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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
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.
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.
Traditional Model 1. Orientation: didactic 2. Hospital 3. Hospital 4. Hospital 5. Hospital 6. Simulation lab: comprehensive
Problem OB class: Unfamiliar, short Clinical: Student Unprepared Anxious Fearful Insecure Lacking skills
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.
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).
METHODS Non-randomized interventional study Population: BSN senior students enrolled in OB class N= 132 43: traditional model 89: interventional model Demographics: Age : mean 24.26 (SD: 5.1, range:21-44) Gender: female 90.5% Male 9.5%
Outcomes measured (Post-test): nervousness/anxiety, discomfort preparedness for clinical Likert scale: 1-none, 2-some, 3- moderate, 4-severe 1 2 3 4
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
percent Results 100 90 80 70 60 50 40 30 20 10 0 76.4 23.6 Nervous/anxious 53.9 46.1 Uncomfortable Yes No Nervousness/anxiety and discomfort about first OB clinicals
percent Results 50 45 40 35 30 25 20 15 10 5 0 43.5 42.3 33.3 21.2 20 15.3 15.4 nervousness discomfort 9 1 2 3 4 (Likert Scale 1-4) The level of nervousness/anxiety and discomfort before starting clinical rotations
percent Results 60 50 46.5 52 40 30 20 27.9 23.2 18 27 1 2 3 10 0 2.4 2.2 traditional model interventional model (Likert Scale 1-4) 4 Prepared: Fetal heart rate (p<0.01)
percent Results 60 55.8 50 40 30 25.6 23.6 31.5 1 2 20 10 0 14 4.6 traditional model 5.6 2.2 interventional model 3 4 (Likert scale 1-4) Prepared: Application of fetal monitor (p<0.001)
Percent Results 60 50 40 30 20 10 0 55.8 40.9 37.5 32.6 19.3 9.3 2.3 2.3 traditional model interventional model (Likert scale 1-4) 1 2 3 4 Prepared: Assessment of uterine activity (p<0.01)
percent Results 70 60 50 40 30 20 10 0 62.8 39.1 25.6 29.9 27.6 9.3 2.3 3.4 traditional model interventional model (Likert scale 1-4) Prepared: Assessment of labor pain (p<0.001) 1 2 3 4
percent Results 70 60 62.8 50 40 30 20 10 0 30.2 7 0 traditional model 30.3 30.3 27 12.4 interventional model 1 2 3 4 (Likert scale 1-4) Prepared: Assessment of cervix (p<0.01)
percent Results 60 50 51.2 54.6 40 30 20 10 0 23.2 25 18.6 17 7 3.4 traditional model interventional model (Likert scale 1-4) 1 2 3 4 Prepared: Postpartum Assessment (p<0.001)
percent Results 60 50 40 30 20 10 0 48.8 34.1 36.4 27.9 20.9 22.7 6.3 2.3 traditional model interventional model (Likert scale 1-4) 1 2 3 4 Prepared: Communication (p<0.05)
percent 40 35 30 25 20 15 10 5 0 Results 36.5 37.2 35.6 36 19.5 18.6 8 8.1 nervousness discomfort Discomfort level (Likert scale 1-4) 1 2 3 4 Nervousness/anxiety and discomfort reduction after simulation
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.
Limitations Randomization Faculty variance Sample size Post-test design
Considerations for Future Research More Research Relevant to OB clinicals Relevant to course outcomes Relevant to client outcomes
Looking Ahead Communication Cervical assessment Faculty consistency Utilize standardized instruments
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.
Thank You! Questions?
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