Student's Perception of vSim for Nursing® using the Simulation Effectiveness Tool—Modified.

Abstract

Background

Due to the COVID-19 pandemic, our nursing program utilized virtual simulation learning experiences to replace clinical hours. This pilot project used both quantitative and qualitative research methods to explore undergraduate pre-licensure (n = 99) and accelerated second-degree students (n = 19) student’s perceived effectiveness of using vSim for Nursing® as a clinical replacement with a second aim that explored their preparedness for the virtual simulation experience.

Method

Efficacy was evaluated using the Simulation Effectiveness Tool-Modified (SET-M).

Results

Mean scores indicated that students strongly agreed on the efficacy of vSim for learning, with all items ranging from 50% to 79.7%. Majority of students strongly agreed that their preparation was highly effective, ranging 67.8% to 77.1%. Qualitative findings from the open-ended feedback supports findings to the effectiveness of virtual simulation, with one of the major themes that emerged was the presence of the clinical nurse educator.

Conclusion

Students perceived vSim for Nursing® to be an effective tool for clinical practice replacement and felt prepared to meet the learning outcomes. Debriefing remains an essential component to any mode of simulation.

Given the unprecedented coronavirus disease 2019 (COVID-19) pandemic crisis, many schools of education became virtual. At this researchers’ university, all hospital-based clinical experiences transitioned to virtual simulation learning experiences (VSLE). Approval was obtained from the researchers’ states’ licensing governing body to utilize vSim for Nursing® as an alternative for all hospital-based clinical experiences ensuring educational progression. The first aim of this study explored one diverse urban pre-licensure baccalaureate nursing students’ perceived effectiveness of vSim for Nursing®, using the Simulation Effectiveness Tool—Modified (SET-M) survey. A second aim explored student preparedness for the virtual learning simulation experience.

Virtual Simulation in Nursing

The aims of this study explored undergraduate pre-licensure student's perceived perceptions of using vSim for Nursing® (vSim) as a clinical replacement and their preparedness for the virtual learning simulation experience. A VSLE is an interactive online platform where learners can engage in patient care, complete assessments, interventions, and treatment tasks (Healthcare Simulation Dictionary, 2020). Virtual simulation has emerged as a format for teaching, learning, and providing application-based experiences. VSLE can promote understanding of nursing concepts, skills development, clinical reasoning, judgement, cognitive knowledge, and retention (Caylor, Aebersold, Lapham, & Carlson, 2015). VSLE can stimulate decision making and communication (Foronda & Bauman, 2014) as well as promote self-efficacy, preparedness, confidence, and comfort levels (Mabry, Lee, Roberts, & Garrett, 2019). VSLE refers only to vSim for Nursing, in the confines of this paper, and are being used interchangeably. vSim for Nursing, designed for undergraduate pre-licensure and accelerated nursing programs, simulate real nursing patient scenarios in a safe, realistic online environment. Students have online access to suggested reading material, graded pre/post simulation quizzes, and graded scenarios (Laerdal, 2020). The VSLE scenario is an adaptive step-by-step nursing care/intervention product, with pre-built case scenarios for a variety of nursing courses (Foronda, et al., 2016 ; Foronda et al., 2017 ; Laerdal, 2020). Still a fairly new pedagogical tool, studies conducted have demonstrated its effectiveness and use as a teaching platform. Findings from a study with 54 accelerated pre-licensure nursing students support the inclusion of vSim as an augmented simulation pedagogy, with most participants rating it easy to use (20% strongly agree, 78% agree); the content of the virtual simulation was directly relevant to a nurses’ role (61% strongly agree, 39% agree) and 98% recommended future inclusion (Foronda et al., 2016 ).

A quasi-experimental, three group, mixed method study explored a convenience sample of 103 undergraduate nursing students in an adult health course (Wright, Tinnon, & Newton, 2018). Findings demonstrated that 91% of the two simulation groups and one control group found vSim enhanced their understanding of adult health concepts and was a meaningful and beneficial learning experiential process (Wright et al., 2018). Post simulation quiz score means revealed that both simulation groups scored higher than the control group, however, the difference was not statistically significant (Wright et al., 2018). However, a VSLE could reinforce content already learned and thereby increase retention, as well as increase proficiency and application of the knowledge that may not be measured by an examination. Encouraging feedback revealed that the virtual learning experience challenged students to use their knowledge and clinical judgment (Wright et al., 2018). A randomized controlled posttest design explored the effectiveness of vSim for Nursing as an auxiliary teaching tool for pre-licensure students in a fundamentals course (Gu et al., 2017). Findings demonstrated significantly increased knowledge in those participants who received the VSLE compared to the control group who received only the course content (Gu et al., 2017).

Another study, a mixed methods design of 99 pre-licensure nursing students’ perceptions of learning supported the use of virtual simulation and its enhancement of assessment, prioritization, and emergency interventions (Foronda et al., 2018). A Norwegian study on 65 second year pre-licensure nursing students’ experiences with the virtual clinical surgical simulation scenario demonstrated that most students expressed the experience to be realistic and useful in gaining and retention of knowledge and a good tool for clinical placement preparation ( Tjoflåt, Brandeggen, Strandberg Dyrstad, & Husebø, 2018). Finally, a recent descriptive qualitative study on 20 South Korean prelicensure nursing students’ perceptions and experiences of using vSim during the COVID-19 pandemic viewed the experience as beneficial for improving their confidence and competence to provide nursing care (Kim, Kang, & Gagnec, 2021). Student nurses viewed utilizing virtual simulation as an effective learning platform (Caylor et al., 2015). However, given that VSLE may be a new learning environment for many students, frustrations related to technical issues may occur (Foronda et al., 2016; Kim et al., 2021; Tjoflåt et al., 2018).

Methodology

This project used both quantitative and qualitative research methods to explore student's perception on the effectiveness of using vSim as a clinical replacement with a second purpose exploring their preparation.

Virtual Simulation Learning Experience Clinical Day Process

As this VSLE was a replacement for clinical hours, all students were required to participate. The Assistant Dean for Academic Operations at the School of Nursing (SON) purchased the vSim licenses for all eligible students. The researcher was not involved in this process. Participants were assigned by clinical groups and consisted of: (a) generic sophomores in a fundamental clinical, (b) generic juniors in a pediatric clinical, and (c) accelerated second-degree nursing students in both maternity and pediatric clinicals. All three educational levels were assigned four virtual simulation case scenarios that corresponded best to their didactic content at the time of the transition from hospital-based to vSim experiences. The accelerated second-degree students were the only group that used vSim for more than one course simultaneously. Hence, the sophomore students completed four vSim scenarios for fundamentals (focusing on contact precautions; safety precautions; patient education and therapeutic communication); the juniors completed four pediatric VSLEs (encompassing prioritization of nursing care and interventions; conducted focused assessments; interprofessional communication and medication administration). The accelerated second-degree students completed a total of eight virtual simulations, the same four pediatric scenarios as the juniors and four maternity cases (medication administration; critical assessments of maternal and fetal status; assess maternal and fetal infection risk and maternal and fetal emergency nursing care and interventions).

Twenty-four hours prior to each assigned VSLE clinical day discussion, each student was expected to complete the suggested readings and all vSim assignments (pre-quiz, simulated scenario, and post-quiz). Students were informed that they could retake the VSLE scenario multiple times to achieve a grade of 70% or better within the allotted 30-minute timeframe. Students were expected to submit to their clinical nurse educator via email, a completed nursing care plan with one to two nursing diagnoses. Clinical faculty, comprised of adjunct faculty and clinical instructors, facilitated the discussion and debriefing for each assigned VSLE. Every clinical group was scheduled for a three-hour virtual clinical day for each vSim, ensuring a comprehensive group conference dialogue. The researcher prepared faculty with a detailed timeframe breakdown for the three-hour time slot assuring their preparedness to facilitate the discussion. Faculty were also provided with material on how to integrate and facilitate the debriefing session. The SON utilizes Debriefing for Meaningful Learning©, fostering student's “reflective thinking and learning; review patient care, cultivate reflective thinking, and foster meaningful learning” (Dreifuerst, 2015, p.268).

The researcher, who was the Simulation Coordinator for this SON, developed a VSLE Overview handout to prepare both students and faculty for this experience. This prebriefing preparatory handout provided information on: how VSLE discussion conducted will occur via Blackboard Collaborate Ultra or Zoom; scheduling; vSIM access code procedure; absence from VSLE; VSLE assignments prior to scheduled experience; how to prepare; VSLE learning objectives; SON simulation conceptual framework and the VSLE letter of understanding and confidentiality statement.

The first hour of the virtual clinical day discussion (the prebriefing aspect of the experience) incorporated going over the basics of the vSim case scenario; learning objectives; medications with nursing implications; assessments required; medical orders; proposed correct treatment steps and appropriate treatment; and nursing care and interventions. Then the debriefing aspect, whereby the instructor would discuss, in further detail, the case scenario and the student's reactions and perceptions in completing the vSim. Instructors discussed the nursing process, nursing diagnoses, and assisted students to explore the clinical reasoning in the care of the simulated patient. The last hour centered around the student exploring their thoughts and feelings on taking care of the simulated patient and discussing their performance. Time was allotted for students to ask additional questions to enhance their critical thinking and reasoning regarding the nursing interventions and prioritization of care. Finally, if time permitted, going over the pre and post quiz content provided an excellent supplement to the discussion.

To summate, the overall virtual simulation learning experience clinical day process began with students completing all vSim assignments, which included the pre-quiz; post-quiz and achieving the required vSim grade. Prior to their scheduled virtual clinical they, students were expected to send their completed nursing care plans to their clinical educator. Then, with their clinical nurse educator, they had the three-hour virtual clinical day to discuss their experience.

Participants

Pre-licensure Bachelor of Science (BSN) and accelerated BSN students participated in VSLEs between April and May 2020. A total of 118 students completed the voluntary survey. Prior to integrating vSim as a clinical replacement, all eligible students were in a hospital-based clinical from February to March 2020. vSim for Nursing was the only virtual substitute modality used and none of the participants used vSim for Nursing prior to this experience.

Instruments

The 19-question open domain SET-M tool (Leighton, Ravert, Mudra, & Macintosh, 2015) was used. The SET-M is useful for evaluating the learner's perception of the effectiveness of the simulation experience in meeting learning objectives and outcomes. The SET-M is consistent with International Nursing Association for Clinical Simulation and Learning Standards of Best Practice, Quality and Safety Education for Nurses practices, and American Association of Colleges of Nursing baccalaureate essentials (Leighton et al., 2015). There are four subscales of the SET-M: two items on prebriefing (increased confidence, beneficial to learning); six on learning (response to patient, empowered to and practice of clinical-decision making skills, understanding medications, pathophysiology, assessment skills); six on confidence (relating to prioritizing patient care, communicating with patient and colleagues, teaching, patient safety and evidence-based practice) and the last five items on debriefing (learning, verbalizing feelings, improve clinical judgement, self-reflection, constructive evaluation) (Leighton et al., 2015).

The perceived learning and confidence in simulation using the psychometric properties of the SET-M has established satisfactory evidence of validity and reliability to assess and evaluate virtual simulation effectiveness with internal consistency in prebriefing α = .833, learning α = .852, confidence α = .913 and debriefing α = .908 (Leighton et al., 2015). A retrospective analysis of the SET tool in Korean nursing students, using 568 cases at three nursing schools, demonstrated psychometric validity and reliability to measure simulation effectiveness (Shin, Kim, Rim, Ma, & Shon, 2020). Though this was on the SET tool, the SET-M is a modified version and as such, validity and reliability may also be established. There is no instituted method to score the SET-M (Leighton et al., 2015).

To explore student preparedness for the virtual learning simulation experience, the researcher incorporated five questions exploring the students’ perceptions of the VSLE Overview prebriefing preparatory handout. These questions explored if the information prepared the student for the experience; was considered helpful; prepared them to fully participate; found pre-assignment prepared them to fully participate and able to fully participate in discussion having completed the simulation scenario in advance. A four-question demographic inventory was also included. All items had a Likert Scale of 1 = Strongly Agree; 2 = Somewhat Agree; 3 = Do Not Agree. Unfortunately, the researcher could not attest that the student reviewed this handout in advance of their assigned VSLE clinical day. To elicit student feedback, an open-ended space for feedback, “please share your thoughts on this experience,” provided qualitative data.

Procedure

Eligible students scheduled for a VSLE due to the COVID-19 pandemic received the survey link through the researchers’ Qualtrics© College Account via their Blackboard didactic course. The scripted email contained the survey link, consent form, SET-M with VSLE Overview questions and demographic inventory. University Institutional Review Board approval was obtained prior to data collection. The researcher sent each educational clinical level a scripted email from the Blackboard course site on the last day of all scheduled VSLE, with a follow up email within seven days. Participants were instructed to complete the survey once with data collection occurring between May and June 2020. As the participants were students, data was not considered anonymous. Instead, data was obtained without identifiers as the participant pool was known and a no coded-survey link was provided. Descriptive statistics were calculated into a contingency table analysis. Qualitative content analysis was performed independently with themes discussed with another researcher until consensus was achieved.

Results

Of the 233 pre-licensure students and 32 accelerated BSN students invited to participate, a total of 118 students completed the voluntary survey. Forty generic sophomore level nursing students (second year), 59 generic junior students (third year) and 19 accelerated students participated. Majority were female (n = 97) with an average age of 22.5.

SET-M Findings

As shown in Table 1 , all 19 item frequencies showed majority strongly agreed responses, ranging from 50% (n = 59) to 79.7% (n = 97). Of the two prebriefing items, 78.8% (n = 93) responded that prebriefing was beneficial to their learning, while increasing students’ confidence had 64.4% (n = 76). Of the six items pertaining to learning, the opportunity to practice clinical-decision making skills had the highest strongly agreeing with 66.9% (n = 79). A better understanding of medication had the lowest strongly agreed upon with 48.3% (n = 57).

Table 1.

Simulation Effectiveness Tool Modified (SET-M), n = 118 (%)

SET-M Item	Strongly Agree	SomewhatAgree	Do NotAgree	Mean*	SD†
1. Prebriefing increased my confidence	76 (64.4%)	39 (33.1%)	3 (2.5%)	1.38	0.54
2. Prebriefing was beneficial to my learning	93 (78.8%)	24 (20.3%)	1 (0.8%)	1.22	0.44
3. I am better prepared to respond to changes in my patient's condition	69 (58.5%)	45 (38%)	4 (3.4%)	1.45	0.56
4. I developed a better understanding of the pathophysiology	66 (55.9%)	40 (33.9%)	12 (10.2%)	1.54	0.67
5. I am more confident of my nursing assessment skills	59 (50%)	51 (43.2%)	8 (6.8%)	1.57	0.62
6. I felt empowered to make clinical decisions	61 (51.7%)	47 (39.9%)	10 (8.5%)	1.57	0.65
7. I developed a better understanding of medications	57 (48.3%)	50 (42.4%)	11 (9.3%)	1.61	0.65
8. I had the opportunity to practice my clinical-decision making skills	79 (66.9%)	35 (29.7%)	4 (3.4%)	1.36	0.55
9. I am more confident in my ability to prioritize care and interventions	70 (59.3%)	44 (37.3%)	4 (3.4%)	1.44	0.56
10. I am more confident in communicating with my patient	59 (50%)	45 (38.1%)	14 (11.9%)	1.62	0.69
11. I am more confident in my ability to teach patients about their illness and interventions	63 (53.4%)	46 (39%)	9 (7.6%)	1.54	0.64
12. I am more confident in my ability to report information to health care team	63 (53.4%)	46 (39%)	9 (7.6%)	1.54	0.64
13. I am more confident in providing interventions that foster patient safety	85 (72%)	31 (26.3%)	2 (1.7%)	1.3	0.49
14. I am more confident in using evidence-based practice to provide nursing care	71 (60.2%)	40 (33.9%)	7 (5.9%)	1.46	0.61
15. Debriefing contributed to my learning	93 (78.8%)	25 (21.2%)	0	1.21	0.41
16. Debriefing allowed me to verbalize my feelings before focusing on the scenario	85 (72%)	29 (24.6%)	4 (3.4%)	1.31	0.53
17. Debriefing was valuable in helping me improve my clinical judgment	88 (74.6%)	29 (24.6%)	1 (0.8%)	1.29	0.47
18. Debriefing provided opportunities to self-reflect on my performance during simulation	94 (79.7%)	24 (20.3%)	0	1.2	0.4
19. Debriefing was a constructive evaluation of the simulation	89 (75.4%)	29 (24.6%)	0	1.25	0.43

^⁎A mean score is the average of a group of scores.

^†Standard deviation shows how much variation there is from the average (mean).

Confidence in providing interventions that foster patient safety had the highest strongly agreeing with 72% (n = 85). More confident in using evidence-based practice to provide nursing care had 60.2% (n = 71) strongly agreeing while more confident in ability to prioritize care and interventions had 59.3% (n = 70) strongly agreeing. Finally, both items in confidence to teach patients about their illness and interventions and report information to health care team had 53.4% (n = 63) strongly agreeing.

The six debriefing items had the majority of the highest strongly agree responses. Debriefing provided opportunities to self-reflect on my performance during simulation had 79.7% (n = 94) strongly agreeing. Debriefing contributed to learning had 78.8% (n=93) strongly agreeing. Debriefing was a constructive evaluation of the simulation had 75.4% (n = 89) strongly agreeing. Debriefing was valuable in helping me improve my clinical judgment had 74.6% (n = 88) strongly agreeing. Debriefing allowed me to verbalize my feelings before focusing on the scenario had 72% (n = 85) strongly agree.

VSLE Overview Findings

As shown in Table 2 , the five survey items demonstrated that the participants felt prepared for the VSLE. Survey item ‘I felt that I was able to fully participate in the V-SLE discussion having completed the simulation scenario in advance’ had 77.1% (n = 91) strongly agreeing. “I found the VSLE Overview material helpful” had 74.6% (n = 88) strongly agreeing. Both items on VSLE Overview material “prepared me for my vSim experience” and “prepared me to fully participate in the vSim experience” had 70.3% (n = 83) strongly agreeing. Finally, “I found the pre-assignments prepared me to fully participate” had 67.8% (n = 80) strongly agreeing.

Table 2.

Virtual Simulation Overview Material, n = 118 (%)

Virtual Simulation Overview Material	Strongly Agree	Somewhat Agree	Do Not Agree	Mean	SD
1. The VSLE Overview material prepared me for my vSim experience	83 (70.3%)	34 (28.8%)	1 (0.8%)	1.31	0.48
2. I found the VSLE Overview material helpful	88 (74.6%)	30 (25.4%)	0	1.27	0.44
3. The VSLE Overview material prepared me to fully participate in the vSim experience	83 (70.3%)	35 (29.7%)	0	1.3	0.46
4. I found the pre-assignment prepared me to fully participate in the VSLE	80 (67.8%)	35 (29.7%)	3 (2.5%)	1.35	0.53
5. I felt that I was able to fully participate in the VSLE discussion having completed the simulation scenario in advance	91 (77.1%)	26 (22%)	1 (0.8%)	1.24	0.45

Note. VSLE = virtual simulation learning experience.

“Please Share Your Thoughts on this Experience” Feedback

Qualitative findings from the open-ended feedback supports findings to the efficacy of virtual simulation. One of the major themes that emerged was the presence of the clinical nurse educator. Quality of the professor leading the VSLE is as important as the experience itself. The ability of nursing faculty to assist students in applying nursing knowledge, understand the dynamics of nursing interventions and procedures while promoting students critical thinking and reasoning contributes to students’ learning process. One participant shared, “my professor led the meeting extremely well…the conversation into nursing care and tasks efficiently while relating to the things we did in the vSim.” Participants viewed vSim as “lifelike, engaging & enriching” and “correlating to patient care, the stress related to patients” immediate reaction to…care or lack of…helped…figure out what…is needed to be done.” This is a wonderful example of reflection and the learning that can be achieved with self-awareness. As one participant stated, “Looking back at results…what I missed and learned…helped.” Participants even agreed that it would “complement didactic learning/supplement material.” Finally, the ability to interact with the patient is limited given the virtual platform, as evidenced by participants stating it “did not give the experience of interacting with a real patient” and “could not interact directly with patient through interview process.”

Discussion

This study's findings corroborated with the literature review conclusions confirming students’ perception that VSLE is an efficacious pedagogy. Overall, participants perceived a positive learning experience in meeting their learning needs and clinical objectives. The data corresponds to the original SET-M findings on the effectiveness of a virtual simulation learning experience (Leighton et al., 2015).

Participants perceived the prebriefing to be beneficial to their learning while increasing their confidence. This corresponds to findings from the SET-M study whereby a significant majority strongly agreed with the importance of prebriefing (Leighton et al., 2015). Creating a safe space for learning, providing instructions, guidance and discussing the learning objectives and outcomes in advance can enhance the experience. Even with a VSLE, prebriefing provides the elemental factors for a successful simulation experience (INACSL Standards Committee, 2016). Preparing students for the virtual simulation can enhance students’ self-efficacy while promoting engagement and participation (Mabry et al., 2019). Students felt more prepared to fully participate in the VSLE discussion having received the prebriefing preparatory material and completing the vSim scenario in advance. As one participant commented, “having researched the simulation prior to the experience using the overview material prepared me…for actually performing it.” This insight demonstrates that having students’ complete assignments prior to the VSLE can increase participation and confidence.

Of the six learning subscale items, the opportunity to practice clinical-decision making skills had the highest strongly agreed responses and being better prepared to respond to changes to patient's condition had the second highest percentage. These results are in accordance with the SET-M findings (Leighton et al., 2015). Virtual simulation experiences can promote students’ knowledge, clinical performance, and critical thinking skills (Gu et al., 2017; Kim et al., 2021; Wright et al., 2018). As one participant in this study stated, ‘It engaged my critical thinking skills…was able to see the vital signs change in real time…see the effects of medications.’ By integrating virtual clinical simulations students can further their understanding and implementation of nursing concepts. Learning new knowledge while strengthening prior knowledge can be achieved when integrating vSim (Tjoflåt et al., 2018). Developing a better understanding of medication had one of the lowest strongly agreed upon responses. This item also had the lowest strongest agreeing with the SET-M survey (Leighton et al., 2015). Yet results from Foronda et al. (2018) suggested that a key point of student learning was medication administration. The ability to develop a better understanding of medications can be implemented with virtual simulation (Wright et al., 2018).

Students’ confidence and proficiency in their abilities to provide assessment, interventions and improve their understanding of nursing actions were significantly strongly agreed upon. This is consistent with other studies finding whereby learning and outcomes of assessment and prioritization of nursing skills and interventions were achieved with virtual simulation experiences (Foronda et al., 2018; Kim et al., 2021; Wright et al., 2018). With regards to nursing assessment skills, a participant shared that having the ‘order of assessments helped, as it…makes sense…prioritize actions in patient care’ and ‘able to apply skills in closest way to reality.’ Students’ confidence to foster patient safety, to practice their clinical-decision making skills and integrate evidence-based practice to provide nursing care further complements how this technology can be viewed as viable to nursing education (Foronda et al., 2016). One participant reflected on their confidence and nursing abilities, stating ‘I went into the meeting…with low confidence…left…feeling much more confident in clinical decision making.’

Virtual simulation provides opportunities to develop and enhance students’ communicative skills. Students’ expressed confidence in communicating with patients, health care team and with teaching patients. The educational integration of VSLE augments communication of peer-to-peer dialogue as well as nurse-to-patient (Foronda et al., 2014). Students can gain experience and knowledge in a variety of educational milieus and virtual simulation is an additional pedagogical tool. As students’ preparedness and confidence in their abilities are developed, so too does their comfort levels (Mabry et al., 2019). Development of clinical reasoning skills, competence and confidence can be developed and enhanced with a VSLE.

As debriefing remains essential in all modes of simulations it is important that students have opportunities to explore and share their thoughts and insights. The importance of debriefing findings is in accord with previous results from VSLE studies (Foronda et al., 2017; Gu et al., 2017; Kim et al., 2021; Leighton et al., 2015; Wright et al., 2018). Students reflecting and evaluating their own actions can lead to personal understanding of strengths and development of areas that need improvement. Debriefing contributes to students’ learning while providing opportunities to self-reflect. Students’ self-reflections, awareness of their critical thinking and self-evaluation of learning and nursing actions can be facilitated during debriefing (Gordon, 2017).

Debriefing requires an educators’ ability to facilitate student experiences and knowledge while assisting them in drawing conclusions. This is corroborated by the major theme, the presence of the clinical instructor, which emerged from the open-ended question for additional feedback on VSLE. As one participant shared, “I liked the vSIM but by far the best part of it was the professors discussion before, during and after…wonderful in bringing the material to life and providing substantive feedback in a way that the computer cannot…the quality of the professor…is as important, if not more so, than the vSim itself’. Nursing faculty need to facilitate students learning process to assist them towards attaining their goals (Kim et al., 2021). Virtual simulation provides opportunities for teaching and learning nursing concepts, practicing clinical skills in a safe environment, integrate decision-making and clinical reasoning which leads to fulfillment of clinical core competencies. Nursing faculty can assist students to translate classroom didactic concepts and connect them to the practice setting, bridging core and clinical competencies.

Limitations

Only students assigned to a VSLE at this single-center facility were eligible minimizing generalization. No data was collected on students’ perceptions on how they felt about having to learn a new form of technology independently in a remote setting or during a pandemic. Data was not obtained separately amongst the different educational levels, only collectively, thus differences in perceptions based on subject matter was not obtained. As this VSLE was part of their regular hospital-based clinical experience, there was no grading associated. However, students were expected to achieve a 70% or better on all preset virtual simulation activities and were provided additional opportunities to meet these criteria. As this SON does not formally grade simulations or VSLE, it is possible that students might have viewed this experience differently if it was graded (Foronda et al., 2016).

Recommendations for Nursing Education

Limited availability of hospital-based clinical experiences and unforeseen occurrences necessitates nursing curricula to explore alternative educational pedagogies and andragogy's to ensure continued student progression. Virtual simulation is one technological pedagogy that can be used as an alternative for a clinical activity, clinical makeup or to supplement didactic content (Foronda et al., 2018; Wright et al., 2018).

Conclusion

Evidence is required to support the efficacy of vSim for Nursing® to support students’ clinical practice progression and achievement. Students perceived virtual simulation to be beneficial to their learning while increasing their confidence. Debriefing remains essential in all modes of simulation. Student preparation provides the foundation to meet clinical competencies ensuring successful experiences. Educators need to be creative to ensure students’ continued progression and success in meeting their learning needs. Faculty's continued guidance, guidelines and supportive instruction is warranted for surety of students’ academic success. Exploration in the nurse educators’ perceptions of this VSLE is required to glean a complete understanding of its impact in nursing education.

Conflicts of Interest

There are no conflicts of interest or financial bias, including financial, consultant, institutional and other relationships, to disclose.