Virtual simulation for teaching cardiology in nursing: a scoping review protocol (2024)

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http://orcid.org/0000-0001-8456-1785Sabrina de Oliveira Carvalho1,
http://orcid.org/0009-0005-8777-4707Ana Beatriz Barbosa Paz1,
http://orcid.org/0000-0002-8682-6481Raylane da Silva Machado2,
http://orcid.org/0000-0002-9320-957XPhellype Kayyaã da Luz3,
http://orcid.org/0000-0002-1772-7439Elaine Maria Leite Rangel Andrade1,
http://orcid.org/0000-0002-3343-1187Marian Luctkar-Flude4

¹Department of Nursing, Federal University of Piauí, Teresina, Piauí, Brazil
²Floriano Technical College, Federal University of Piauí, Teresina, Piauí, Brazil
³Bom Jesus Technical College, Federal University of Piauí, Teresina, Piauí, Brazil
⁴School of Nursing, Queen's University, Kingston, Ontario, Canada

Correspondence to Dr Elaine Maria Leite Rangel Andrade; elairgel{at}gmail.com

Abstract

Introduction Virtual simulation (VS) can be an effective learning strategy in the context of nursing education on cardiovascular disease; however, its use in teaching cardiology in nursing is less studied. The objective of this scoping review is to map the use of VS for teaching cardiology in nursing.

Methods and analysis This scoping review will be conducted according to the Joanna Briggs Institute methods, and the results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Eight databases will be searched: MEDLINE (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature, Web of Science, Latin American and Caribbean Literature in Health Sciences, Spanish Bibliographic Index of Health Sciences, Database of Nursing, EMBASE and Google Scholar from inception to 31 July 2024. This study will include any existing peer-reviewed literature and grey literature. There will be no time or language restrictions. Two reviewers will screen and select the articles independently, and when there are differences, they will be resolved with a third opinion. When appropriate, broad themes and categories derived from the review questions will be accompanied by other illustrative formats (eg, tables or graphs, word clouds and infographics).

Ethics and dissemination This research project does not require ethical committee approval. The study is part of a cooperative research project between researchers from the Federal University of Piauí, Northeast of Brazil, and Queen’s University, Ontario, Canada, to develop and seek evidence of content validity of a VS game about valvular heart disease. The protocol and review will be published in peer-reviewed journals.

Registration details Open Science Framework (https://doi.org/10.17605/OSF.IO/S3UMH).

Nurses
Cardiovascular Disease
Health Education
eHealth

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2024-085965

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Nurses
Cardiovascular Disease
Health Education
eHealth

STRENGTHS AND LIMITATIONS OF THIS STUDY

Search strategy allows for broad record retrieval.
Identification of knowledge gaps on the topic.
Search for evidence in only eight databases.
Research involving non-nurses will be excluded.
No consensus about the concept of virtual simulation.

Introduction

Cardiovascular disease (CVD) takes around 17.9 million lives annually,1 and this number is increasing due to changes in lifestyles, environmental factors and population ageing. According to the Global Burden of Disease Report, ischaemic heart disease remained the leading cause of death worldwide in 2021, surpassing the numbers from COVID-19.2 Therefore, cardiovascular care is a global priority and one of the main topics of cardiology teaching in nursing.3–6

Nurses are constantly involved in the early identification, treatment and recovery of the health of people with CVD, but the low quality of cardiology teaching in undergraduate nursing courses may contribute to knowledge gaps and cardiovascular misconceptions.7–9 Cardiovascular misconceptions are false opinions or mistaken attitudes about heart problems that can influence patients’ interpretations of their recovery and coping strategies.9

A study conducted in Hong Kong, China9, showed diversity in levels of knowledge among nursing students and associations between experience in caring for patients with CVD and cardiovascular misconceptions. During the care process, students could not provide information to patients about coping strategies.9 In another study conducted in China10, not all nurses were motivated to educate and encourage patients to undertake healthy lifestyle changes. Most of these professionals knew the risk factors for CVD but were unable to identify them in clinical practice.10 In the USA, the knowledge and practice of cardiology specialist nurses regarding warfarin were not of good quality, despite the importance and risks of this medication.11

Therefore, to improve care for patients with CVD, it is necessary to adapt nursing curricula with educational strategies that are not restricted to traditional theoretical teaching but allow practical experience in safe environments involving realistic situations.12 Virtual simulation (VS) has been applied to this purpose, and many studies show that it improves learning (knowledge), skills, critical thinking and self-confidence and provides satisfaction to students.13 This strategy can contribute to reducing cardiovascular misconceptions in nursing and improving patient safety in health services.14

A systematic review that evaluated randomised controlled trials on VS for nursing students from 1996 to 2018 identified an increase in these publications over the years, predominantly from the USA.13 Although research on the use of this teaching strategy has expanded, there is no consensus in the literature on its definition. A broad concept defines VS as an interactive educational process in which users participate in clinical scenarios through a computer screen, the internet or a digital learning environment.15 16

Some scoping reviews regarding the topic of the use of VS in undergraduate education were identified. A 2022 study from China mapped 92 medical publications, in which more than half of the studies were about virtual reality, and the main topic was surgical procedures.17 Another 2023 study from Norway mapped 41 nursing publications focusing on the characterisation of debriefing or feedback for each technology.18 However, no article or protocol on the use of VS associated with cardiology teaching was identified.

A preliminary search of databases found evidence of the use of VS for teaching cardiology in nursing. A study from South Korea concluded that the effects of computer simulation are beneficial for nursing students to master cardiac resuscitation skills, assessing its effects on their performance, self-efficacy, stress and satisfaction.19 In Canada, a VS game that depicts collaborative actions of an interprofessional healthcare team for patients with ventricular fibrillation20 was evaluated for its effects on senior nursing students’ performance and demonstrated to be an effective pre-simulation preparation tool in resuscitation education.21 In China, VS was implemented with 72 undergraduate nursing students as part of the preparation for clinical simulation, which effectively improved the students’ learning and cardiopulmonary resuscitation skills.22

In this context, considering the recent expansion of the use of VS and technological advances in health courses, this review is highly relevant to reveal existing uses of VS for teaching cardiology in nursing and to identify gaps that need to be addressed. The aim of this scoping review protocol is to map the use of VS for teaching cardiology in nursing.

Methods and analysis

Study design

The authors will follow the scoping review methodology proposed by the Joanna Briggs Institute (JBI)23 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.24 The protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/S3UMH).

Review questions

The main question of this review is as follows: Wwhat is the extent of the existing literature on the use of VS for teaching cardiology in nursing?

The following sub-questions will be addressed:

What are the designs and theories used to develop VS for teaching cardiology in nursing?
What are the benefits and challenges of using VS to teach cardiology in nursing?
What are the gaps in the literature regarding the use of VS for teaching cardiology in nursing?

Inclusion criteria

The mnemonic ‘population, concept, context’ was used to specify the inclusion criteria.

Participants

This scoping review will include studies involving undergraduate and graduate nursing (Master’s and PhD) students or nurses working in any healthcare environment. Undergraduate and graduate nursing students are people enrolled in a school or formal education programme that leads to undergraduate and graduate nursing degrees.25 Nurses are professionals who graduated from a nursing school that provide services to patients who require assistance to recover or maintain their physical or mental health.26 27

Studies will be excluded if the participants are nursing technicians. According to the Library of Medicine, these professionals are ‘licensed practical nurses’ who do not hold professional degrees or credentials and are required to practice under the direction of registered nurses and physicians. These professionals receive less in-depth nursing training than registered nurses, which restricts the use of the same virtual scenario for both.26 28

Concept

This scoping review will include studies that demonstrate the use of VS for teaching cardiology to nursing students or nurses working in any healthcare environment. The focus is on VS, which in this scoping review will be defined as an interactive educational strategy, in which real users operate clinical scenarios through a computer screen, the internet or virtual and augmented reality.15 In VS, the learner can apply knowledge in clinical scenarios, identify priorities, practice decision-making and clinical reasoning in a safe environment and be exposed to patient care situations and high-risk events that cannot be experienced often in clinical practice.29

Context

Studies will be included if VS is used for teaching cardiology in nursing (undergraduate and graduate nursing students or nurses working in any healthcare setting). Cardiology teaching may be related to health assessment, pathophysiology, treatment and patient education about cardiovascular care. The inclusion and exclusion criteria are presented in table 1.

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Table 1

Inclusion and exclusion criteria

Evidence sources and search strategy

This study will be based on any existing literature, of any methodological, quantitative, qualitative or mixed approaches; reviews; and grey literature. There will be no time or language restrictions.

An initial search of MEDLINE via NCBI/PubMed was undertaken to identify key articles on the research topic. Next, the text words contained in the title and abstract of the retrieved articles and indexed terms were used to develop the full search strategy, with the search terms adapted for each information source. Reference lists of relevant articles and reviews will be assessed to identify additional studies.

The searches will begin in the following databases: MEDLINE via NCBI/PubMed; Cumulative Index to Nursing and Allied Health Literature via Thomson Reuters Collection; Web of Science (main collection)—via Clarivate Analytics and Embase via Elsevier, accessed through the Periodicals Portal of the Coordination for the Improvement of Higher Education Personnel; Latin American and Caribbean Health Sciences Literature; Spanish Bibliographic Index of Health Sciences ; Database of Nursing through the Virtual Health Library ; EMBASE; and Google Scholar from inception to 31 July 2024. The proposed strategy to be used in MEDLINE is shown in box 1.

Box 1

Search terms

# P: "nursing"[MeSH Terms] OR (Nursing*) OR "nurses"[MeSH Terms] OR (Nurse*) OR "students, nursing"[MeSH Terms] OR (students, nursing) OR (Pupil Nurses) OR (Student, Nursing) OR (Nurses, Pupil) OR (Nurse, Pupil) OR (Pupil Nurse) OR (Nursing Student) OR (Nursing Students) OR (Nursing Personnel) OR (Registered Nurse*) OR (“Nursing faculty members”) OR (nurse student) OR (student nurse)

# C: "Computer simulation"[MeSH Terms] OR "Simulation Training"[MeSH Terms] OR "Computer-Assisted Instruction"[MeSH Terms] OR "Virtual Reality"[MeSH Terms] OR "Augmented reality"[MeSH Terms] OR "High Fidelity Simulation Training"[MeSH Terms] OR (Computer simulation) OR (Simulation Training) OR (Computer-Assisted Instruction) OR (Virtual Reality) OR (Augmented reality) OR (Training, Simulation) OR (Simulation Exercise) OR (Patient Simulation) OR (Interactive Learning) OR (Learning, Interactive) OR (Computer Simulations) OR (Simulation, Computer) OR (Simulations, Computer) OR (Models, Computer) OR (Computerized Models) OR (Computerized Model) OR (Model, Computerized) OR (Computer-Assisted Instruction) OR (Virtual Simulation Game) OR (Simulation Game) OR (Simulation Gaming) OR (Clinical Simulation) OR (Programmed Instruction, Computerized) OR (Self-Instruction Programs, Computerized) OR (Simulations) OR (Simulat*) OR (Computerized Clinical Simulation Testing) OR (virtual patient*) OR (Serious Game*) OR (Game*) OR (Digital Games) OR (Augmented reality) OR (Interactive virtual simulation learning) OR (Screen-based simulated systems) OR (Virtual simulation gaming) OR (Conceptual simulation model) OR (Digital learning environment) OR (Virtual Learning Environment) OR (Mixed Reality)

# C: "Cardiology"[MeSH Terms] OR "Heart Diseases"[MeSH Terms] OR "Heart Valve Diseases"[MeSH Terms] OR "Cardiovascular Diseases"[MeSH Terms] OR "Cardiovascular System"[MeSH Terms] OR "Heart"[MeSH Terms] OR "Veins"[MeSH Terms] OR "Arteries"[MeSH Terms] OR (Cardiology) OR (Heart Diseases) OR (Heart Valve Diseases) OR (Cardiovascular System) OR (Heart) OR (Veins) OR (Arteries) OR (Heart Disease) OR (Cardiac Disease*) OR (Cardiac Disorders) OR (Cardiac Disorder) OR (Heart Disorders) OR (Heart Disorder) OR (Cardiovascular Disease*) OR (Major Adverse Cardiac Events) OR (Cardiac Event*) OR (Cardiac Event*, Adverse) OR (cardiac) OR (cardio*) OR (Heart Valve Disease) OR (Valve Disease, Heart) OR (Heart Valvular Disease) OR (Disease, Heart Valvular) OR (Heart Valvular Diseases) OR (Valvular Disease, Heart) OR (Valvular Heart Diseases) OR (Heart Disease, Valvular) OR (Valvular Heart Disease) OR (Cardiovascular Nursing) OR (Vascular Medicine) OR (Medicine, Vascular) OR (Angiology) OR (Cardiovascular Disease Specialty) OR (Disease Specialty, Cardiovascular) OR (Specialty, Cardiovascular Disease) OR (Hearts) OR (Vein) OR (Artery)

# P AND C AND C: Search: (("nursing"[MeSH Terms] OR (Nursing*) OR "nurses"[MeSH Terms] OR (Nurse*) OR "students, nursing"[MeSH Terms] OR (students, nursing) OR (Pupil Nurses) OR (Student, Nursing) OR (Nurses, Pupil) OR (Nurse, Pupil) OR (Pupil Nurse) OR (Nursing Student) OR (Nursing Students) OR (Nursing Personnel) OR (Registered Nurse*) OR ("Nursing faculty members") OR (nurse student) OR (student nurse)) AND ("Computer simulation"[MeSH Terms] OR "Simulation Training"[MeSH Terms] OR "Computer-Assisted Instruction"[MeSH Terms] OR "Virtual Reality"[MeSH Terms] OR "Augmented reality"[MeSH Terms] OR (Computer simulation) OR (Simulation Training) OR (Computer-Assisted Instruction) OR (Virtual Reality) OR (Augmented reality) OR (Patient Simulation) OR (Computer Simulations) OR (Simulation*, Computer) OR (Models, Computer) OR (Computerized Model*) OR (Computer-Assisted Instruction) OR (Virtual Simulation Game) OR (Simulation Game) OR (Simulation Gaming) OR (Clinical Simulation) OR (Programmed Instruction, Computerized) OR (Self-Instruction Programs, Computerized) OR (Simulations) OR (Simulat*) OR (Computerized Clinical Simulation Testing) OR (virtual patient*) OR (Serious Game*) OR (Game*) OR (Digital Games) OR (Augmented reality) OR (Interactive virtual simulation learning) OR (Screen-based simulated systems) OR (Virtual simulation gaming) OR (Conceptual simulation model) OR (Digital learning environment) OR (Virtual Learning Environment) OR (Mixed Reality))) AND ((("nursing"[MeSH Terms] OR (Nursing*) OR "nurses"[MeSH Terms] OR (Nurse*) OR "students, nursing"[MeSH Terms] OR (students, nursing) OR (Pupil Nurses) OR (Student, Nursing) OR (Nurses, Pupil) OR (Nurse, Pupil) OR (Pupil Nurse) OR (Nursing Student) OR (Nursing Students) OR (Nursing Personnel) OR (Registered Nurse*) OR ("Nursing faculty members") OR (nurse student) OR (student nurse)) AND ("Computer simulation"[MeSH Terms] OR "Simulation Training"[MeSH Terms] OR "Computer-Assisted Instruction"[MeSH Terms] OR "Virtual Reality"[MeSH Terms] OR "Augmented reality"[MeSH Terms] OR "High Fidelity Simulation Training"[MeSH Terms] OR (Computer simulation) OR (Simulation Training) OR (Computer-Assisted Instruction) OR (Virtual Reality) OR (Augmented reality) OR (Training, Simulation) OR (Simulation Exercise) OR (Patient Simulation) OR (Interactive Learning) OR (Learning, Interactive) OR (Computer Simulations) OR (Simulation, Computer) OR (Simulations, Computer) OR (Models, Computer) OR (Computerized Models) OR (Computerized Model) OR (Model, Computerized) OR (Computer-Assisted Instruction) OR (Virtual Simulation Game) OR (Simulation Game) OR (Simulation Gaming) OR (Clinical Simulation) OR (Programmed Instruction, Computerized) OR (Self-Instruction Programs, Computerized) OR (Simulations) OR (Simulat*) OR (Computerized Clinical Simulation Testing) OR (virtual patient*) OR (Serious Game*) OR (Game*) OR (Digital Games) OR (Augmented reality) OR (Interactive virtual simulation learning) OR (Screen-based simulated systems) OR (Virtual simulation gaming) OR (Conceptual simulation model) OR (Digital learning environment) OR (Virtual Learning Environment) OR (Mixed Reality))) AND ("Cardiology"[MeSH Terms] OR "Heart Diseases"[MeSH Terms] OR "Heart Valve Diseases"[MeSH Terms] OR "Cardiovascular Diseases"[MeSH Terms] OR "Cardiovascular System"[MeSH Terms] OR "Heart"[MeSH Terms] OR (Cardiology) OR (Heart Diseases) OR (Heart Valve Diseases) OR (Cardiovascular System) OR (Heart*) OR (Heart Disease) OR (Cardiac Disease*) OR (Cardiac Disorders) OR (Cardiac Disorder) OR (Heart Disorders) OR (Heart Disorder) OR (Cardiovascular Disease*) OR (Major Adverse Cardiac Events) OR (Cardiac Event*) OR (Cardiac Event*, Adverse) OR (cardiac) OR (cardio*) OR (Cardiovascular Nursing) OR (Vascular Medicine) OR (Medicine, Vascular) OR (Angiology) OR (Cardiovascular Disease Specialty)))

Source of evidence selection

Articles will be imported into Endnote software to exclude duplicates. After a pilot test, articles will be imported into Rayann software, and selection will be carried out based on inclusion criteria pre-specified in the review protocol (both title/abstract screening and full-text screening) by two independent reviewers. In cases of disagreement between reviewers, the opinion of a third reviewer will be requested. Grey literature studies will have the same standardised dynamics for analysis of published literature (peer review). The steps for selecting studies will be presented in a flowchart based on the PRISMA-ScR checklist.24

Data extraction

The extraction will be carried out by two reviewers independently using an instrument adapted from the JBI.23 The variables will be as follows: title, authors, country of origin, year and study design, objective of the study, population and sample size, type of virtual simulation, design and theory used to develop the virtual simulation, benefits and challenges of using simulation and gaps in the literature. During the data pruning process, a pruning table will be modified accordingly, and differences between reviewers will be resolved through discussion.

Evidence analysis

Review articles will have their quality and validity verified using JBI’s Critical Appraisal Tools (https://jbi.global/critical-appraisal-tools).

Analysis and presentation of results

The data will be analysed, and the results synthesised in a descriptive way, using tables and diagrams accompanied by descriptive summaries of the variables of importance for the review. When appropriate, broad themes and categories derived from the review questions will be accompanied by other illustrative formats (eg, tables or graphs, word clouds and infographics).

Strengths and limitations of this study

The scoping methodology allows the inclusion of all records that address the researched topic, resulting in a broad literature review and identification of knowledge gaps. To achieve this objective, it is necessary to systematise the methodological steps, which in this protocol occurred through the JBI guidelines for completing the PRISMA-ScR checklist, available in online supplemental file 1. In addition, the search strategies must include all keywords, synonyms and alternative terms in each database, available in online supplemental file 2.

Supplemental material

[bmjopen-2024-085965supp001.pdf]

Supplemental material

[bmjopen-2024-085965supp002.pdf]

The limitation of eight databases was defined by the time to complete the research as part of a Master’s thesis. The exclusion of records that included non-nursing participants is justified by the need to identify specific technologies for teaching cardiology in nursing. And the lack of consensus on the definition of VS may create a selection bias based on the researchers’ interpretation.

Contributions of the study

This study protocol presents the necessary steps to map the scientific literature and subsequently will guide the completion of a scoping review on the topic. According to JBI guidelines for scoping reviews, protocol preparation and registration are considered essential for limiting the occurrence of reporting bias.

Ethics and dissemination

The scoping review does not require approval from an ethics committee, as it does not involve data collection with human beings. The study is part of a cooperative research project between researchers from the Federal University of Piauí, Northeast of Brazil, and Queens University, Ontario, Canada, to develop and seek evidence of content validity of a VS game about valvular heart disease. An ethical pre-selection of the research project will be carried out at the Federal University of Piauí, Brazil, where the responsible researcher is completing her studies. The protocol and review will be published in peer-reviewed journals.

Patient and public involvement

Not applicable.

Ethics statements

Patient consent for publication

Not applicable.

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Footnotes

Contributors SdOC and ABBP drafted the protocol; contributed to the development of the selection criteria, data extraction criteria and search strategy; and approved the final protocol. RdSM contributed to the development of the selection criteria and data extraction criteria, developed search strategy and approved the final protocol. PKdL contributed to the development of the selection criteria, data extraction criteria and search strategy, approved the final protocol; and registered the protocol in Open Science Framework. EMLRA is the guarantor, and she conceptualised and drafted the protocol; contributed to the development of the selection criteria, data extraction criteria and search strategy; and approved the final protocol. ML-F conceptualised and drafted the protocol, contributed to the development of the selection criteria, data extraction criteria and search strategy; and approved the final protocol.
Funding This work was supported by a Canadian Alliance of Nurse Educators Using Simulation (CAN-Sim) 2022 Research and Innovation Grant and National Council for Scientific and Technological Development – CNPq.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, report or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Virtual simulation for teaching cardiology in nursing: a scoping review protocol (2024)

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Abstract

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STRENGTHS AND LIMITATIONS OF THIS STUDY

Introduction

Methods and analysis

Study design

Review questions

Inclusion criteria

Participants

Concept

Context

Evidence sources and search strategy

Search terms

Source of evidence selection

Data extraction

Evidence analysis

Analysis and presentation of results

Strengths and limitations of this study

Supplemental material

Supplemental material

Contributions of the study

Ethics and dissemination

Patient and public involvement

Ethics statements

Patient consent for publication

References

Footnotes

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