Human Patient Simulations: Evaluation of Self-Efficacy and Anxiety in Clinical Skills Performance

Human Patient Simulations: Evaluation of Self-Efficacy and Anxiety in Clinical Skills Performance

Grace N. Onovo (Hostos Community College, USA)
DOI: 10.4018/978-1-4666-6260-5.ch014
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The relationship between self-efficacy (self-confidence) and anxiety levels, and the use of Human Patient Simulations (HPS) as a teaching-learning strategy, has not been sufficiently studied in the area of clinical nursing education. The purpose of this chapter is to evaluate the self-efficacy/self-confidence and anxiety levels in clinical skills performance of undergraduate nursing students, pre-use and post-use of Human Patients Simulations (HPS), as a teaching and learning strategy in maternity nursing. The study used a quantitative, pre-experimental, one group study design with a pretest and posttest experiment in data collection. The findings concluded that HPS reduced anxiety and increased self-efficacy/self-confidence in clinical skills performance and decision-making of the participants. In addition, the study found that the participants had difficulties in tasks performance with the following action verbs associated with the cognitive domain of Bloom's taxonomy. The verbs were “identify,” “apply,” and “analyze.”
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An alarming number of undergraduate nursing students have low self-efficacy and high anxiety levels in clinical skills performance despite the use of Human Patient Simulations (HPS) as a teaching-learning strategy in the nursing learning laboratory (Kameg et al., 2009; Shepherd et al., 2007; Shepherd et al., 2010; Omansky, 2010). According to Leigh (2008), National League for Nursing 2006, 2007, Nehring, 2008), the use of simulators as a teaching tool is new to the field of nursing compared to other fields of studies such as the fields of aviation, infantry, and medicine. Although a decade has passed since the beginning of the use of HPS as a teaching tool in nursing, much is still not known about the deficiencies of HPS on undergraduate nursing students' learning (Nehring, 2008, 2010). The literature indicated that self-efficacy and anxiety are barriers to students’ clinical skills performance in all areas of nursing clinical practice (White, 2003; White, 2011). Historically, a few research studies exist on the effects of HPS on self-efficacy, anxiety levels and poor clinical skills performance of the undergraduate nursing students (Laster, 2007a; National League for Nursing, 2010; Nehring & Lashley, 2004; Nehring, 2008; Waxman, 2011). This research study therefore, explored the effect of the use of HPS as a teaching strategy on the self-efficacy and anxiety levels of the third-year undergraduate nursing students enrolled in maternal and child health specialty course.

Key Terms in this Chapter

Bloom's Taxonomy Verbs: The Bloom's Taxonomy Verbs are verbs that identify and describe the cognitive, affective, and psychomotor domains used in the development of courses and course objectives. The verbs help educators to focus on the three domains in their course development and course objectives in order to provide quality education to learners, assess the learners work, and perform formative and summative evaluations in order to assign a grade to the learners work ( Gronlund & Waugh, 2009 ; McKenchie & Svinicki, 2006 AU75: The in-text citation "McKenchie & Svinicki, 2006" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ; Oermann & Gaberson, 2006 ). The verbs describe the clinical skills tasks to be performed in the instructions for the students in didactics and the nursing clinical practice.

Self-Efficacy: Bandura (1997) defined self-confidence conceptually as a “belief in one's capabilities to organize and execute the courses of action required to attain goals” (p. 3). For example, the courses of action for the undergraduate nursing students in this study were to learn and perform effective psychomotor skills in order to attain competency in clinical skills performance and clinical decision-making in the nursing learning laboratory setting before they transition to the real-life hospital setting.

Debriefing: Like pre briefing, debriefing is also a facilitator-led learning group post use of HPS in a suitable learning laboratory classroom environment where the students and their facilitator(s) sit for a round table conference, and make eye contact as they discuss students' feelings, and reflect on their actions and decision-making activities during the HPS clinical scenarios ( Cant & Cooper, 2010 , 2011 ; Nehring & Lashley, 2010 ). The debriefing discussions focus on giving the students opportunities to ventilate their emotional feelings about their clinical decision-making, the good and the bad decisions they made, and the mistakes they made with the answers they chose that killed their mannequin patients in the learning laboratory.

Anxiety: According to Bandura (1988) anxiety is a state of anticipatory apprehension over possible harmful happenings. The Beck Anxiety Inventory (BAI) described anxiety as “a subjective disorder affecting emotional, physiological and the cognitive abilities of an individual to perform the activities of daily living leading to the poor performance of daily activities” ( Beck et al. 1988 , p. 1).

Critical Thinking: Critical thinking might be a reflective process where thinkers need to fill the gaps of understanding the assumptions associated with the topic being explored ( Brookfield, 1995 , 2013 ). Furthermore, Brookfield (1987) defined the concept of critical thinking as “a process that might be a result or a reaction to a positive or a negative event or situation in one’s life” (p. 23). Those events for instance, were positive or negative triggers because they stimulated personal emotions that motivated critical and reflective thinking for the thinker. The thinker with negative triggers might develop critical action and analysis with active inquiry in order to resolve the problem, if the thinker had the skills and courage ( Brookfield, 1987 ). Paul and Elder (2006) defined critical thinking as “the art of thinking about thinking while thinking in order to make things better” (p. xxii). Nosich (2009) AU76: The in-text citation "Nosich (2009)" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. described critical thinking as “a concept that cannot be achieved by reading alone but by thinking, hearing the lecture and reasoning as one is writing and using standards that will lead to a conclusion” (p. 3).

Pre Briefing: Pre briefing is a term describing a facilitator-led group's learning of the outcomes of a course material and course topics before the use of HPS as a teaching strategy in the nursing learning laboratory environment. Both the facilitator and students, collaborate, communicate and contribute to the pre simulation review of their already assigned reading and assignment in their simulation tickets, before the use of HPS as a teaching and learning strategy ( Cant & Cooper, 2010 ; Hayden, 2010 ; Nehring & Lashley, 2010 ; Reese et al., 2010 ; Rothgeb, 2008 ; Waxman, 2011 ).

Human Patient Simulations: The literature defined HPS in nursing education as the act of performing the nursing psychomotor skills on the mannequins in simulated clinical environment ( Gaba, 2004 ; Reese et al., 2010 ; Rothgeb, 2008 ). The act of performing psychomotor skills uses diverse clinical scenarios in a safe clinical environment; an environment that encourages group learning, critical thinking, communication, collaboration, and clinical decision-making of the participants. There are low fidelity, high fidelity and full mission simulations in addition to real-life human volunteers for some nursing school learning laboratories. Simulators support the development of pre-planned scenarios that mimic a wide variety of clinical situations ( Fanning & Gaba, 2007 ; Nehring & Lashely, 2004 AU77: The in-text citation "Nehring & Lashely, 2004" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ; Nehring, 2008 ).

Self-Directed Learning: The operational definition most used in defining self-directed learning includes that it consists of a complex of attributes, values and interests, and creates the likelihood that adult learners are capable of self-directing their learning ( Merriam et al., 2007 ; Wang & Cranton, 2012 ).

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