Inclusive pedagogy in online simulation-based learning in undergraduate nursing education: A scoping review protocol

Introduction

Education is recognised as a human and constitutional right (UNESCO, 1960; UNESCO, 2021; United Nations, 1948). However, access to and participation in higher education (HE) can be challenging for some students. Several factors (gender, marital status, pregnancy, race, religion and sexual orientation) are known to create challenges for students (European University Association, 2021; European Commission, 2020a; European Commission, 2020b). Further, some population groups are identified as being underrepresented in HE (low-income groups, women, minority groups linked to specific characteristics (e.g., ethnic/linguistic/religious/cultural/age or residence, and individuals with disabilities) (Salmi, 2020). This has led to the promotion of inclusion in education, with a particular focus on marginalised groups in society.

Inclusion can be conceptualised in many ways depending on various standpoints as it is considered highly context and philosophically bound (Messiou, 2017; Nilholm, 2021). As yet, no universal definition of inclusion exists. In education, the concept of inclusion is influenced by the UN Salamanca Statement regarding special needs education for children (UNESCO, 1994). That statement highlighted the importance of learner-centredness, the embracing of diversity, inclusion of all and pedagogy, which are equally applicable to the HE sector (Carballo et al., 2021; Floretta, 2021). The influence of ethical values such as social solidarity and respect towards the diversity of others are also prominent in the inclusion literature (Nilholm, 2021; Stentiford & Koutsouris, 2021).

Some inclusion terms are used interchangeably in HE literature and need clarification. Inclusive education works to identify and remove all barriers to education, and cover everything from curricula to pedagogy and teaching (UNESCO, 2021). In contrast, inclusive practice refers to any specific teaching practices that promote learning and engagement of all students (Moriña, 2020). Inclusive pedagogy extends beyond teaching practices to the rationale behind how and why they are used (Florian & Black-Hawkins, 2011).

Moriña (2020), encompasses four specific components in her framework of inclusive pedagogy: beliefs, knowledge, design and actions, which could be used to guide educators in HE and thus will be the focus of this review. The first component beliefs: begins with a view that students’ contribution is valuable to their own learning and to the learning of others (Moriña, 2020). Beliefs play a pivotal role in how educators develop their inclusive approaches. This can vary from providing for 1) needs common to all or 2) needs specific to sub-groups (e.g., an identified minority group) or 3) individual needs (Stentiford & Koutsouris, 2021). The second component encapsulates the vast body of knowledge required by educators regarding various T&L strategies, how to support students and their needs, how and what students learn, and how to identify and evaluate student learning (Moriña, 2020). Florian and Black-Hawkins (2011) go further and note that the “craft of knowledge” required by educators must also include the iterative process of reflection and problem solving as these shape what is carried out in teaching practice.

The third component, the design refers to the design of a pedagogy that recognizes the value of all students, involves them in the design of their studies from the beginning and meets the needs of as many students as possible (Gale & Mills, 2013; Moriña, 2020). The third component of Moriña (2020) inclusive pedagogy framework share the same ideals as the Inclusive Design Research Centre’s (IDRC) portrayal of the concept of “Inclusive Design”, whereby individuals are involved throughout the design process from the beginning (IDRC, 2022). Inclusive Design is a prime example of an equity/equality, diversity and inclusion (EDI) theoretical framework, underpinning accessibility and participation to the widest extent feasible (Eikhaug & Gheerawo, 2021). Zhang et al. (2017:4) define inclusive design as: “the methodology of co-designing technological solutions with user groups to personalise their learning …to best support each individual”. The interpretation is that regular discourse through co-design with students, creates opportunities for the continuous adaptation of teaching and learning (T&L) strategies. This framework can thus be used to gain insight into real challenges for students and identify shortfalls in inclusion (Eikhaug, 2019). Another example of an EDI framework is Universal Design for Learning (UDL), where the educator designs teaching strategies with multiple means of representation (the ‘what’ of learning), expression (the ‘how’ of learning) and engagement (the ‘why’ of learning) to cover the needs of all students (CAST, 2018).

The final element identified by Moriña (2020) refers to the actions or practices that ‘work with’ rather than ‘act on’ students. Developed practices include: flexible learning, student-centred learning and peer learning - the sharing of beliefs, knowledge, and experiences among students (Aguirre et al., 2021; Aguilar et al., 2020).

Internationally, several reports paved the way forward to promote inclusion for all students in education (UN, 1989; UN, 2006; UNESCO, 1994; UNESCO, 2017). These have inspired nations in the promotion of EDI in practice (European Commission, 2020b). In Ireland, six underrepresented priority groups in HE were identified (HEA, 2018) and initiatives such as the Delivering Equality of Opportunity in Schools (DEIS) programme, the Disability Access Route to Education (DARE) initiative, the Programme for Access to Higher Education (PATH), and the Higher Education Access Route (HEAR) were developed (Nic Fhlannchadha, 2018). This has resulted in a substantial increase in enrolment of these target groups into HE and a rapid increase in the diversity of our student population (IUA, 2018; HEA, 2020). This scene is replicated across Europe and the developed world and has implications for educators. They must now rethink traditional T&L strategies and pedagogies, to encompass inclusion principles and plan for current and future increases in student diversity (Arellanes & Hendricks, 2021; Neilis et al., 2021).

Teaching and learning in nursing education

In tandem with the EDI initiatives, educators are also influenced by the many technological advancements that have occurred recently in academic settings and nursing is no exception. T&L strategies are becoming more portable and digitally-based (Garcia-Tudela et al., 2020) and include a range of simulation-based learning (SBL) pedagogies including online simulations, virtual patients, serious gaming and 3-D simulations (Asad et al., 2021; Maheu-Cadotte et al., 2021). SBL is an educational method guided by a theoretical foundation used to “replace or amplify real experience with guided experiences” (Gaba, 2004, p.i2) and improve nursing students’ knowledge, communication and critical thinking skills as well as technical skills (Dubovi, 2018; Linn et al., 2019). The rapid growth of online simulation in nursing education reflects the advantages of this pedagogy: it is less time intensive than face-to-face SBL, it does not require significant resources (for example, high fidelity mannequins and facilitators) to function, and it has been shown to be comparable or superior to other simulation methods (Borg Sapiano et al., 2018; Dubovi, 2018). Other advantages include its flexibility and ease of access, it ensures standardisation of approaches to facilitation and debriefing for all, it allows repetitive practice and can be utilised simultaneously by all (Havola et al., 2021; Tinôco et al., 2021).

While online SBL does promote inclusion for all students by introducing a flexible and accessible learning strategy where students can learn at their own pace and at their chosen time and place, many of the underpinning theories supporting SBL were not developed to specifically target EDI principles. In order for online SBL to be a fully inclusive pedagogy an EDI theoretical framework should also be used to guide the process of the design of the simulation (Dede & Richards, 2020; Eikhaug & Gheerawo, 2021). Such frameworks are available, but it is unknown if nurse educators purposely utilise an EDI theoretical framework as a guide.

In summary, as online SBL is becoming more prevalent in undergraduate nursing education it is important to anchor this pedagogy to principles that support student diversity and inclusion. However, an initial exploratory search of the literature showed a lack of clarity regarding if and how inclusive pedagogy is being incorporated into online SBL. A comprehensive approach to inclusion would include all four components of inclusive pedagogy; however to date no primary research study has explored this. Therefore, a systematic synthesis of the literature is necessary to identify the degree to which each of the components of inclusive pedagogy has been reported and highlight barriers and facilitators to inclusion. This will enable us to address gaps in the literature as well as to make suggestions and recommendations for policy and practice. Furthermore, the findings from the scoping review will be used to reflect on how emerging trends may impact nurse educators' delivery of and nursing students experience of inclusive pedagogy.

Protocol

This scoping review will provide the rigorous mapping of the body of literature, to identify the presence of inclusive pedagogy in online SBL in undergraduate nursing education and will aim to identify any existing gaps in the literature (Pham et al., 2014; Munn et al., 2018). Arksey and O'Malley’s (2005) six-stage methodology framework, the Joanna Briggs Institute (JBI) guidelines (Peters et al., 2020) and the Preferred Reporting Items for Systematic Reviews and Meta-analyses for systematic review protocols (PRISMA-P) checklist has guided this scoping review protocol (Moher et al., 2015) (see Langan et al., 2022); and the PRISMA-ScR will guide the subsequent review (Page et al., 2021; Tricco et al., 2018).

Design

Aim and objectives

The aim of this scoping review protocol is to explore the evidence reporting the use of inclusive pedagogy in online SBL in undergraduate nursing education. The following objectives will be addressed:

Study status

The scoping review protocol is in stage 5, and is in the analysis phase.

Conclusion

Online SBL is a growing pedagogy in nursing education and research (Jackson et al., 2022; Stenseth et al., 2022). In response to national policies, nurse educators are embedding EDI principles across curricula and seek strategies to ensure access and participation of all their students. However, to the best of the authors’ knowledge, no review exists which investigates the use of inclusive pedagogy in online SBL within undergraduate nursing education. This paper describes a review protocol that seeks to synthesize the literature on this topic. It will expose what is (un)known and will identify any existing gaps in the literature This review will have benefits for both informing and improving nursing education for both educators and students, as well as clinical practice. The results of the scoping review will be published in a peer-reviewed journal and presented at local, regional, national and international conferences.

Data availability