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NR 621 Literature review

NR 621 Literature review

Literature review 

In role-play activities, participants are assigned to work in small groups and to analyze assigned tasks based on the learning objectives as identified both by individuals in a group and by the group as a whole. They will meet with a tutor, discuss given issues, and assist one another in cognitively connecting newly learned knowledge and new concepts to generate new meanings for their learning. PBL stands for process-oriented learning. It allows pupils to work together in small groups to find answers to problems they’ve been given. The development of problem-solving abilities and the strong bonds formed among participants during role-playing games are far more significant than accurate responses to the prescribed problems (Zhan, 2012). The practice of role-playing focuses on a succession of settings and situations to promote students’ learning motivation and knowledge acquisition, since the theological foundation of PBL is constructivism, which asserts that the attainment of new information is built on learners’ existing knowledge. The students co-constructed information through their group effort and exhibited a high degree of engagement during the roleplay planning and execution. They were able to experience the varied characters’ worries and answers both during their own role-play and while watching other groups’ role-plays. The literature is organized into below themes and subthemes will be organized into three themes:

Roles playing improves the practice problem-solving skills & learning the principles of patient education

Clinical skill teaching techniques are not relevant to actual clinical settings, which is one of nursing education’s flaws. Students, on the other hand, require genuine clinical situations in order to develop problem-solving abilities. Students are provided this opportunity through role-playing, which allows them to place themselves in real-life situations and act appropriately. Students learn how to cope with real-life events and difficulties as a result of this. Role-playing can improve students’ clinical performance by increasing their understanding of diverse circumstances while also reducing their stress. Students’ self-confidence and willingness to study improve as a result of this technique, which leads to better patient outcomes. According to Kirkpatrick’s assessment methodology, role-playing was helpful in improving nursing students’ learning outcomes (Safoura, et.al 2018). According to the assessment methodology, role-playing enhanced nursing students’ knowledge, which led to greater patient satisfaction. Kirkpatrick’s methodology improves the efficiency with which nursing students acquire the concepts of patient education. So, that they could demonstrate a better performance as nurses, i.e., one of the main goals of medical sciences education, which leads to a higher quality of care services in the country.( Safoura, et.al 2018)

NR 621 Literature review

Role-plays promote critical thinking and encourage creativity

In practise, critical thinking not only assists students in processing complicated concepts and interpreting the validity of external data, but it also allows us to discern between what is reasonable and what is illogical. Critical thinking is largely reliant on decision-making, problem-solving, and management of contentious situations in our daily lives (Couger, 1995). Role-playing helps students to critically reflect on their impressions of the patient’s needs and feelings through active participation in the role-play as well as observation of other groups’ role-plays.  Critical thinking, in particular, was thought to be encouraged in the PBL class, based on comments from about four students on how roleplay benefited their learning. We will identify and consider the assumptions that underpin our conclusions (or judgments) from multiple perspectives, justify or even modify our beliefs and actions as needed, articulate our ideas and points of view, and, most importantly, evaluate the decisions we have made and the potential commitments we have made (DeYoung, 2003). In the PBL classroom, the role-playing learning technique complements the aforementioned four requirements for creative thinking. The groups of five kids, for example, were well acquainted with one another and had developed the essential trust and support to provide psychological safety. The internal locus of assessment was boosted by students participating in and witnessing their own and other students’ role-play performances. Writing the role-play scripts and portraying the many characters in the role-play needed an open mind and new experience. The students’ comment on their involvement in the PBL lesson with the role-playing approach and creativity is as follows.

Role-play as a simulation methodology

In a variety of fields and with learners of various ages, role-playing is used as a training approach to gain information, attitudes, and abilities (e.g. language learning, cross-cultural training, business and human resources) (Nestel, and Tierney, 2007). Role-playing is pretty consistently characterised in the education and training literature, despite its broad use. Role-playing exercises can be done in a variety of ways. For the development of patient-centered interviewing skills, we frequently employ a method in which students act out the role of a medical student and are expected to perform as they would in real-life clinical interactions. There are, however, several variants on this topic. Role-playing can be entirely scripted (all participants act out scripts verbatim) or partially scripted (players are given certain cues, such as an introductory phrase). Alternatively, one participant (for example, a patient) is given a job description while the other (for example, a student) is given their assignment. Within a single role-play, participants can move between roles to obtain insight into other roles or viewpoints, or observers can substitute actors at various times throughout the role-play. Role cards are used in some role-playing events to inject fresh information into a role-play.

Teachers’ impacts on incivility

The articles hold teachers have a significant impact on incivility as they are sometimes cause of the disruptive behaviors. Erturk  (2015), for instance, hold that teachers who use punishment in an attempt to correct students for disruptive behavior end up making the situation worse. Latif et al. (2016) elucidate that the teachers’ behaviors may cause students’ behaviors.

NR 621 Literature review

Peer role-playing Simulation

Simulations that are based on good educational principles and theorems and give an actual chance for performance practise have been demonstrated to aid in the development of clinical competency and learner satisfaction (Yamauchi, 2021). Peer role-playing will allow educators to polish medical students’ proficiency in musculoskeletal physical exams, clinical reasoning, and diagnosis in a clinical context using a low-fidelity simulation and practical teaching opportunity. Students who underwent peer role-playing as a low-fidelity simulation for MSK cases improved their proficiency in completing a physical examination, exercising clinical reasoning, and diagnosing in a clinical environment, according to Yamauchi et al (2021).

Struggles for students with uncivil behaviors

Several publications addressed the issue of struggle, describing how disruptive actions cause pupils to agonise. According to Vizeshfar, Fatemeh, and Dehghanrad (2016), students with disruptive behaviours have a harder time performing in-class examinations because they put less effort into class activities. Low-achieving students, according to Kessels and Heyder (2020), often find disruptive conduct helpful since it results in a lack of effort in class.

 These themes are related to the PICOT question, “Among nursing educators, is a role-playing intervention, compared to cognitive rehearsal intervention, more effective strategy in the management of incivility as measured by a pre and post-test of learner perceptives of a positive learning environment?”. The goal of the PICOT question is to come up with a variety of methods to assist prevent students with disruptive behaviours from misbehaving. That being said, zero-tolerance rules, which have proven to be effective in dealing with uncivil behaviour in educational institutions, are one of the best practises associated with the intervention.

NR 621 Literature review


Safoura, D., Mansoureh, A., Elnaz, M., & Hamid, H. (2018). Effect of role-playing on learning outcome of nursing students based on the Kirkpatrick evaluation model. Journal of Education and Health Promotion (Vols. 1 to 10; 10: 415–425),https://doi.org/10.4103/jehp.jehp_138_19   

 Chan, Z. (2012). Role-playing in the problembased learning class. Nurse Educ Pract. 12(1):21-7 https://doi.org/10.1016/j.nepr.2011.04.008  

 Yamauchi, K., Hagiwara, Y., Iwakura, N., Kubo, S., Sato, A., Ohtsuru, T., Okazaki, K., & Okubo, Y. (2021). Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations. BMC medical education, 21(1), 322. https://doi.org/10.1186/s12909-021-02742-4  

Erturk, E. (2015). Evaluation of Role Play as a Teaching Strategy in a Systems Analysis and Design Course. International Journal of Learning. 13. 150-159.

(https://www.researchgate.net/publication/284285165_Evaluation_of_Role_Play_as_a_Teaching_Strategy_in_a_Systems_Analysis_and_Design_Course )  

NR 621 Literature review

Nestel, D., Tierney, T. (2007). Role-play for medical students learning about communication: Guidelines for maximising benefits. BMC Med Educ 7, 3. https://doi.org/10.1186/1472-6920-7-3  

 Vizeshfar, Fatemeh & Dehghanrad, J. (2016). Effects of Applying Role Playing Approach on Nursing Students’ Education. International journal of humanities and cultural studies. Vol 8, No 1 (2021)  (https://www.researchgate.net/publication/307378846_Effects_of_Applying_Role_Playing_Approach_on_Nursing_Students’_Education )

 Sebold, L., Julia, E., & Vivian, C. (2018). Role-playing: teaching strategy that encourages reflections on nursing care. Revista brasileira de enfermagem. 71. 2706-2712. https://doi.org/10.1590/0034-7167-2017-0733

Liset, S. (2020). Role play: quasiexperiment for the development of social skills. International Journal of Early Childhood Special Education 12(1):496-502, https://doi.org/10.9756/INT-JECSE/V12I1.201030   

NR 621 Literature review

Dhea, M.(2017). The Effectiveness of Role Play Techniques in Teaching Speaking for EFL College Students, Journal of Language Teaching and Research 8(5):863,
https://doi.org/ 10.17507/jltr.0805.04     

Rebecca, J. (1987).Role Playing As a Group Intervention. Small Group Behavior, Vol: 1: 4, page(s): 470-482, https://doi.org/10.1177/104649648701800403  (https://www.journals.uchicago.edu/doi/full/10.1086/712494

NR 621 Literature review

Appendix A

Research Summary Table Template

Author (Date)DesignSample/SettingFindingsMeasures (Outcomes)Limitations/Evidence Level
Safoura, D., Mansoureh, A., Elnaz, M., & Hamid, H. (2018). The role-playing teaching approach was used in a quasi-experimental research. The learning outcomes were assessed using Kirkpatrick’s methodology.74 nursing students at Iran University of Medical Sciences were selected. The participants were selected through census and were randomly allocated to control (n = 35) and experimental (n = 39) groups.Patients in the experimental group were more happy with patient educational performance than those in the control group.The Kirkpatrick’s model found that using the role-playing technique enhanced nursing students’ learning outcomes.Some of the questions were difficult to complete out due to the poor education level of some of the patients. Another restriction was the age disparity between the two groups of students. The kids were also randomly assigned to two classrooms by the education department; it was impossible to homogenise the children in terms of age.
Yamauchi, K., Hagiwara, Y., Iwakura, N., Kubo, S., Sato, A., Ohtsuru, T., Okazaki, K., & Okubo, Y. (2021).Simulation programme which used Peer role-play (student to student), Learners had to use two programme competencies: (1) to perform an MSK physical examination and (2) to present their clinical reasoning process 90 fifth-year female medical students, women’s medical university, who participated as part of their orthopaedic clinical clerkship rotationMedical students that participate in a peer role-playing simulation programme may increase their clinical abilities in physical examination, clinical reasoning, and diagnosis, as well as their overall clinical competency in MSK outpatient interactions.Medical students who participated in peer role-playing simulation programme have improved clinical skills. Because the students who participated in this study were all female and from a women’s medical university, the findings may not apply to the whole teenage population. The fact that each group had a varied number of participants was a second restriction. Third, because the students cycle through the orthopaedic clerkship throughout a year, their learning stages range slightly from group to group.
 Chan, Z. (2012).Development of a classroom-based innovation using role-play, and PBL case scenarioThe PBL class for higher diploma year-one nurse students (a total of 20 students, five per group).Students’ learning motivation, inventiveness, and knowledge of the patient’s and family’s requirements improve when role-plays are included in PBL.Traditional PBL, which stresses problem-solving abilities, was enhanced by this learning activity, which emphasised creativity and a student-driven approach.First, this exercise may not encourage pupils who are not engaged in role-playing or who are bashful. Second, at this time, there is no objective means to measure students’ level of comprehension of a subject by watching role-plays.
Erturk, E. (2015). Learning  design  plans  were  prepared with the expectation that role play activities would contribute positively.It  has involved  students  in  the  computing  and  information  technology bachelor’s  degree  programme.Disruptive behaviour was found to have a negative impact on students’ success, despite instructors’ attitudes and the learning institution’s disciplinary policies being inadequate. Throughout the sessions, students and their replies received a lot of good comments and acknowledgment.Teachers must develop their asking abilities in order to excite students during role play and then assist them reflect. Although it is critical to finish the lesson on time, it has been proven that giving students additional time to think about and prepare replies is advantageous.The role play activities in this course have been concise and experimental
Nestel, D., Tierney, T. (2007)Qualitative analysis, In the pre-session questionnaire, was used to ask students about their experiences of role-play and asked to identify helpful and unhelpful elements. Descriptive statistics were used to analyse quantitative data and qualitative data was thematically analysed.First-year undergraduate medical students participated in a role-play session as part of their communication programmeStudents stated that chances for observation, practise, and discussion, realistic roles, and alignment of roles with other elements of the curriculum were the most beneficial components of role-playing.Students appreciated role-playing in the development of communication skills, despite some past negative experiences. Adequate preparation, alignment of roles and tasks with level of practise, organised feedback standards, and recognition of the value of social connections for learning are all criteria for effective role-playing.Because the study was part of a communication curriculum, students’ replies may have been skewed toward socially desirable responses. The replies were only collected from first-year medical students and may not represent those of students farther along in their medical study, graduates, or students at other medical institutions.
Vizeshfar, Fatemeh & Dehghanrad, J. (2016). Quasi-experimental study design was used. Experimental study was done where one group of students was taught using role-playing and the control group was  taught using traditional approach228 nursing students at Shiraz University and which were randomly allocated  in  role  playing  and  traditional  training  groups  to  participate  in  a  4  hour workshop.The role-playing results were higher than the writing exam and statistically significant. The average score and gender have a strong relationship.Role playing is an effective and  attractive method in education  of students and as a model of teaching, in addition to association of students, improved group working morale and led to learning of students from each otherThe study involved just 228 nursing students from a single university, which restricted the entire student population.
Rebecca, J. (1987).Learning  design  plans and exploratory research. A classification scheme for organizing these diverse role-playing uses, in terms of intraindividual and intact group change, isPresented in this research.secondary research, reviewing available literature and explaining the role playing strategiesThe influence of role playing on improving sensitivity to other people’s feelings is a key characteristic. The fact that actions and their consequences are amplified is a key feature of role playing that separates it from real-life experience.Role acting is an effective and appealing form of student education, and as a teaching model, it boosted group working morale and allowed students to learn from one other.These reviews often fail to provide details of the overall research strategy.
Liset, S. (2020). The quantitative-quasi-experimental methodology was applied79 students of the Intercultural Education specialtyAt the conclusion of the intervention, there is a substantial difference, demonstrating the impact of the role-playing approach on various social skills and the relevance of employing active methodology in higher education.The use of role-playing facilitated social interaction by promoting individual and group components such as decision-making, cooperation, and the ability to express oneself.The research was conducted on only 79 nursing students and in only one university which limited the overall population of students.
Dhea, M.(2017). Pre-test and post-test , Questionnaires. Pilot administration of the test was done. The students are 40 college language students in University of Baghdad, College of Education Ibn-RushdThe findings of this study show that the therapy used had an impact on the outcomes; hence, it can be inferred that employing role-play as a classroom approach can help Iraqi EFL students perform better on a speaking exam.Role-playing tactics created an engaging atmosphere in which the kids could thrive. The experimental group’s vocabulary improved slightly more than the control group’s, but not considerably. Students’ receptive abilities improved, although not as much as their producing abilities.The study depended entirely on the secondary resources.  
Sebold, L., Julia, E., & Vivian, C. (2018). Qualitative research with descriptive-exploratory approach and documentary base.The data were collected from portfolios of 32 students from an undergraduate course in the Southern Brazil.Teachers and other students have noticed that using role-playing as a technique for teaching the topic of care to undergraduate students has benefited the students’ self-perception as nurses, seizing the essence of their future vocation.The role-playing method aided the pedagogical dynamic in nursing education, addressing the relationship between trust and care, and demonstrating that placing oneself in the shoes of another is a difficult job that takes training.The fact that this study was conducted in a single setting is viewed as a restriction, because generalisations regarding the results must be made while taking into account the unique characteristics of each situation.

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