Virtual Simulation Curriculum Technology Proposal

Introduction

The use of technology in the field of nursing is of utmost importance since the better equipment healthcare practitioners use, the higher the quality of their services is. The process of educating nursing students requires the most innovative approaches, as well. The current proposal was created with the aim of introducing virtual simulation (VS) into the community health nursing course “The Role of the BSN Nurse in Promoting Community Health.” The review of literature allowed singling out the most relevant topics of academic interest related to technologies in education, as well as finding gaps in current curriculum technology. The synthesis of scholarly studies and the needs gap analysis allowed concluding that the current technology – manikin simulation – is rather beneficial, but it does not provide as much accessibility and innovativeness as VS.

The needs assessment revealed three potential challenges to technology change: cost, availability, and impossibility of updating. At the same time, it was expected that the collaboration between the three main groups of stakeholders – administration, faculty, and students – would enable overcoming the barriers. The force field analysis presented facilitating forces (flexibility, promotion of critical thinking, and improvement of practical skills), as well as impeding ones (budgetary deficiency, faculty’s resistance to change, and learners’ dissatisfaction). The change theory suggested for the technology change was Kurt Lewin’s three-phase change model. With the help of the unfreezing, change process, and refreezing stages, it became possible to introduce the desired change and sustain it. The conclusion reflects the rationale and purpose of the proposal and explains its significance for the broader field of nursing and the community. The conclusion also explains how the curriculum gap can be filled with the help of the proposed change.

Table 1. Literature Review Summary Table

First Author (PubYear)	Title	Purpose	Context	Findings	Relevance	Strength of Evidence
Foronda (2020)	“Virtual simulation in nursing education: A systematic review spanning 1996 to 2018”	The authors’ focus was on identifying the influence of VS on nursing students’ learning outcomes. The purpose was associated with the growing popularity of VS and the need to prove its effective-ness to the faculty.	80 full-text peer-reviewed articles focused on VS as an educational tool for nursing students were analyzed by the authors. The systematic review evaluated and synthesized the findings from scholarly studies published between 1996 and 2018 and containing research from 15 countries.	VS was reported to have a beneficial impact on nursing students’ learning outcomes. Additionally, such indicators as critical thinking, self-confidence, learner satisfaction, and skill performance were found to improve with the use of VS.	The review is relevant to the proposal since it provides the synthesis of findings proving the positive effect of implementing VS in nursing students’ education.	Level of evidence: 1 – a systematic review Strengths: a wide range of scholarly studies have been analyzed, which testifies the reliability of findings; the authors analyzed a variety of factors that can be influenced by the inclusion of VS in educational programs. Weaknesses: the search was limited by the key phrase ‘virtual simulation,’ which excluded the analysis of other types of learning games; due to the variety of studies included in the review, the authors were not able to conduct a meta-analysis.
Gu (2017)	“The effects of vSIM for Nursing™ as a teaching strategy on fundamentals of nursing education in under-graduates”	The purpose was to investigate the effectiveness of a VS program “vSIM for Nursing” as a supplemental method of education for undergraduate students. .	28 second-year students of a university in China were randomly assigned to a control or experimental group (27 completed the procedure).	The inclusion of VS in the learning process enabled students to demonstrate better results. VS can be suggested for use in nursing universities as a supplementary strategy enhancing students’ practical skills and knowledge.	The article is relevant to the proposal since it illustrates how effective VS is in the education process of nursing students. The authors mention the benefits of VS as opposed to manikin-based one.	Level of evidence: 2 – a randomized controlled trial Strengths: randomized assignment of students into groups allowed for valid results; instantaneous feedback, which promoted the transfer of skills and knowledge. Weaknesses: the sample was rather small (28 consented, one withdrew); the VS program was developed in English, which might have caused difficulty to some of the participants.
Padilha (2018)	“Clinical virtual simulation in nursing education”	The purpose of the article was to determine the motives of pregraduate nursing students to engage in VS exercises. Also, the authors aimed to evaluate the level of usefulness and simplicity of virtual simulators for the mentioned population.	426 pregraduate students from a Portuguese nursing school filled out a questionnaire regarding their attitudes toward the use of virtual simulators in the learning process.	The research found high degrees of perceived usefulness and ease of VS in nursing education. Also, researchers reported a high rate of students’ intention to engage in VS games.	The article is relevant to the proposal since it investigates the level of VS acceptance by nursing students. Findings indicate that the inclusion of VS in educational programs is likely to bring positive results.	Level of evidence: 4 – an exploratory, descriptive, cross-sectional study (using a quantitative approach) Strengths: the use of a ten-point Likert scale allowed for the maximally precise choices of answers; a large sample of students was utilized in the study. Weaknesses: the research was based on Portuguese nursing students, which does not allow for generalizing findings to learners from other countries; the numbers of female and male respondents were highly unequal (86.9% and 13.1%, respectively), which prevented researchers from making valid conclusions about the differences in genders’ perceptions of virtual simulators in education.
Shin (2019)	“Educational characteristics of virtual simulation in nursing: An integrative review”	The focus of researchers was on singling out the educational features of VS as a potential strategy to employ in nursing education.	By utilizing Whittemore and Knafl’s integrative review method, the authors found 40 scholarly articles meeting the inclusion criteria (published between 2011 and 2016, research was conducted in the nursing field). The contents of selected studies were analyzed with the aim of singling out the educational characteristics of VS.	Fourteen educational characteristics of VS in the nursing field were identified: seven general and seven virtual-specific. General features included the theoretical framework, simulation feedback, teaching approach, the aim of simulation, scenario, debriefing method, and outcome. Virtual-specific features were virtual ethics, interaction, representation mode, the role of participants, the competency of the instructor, virtual framework, and platform type.	The study is relevant to the proposal since it outlines a variety of characteristics on which the success of implementing VS in the educational nursing environment depends.	Level of evidence: 1 – an integrative review Strengths: a comprehensive list of VS’s features was compiled, which allowed singling out the factors to consider when integrating this educational method; a thorough process of inclusion/exclusion was performed. Weaknesses: a comparatively small sample of studies was utilized; only 75% of the studies under analysis had nursing students as subjects, whereas 25% focused on registered nurses.
Verkuyl (2017)	“Virtual gaming simulation for nursing education: An experiment”	The study aimed at comparing laboratory and VS in regard to three outcomes: students’ satisfaction, self-efficacy, and pediatric knowledge.	The population was composed of students who had completed a second year in a baccalaureate program or were engaged in an RPN to BScN bridging program. The control group worked on case scenarios, whereas the experimental group played VS games.	A small knowledge gain was found in the experimental group as compared to the control group. What concerns self-efficacy, students engaged in VS reported higher gains.	The study is relevant to the proposal since it defends the usefulness of VS in nursing students’ learning. The authors concluded that VS could benefit students’ knowledge and skills.	Level of evidence: 2 – an experimental design Strengths: VS was found to offer a higher degree of accessibility to education; no previous pediatric experience was reported by the majority of respondents. Weaknesses: only pediatric students were involved in the experiment; a five-point Likert scale was used, which did not allow for precise answers to questions.

Evidence Summary

The analysis of literature allowed singling out two key themes regarding the use of the selected technology in nursing students’ education. The first topic investigated and grounded by scholars in the usefulness of VS as a methodology for nursing students’ education (Foronda et al., 2020; Gu et al., 2017; Verkuyl et al., 2017). Scholars reported the positive effect of VS on learning outcomes (Foronda et al., 2020; Gu et al., 2017). Even though one study did not find a significant knowledge gain in those students who engaged in VS games, its authors still considered VS a highly potential approach to boosting learners’ self-efficacy (Verkuyl et al., 2017). Foronda et al. (2020) mentioned that VS had a positive influence on learning outcomes. Gu et al. (2017) emphasized the role of VS in improving nursing students’ practical skills. Overall, the findings of the mentioned articles indicated that VS was a prospective method of teaching nursing students.

The second key theme was the willingness of nursing students to engage in virtual simulation games. Padilha et al. (2018) and Shin et al. (2019) found a high rate of students’ perceived intention to engage in VS. Learners were reported to consider VS as a crucial complementary strategy (Padilha et al., 2018). In addition to that, Shin et al. (2019) recommended a set of characteristics the inclusion of which was expected to make VS games most productive. Scholars also noted that nursing students’ interest in technology was growing due to innovation being “demand and reality” (Padilha et al., 2018, p. 13). VS was mentioned to assist clinical practice skills (Foronda et al., 2020; Gu et al., 2017; Padilha et al., 2018; Shin et al., 2019; Verkuyl et al., 2017). The review of literature showed that nursing students were interested in VS games and that VS was an effective learning tool. However, the analysis also revealed some gaps in the use of technology in nursing education, which will be discussed further.

Discussion of Gaps in the Use of Technology in Nursing Education

Despite the evident benefits of VS as a teaching and learning tool, there still exist some gaps in its use. First of all, VS is not widely used due to the fact that some educational institutions cannot afford to buy the necessary software. Technology use is gaining more and more attention in the modern educational system, yet some medical colleges and universities may not be ready to spend extra money on VS games. However, as pointed out by Foronda et al. (2020), Gu et al. (2017), and Verkuyl et al. (2017), VS is less expensive than manikin-based or laboratory simulation. Whereas the latter two types are more conventional, and faculty members are more accustomed to them, scholarly findings indicate that purchasing VS software proves more cost-efficient (Verkuyl et al., 2017). Hence, extra expenditures faced by institutions will be compensated rather quickly.

Another gap in technology use is concerned with its practical inclusion in the educational process. Many teachers are not acquainted with modern technologies to the necessary extent. Therefore, they would require additional time and effort to master VS games before teaching them to their students. The latter may also feel uncomfortable at first, being forced to apply their skills not on manikins but by means of virtual tools. This knowledge gap is closely linked to the possible need for hiring additional personnel at least temporarily, who would explain the basics of VS to professors and/or students. However, it is crucial to understand that VS is less “time intensive” than manikin-based simulation (Gu et al., 2017, p. 196). Therefore, even while the initial phase of implementing VS might pose some difficulties, both financial and knowledge gaps can and should be overcome due to the benefits they will generate.

Needs Assessment

To confirm the need for the proposed technology, an affinity analysis among stakeholders was performed. Specifically, administration, faculty, and students as key stakeholder groups were asked about attitudes towards and expectations of the VS implementation in the learning process. Whereas students and faculty made emphasis on the need to enhance practical simulation via the adoption of new technologies, they also admitted the low level of preparedness to the innovation. Additionally, technical requirements to VS games were an issue of concern since educators noticed the deficiency of computers, as well as the lack of software quality and accessibility. Technical requirements for VS adoption included the presence of high-quality audio and visual tools, the sufficient number of computers in technical laboratories, and the possibility to schedule students’ attendance of those labs.

On the part of administration, the major concerns were associated with the need to find additional financial resources. Both purchasing software and hiring temporary personnel posed a difficulty to the educational institution. However, stakeholders agreed that for the process to be maximally successful, the suggested technology implementation should correspond to the SMART goal requirements. Hence, during the needs assessment, faculty was made responsible for making sure that the goals of VS introduction in the learning process would be specific, relevant, measurable, attainable, and time-bound (Bjerke & Renger, 2017). Current indicators of students’ practical skills level were quite satisfactory, but there was a potential for improvement. Thus, all three groups of stakeholders admitted that despite the need for additional expenses and schedule changes, the VS technology was crucial for adopting.

Need-Gap Analysis

To conduct a needs assessment, students and faculty members were asked about the drawbacks of the current curriculum technology (manikin simulation) compared to VS. The evaluation included such aspects as time- and cost-efficiency, availability, and the potential for corresponding to the latest developments in technology. The assessment revealed that the current technology was quite beneficial for developing students’ practical skills. However, both students and teachers expressed dissatisfaction with the lack of ability for many learners to engage in practical sessions simultaneously. Hence, some students could be scheduled for work with manikins in unsuitable hours or too rarely. Additionally, the problem of manikins’ outdated status was mentioned: even the ones bought latest could not catch up with emerging technology. Meanwhile, VS software could be updated whenever the organization from which it was purchased offered such an option.

Table 2. Curriculum Technology Need-Gap Analysis

Current Curriculum Technology	Desired Curriculum Technology	Need-Gap	Action Steps to Meet the Need-Gap
Manikin simulation	Virtual simulation	Manikin simulation did not provide the necessary level of innovativeness. Also, the current curriculum technology did not allow many students to participate in training simultaneously.	1. Purchase vSim® for Nursing software (Laerdal, 2021) 2. Hire a temporary information technology specialist to explain the use of software 3. Train information specialists at the faculty 4. Explain the use of technology to teachers 5. Use VS in teaching students

Identifying Three Academic Stakeholders

• Administration. The first stakeholder was the administration since without its approval, no change would be possible. The administration performed the functions of supervision and analysis of the suggested curriculum technology change. Additionally, any expenses that the change might entail should receive the administration’s agreement. Therefore, without this stakeholder, one could not expect to gain a positive development of the curriculum technology change.
• Faculty. Faculty was the next important part of the process since teachers and technical staff were the ones who would be responsible for the implementation of the curriculum change. Educators performed the need-gap analysis as well as explained the possible barriers to change implementation. The most significant role of the faculty was in their influence on the change process.
• Students. Finally, students’ opinion on the proposal was highly significant since it was their progress that was at stake of the whole endeavor. Learners’ insights on the current curriculum and prospective change were important in creating the proposal. Students’ feedback on the current and suggested technologies was the decisive factor that promoted the change.

Methods of Collaboration with Interprofessional Teams

• Weekly meetings. The first and major method of collaboration was arranging a meeting every week so that all stakeholders could share their ideas, opinions, and suggestions, as well as share feedback. Regular meetings disciplined the team members since everyone knew that they had to prepare a report on what had been done over the past week. At the first meeting, roles were assigned, and a prospective plan was created. During subsequent meetings, emerging issues were resolved, and necessary adjustments made.
• Emails. Apart from meeting in person, the team arranged an effective way of sharing daily updates via email. The benefits of that method were its availability and easiness of use. Each team member knew when emails concerning the proposal arrived since they were marked “Curriculum Technology Change” in the subject line. There was one member of the team assigned for collecting ideas from various stakeholders and sending them to the whole team upon synthesizing and summarizing.

Comparing Two Technologies

There is an apparent advantage in both technologies’ use in the curriculum. Manikin simulation and VS have the potential to boost nursing students’ practical skills considerably in a variety of areas. Both manikin and virtual simulation allow learners to train in recognizing alterations in patients’ health conditions in a safe educational environment (Erlinger et al., 2019). Hence, students are maximally close to real-life situations but, at the same time, they do not experience excessive stress. Research by Erlinger et al. (2019) indicated that the two simulation modalities under analysis are helpful in training and evaluating students’ skills. Other frequently reported advantages of VS are flexibility and convenience (Gu et al., 2017; McGrath et al., 2018). Furthermore, VS enables more students to study simultaneously, which is rather convenient both for learners themselves and the faculty since no additional laboratory time is needed. Thus, generally, both approaches are beneficial for use in the curriculum, with VS having more advantages.

However, manikin simulation, as well as VS, is not void of some disadvantages. For instance, manikin simulation is associated with higher costs (Foronda et al., 2020; McGrath et al., 2018). Meanwhile, VS is expensive when launched for the first time. Also, when using VS, students might lack the physical connection with the patient, which is present during the practice with high-fidelity manikins. Thus, the main drawbacks of the two technologies are related to cost- and time-efficiency. Based on the analysis of technologies’ benefits and limitations, VS has more potential for promoting nursing students’ skills.

Discussing Three Anticipated Challenges

Cost of Technology

The major challenge posed by the current state of technology in the “The Role of the BSN Nurse in Promoting Community Health” course is the cost of manikins. According to the analysis conducted by Haerling (2018), the cost-utility ratio of VS is $1.08, whereas that of manikin simulation is $3.62. Thus, even though both technologies are considered highly effective in terms of promoting nursing students’ practical skills, the current state of technology is not cost-effective enough.

Availability of Technology

The second challenge with manikins is that there is a limited number of them, which is why only a few students can work with the technology simultaneously. Since the cost of manikins is high, the administration cannot afford to buy a large number of them. Because of this, students’ and faculty’s schedules frequently contain inconvenient hours, which leads to excessive fatigue and low perception of new skills.

Impossibility to Update Technology

Finally, once manikins have been purchased, they can only be utilized in the form they existed at the moment of production. No matter how progress evolves, no changes to the manikins can be made. Sometimes, a new version may appear right after a university has paid for the previous one. Furthermore, if some detain of the manikin becomes damaged, it is necessary to pay for the replacement and wait as much as the production company requires.

Overcoming the Challenges

Cost of Technology

On the contrary to manikins, the use of VS is much more cost-efficient. VS and online modules for them cost less than manikins when all expenditures are considered. Therefore, to overcome the financial challenge posed by the current technology state, it is necessary to switch to VS. The suggested technology change will allow saving costs, which is highly beneficial for the institution.

Availability of Technology

The introduction of VS instead of manikins will also solve the problem with technology’s availability. Once the software is purchased, it is possible to launch it on various devices simultaneously, which will enable more students to practice without having to sacrifice their free time. Due to the increased access to technology, students’ levels of satisfaction and self-efficacy will grow (Verkuyl et al., 2017).

Impossibility to Update Technology

The suggested change is also likely to help overcome the third challenge, which is related to updating the technology. With VS, it is much easier to renew the set of simulators than it is with manikins. Whenever a modernized version of software is released, the university can obtain it merely by making an additional payment. With the possibilities of discounts and bonuses, such purchases will not trigger much financial burden. Most importantly, such updates will take almost no time to implement.

Summarizing Findings

The curricular technology needs assessment allows singling out positive and negative sides in both current and desired technologies. Current technology (manikin-based simulation) has prevailed for a long time and has rightly been considered as an effective tool for developing nursing students’ practical skills while reducing the risks for patients and alleviating students’ psychological distress. At the same time, manikins are expensive, they cannot be updated, and they allow only a small number of learners to practice simultaneously. Meanwhile, the suggested technology, VS, is more cost-efficient, can be updated whenever needed, and enables many students to work with it concurrently. Although VS implementation requires additional preparation and financial contributions, it offers more benefits in the long run. All the identified challenges of the current technology – cost, availability, and impossibility to update it – can be overcome by introducing the desired technology. Thus, collaboration with stakeholders was arranged with the aim of reaching a consensus on VS implementation.

Collaboration with Stakeholders on VS Technology

No matter how beneficial and promising any change is, it cannot be put in force without communication and collaboration of key stakeholders. In order to analyze the probability of switching from manikin simulation to VS, all three groups of stakeholders met. At the initial meeting, a discussion was held about the usefulness of the desired technology and its benefits over the current one. Additionally, the goals for the change were set, and roles were divided between the stakeholder groups in general and each member of the group in particular. At the second meeting, stakeholders were encouraged to express their hopes and apprehensions related to the technology change. Due to the conscientious preparation of each participant, it became possible to gain a mutual understanding and outline further steps in the process of change.

• Administration. Upon weighing the pros and cons of technology change, the administration stakeholder group admitted the potential of VS in increasing students’ knowledge and skills. However, one of the administrators said that they would need several weeks to analyze the budget thoroughly and come up with possible ways of finding money to pay for VS software. Another administrator mentioned that they could sell the manikins to nursing schools for which that technology would be sufficient, thereby earning a part of the sum needed for purchasing VS software. Overall, the administration supported the idea of change but expressed their concern about finding financial support sooner than within a few weeks.
• Faculty. Being at the forefront of gap analysis, faculty members were hesitant about the change of technology. On the one hand, educators realized the need for improvement in such areas as simulation availability and students’ practical skills development. On the other hand, some faculty members, especially those belonging to the older generation, expressed apprehension regarding the need to master new skills and utilize new tools. One professor was especially ardent about not allowing the technology change to happen since he “did not want to waste free time on learning something that would replace an already perfectly working mechanism.” However, the majority of faculty members agreed that even though they would have to sacrifice some time, their students would benefit from the change.
• Students. Being the stakeholder group most interested in change, students were particularly attentive and active during discussions. They understood that they would need to learn new things, but they were quite enthusiastic about it. What was the most crucial for students was the opportunity to practice as much as they could and polish their skills so as to become excellent professionals. Additionally, students were happy to hear about switching to VS since they had heard about the method from their peers studying at other universities, as well as had seen advertisements of VS, which interested them to a great extent.

Force Field Analysis Assessment

Force Field Analysis

Factors that Could Impact the Adoption of the Proposal

Internal Organizational Factors

The first organizational factor that could impede the introduction of the change is concerned with financial restrictions. It may be difficult for the administration to find the necessary funds for purchasing the software and paying the trainer who would show the basics of the program. The second internal factor may be the insufficient number of faculty members who could dedicate time to mastering the new technology and later teach it to students. If the university has a shortage of educators, it may be difficult, if not impossible, to find such volunteers.

External Organizational Factors

An external factor that might promote the change is the level of competition among similar institutions in the area. If other universities and colleges have VS implemented and successfully utilized, the institution will have to initiate the change process in order to remain competitive in the market. Graduates check the prospective educational institutions rather thoroughly, and they would definitely give preference to the one with better training opportunities. Another external factor might be the local or federal nursing commission or another organization on which the institutions’ accreditation depends. If VS is designated as one of the accreditation conditions, the institution will be eager to initiate its launch as soon as possible.

Forces of Integration

Facilitating Forces

• Flexibility. The first facilitating force is the flexibility of technology’s use in comparison to that of the current curriculum. VS is more accessible both to the faculty and students; hence, no complicated schedule for practical simulation sessions is needed. In the conditions of a busy timetable as an inevitable element of any nursing student’s educational process, the possibility to train whenever one can is a vital feature.
• Promotion of critical thinking. The second facilitating force is the increase in students’ critical thinking while using the technology. VS is reported to increase such skills as critical judgment, clinical problem solving, and recognition of poverty and clinical deterioration (Gu et al., 2017; Foronda et al., 2020). Therefore, in order to promote these vital skills of nursing students, the institution should be interested in facilitating the implementation of change.
• Improvement of practical skills. The third force promoting the change is the enrichment of nursing students’ practical skills. VS is likely to increase learners’ abilities in discerning various clinical situations and modeling solutions for them. Furthermore, with the help of VS, students are able to try themselves in different professional positions, which enables them to select the future specialty easier. This force is highly important since both the faculty and students are driven by it.

Impeding Forces

• Budgetary deficiency. The most crucial impeding force is the probable lack of funds to facilitate the change. If the institution does not have any extra costs, it might be difficult for the administration to allocate resources for the purchasing of new technology. Furthermore, the updates of software might be needed, which may also be difficult to pay for; thus, funding is the main impeding force to change.
• Faculty’s resistance to change. This force pertains to both students and educators, but the latter seem to be impacted more severely. Many faculty members are acquainted with the current technology and might feel dissatisfied at having to gain additional training. The problem is not only in the acquisition of new skills but also in the need to spend one’s time on this process. Hence, the forefront stakeholder group might not feel inclined to accept the change readily.
• Learners’ dissatisfaction. Students may feel discouraged by the new technology’s introduction since they will have to master a new program in the success of which they cannot be sure. The students in their last year of education may feel worried that their previously gained knowledge will not help them to pass final exams. Learners may consider the current technology effective enough and express unwillingness to adjust to innovation.

Change Theory

The change theory utilized in the process of change is Kurt Lewin’s theory. Lewin’s approach consists of three stages: unfreezing, change process, and refreezing (Hussain et al., 2018). At the unfreezing stage, the need for change is identified. It is necessary to determine what has to be changed and how this can be achieved. At the second stage, the change is implemented with the help of communication and collaboration among stakeholders. Finally, the refreezing stage is about sustaining the change that has taken place. It is necessary to make sure that stakeholders have accepted the new reality and are no longer resistant to change.

Justification for the Selected Theory

The reason for choosing Lewin’s change model is that it is rather successful in organizational change, which is exactly the case of the proposal. During the unfreezing phase, it was possible to analyze the curriculum and identify the need for its adjustment. At that point, the drawbacks of the current technology were pointed out, and the benefits of the suggested technology were identified. At the second stage, all three groups of stakeholders created an interdisciplinary team, the aim of which was working on the implementation of the new technology together. Finally, at the refreezing phase, efforts were taken to explain the mutual benefits of the change. With the help of steps identified by Lewin, the process of change was run smoothly and with minimal inconvenience for stakeholders.

Potential Resistance and Barriers to the Technology Change

Barriers to the technology change are expected to be mostly concerned with the administration stakeholder group. It is their task to provide the necessary conditions for the new technology’s implementation in terms of financial support. Meanwhile, resistance is met on the part of the faculty and students. The older generation of educators might not want to become acquainted with the new technology because they would like to spend their last years at work peacefully and without excessive stress caused by innovation. Other faculty members might feel resistant because they would be the ones conducting the process of change and sacrificing their free time to it. Finally, students may express disagreement with the change process because they would need to learn new equipment, which might lead to other grades and levels of understanding of the curriculum. It is important to overcome the barriers and resistance in order to gain the full benefit from the proposal.

Implementation of the Theory

The need for a change was determined by the drawbacks in the current technology and the potential benefits of the new one. The use of Lewin’s change model benefited the course “The Role of the BSN Nurse in Promoting Community Health” since it allowed for a smooth transition from the existing technology (manikin simulation) to a new one (VS). The implementation of the change model was arranged in several stages described below.

1. Unfreezing. The first stage incorporated the following steps:
   1. The insufficiencies of the current curriculum technology were identified. The review of literature was conducted by the faculty, and a report was prepared for the administration to see the current gaps.
   2. A meeting with stakeholders was arranged, where the need for change was explained and justified.
   3. The student stakeholder group prepared a presentation on the benefits of VS over manikin simulation in terms of practical skills enrichment and availability.
   4. Stakeholder groups created a meeting plan with a regular weekly meeting on the agenda, as well as any other additional meeting upon the request of any stakeholder group (which would be announced via emails if necessary).
2. Change process. The second stage included the following steps:
   1. An interdisciplinary team was created, the task of which was to create a plan of implementing new technology. Nurse educators were the most important members of the team. However, their close collaboration with students and the administrators was crucial for gaining the best outcomes.
   2. Training for faculty by VS technology specialists members was arranged.
   3. The new technology was introduced to the curriculum gradually over eight weeks.
   4. By the end of the second month of the new technology’s use, all benefits and limitations were discussed at weekly meetings and analyzed thoroughly.
3. Refreezing. The last stage of the change process presupposed the following steps:
   1. Education and training of the faculty on a regular basis.
   2. Conducting surveys among students and educators to learn about the positive changes brought by the new technology and inquire about their recommendations.
   3. Comparing the students’ knowledge indicators within three and six months after the technology’s change to find out whether VS was more beneficial than manikin simulation for promoting students
   4. Arranging regular technology updates and faculty training to keep up with innovations in the VS sphere.

Conclusion

Rationale and Purpose of Proposal

The purpose of the proposal is to optimize the level of nursing students’ practical skills in view of the current technology evolution. It is necessary to promote future nurses’ knowledge to the highest level possible. Hence, the more innovative equipment is available to them, the more skilled they will be in their future workplaces, which will benefit patients and communities. The proposal is, therefore, justified by its direction toward the improvement of nursing service quality.

Filling the Curriculum Gap

The proposal allows filling the identified curriculum gaps: the insufficient access to simulators and the outdated status of manikins compared to VS. By adopting the proposal, it will become possible to fill these gaps and increase nursing students’ ability to train on the most current simulation instruments. VS is likely to enhance students’ practical skills and allow them to spend more time on other tasks since they will be able to have more convenient schedules.

Significance of the Proposal

The proposal is likely to have a positive impact on the broader field of nursing since it will promote innovative technology use in educational institutions and encourage teachers to review outdated practices. Such changes will lead to the enhancement of healthcare services. Therefore, citizens will receive prompt and high-quality management of their health problems. Overall, with the implementation of the proposal, nurses’ preparation will become stronger, which will inevitably benefit the community.

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