Does Nursing Student Self-efficacy Correlate with Knowledge When Using Human Patient Simulation?

The efficacy of high-fidelity simulation on knowledge and performance in undergraduate nursing students: An umbrella review of systematic reviews and meta-analysis

OBJECTIVES

This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students.

DESIGN

Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results.

DATA SOURCES

Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies.

REVIEW METHODS

The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias.

RESULTS

Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported.

CONCLUSIONS

The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.

Mood states and academic performance in the objective structured clinical examination. The mediating effect of self-efficacy

BACKGROUND

The role of self-efficacy on academic outcomes in clinical simulation evaluations is well-known. However, no previous studies have reported the mediating effect of self-efficacy in the link between mood state and academic performance in the Objective Structured Clinical Examination (OSCE).

OBJECTIVES

This study explores the following aims: i) to determine the effects of mood states on academic performance; ii) to assess the effect of mood states on self-efficacy; and iii) to analyze whether self-efficacy mediates the relationship between mood state and academic performance in the OSCE.

DESIGN

This quantitative and cross-sectional study received Institutional Review Board approval.

SETTINGS

A private university in Santiago, Chile.

PARTICIPANTS

A convenience sample of 117 nursing students from fourth and sixth semester.

METHODS

Data were collected using two questionnaires (the short version of the Profile of Mood State, and the General Self-Efficacy Scale), and the objective structured clinical examination in adult medical-surgical nursing and pediatric nursing courses.

RESULTS

Mood state has a significant effect on self-efficacy β = -0.068 p = .001. There was, however, no significant relationship between mood and academic performance (= - 0.004 p = .114). Similarly, Sobel's test indicated a non-significant mediation effect for self-efficacy-0.000544; 95 %; CI (-0.00256, 0.00148) p = .597.

CONCLUSIONS

The results of this study improve the understanding of students' self-efficacy and academic performance. Further investigation regarding the use of the self-efficacy construct as a mediating variable in different high-stakes evaluations and in students with varying training levels is needed.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis

AIM

To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation.

REVIEW METHODS

This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods.

RESULTS

Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence.

CONCLUSIONS

Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions.

RELEVANCE TO CLINICAL PRACTICE

These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Integrating simulation training during clinical practice in nursing homes: an experimental study of nursing students' knowledge acquisition, self-efficacy and learning needs

BACKGROUND

Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students' clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students' knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment.

DESIGN

The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison.

METHODS

First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students' outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests.

RESULTS

Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges' g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen's d from 0.3 to 1.0).

CONCLUSION

Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.

High-fidelity simulation and nursing students' anxiety and self-confidence: A systematic review

BACKGROUND

As a complementary teaching pedagogy, high-fidelity simulation remains as an effective form of simulation modality. Empirical evidence has additionally shown high-fidelity simulation (HFS) to be an effective contributor to students' learning outcomes.

PURPOSE

This paper critically appraised existing scientific articles that covered the influence of utilizing HFS on the effects of nursing students' anxiety and self-confidence during undergraduate nursing education.

METHODS

This was a systematic review of scientific articles conducted from 2007 to 2017 on the topic of the influence of using HFS on students' self-confidence and anxiety. The literature of six electronic databases (Proquest, SCOPUS, MEDLINE, PubMed Central, CINAHL, and PsychINFO) was reviewed.

RESULTS

Following the literature search, 35 articles were selected. This review provides updated evidence on the efficacy of HFS in reducing anxiety and enhancing self-confidence among nursing students when performing nursing duties or managing patients. Moreover, this review highlights the need for more research that examines the impact of HFS on students' anxiety.

CONCLUSION

As this form of simulation is found to be effective in the enhancement of nursing student self-confidence and the reduction of their anxiety when caring for patients and/or employing nursing skills, the inclusion of simulation-based activities in all clinical nursing courses is vital.

Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis

OBJECTIVE

The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes.

DESIGN

A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

DATA SOURCES

PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references.

STUDY SELECTION

To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis.

REVIEW METHOD

Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria.

SYNTHESIS METHOD

For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI.

RESULTS

Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected.

CONCLUSIONS

Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.

Self-Efficacy and the Competency of Nursing Students Toward the Implementation of Evidence-Based Practice

Introduction: Professional nurses should have adequate competency in order to apply Evidence Based Practice (EBP) in their nursing care. However, many nurses provide nursing care based on traditions, habits and personal experience. Less confidence in the feeling of nurses about their competency when employing EBP could inhibit successful EBP implementation in nursing care. Therefore, introducing and applying EBP during clinical placements in the Ners program is essential to form a professional attitude and to provide a basic level of experience when applying EBP in patient care. However, the self-efficacy and competence of the students when applying EBP has not yet been evaluated properly and there is little known about the nursing students’ competences and self-efficacy toward EBP implementation during clinical practice. Thus, the study aims to describe the self-efficacy and competency of nursing students toward the implementation of EBP, while also investigating the relationship between self-efficacy and the competency of nursing students in the implementation of EBP.Methods: This descriptive correlational study involved 120 nursing students who were actively registered on the Ners program 2016/2017. The data was collected by using the self-reporting Evidence-Based Practice Questionnaire (EBPQ), which was then analysed descriptively and inferentially using statistics.Results: The results of this study revealed that more than half (55%) of the participants had a high score of self-efficacy and almost half (49%) were categorised as having a high competence when implementing EBP. The self-efficacy score was significantly correlated to the score of competency (r = 0.607, p < 0.01).Conclusion: This study recommends that the development of the students’ competence in implementing EBP is essential to promote self-efficacy when applying EBP, and vice versa.  

Learning Styles: Impact on Knowledge and Confidence in Nursing Students in Simulation and Classroom

Nurse Educators must develop nursing curriculum with engaging learning strategies that promote the knowledge and confidence needed for safe, effective nursing practice. Faculty should explore new methods of teaching that consider how students learn. Studies have shown mixed results regarding student learning styles, academic achievement, and development of confidence in nursing practice. An experimental study using Felder and Soloman’s (2004). Index of learning styles instrument was conducted to examine nursing student learning styles and their impact on confidence and knowledge in traditional and high fidelity simulation settings. Findings revealed students were more likely to have active, visual, sensing, and sequential learning styles. Student confidence or knowledge did not significantly differ among the learning styles in either simulation or traditional classroom methods. Awareness of learning styles may aid faculty in adapting engaging teaching strategies. Further research is needed with larger samples to identify best approaches to enhance student learning within the context of learning styles.