Transforming nurse education through co-design

: creating an effective high-fidelity simulation scenario

Abstract

Background: High-Fidelity Simulation (HFS) is increasingly recognized as a valuable teaching modality in healthcare education, particularly for its ability to enhance clinical skills and critical thinking among nursing students. However, the adoption of HFS often faces challenges such as limited faculty engagement, lack of culturally relevant scenarios and inadequate resources. This research explored the need for a structured approach to implementing HFS in paediatric nursing education at the College of Nursing in Kuwait, seeking to improve the quality of nursing education and student outcomes.

Aim: The primary aim of this study was to develop and evaluate a co-design approach which involves stakeholders in the creation and integration of culturally relevant HFS scenarios tailored to the needs of paediatric nursing students in Kuwait. This approach seeks to overcome existing barriers to HFS adoption, enhance faculty engagement and improve student motivation and learning outcomes.

Methods: The study employed a sequential approach structured around four phases to develop and evaluate a co-design process for integrating culturally relevant HFS scenarios into paediatric nursing education in Kuwait:
Phase One: The study commenced with an umbrella review of 27 systematic reviews, sixteen from the period 2005 to early 2020 and eleven more recent from 2020 to 2024. This review synthesized findings on the impact of HFS in undergraduate nursing education, providing a comprehensive evidence base on its benefits in areas such as knowledge acquisition, critical thinking and clinical skills. The review also identified gaps in the existing research, particularly in the variability of evaluation tools, which guided the selection of appropriate methodologies for the subsequent phases.

Phase Two (Step One in Co-Design): This phase employed qualitative methods to explore nursing faculty perceptions at the College of Nursing in Kuwait regarding the adoption of HFS. Using methodological triangulation, data were collected through individual interviews and focus group. The qualitative data were analysed using thematic analysis, which involved identifying, analysing and reporting patterns (themes) within the data. This analysis provided insights into the facilitators and barriers to implementing HFS, informing the co-design process in the next phase.

Phase Three (Step Two in Co-Design): In this phase, a co-design workshop was conducted with nursing faculty, practising nurses and students. The participants collaboratively adapted an existing UK-based HFS scenario to the Kuwaiti context. The workshop involved iterative discussions and refinements to ensure the scenario's cultural relevance and applicability. Additionally, a 'train the trainer' course was devised to prepare faculty for the implementation of the co-designed scenario. This course included both instructional videos and hands-on practice, equipping faculty with the necessary skills and confidence.

Phase Four (Step Three in Co-Design): The final phase involved the evaluation of the co-designed HFS scenario with 51 paediatric nursing students. Data were collected using the Reduced Instructional Materials Motivation Survey (RIMMS), which is based on the ARCS-V framework, to assess student motivation across dimensions such as attention, relevance, confidence and satisfaction. Qualitative feedback was also gathered through open-ended questions to gain deeper insights into the student experience. The quantitative data were analysed statistically whereas the qualitative data were subjected to thematic analysis to identify common themes and areas for improvement.
Results: The umbrella review demonstrated that HFS significantly enhances educational outcomes such as knowledge acquisition, critical thinking, clinical skills, communication, confidence and satisfaction among nursing students. Building on these findings, the exploration phase of the co-design process, guided by the framework of Iniesto, Charitonos and Littlejohn (2022), identified key facilitators and barriers to HFS adoption at the College of Nursing in Kuwait. These included the need for technical support, faculty training and collaboration with practising nurses to ensure that the scenarios reflected real-world clinical practices. Faculty insights during this phase were instrumental in shaping the development of culturally relevant HFS scenarios. In the subsequent co-design phase, stakeholders – including faculty, practising nurses and students – collaboratively adapted the HFS scenarios to ensure that they were culturally appropriate and practically applicable in the Kuwaiti context. This collaborative effort resulted in a co-designed HFS scenario which effectively addressed the specific needs of the local educational environment. The final evaluation of the co-designed HFS scenario, involving 51 paediatric nursing students, revealed high levels of student attention, relevance, confidence and satisfaction. However, the evaluation also identified areas for improvement, such as the need for a variety of scenarios to cover diverse clinical situations.

Conclusion: This study demonstrates the effectiveness of using a structured co-design approach, guided by the framework of Iniesto, Charitonos and Littlejohn (2022), to develop and implement culturally relevant HFS scenarios in paediatric nursing education in Kuwait. Through a systematic process involving an umbrella review, faculty exploration, scenario co-design and final evaluation, the study addressed key barriers to HFS adoption, such as the need for enhanced technical support and comprehensive faculty training. The involvement of practising nurses was particularly crucial in ensuring that the scenarios were grounded in real-world clinical practices, thereby increasing their relevance and applicability. The final evaluation of the co-designed scenarios showed significant improvements in student motivation while also highlighting areas for further refinement, such as the need for privacy during simulations and a broader range of scenarios. Overall, this research provides a valuable framework for the successful integration of HFS into nursing education, emphasizing the importance of stakeholder involvement and continuous feedback to create effective and sustainable educational tools.

Thesis is embargoed until 31 July 2028.

Date of Award	Jul 2025
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Kuwait Civil Service Commission
Supervisor	Olinda Santin (Supervisor), Billiejoan Rice (Supervisor) & Janine Stockdale (Supervisor)