Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios

OBJECTIVE

To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations.

BACKGROUND

Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB.

DESIGN

Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments.

METHODS

The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice.

RESULTS

Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC.

CONCLUSION

NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation.

RELEVANCE FOR CLINICAL PRACTICE

Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety.

PATIENT OR PUBLIC CONTRIBUTION

Experts participated in the Delphi rounds and nurses in the pilot test.

Nursing students' personality (Temperament and Character), burnout symptoms, and health and well-being

Background

About 9 million nurses will be needed by 2030. To face these unprecedented times, governments/institutions focus on educating as many nursing students as possible. This strategy is clouded by burnout and lack of both health and well-being among students and by the fact that personality is one of the major determinants of these health outcomes. Nevertheless, recent findings show that personality is a complex adaptive system (i,e., nonlinear) and that combinations of people's temperament and character traits (i.e., joint personality networks) might provide further information to understand its development, academic burnout, and lack of health and well-being.

Aims

Our aims were to investigate the linear relationship between nursing students' personality, burnout, health, and well-being; investigate the linear mediational effects of personality and burnout on health and well-being; and investigate differences in these health outcomes between/within students with distinct joint personality networks (i.e., nonlinear relationships).

Method

Swedish nursing students (189 women, 29 men) responded to the Temperament and Character Inventory, The Maslach Burnout Inventory-General Survey for Students, and the Public Health Surveillance Well-Being Scale. We conducted correlation analyses and Structural Equation Modeling and, for the nonlinear relationships, Latent Profile Analysis and Latent Class Analysis for clustering and then Analyses of Variance for differences in health outcomes between/within students with distinct personality networks. This study was not pre-registered.

Results

High levels of health and well-being and low burnout symptoms (low Emotional Exhaustion, low Cynicism, and high Academic Efficacy) were associated with low Harm Avoidance and high Self-Directedness. Some personality traits were associated with specific health outcomes (e.g., high Self-Transcendence-high Emotional Exhaustion and high Persistence-high Academic Efficacy) and their effects on health and well-being were mediated by specific burnout symptoms. Cynicism and Emotional Exhaustion predicted low levels of health and well-being, Academic Efficacy predicted high levels, and Cynicism lead both directly and indirectly to low levels of health and well-being through Emotional Exhaustion. We found two joint personality networks: students with an Organized/Reliable combination who reported being less emotionally exhausted by their studies, less cynical towards education, higher self-efficacy regarding their academic work/skills, and better health and well-being compared to nursing students with an Emotional/Unreliable combination.

Conclusions

The coherence of temperament-character, rather than single traits, seems to determine students' health outcomes. Thus, nursing education might need to focus on helping students to develop professional skills and health-related abilities (e.g., self-acceptance and spiritual-acceptance), by supporting self-awareness.

Approaches for boosting self-confidence of clinical nursing students: A systematic review and meta-analysis

Background

Self-confidence is a key element in successfully promoting achievement strivings among the healthcare workforce. Targeted interventions can strengthen this characteristic in nursing students, thus improving the quality of hospital services.

Objectives

We evaluated the effect of educational interventions on boosting self-confidence in nursing students using systematic review and meta-analysis.

Methods

A comprehensive search was used to screen the related studies in Scopus, PubMed, Embase, Web of Science, and PsycINFO. Peer-reviewed literature in English until June 2023 was reviewed. Inclusion criteria were controlled trials, either non-randomized studies of intervention (NRSI) or randomized (RCTs). Studies were assessed for methodological quality by the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and the Cochrane "Risk of Bias" tool for RCTs (RoB 2.0) and quality assessment tool for before-after (pre-post) studies with no control group. The main outcome was the self-confidence score of nursing students because of educational methods or intervention/s. Using the inverse variance weights method, a pooled standardized mean difference (SMD) estimate with a corresponding 95% confidence interval (CI) was determined. Random-effects meta-analysis was used to assess conceptual heterogeneity using Stata.

Results

Twenty-two studies were selected involving 1758 participants and 940 cases of nursing students in the intervention group on boosting self-confidence (Fourteen Randomized controlled trials, Five Quasi-experimental, and three Before-After studies). The post-intervention self-confidence results in the nursing student's intervention group were significantly greater (SMD) (SMD for Controlled experimental design = 0.51; 95% CI = 0.14-0.89), (SMD for Quasi-experimental = 0.04; 95% CI = -0.33-0.41), (SMD for Before-After (Pre-Post) = 2.74; 95% CI = 1.85-3.63). The random-effect meta-analysis of 22 interventional studies determined that educational interventions are significantly associated with the improving self-confidence of nursing students. The intervention showed a moderate impact on the research units, according to Cohen's d results. Also, the results of simulation learning intervention (SMD = 0.42; 95% CI = 0.03-0.81) showed a significant relationship between intervention and outcome in studies.

Conclusions

Analysis of our findings revealed the successful impact of most interventional approaches in boosting self-confidence, especially in the long term. It can be concluded that self-confidence is a multifactorial concept that can be improved by using targeted combination intervention strategies.

Comparing the effect of assessment-simulation-animation-based against traditional education on nursing students' anxiety and self-efficacy in maternity clinical practicum

BACKGROUND

The clinical practicum is the practical course that causes the most anxiety in nursing undergraduates. Although high-fidelity simulation education has been demonstrated to boost nursing students' self-efficacy and decrease anxiety in patient care, it is also associated with excessive psychological stress. Assessment-simulation-animation-based (ASA-based) education has been developed to solve the drawbacks of simulation-based education while preserving positive learning outcomes.

OBJECTIVES

To compare the effects of ASA-based education and traditional education in reducing anxiety and improving self-efficacy of junior nursing students in their maternity clinical practicum.

DESIGN

This study used a two-group pre-post quasi-experimental design. The comparison group was studied first followed by the experimental group.

SETTINGS

Department of Nursing and affiliated medical center at a medical university in southern Taiwan.

PARTICIPANTS

We enrolled 114 junior nursing students from two different class years.

METHODS

A convenience sample of junior nursing students was used in this study, with 55 in the experimental group and 59 in the comparison group. The intervention included online ASA-based education videos with pamphlets and was conducted three days a week for five weeks encompassing the maternity nursing clinical practicum. We developed and applied the Clinical Situation Anxiety Scale (CS-AS) and Clinical Situation Self-Efficacy Scale (CS-SES) before and after the intervention. Qualitative feedback was assessed after the intervention. Data were collected from both the comparison and experimental groups during the fall and spring terms of both the 2019-2020 and 2020-2021 academic years.

RESULTS

Compared with the comparison group, the total CS-AS and CS-SES scores significantly improved from before to after the intervention in the experimental group. The students responded to the intervention by demonstrating clinical consistency, knowing what to do and how to do it and more confidently practicing health education.

CONCLUSION

Our results suggest that ASA-based education with videos and pamphlets contributed to reducing anxiety and increasing self-efficacy in nursing students during their maternity clinical practicum.

Development of a low-cost congenital abdominal wall defect simulator (wall-go) for undergraduate medical education: a validation study

BACKGROUND

Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication.

METHODS

Market research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher's Exact Test.

RESULTS

Gastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05).

CONCLUSIONS

The WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries.

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.

An Observational Cross-Sectional Study on the Correlation between Professional Competencies and Self-Efficacy in Albanian Registered Nurses

(1) Background: The assessment and application of registered nurses' professional skills are essential to providing quality and safe care. Self-efficacy can positively affect the professional competence of registered nurses. This study analysed professional competence and its association with self-efficacy among registered nurses. (2) Methods: A cross-sectional observational study was conducted. The sampling was conventional. The data collection took place through the Albanian version of the Nurse Professional Competence Scale Short Form (A-NPCS-SF), which was used to assess their professional skills, and the Albanian version of the Nursing Profession Self-Efficacy Scale (A-NPSES), which was used to assess their self-efficacy. The study was based on a convenience sample of 985 registered nurses from the 12 Albanian provinces. (3) Results: The Cronbach alpha value for the A-NPCS-SF scale was 0.947, while for the A-NPSES scale, it was 0.875, proving both scales to be reliable. Self-efficacy does not play an essential role in the development of the professional competence of registered nurses since our survey found only one dimension correlates with these two elements. (4) Conclusions: The results of our analysis have instead highlighted the importance of a close relationship between job satisfaction and the development of professional skills.

Nursing Profession Self-Efficacy Scale-Version 2: A Stepwise Validation with Three Cross-Sectional Data Collections

BACKGROUND

The nursing professional self-efficacy scale (NPSES) is one of the most used self-reporting tools for assessing nursing self-efficacy. Its psychometric structure was described differently in several national contexts. This study aimed to develop and validate version 2 of the NPSES (NPSES2), which is a brief version of the original scale selecting items that contribute to stably detecting attributes of care delivery and professionalism as descriptors of salient aspects of the nursing profession.

METHODS

Three different and subsequent cross-sectional data collections were employed to reduce the number of items to generate the NPSES2 and validate its new emerging dimensionality. The first (June 2019-January 2020) involved 550 nurses and was used to reduce the number of the original scale items by using a Mokken scale analysis (MSA) to ensure the selection of items consistently with the invariant item ordering properties. The subsequent data collection was performed to conduct an exploratory factor analysis (EFA) involving 309 nurses (September 2020-January 2021), and the last data collection (n = 249) was performed to cross-validate with a confirmatory factor analysis (CFA), the most plausible dimensionality derived from the EFA (June 2021-February 2022).

RESULTS

The MSA led to the removal of twelve items and retention of seven items (Hs = 0.407, standard error = 0.023), which showed adequate reliability (rho reliability = 0.817). The EFA showed a two-factor solution as the most plausible structure (factors loading ranged from 0.673 to 0.903; explained variance = 38.2%), which was cross-validated by the CFA that showed adequate fit indices: χ² (13, N = 249) = 44.521, p < 0.001; CFI = 0.946; TLI = 0.912; RMSEA = 0.069 (90% CI = 0.048-0.084); SRMR = 0.041. The factors were labeled as care delivery (four items) and professionalism (three items).

CONCLUSIONS

NPSES2 is recommended to allow researchers and educators to assess nursing self-efficacy and inform interventions and policies.

The Impact of Clinical Training Seminars on Stress and Perception of Clinical Placement Stressors among Spanish Undergraduate Nursing Students: A Two-Phase Mixed-Methods Study

Stress and stressors related to clinical practice are some of the main reasons for the discomfort reported by nursing students. It is important to identify the causes of stress and seek strategies to reduce the stress levels in nursing students. Clinical training seminars have proven to be a useful tool to reduce stress levels. This study aims to evaluate the effects of a series of clinical training seminars on the levels of stress and perception of stress factors before the start of clinical practice among undergraduate Spanish nursing students. A two-phase, sequential mixed-methods design was used. For the quantitative phase, data were collected using Cohen's Perceived Stress Scale and the KEZKAK questionnaire before and after the clinical training seminars. Qualitative data were collected through a focus group session held after the clinical training period. The results show a significant reduction (p = 0.002) in perceived stress levels after the clinical training seminars, and also a change in students' perception of stressors in the clinical placement. This study provides valuable information for the development of content for clinical training seminars. Universities should develop strategies to reduce stress in their students caused by the clinical placement.

Technology-enhanced simulation for healthcare professionals: A meta-analysis

Aim

There have been substantial changes in the simulation technology landscape, in particular virtual reality (VR), during the past decade, which have resulted in increased abundance and decreased cost. We therefore updated a previous meta-analysis conducted in 2011, aiming to quantify the impact of digital technology-enhanced simulation (T-ES) compared with traditional teaching in physicians, physicians-in-training, nurses, and nursing students.

Design

We conducted a meta-analysis consisting of randomized controlled trials published in English between January 2011 and December 2021 in peer-reviewed journals indexed in seven databases. Moderators for study duration, instruction, type of healthcare worker, type of simulation, outcome measure, and study quality rated by Medical Education Research Study Quality Instrument (MERSQI) score were included in our model and used to calculate estimated marginal means (EMMs).

Results

The overall effect of T-ES was positive across the 59 studies included in the analysis compared with traditional teaching [overall effect size 0.80 (95% CI 0.60, 1.00)]. This indicates that T-ES is effective in improving outcomes across a wide variety of settings and participants. The impact of T-ES was found to be greatest for expert-rated product metrics such as procedural success, and process metrics such as efficiency, compared with knowledge and procedure time metrics.

Conclusions

The impacts of T-ES training on the outcome measures included in our study were greatest in nurses, nursing students and resident physicians. T-ES was strongest in studies featuring physical high-fidelity mannequins or centers, compared with VR sensory environment T-ES, though there was considerable uncertainty in all statistical analyses. Further high-quality studies are required to assess direct effects of simulation training on patient and public health outcomes.