tamale CHNTC | 12 |
| Yendi CoH | 12 |
| Gushegu MTC | 20 |
| Total | 138 |
Abbreviation: HTI, Health Training Institution.
Source: Field data (2020).
3.4. Data collection tool and procedure
The instrument for data collection in this study was a self‐administered questionnaire. The questionnaire was designed after reviewing the literature on the research questions. The self‐reporting nature of the questionnaire was deemed appropriate for this study because the participants were able to read and write, hence their responses were readily provided. The questionnaire for the participants was made up of 20 items in three sections: A–C, consisting of a four‐point Likert scale type and close‐ended items. Section A was on the demographic features and comprised seven items, that is, gender, age, highest educational qualification, years of teaching, professional category, rank of participants and type of nursing midwifery course thought. This was then followed by Section B, which also consisted of nine items that sought to assess the level of knowledge of the health tutors on the types and phases of simulation. Lastly, Section C, on the practice of simulation, consisted of four items. The instrument was pre‐tested, and a reliability coefficient of 0.84 was obtained for the items on knowledge of simulation. Subsequently, a reliability coefficient of 0.72 and 0.81 was obtained for the post‐test analysis.
Ethical clearance by the Institutional Review Board ‘Redacted’ and permission letter was sent to all the principals of the selected health training institutions to seek permission to conduct the study. Each institution was contacted separately and meetings were held with the principals, and in some instances, the academic officers for permission and to arrange for a time to administer the questionnaires.
The participants were contacted individually and informed of the purpose of the study as well as their right to voluntary participation; hence, they could withdraw at any time with no consequences. The participants were further assured of confidentiality and anonymity; hence, the respondent's identities were not required in any form on the questionnaire. All participants who were contacted agreed to participate in the study, and they were then presented with a questionnaire after signing an informed consent form. The researcher contacted the tutors and collected the completed questionnaires, which were immediately scanned for completeness. Those who did not complete theirs were gently prompted to do so. The researcher was able to retrieve 120 questionnaires, representing a response rate of 87%, which is deemed acceptable by Baruch and Holtom (2008). The administration of questionnaires and their collection took about 6 weeks to complete, starting from 25 June to 7 August 2020.
3.5. Data analysis
Descriptive statistics, specifically percentages and frequencies, were used to analyse the demographic information of the participants. Research question one sought to assess the level of knowledge of health tutors on simulation. Each correctly answered item was scored four marks, and an incorrectly answered item was scored zero. This resulted in a maximum of 36 marks and a minimum of 0 marks which were then converted to a scale of 10 points. A mean value of 3.7 was obtained, and a range of the total scores for the health tutors were summarized and categorized as: <3.7 (low knowledge), 3.7–7 (adequate knowledge) and >7 (high knowledge).
Research question two sought to determine the practice of simulation among health tutors. It was also measured on a four point Likert scale, where the responses ranged from strongly agree to strongly disagree. However, the variables were transformed into dichotomous variables to allow for better discussion. For instance, strongly agree and agree were put together, while strongly disagree and disagree were also added together. The results were analysed using frequency counts and percentages.
3.6. Ethical considerations
A letter to seek approval and a detailed research proposal were sent to the Institutional Review Board (IRB) for ethical clearance. The study was then conducted after an ethical clearance letter was obtained from the IRB ‘Redacted’.
4. RESULTS
4.1. Demographic characteristics of respondents
This part presents and discusses the preliminary data, which consists of the background data of the respondents for the study.
From Table 2, 74 (61.7%) health tutors, forming the majority of the respondents, are males and 46 (38.3%) are females. Also, Table 2 reveals that 59 health tutors (49.2%) forming the majority of the respondents had MPhil/MSc/M.Ed./MPH as their highest educational qualification. The number of health tutors having B.Ed./BSc are 57 (47.5%), representing the second largest group following those with MPhil/MSc/M.Ed./MPH while only 4 (3.3%) health tutors have diploma as their highest educational qualification.
TABLE 2.
Distribution of respondents' demographic characteristics.
| Frequency (N) | Percentage | |
|---|---|---|
| Gender | ||
| Male | 74 | 61.7 |
| Female | 46 | 38.3 |
| Total | 120 | 100.0 |
| Educational qualification | ||
| Diploma | 4 | 3.3 |
| B.Ed/BSc | 57 | 47.5 |
| MPhil/MSc/M.Ed/MPH | 59 | 49.2 |
| Total | 120 | 100.0 |
| Professional qualification | ||
| RGN | 76 | 63.3 |
| RM | 20 | 16.7 |
| RMN | 13 | 10.8 |
| PHN/RCN | 11 | 9.2 |
| Total | 120 | 100.0 |
| Current rank | ||
| Health Tutor | 27 | 22.5 |
| Senior Health Tutor | 60 | 50.0 |
| Principal Health Tutor | 26 | 21.7 |
| Deputy Chief Health Tutor | 7 | 5.8 |
| Total | 120 | 100.0 |
| Number of courses taught | ||
| 1 course | 0 | 0.0 |
| More than 1 courses | 120 | 100.0 |
| Total | 120 | 100.0 |
Abbreviations: PHNs, Public Health Nurses; RCN, Registered Community Health Nursing; RGN, Registered General Nursing; RM, Registered Midwifery; RMNs, Registered Mental Nurses.
Source: Field survey (2020).
On the professional classification of the health tutors, Table 2 indicates that 76 (63.3%) health tutors, forming the majority, were RGN. Following the RGN as the category with the highest number of health tutors is the RMs, where 20 (16.7%) health tutors identify as such. The number of health tutors who are Registered Mental Nurses (RMNs) are 13 (10.8%) while 11 (9.2%) of them forming the minority were Public Health Nurses (PHNs).
The current rank of the health tutors was sought. As represented in Table 2, exactly half of the respondents 60 (50%) are in the rank of Senior Health Tutor. This is followed by the health tutors 27 (22.5%) and the Principal Health Tutors 26 (21.7%), while the minority 7 (5.8) is in the rank of Deputy Chief Health Tutor. Again, Table 2, shows that all the health tutors 120 (100%) taught more than one course in an academic year.
4.2. Knowledge of health tutors on simulation
In assessing the knowledge of health tutors about simulation as a teaching strategy, the responses of the participants are shown in Table 3. The questionnaire had nine items that sought to assess the level of knowledge of health tutors on simulation. Each correctly answered item was scored four marks, and an incorrectly answered item was scored zero. This resulted in a maximum of 36 marks and a minimum of 0 marks, which were then converted to a scale of 10 points. A mean value of 3.7 was obtained, and a range of the total scores for the health tutors were summarized and categorized as: <3.7 (low knowledge), 3.7–7 (adequate knowledge), and >7 (high knowledge).
TABLE 3.
Health tutors' knowledge on simulation.
| Categories of health tutors' knowledge | Frequency (N) | Percentage |
|---|---|---|
| Low knowledge | 68 | 56.8 |
| Adequate knowledge | 49 | 40.9 |
| High knowledge | 3 | 2.5 |
| Total | 120 | 100 |
Source: Field survey (2020).
Table 3 shows that more than half of the 68 health tutors (56.8%) had low knowledge of the types of simulation modalities and the activities undertaken within the various phases of a simulation session. The results also showed that 49 (40.9%) of the health tutors had adequate knowledge about simulation, while 3 (2.5%) health tutors, representing the minority group, had high knowledge about simulation. This implies that more tutors have inadequate knowledge as compared with tutors with adequate knowledge of simulation.
4.3. The practice of simulation among health tutors
As presented in Table 4, participants were asked to respond to several statements concerning the use of simulation as a teaching strategy.
TABLE 4.
The practice of simulation among health tutors.
| Item | Subscale | Frequency (%) |
|---|---|---|
| Familiarity with simulation | Yes | 80 (66.7) |
| No | 40 (33.3) | |
| How health tutors got exposed to simulation | Workshop | 50 (41.7) |
| Others | 70 (58.3) | |
| Practice of simulation | Agree | 69 (57.5) |
| Disagree | 51 (42.5) | |
| Type of simulation modality used | Low fidelity | 31 (45.0) |
| Medium fidelity | 28 (40.5) | |
| High fidelity | 8 (11.6) | |
| Other | 2 (2.9) |
Source: Field survey (2020).
Table 4 shows that the majority (80; 66.7%) of the respondents confirmed that they were familiar with the use of simulation. Less than half of the respondents (50; 41.7%) indicated that they got exposed to simulation through a workshop purposely organized to train them on simulation. Also, a slight majority (69; 57.5%) of the respondents agreed that they practice simulation. Participants who said they practiced simulation (n = 69) were asked again to list the most common simulation modality they used in teaching. Low fidelity was listed by 58 (45.0%) of the health tutors as the most commonly used simulation modality in teaching, while a few health tutors, 8 (11.6%), stated that they commonly used high fidelity in teaching.
4.4. Relationship between tutors' knowledge of simulation and practice of simulation in teaching
The Pearson product‐moment correlation coefficient was used to study the relationship between simulation knowledge and simulation practice, and the results are summarized in Table 5. Preliminary investigations were performed to ensure that the assumptions of normality, linearity, and homoscedasticity were not violated.
TABLE 5.
Pearson product‐moment correlation coefficient between knowledge of simulation and practice of simulation among health tutors.
| Knowledge of simulation | Practice of simulation | |
|---|---|---|
| Knowledge of simulation | ||
| Correlation coefficient | 1.00 | 0.217 |
| Sig. (2‐tailed) | 0.018 a | |
| N | 120 | 120 |
Correlation is significant at the 0.05 level.
Source: Field survey (2020).
From Table 5, a Pearson product‐moment correlation coefficient of 0.217 indicates a weak positive association between knowledge simulation and practice of simulation among health tutors.
Table 5 indicates that there is a weak positive correlation between the two variables, r = 0.22, n = 120, p ˂ 0.05. This means that an increase in the health tutors' knowledge of simulation will cause an increase in their practice of simulation. The relationship between knowledge of simulation and practice of simulation was statistically significant at 0.018 (p < 0.05). Therefore, we refuse to accept the null hypothesis, which states that there is no statistically significant correlation between knowledge of simulation and practice of simulation among health tutors.
5. DISCUSSION OF RESULTS
5.1. Level of knowledge of health tutors on simulation
The findings of the study revealed that less than half of the health tutors had adequate knowledge of simulation. The low number of tutors with adequate knowledge could be attributable to the fewer number of participants who reported that they had been trained in simulation. The findings of this study support those of Sanli et al. (2022) where only 20.8% of health tutors had adequate knowledge of simulation, with most tutors' 80.2% not possessing adequate knowledge of simulation. The inability of tutors to identify the various types of simulation modalities could be attributed to the lack of this equipment in health training institutions. However, the findings of a study conducted by Katoue et al. (2015) contradicts those of this study, as they reported that all participants in their study were able to correctly identify types of simulators and fidelity. This study's findings do not support the findings of a study conducted by Teni and Gebretensaye (2019). They sought to assess the knowledge and perception of nursing clinical simulation among health tutors who work in teaching institutions in Ethiopia. Their study found that a little over half 59 (59.6%) of the total respondents of health tutors were knowledgeable about simulation, whereas 40 (40.4%) of the respondents did not have knowledge of simulation.
5.2. Practice of simulation among health tutors
This study found that most participants, 80 (66.7%), were familiar with simulation as a teaching strategy, and the majority also reported workshops as the means through which they got introduced to simulation. Similar findings were reported by Teni and Gebretensaye (2019), whereby 87 (87.9%) of participants reported that they were familiar with simulation. Their study also reported a higher number of participants, 70 (70.5%), being exposed to simulation through a workshop. The similar findings reflect the use of workshops as one of the common means by which in‐service training is conducted in the sub‐region and may be recommended for providing training for health tutors on simulation. This study found that a slight majority, 69 (57.5%), of the participants utilized simulation as a teaching strategy, though quite a considerable number 51 (42.5%) did not use simulation in teaching. This contradicts the findings of Dudding and Nottignham (2018) where 67 (49%) of the faculty did not use simulation as a teaching strategy. The findings support those of Dudding and Nottignham (2018) where a slight majority of 67 (49%) of the faculty did not use simulation as a teaching strategy.
On the contrary, a study conducted by Nye et al. (2018) revealed that an overwhelming majority 130 (97.7%) of nurse educators utilized simulation as a teaching strategy. The increased use of simulation as reported by Nye et al. (2018) might be attributable to the fact that the study was conducted in North America, where they are mandated to replace 50% of clinical hours with simulation. This, therefore, suggests that if the N&MC makes the use of simulation mandatory, more tutors will use it as a teaching strategy.
In addition, this study also found that very few health tutors used high fidelity simulation modality 8 (11.6%) as compared to the use of low fidelity modality 31 (45.0%) by health tutors. The results of a study conducted by Thurling (2016), to assess the prevalence and use of simulation in nursing institutions in South Africa supports this study. They reported that 14 (27.27%) of nurse educators used high fidelity simulators as compared with 42 (83.33%) who used low fidelity simulators. The findings of Baghoomian (2014) further corroborate the results of this study, as her study revealed that the majority of nurse educators 22 (86.4%) used low fidelity simulation in teaching. This may suggest that high fidelity simulators are not common in health training institutions in resource‐constrained areas, including Ghana.
5.3. Relationship between tutors' knowledge of simulation and practice of simulation in teaching
This study found that there was a statistically significant correlation between knowledge of simulation and practice of simulation among health tutors at a significant level of 0.018 (p < 0.05). The findings of this study supports that of Xie and Sharif (2014), who carried out a study to establish a link between teacher expertise and simulation‐based learning implementation.
6. LIMITATIONS
The study should have been undertaken in several or almost all the health training institutions in the five regions of Northern Ghana, and this could have had a bearing on the generalization. However, the school climate and resources of health training institutions in the other regions might not be too different from those of the institutions selected. It was therefore, expected that the findings of this study might still be useful in the other health training institutions. In addition, the use of the questionnaire as an instrument had some inherent disadvantages. For instance, the use of the questionnaire may elicit some responses that might not reflect the true picture on the ground. The purpose of the study was therefore explained in detail to the respondents in order to curb this. That notwithstanding, the questionnaire was believed to guarantee the confidentiality and anonymity of respondents, thereby eliciting more honest responses. Moreover, an observation of the practice of simulation among the health tutors could have been undertaken to corroborate the self‐reported practice. However, this could not be done due to time constraints. Despite these possible limitations, it is believed that the findings of this study will still be fairly generalizable to health tutors of health training institutions in the other regions and the nation as a whole.
7. CONCLUSION
Based on the results of the study, it can be inferred that the number of health tutors who have adequate knowledge of simulation is less than that of those without adequate knowledge of simulation in relation to the types of simulators and the various phases of a simulation session. This might indicate that tutors are unable to select the appropriate simulation modality to achieve successful learning outcomes. Therefore, there is a need to equip tutors with knowledge of the simulation. Also, steps need to be taken to maintain and further increase tutors use of student‐centred teaching strategies such as simulation and reduce the use of teacher‐centred teaching strategies.
8. RECOMMENDATIONS
The following recommendations were made from the findings of the study for consideration by the following institutions and personnel.
Firstly, the principals of health training institutions should liaise with the HTI to recruit more health tutors to reduce the number of lessons taken per tutor. Also, provision of routine in‐service training to equip newly recruited and serving health tutors with the requisite knowledge on simulation as a teaching strategy.
Secondly, health tutors should increase their desire for continuous professional development to enhance their knowledge of simulation.
Thirdly, the N&MC of Ghana must formulate policies to ensure the mandatory replacement of some clinical contact hours with simulation.
Finally, the N&MC should routinely monitor skills laboratories to ensure that they are well equipped with standard and up‐to‐date simulation resources.
FUNDING INFORMATION
This paper did not receive any funding.
CONFLICT OF INTEREST STATEMENT
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
ETHICS STATEMENT
This study received approval from the Institutional Review Board (IRB) of the University of Cape Coast (UCC) with ID (UCCIRB/CES/2020/21) and the various Health Training Institutions used for this study. Informed consent was obtained from all respondents before data collection per ethical requirements.
ACKNOWLEDGEMENTS
We would like to express our gratitude to our respondents for consenting to the study and their cooperation during the data collection. To our families, we are grateful for the physical, emotional and spiritual support they gave us throughout the study.
Alhassan, B. A. , Diebieri, M. , Anliengmene, A. A. , & Issah, S. (2023). A survey of knowledge and practice of simulation among health tutors in selected health training institutions. Nursing Open, 10, 6390–6397. 10.1002/nop2.1887
No patient or public contribution towards the project.
DATA AVAILABILITY STATEMENT
The data that supports the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that supports the findings of this study are available from the corresponding author upon reasonable request.