Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review.
OBJECTIVE
This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education.


BACKGROUND
In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education.


METHODS
An integrative review adapted a systematic approach.


METHODS
Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied.


METHODS
The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education.


METHODS
Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted.


RESULTS
Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator."


CONCLUSIONS
Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers.
Saudi Arabia Cultural Mission in Canberra, Ministry of Higher Education, Saudi Arabia; School of Nursing and Midwifery, Monash University, Berwick Campus, PO Box 1071, Narre Warren, VIC 3805, Australia. Electronic address: amal.ghareeb@monash.edu.
Amal Z
AZ
Al-Ghareeb
School of Nursing, Midwifery and Healthcare, Federation University Australia, Gippsland Campus, Churchill, VIC, Australia. Electronic address: s.cooper@federation.edu.au.
Simon J
SJ
Cooper
D004506:Education, Nursing / Q000379:methods*; D008348:Manikins; D016544:Patient Simulation
Educator nurse and integrative review; Faculty nurse; Human patient simulator; Manikin; Nursing students; Patient simulation