Text-based Document. Authors Showalter, Darlene A. Downloaded 30-Jun :30:11.

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1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Presentation Text-based Document Student Perception and Appraisal of a New Interventional Model to Prepare Them for Entry into Maternal-Infant Clinical Rotations and to Reduce Anxiety Authors Showalter, Darlene A. Downloaded 30-Jun :30:11 Link to item

2 Use of Simulation to Improve Student Confidence Darlene A. Showalter, DNP, RN, CNS Clinical Associate Professor at the University of Alabama in Huntsville & Azita Amiri, PhD, RN Assistant Professor at the University of Alabama in Huntsville

3 Disclosure Statement Dr. s Showalter and Amiri do not have financial interests, sponsorships, relationships, nor conflict of interests with any of the products and/or services discussed in the program.

4 Learning Objectives Compare and contrast student perception of readiness for clinical and anxiety/nervousness level without and with the interventional simulation model. Appreciate the benefit of conducting a simulation prior to student entry to clinical in the acute care setting.

5 Traditional Model 1. Orientation: didactic 2. Hospital 3. Hospital 4. Hospital 5. Hospital 6. Simulation lab: comprehensive

6 Problem OB class: Unfamiliar, short Clinical: Student Unprepared Anxious Fearful Insecure Lacking skills

7 Student Feedback: Traditional Model I didn t feel ready for this clinical. It would have been helpful to have been exposed to more fetal strips. Let us brush up on skills and learn new ones prior to first day in hospital. Great program but we need to know how to put on fetal monitors before getting to the patient s room. Do sims early in the course or at least before clinicals.

8 ROL Nursing students experience increased levels of depression, anxiety, and stress (Parkes, 1982; Beck & Srivastava, 1991; Pryjmachuk & Richards, 2007; Papazisis et al., 2008). High stress and anxiety impede concentration, memory, and problem-solving ability; affects academic performance and learning (Beddoe & Murphy, 2004). Simulation decreased anxiety in Nursing students prior to clinical entry (Szpak & Kameg, 2011, Megel et al., 2012, Doolen et al., 2014). Simulation enhanced students communication skills and confidence. (Doolen et al., 2014). Skill-practice program helped students increase their competence and confidence (Lioua, Changa, Tsaib, Chenga, 2013). Competence and self confidence are the most important factors in allowing students to make appropriate decisions in patient care (Hagbaghery et al., 2004).

9 METHODS Non-randomized interventional study Population: BSN senior students enrolled in OB class N= : traditional model 89: interventional model Demographics: Age : mean (SD: 5.1, range:21-44) Gender: female 90.5% Male 9.5%

10 Outcomes measured (Post-test): nervousness/anxiety, discomfort preparedness for clinical Likert scale: 1-none, 2-some, 3- moderate, 4-severe

11 Interventional Model 1. Orientation: didactic 2. Simulation lab (formative): FHT/EFM, labor support, cervix, birth, communication, postpartum assessment 3. Hospital 4. Hospital 5. Hospital 6. Simulation lab: Comprehensive

12 percent Results Nervous/anxious Uncomfortable Yes No Nervousness/anxiety and discomfort about first OB clinicals

13 percent Results nervousness discomfort (Likert Scale 1-4) The level of nervousness/anxiety and discomfort before starting clinical rotations

14 percent Results traditional model interventional model (Likert Scale 1-4) 4 Prepared: Fetal heart rate (p<0.01)

15 percent Results traditional model interventional model 3 4 (Likert scale 1-4) Prepared: Application of fetal monitor (p<0.001)

16 Percent Results traditional model interventional model (Likert scale 1-4) Prepared: Assessment of uterine activity (p<0.01)

17 percent Results traditional model interventional model (Likert scale 1-4) Prepared: Assessment of labor pain (p<0.001)

18 percent Results traditional model interventional model (Likert scale 1-4) Prepared: Assessment of cervix (p<0.01)

19 percent Results traditional model interventional model (Likert scale 1-4) Prepared: Postpartum Assessment (p<0.001)

20 percent Results traditional model interventional model (Likert scale 1-4) Prepared: Communication (p<0.05)

21 percent Results nervousness discomfort Discomfort level (Likert scale 1-4) Nervousness/anxiety and discomfort reduction after simulation

22 Student Feedback: Intervention Model A needed step prior to going into clinical. The first simulation helped me transition to the hospital setting. I felt confident on my first day at the hospital. The first simulation day showed me what to do when I actually got to clinical. After the first simulation I was no longer nervous, but excited. I knew what to expect. I still struggled with the communication piece.

23 Limitations Randomization Faculty variance Sample size Post-test design

24 Considerations for Future Research More Research Relevant to OB clinicals Relevant to course outcomes Relevant to client outcomes

25 Looking Ahead Communication Cervical assessment Faculty consistency Utilize standardized instruments

26 Findings: Summary *A pre-clinical simulation-based session can decrease student nervousness/anxiety and discomfort and can improve their sense of readiness to deliver patient care. *Pre-clinical simulation-based teaching should be considered a viable option for preparing students for clinicals.

27 Thank You! Questions?

28 References Beck, D.L. & Srivastava, R. (1991). Perceived level and sources of stress in baccalaureate nursing students. Journal of Nursing Education, 30: Beddoe, A.E., & Murphy, S.O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43, Doolen, J. et al. (2014). An evaluation of mental health simulations with standardized patients. International Journal of Nursing Education Scholarship, 11(1): Ganley, B.J., Linnard-Palmer, L. (2012). Academic Safety during Nursing Simulation: Perceptions of Nursing Students and Faculty. Clinical Simulation in Nursing, 8 (2), e49 e57. Hagbaghery, M.A, Salsali, M. & Ahmadi, F. (2004). The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study. BMC Nursing, 3(1): 2. Lioua, S. Changa, C., Tsaib, H., Chenga, C. (2013). The effects of a deliberate practice program on nursing students' perception of clinical competence. Nurse Education Today, 33(4), Megel, M.E. et al. (2012). Effect of high-fidelity simulation on pediatric nursing students' anxiety. Clinical Simulation in Nursing, e419 e428. Papazisis, G., Tsiga, E., Papanikolaou, N., Vlasiadis, I., Sapountzi-Krepia,D. (2008). Psychological distress, anxiety and depression among nursing students in Greece. International Journal of Caring Sciences, 1: Parkes, R.R. (1982). Occupational stress among student nurses: a natural experiment. Journal of Applied Psychology, 67: Pryjmachuk, S., Richards, D.A. (2007). Predicting stress in pre-registration nursing students. British Journal of Health Psychology, 12: