Self-Efficacy and Simulation 31

Self-Efficacy and Simulation 31

The Effects of Simulation on Nursing Students’ Self-Efficacy

Kristina Nappi, MSN, ARNP

University of Alabama

In partial fulfillment of Comps

August 15, 2017

TABLE OF CONTENTS

Abstract 2

Introduction 3

Statement of Problem 5

Purpose of the Study 5

Functional Definitions 6

Review of Theoretical Literature 6

Conceptual Framework 13

Methodology 17

Research Questions 17

Research Design 18

Sample 18

Setting 19

Ethical Considerations 19

Data Collection 20

Data Analysis 20

Conclusion 22

References 23

Appendix A 27

Appendix B 28

Appendix C 29

Abstract

Nursing education is challenged with preparing new graduates to succeed in a complex health care environment. When nurses graduate they work in very fast paced stressful environments. Tuttle (2009) states that upon graduation “nurses must be able to care for patients in a fast paced, stressful environment that emphasizes clinical competency and accurate, timely decision-making skills.” To facilitate the transition of nurses from clinical to practice the use of high-fidelity simulation within nursing education has increased dramatically over the past decade. Simulation is a standardized way of exposing nursing students to clinical situations where they can safely learn from their mistakes.

Self-efficacy is a characteristic that is believed to increase a student’s ability to be successful at a task. The purpose of this study is to assess the effectiveness of high fidelity simulation on junior level associate degree nursing students’ sense of self-efficacy at a southern community college. This quantitative study will test the hypothesis that incorporating high fidelity simulation into nursing curricula increases associate degree nursing students’ self-efficacy. Studies show students who participate in high-fidelity simulation develop increased self-efficacy which correlates with increased confidence in their overall skills. The results of this study will be significant and relevant to the field of nursing as high-fidelity simulation is an integral part of the nursing curricula. The findings of this will also assist faculty needs regarding the development of avenues which will promote self-efficacy in nursing students and confidence in their nursing skills.

Introduction

Nursing education faces the challenge of preparing graduates to succeed within the complexities of our health care environment. The challenge of preparing nursing graduates is compounded by the growing number of nursing student admissions, the need for increased clinical opportunities among decreasing hospital based clinical sites, and the growing knowledge base needed for graduate nurses. Furthermore, compounded by faculty shortages and the fact that nurse educators are continually striving to meet the needs of students it is essential to enhance the commitment to incorporate high fidelity simulation within the curricula. In an effort to accommodate the needs of nursing programs, faculty, students and community stakeholders, high fidelity simulation has become a core component of nursing curricula.

“Simulation, the art and science of recreating a clinical scenario in an artificial setting, has been an important aspect of nursing programs’ curricula for decades “(Gomez & Gomez, 1987, p. 21). For years high fidelity simulation has been utilized in nursing education to enable the learner to enter the clinical setting better prepared (Lasater, 2007). High fidelity simulation is used to teach, remediate and evaluate the clinical competency of nursing students while building self-efficacy and opportunities for reflection. (Patterson, 2015).

Self-efficacy is a person’s belief about their capabilities to perform a skill. An individual’s self-efficacy determines how they think, feel and motivate themselves. A strong sense of self-efficacy enhances a person’s well- being. Individuals with high self-efficacy approach difficult tasks as challenges to be mastered. Nursing students tend to be hesitant and unsure about their role, skills, and decision making capabilities as they care for their patients in the clinical setting. The development of a student’s self-efficacy may enhance their decision making capabilities. Incorporating high fidelity simulation into nursing curricula will allow nurse educators to develop learning environments which encourage the development of students’ self-confidence and their ability to make sound decisions while developing good clinical skills. High fidelity simulation is becoming increasingly popular in nursing education. Incorporating teaching and learning strategies which enhance students’ self-efficacy will theoretically improve their clinical competence (O’Donnell & Pike, 2010).

The purpose of this study is to assess the influence of high fidelity simulation on junior level associate degree nursing students’ sense of self-efficacy at a southern community college. The development of self-efficacy during simulation is an area of research which needs to be investigated as nursing programs worldwide are implementing high-fidelity simulation as a learning strategy in combination with actual direct patient care. Tuttle (2009) states “as students matriculate through their educational experiences they need strong foundational knowledge and learning experiences which will provide them with the opportunities to become confident in their clinical skills and decision making capabilities.” For schools to effectively increase the capacity within nursing programs, meet the clinical needs of students and accreditation, as well as provide quality clinical sites that mimic the complexity of contemporary health care systems, schools will need to collaborate with other health programs in order to institute high-fidelity simulation in order to supplement traditional clinical experiences. From this research, community college nurse educators will gain valuable insight into the correlation between the use of high fidelity simulation and students’ self-efficacy.

Statement of Problem

In light of the implementation of high-fidelity simulation into nursing curricula and decreased hospital-based clinical experiences, there are few studies which show a correlation between high fidelity simulation and the development of positive self-efficacy in associate degree nursing students. Most previous studies have focused on baccalaureate nursing students and have demonstrated that high fidelity simulation enhances student’s self-efficacy as well as providing for the development of safe, secure quality learning environments that enhance student confidence.

Purpose of the Study

Upon graduation, many students do not feel prepared to face the challenges of nursing nor do they have confidence in their ability to perform clinical skills or make decisions. This lack of confidence ultimately influences students’ ability to care for their patients. The purpose of this study is to assess the effectiveness of high fidelity simulation on junior level associate degree nursing students’ sense of self-efficacy at a southern community college.

Functional Definitions

High-fidelity simulation: “Patient –care scenario that uses a standardized patient or full body patient simulation that can be programmed to respond to affective and psychomotor changes, such as breathing chest action” (Hayden, 2010, p.52).

Learner Satisfaction - The degree to which the learner believes that the learning experience meets their learning needs. Satisfied learners value their learning experience and will put more effort into their performance (Chickering & Gamson, 1987).

Self Efficacy - “The conviction that one can successfully execute the behavior required to produce the outcomes”. (Bandura, 1977, pg.79).

SPSS – Statistical package of the social sciences (Pallant, 2010).

VAS – Visual Analog Scale (Pallant, 2010).

Review of Theoretical Literature

Current literature illuminates the problem of self-efficacy in simulation by acknowledging the increased use of simulation in place of real patient interactions and the increased need for nursing faculties to utilize teaching strategies that will support student learning with positive self-efficacy. Many studies support the use of high-fidelity simulation and increased self-efficacy with nursing students and health care professionals. Literature related in the history of simulation, learning theories associated with the development of self-efficacy, and the use of simulation in health care education were reviewed. Lin (2015) stated that learning theories associated in the development of self-efficacy and simulation based learning could enhance students’ self-efficacy and performance. According to Lin (2015) while learning fundamental skills and facing skills assessments, nursing students seem to experience low confidence and high anxiety levels. Positive self-efficacy is shown to decrease anxiety with students while learning their skills and performing assessments.

According to Bradley (2006), recent advances have made available technology which permits the reproduction of clinical events with sufficient fidelity to permit the engagement of learners in a realistic and meaningful way. Simulation is a teaching strategy that has been utilized in nursing education which enables the learner to enter the clinical setting better prepared (Lasater, 2007, p. 272). According to Jeffery and Rogers (2007), simulation has been defined as activities that mimic reality and involve role playing interactive videos and mannequins which help students learn and allow them to demonstrate decision making and critical-thinking skills. Abersold & Tschannen (2013) describe simulation as a technique, not a technology, to replace or amplify real-life experiences with guided experiences, often immersive in nature that evokes or replicates substantial aspects of the real world in a fully interactive fashion. Rauen (2004) defined simulation as an event or situation made to resemble the clinical practice as closely as possible. Simulation is a technique, not just the technology which needs to be presented realistically while promoting learning. Although there is not one standard framework for utilizing simulation, the art of simulation typically includes prep work, implementation of the simulation, followed by a debriefing session.

The art of simulation has been utilized with flight simulators, space programs, and the car industry. These industries share one important aspect with health care; lives depend on successful teamwork during emergency situations. Simulation has been utilized for a variety of purposes and in the education of various health care professionals. The Institute of Medicine (IOM) (2007) reported the majority of medical errors were the result of system issues rather than poor performance by particular individuals. The report called for systematic change in health care practices while highlighting the benefits of teamwork and simulation. According to Nickerson & Pollard (2010), in response to the IOM 2000 report on medical errors, nurse educators began to add components on critical incident management, critical thinking and professional competencies into curricula. At this point, simulation became an integral part of the curricula.

The literature review looked at studies regarding simulation and self-efficacy. Simulation has been utilized for a variety of purposes and in the education of various health care professionals. Physicians, nurses, pharmacists and emergency medical technicians have benefited from simulation as part of their professional preparation. Simulation has been utilized as assessment tools, evaluation tools, teaching, and learning strategies. When researching the use of simulation within healthcare, numerous studies were found which looked at the use of simulation as a teaching strategy with many disciplines within the health care system. Most of the studies were conducted with baccalaureate nursing degree students. These studies explored the link between high-fidelity simulation and self-efficacy with regard to health teaching, structural empowerment, and clinical practice. There were limited studies devoted to the associate degree nursing student as well as new graduates.

The literature review looked at studies conducted in baccalaureate nursing programs; Tuttle (2009), Babenko-Mould, Ferguson, Riddell et al (2014), Goldenberg, D., Andrusyszyn, M., & Iwasiw, C. (2005), Kameg, K., Clochesy, J., Mitchell, A., & Suresky, J. (2010), Lin, H. (2016), Roh, Y., & Lim, E. (2016) and Zhu and Wu (2015). Most of these studies conducted quantitative research studies regarding high fidelity simulation and increased self-efficacy among junior and senior level baccalaureate nursing students. Zhu and Wu (2015) studied the impact of high-fidelity simulation on clinical nursing practice. The study looked at the need for alternative educational strategies that would increase student’s confidence or self- efficacy. Zhu and Wu’s study showed a positive correlation between teacher objectives and information which indicated strong student satisfaction with high-fidelity simulation and clinical self-efficacy. The study suggests that providing students with clear teaching objectives and sufficient information before high fidelity simulation has a sizeable impact on its effectiveness.

Tuttle examined the impact of simulated learning experiences on the clinical self-efficacy and learner satisfaction of baccalaureate nursing students while Babenko- Mould, Ferguson & Riddell et al evaluated structural empowerment and self-efficacy with students’ achievement utilizing high -fidelity simulation. The research study utilized an evaluation tool which was administered pre and post simulation, which examined students’ perceptions about their ability to perform identified skills as they cared for patients. Tuttle’s study demonstrated that students not only enjoyed participating in simulation, they found the experience very rewarding. The study further confirmed that simulation has the ability to increase self-efficacy in learners. The study conducted by Babenko-Mould, Ferguson & Riddell et al assessed baccalaureate nursing students’ empowerment and self-efficacy immediately after a simulated vaccine clinic and data showed the same results. The students who participated in a simulation vaccine learning clinic as well as an online vaccine and immunization assessment felt empowered and confident about their ability to master the skill. Students perceived the simulation experience with substantial support, resources, information and opportunities. Some of the limitations of the studies were that Tuttle’s study utilized a convenience sample with a small sample size, while Babenko-Mould, Ferguson & Riddell et al and Zhu and Wu had a larger group of students who participated.

A study completed by Goldenberg, Andrusyszyn and Iwasiw (2005) evaluated the effect of classroom simulation on third-year baccalaureate nursing students’ self-efficacy in health teaching. An exploratory, descriptive design was used, convenience sampling with 22 female students participating, the majority under the age of 25, and all enrolled in a baccalaureate nursing program. The study did reference the fact that numerous studies have been conducted regarding the effects of simulation on student learning, but few have looked into the effects of classroom simulation on nursing students’ confidence related to health teaching using self -efficacy theory. The results indicated following simulation students’ self-efficacy scores were significantly higher, reflecting a greater overall confidence associated with health teaching after participation in the workshop.

Kameg, Clochesy, Mitchell, at el (2010) discussed the importance of communication as a critical component of nursing education and a necessity during mental health clinical due to high patient acuity, difficulty securing appropriate clinical sites, and increased student to faculty ratios. This study looked at two teaching strategies, traditional lecture and high-fidelity simulation on nursing student’s self-efficacy of communication skills. Of the 38 pre-licensure baccalaureate nursing students in a psychiatric nursing course, the results demonstrated increased self-efficacy scores in students who utilized high-fidelity simulation rather than traditional lecture. This study demonstrated that high-fidelity simulation enhanced student self-efficacy of communication as measured by the self-efficacy single item visual analogue scale (VAS). The limitations stated by the researchers of this study was the inability of the simulator to show emotion, small sample size, and lack of diversity related to age, gender and ethnicity. Some of the benefits of simulation were that students stated they felt clear about the expectations, felt they could openly discuss learning concerns with their instructor, were clear about expectations, and acknowledged the instructor was always available.