Nursing students' perceptions of combining hands-on simulation with simulated patients and a serious game in preparing for clinical placement in home healthcare: A qualitative study

Background: There is a growing demand to provide complex healthcare services in patients' own homes. However, high quality home healthcare clinical placements are often difficult to obtain, and arranging laboratory based simulations to provide relevant clinical-practical learning experiences for all students is resource intensive.Objectives: The aim of this study was to explore nursing students' perceptions of using a blended simulation approach, including hands-on simulation with simulated patients and a video-based serious game, in preparation for their home healthcare clinical placements.Design: An exploratory qualitative design using focus group interviews was utilized.Setting and participants: Secondand third-year nursing students in home healthcare courses in Norway participated in this study.Methods: Five focus group interviews were conducted with a total of 26 nursing students. Data were collected over two semesters in three home healthcare courses. The data were analyzed using thematic content analysis.Results: The study identified four main themes that influenced students' perceptions of combining the two simulations. These included personal engagement, contextual and environmental factors, a safe and structured learning environment, as well as organizational and technical factors. In relation to the different themes, students expressed that disadvantages in one simulation were counteracted in the other.Conclusions: The blended simulation approach was perceived to address curricular objectives in different but complementary ways. The blended simulation approach was perceived to facilitate personal engagement and reflections and to provide relevant clinical-practical learning experiences. However, results also indicated that the organization of such a blended simulation approach (i.e., group compositions and size), facilitation from teachers, and technical issues (i.e., with medical equipment and the serious game) may influence students' perceptions and satisfaction directly. The results should provide useful information for designing future teaching strategies in Bachelor of Nursing programs.