Stress of nursing students in clinical simulation: a randomized clinical trial

Teaching Strategies for Developing Clinical Reasoning Skills in Nursing Students: A Systematic Review of Randomised Controlled Trials

BACKGROUND

Clinical reasoning (CR) is a holistic and recursive cognitive process. It allows nursing students to accurately perceive patients' situations and choose the best course of action among the available alternatives. This study aimed to identify the randomised controlled trials studies in the literature that concern clinical reasoning in the context of nursing students.

METHODS

A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) was performed to identify relevant studies published up to October 2023. The following inclusion criteria were examined: (a) clinical reasoning, clinical judgment, and critical thinking in nursing students as a primary study aim; (b) articles published for the last eleven years; (c) research conducted between January 2012 and September 2023; (d) articles published only in English and Spanish; and (e) Randomised Clinical Trials. The Critical Appraisal Skills Programme tool was utilised to appraise all included studies.

RESULTS

Fifteen papers were analysed. Based on the teaching strategies used in the articles, two groups have been identified: simulation methods and learning programs. The studies focus on comparing different teaching methodologies.

CONCLUSIONS

This systematic review has detected different approaches to help nursing students improve their reasoning and decision-making skills. The use of mobile apps, digital simulations, and learning games has a positive impact on the clinical reasoning abilities of nursing students and their motivation. Incorporating new technologies into problem-solving-based learning and decision-making can also enhance nursing students' reasoning skills. Nursing schools should evaluate their current methods and consider integrating or modifying new technologies and methodologies that can help enhance students' learning and improve their clinical reasoning and cognitive skills.

Evaluation of tracheostomy suctioning procedure among nursing and respiratory therapy students: wearable manikin vs. standard manikin

Introduction

This study aims to evaluate cognitive load (CL), emotional levels (EL), and stress levels (SL) of students when using a wearable manikin vs. a standard manikin for tracheostomy suctioning (TS).

Methods

This study was approved by the Institutional Review Board. Subjects were recruited by email. Subjects completed a baseline demographics questionnaire, then they were randomized into two groups: wearable manikin group (WMG) or standard manikin group (SMG). For the WMG, an actor simulated a patient by wearing the device. In phase I, both groups were educated on how to perform TS by video and offered hands-on practice. Then I put through a tracheostomy suctioning clinical simulation and completed a post sim-survey. In phase II, the same survey was repeated after encountering a real patient as part of their clinical rotation.

Results

A total of 30 subjects with a mean age 26.0 ± 5.5 years participated. 20 (66.7%) were respiratory care students and 10 (33.3%) were nursing students. In the WMG, the median stress level dropped significantly post phase II compared to post phase I [2(1,4) vs.3(1,5), p = 0.04]. There were no significant changes in median CL, confidence, and satisfaction levels between post phase II and post phase I (p > 0.05). In the SMG, the satisfaction level increased significantly post phase II compared to post phase I [5(4,5) vs.4(2,5), p = 0.004], but there were no significant changes in CL, SL, and confidence levels between post phase I and phase II. There was no significant difference in mean EL scores over time and these changes did not differ by group. Subjects in the WMG showed a higher mean competency score than those in the SMG (85.5 ± 13.6 vs. 78.5 ± 20.8, p = 0.14, Cohen's d = 0.4), yet not significant.

Conclusion

Our results showed that the WMG is beneficial in helping bridge the gap of learning TS from the sim setting to the real-world clinical setting. More studies with higher sample size and use of other CL scales that assesses the different types of CL are needed to validate our findings.

Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study

AIM

To determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations.

BACKGROUND

Clinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance.

DESIGN

A quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21).

METHODS

Before conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing.

RESULTS

Physiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed.

CONCLUSIONS

The clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.

Pensamento reflexivo na enfermagem

Objetivo: compreender como o debriefing se constitui como elemento pedagógico no desenvolvimento do pensamento reflexivo na Enfermagem. Método: estudo de caso único, de abordagem qualitativa, desenvolvido no Centro de Simulación en Salud (CESISA) da Universidad de Costa Rica. Dados coletados entre agosto e outubro de 2018 através de análise documental, observação não participante e entrevistas semiestruturadas com professores, estudantes e técnicos. Resultados: os dados apontam que o debriefing se constitui como elemento pedagógico no desenvolvimento do pensamento reflexivo quando todos compreendem o papel desse método, buscam seguir a suposição básica de que todos são inteligentes e estão dispostos a melhorar, garantindo-se um ambiente seguro; quando todas as etapas da simulação são planejadas com objetivos claros de aprendizado; e quando o professor assume uma postura de facilitador. Conclusão: o debriefing é um elemento pedagógico que necessita de outros fatores associados para cumprir seu papel no desenvolvimento do pensamento reflexivo.

Early steps towards professional clinical note-taking in a Swedish study programme in dentistry

BACKGROUND

Higher education tends to focus on academic writing only, instead of emphasizing that professional texts are also used as a basis for communication in contexts with a variety of participators. When it comes to clinical notes, research is scarce and focused on technology and informatics. Therefore, the aim was to explore dental students' clinical notes, and specifically which aspects of the clinical notes characterizes clinical notes that are not sufficient enough for professional purposes.

METHODS

The object of analysis was the student's written completion of a teacher constructed protocol regarding oral mucosa, the dental apparatus including pathology on tooth level, oral hygiene, and a validated international clinical examination protocol of the temporomandibular region. The study was framed within the New Literacy Studies approach, and the clinical notes were analyzed using thematic analysis.

RESULTS

Within the clinical notes three themes were identified; a) familiar content; b) familiar content in new context; and c) new content. The forms of notes could refer to either categorizational clinical notes or descriptive clinical notes. Most students were able to write acceptable clinical notes when the content was familiar, but as soon as the familiar content was in a new context the students had difficulties to write acceptable notes. When it comes to descriptive notes students suffered difficulties to write acceptable notes both when it came to familiar content, or familiar content in a new context.

CONCLUSIONS

Taken together, the results indicate that students have difficulties writing acceptable notes when they are novices to the content or context, making their notes either insufficient, too short or even wrong for professional purposes. With this in mind, this study suggests that there is a need to strengthen the demands on sufficient professional quality in clinical notes and focus on clinical notes already in the early stages of the different medical educations.

Debriefing in clinical nursing simulation: an analysis based on the theory of experiential learning

OBJECTIVE

To understand the meaning of the debriefing process performed in clinical simulation activities in a nursing course, based on Kolb's Theory of Experiential Learning.

METHOD

Qualitative, case study type, carried out in a nursing course at a University in southern Brazil, from March to June 2018. For data collection, documentary research was used, the interview based on Kolb's Leaning Style Instrument, with 29 participants and direct observation of eight debriefing scenes. For analysis, the integrated units of analysis obtained from the construction of explanation were used.

RESULTS

Documentary data and the Inventory contributed to the understanding of clinical simulation and debriefing was categorized into four learning modes.

CONCLUSION

Clinical simulation as an experiential learning methodology relates experience, perception, cognition and behavior with elements identified in the debriefing by students.

Debriefing na simulação clínica em enfermagem: uma análise a partir da teoria da aprendizagem experiencial

RESUMO Objetivo: Compreender o significado do processo de debriefing realizado nas atividades de simulação clínica em um curso de enfermagem, a partir da Teoria da Aprendizagem Experiencial de Kolb. Método: Qualitativo do tipo estudo de caso, realizado num curso de enfermagem de uma Universidade do Sul do Brasil, de março a junho de 2018. Para a coleta de dados, utilizou-se a pesquisa documental, a entrevista baseada no Instrumento de Estilo de Aprendizagem de Kolb, com 29 participantes, e a observação direta de oito cenas de debriefing. Para análise, utilizaram-se as unidades integradas de análise obtidas a partir da construção de explanação. Resultados: Os dados documentais e o Inventário contribuíram para o entendimento da simulação clínica e o debriefing foi categorizado em quatro modos de aprendizagem. Conclusão: A simulação clínica como metodologia de aprendizagem experiencial relaciona a experiência, a percepção, a cognição e o comportamento com elementos identificados no debriefing pelos estudantes.

Simulation in cardiorespiratory arrest: assessment of satisfaction with the learning of nursing students

OBJECTIVE

To evaluate the satisfaction and self-confidence of undergraduate nursing students' learning in a scenario of realistic clinical simulation with the theme of advanced cardiopulmonary arrest maneuvers.

METHOD

Exploratory-descriptive study, with a quantitative approach. In order to evaluate the simulation activity developed undergraduate nursing students responded to the Student Satisfaction and Self-Confidence with Learning Scale.

RESULTS

19 students participated in the study. Students' satisfaction and self-confidence with learning were identified, with an average of 4.17 ± 0.59 in the developed scenario. In the subscale of satisfaction with current learning and in the subscale of self-confidence with learning, 86.3% and 76.6% of students scored the items in a maximum way (4-5), respectively.

CONCLUSION

Nursing students demonstrate satisfaction and self-confidence with learning from a realistic clinical simulation scenario on the theme of advanced cardiorespiratory arrest maneuvers.

Stress level experienced by participants in realistic simulation: a systematic review

OBJECTIVES

to identify the available evidence regarding stress levels experienced by participants in education based on a realistic simulation.

METHODS

systematic review that included randomized clinic trials on electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Latin-American and Caribbean Literature in Health Sciences, LIVIVO, PubMed, Scopus, and Web of Science. The additional search was performed on Google Scholar and OpenGrey. All searches occurred on September 24, 2020. The methodologic quality of the results was evaluated by the Cochrane Collaboration Risk of Bias Tool.

RESULTS

eighteen studies were included, which evaluated the participants' stress using physiologic, self-reported measures, or the combination of both. Stress as experienced in a high level in simulated scenarios.

CONCLUSIONS

evidence of the study included in this systematic review suggest that stress is experienced in a high level in simulated scenarios.

Risk factors for coronary artery disease in nursing students

OBJECTIVES

to identify and discuss the main risk factors for coronary artery disease, observed in nursing students.

METHODS

an observational and cross-sectional study conducted with nursing students at a public college in Niterói, RJ. Data collection involved instruments validated for use in Brazil. PROCAM Quick Check score was used to estimate cardiovascular risk.

RESULTS

of the 110 students, 88 (80%) were female, with a mean age of 22.03±3.63 years. The most relevant cardiovascular risk factors were alcohol consumption 62 (56.4%), family history of coronary artery disease 35 (31.8%), poor eating habits (49.5%) and stress, whose domain "Professional training" received the highest mean, with 11.62 ± 3.42 points.

CONCLUSIONS

the most frequent risk factors in nursing students are stress, inadequate nutrition and risky consumption of alcoholic beverages. These present a low risk for coronary artery disease through PROCAM Quick Check score.

Stress and anxiety in nursing students between individual and peer simulations

BACKGROUND

The use of high-fidelity simulation practice as an educational tool is becoming increasingly prevalent in nursing education. Despite the learning effects of simulation practice, students have been shown to experience high levels of stress and anxiety during simulation. In recent years, peer learning has been defined as an acquisition of knowledge and skills through active support and support among equal or equal peers and has been shown to be an effective educational intervention for clinical health science students.

AIM

The purpose of this study was to incorporate peer learning into simulation learning and to clarify the differences between stress and anxiety during personal and peer simulations.

METHOD

Third-grade undergraduate students in a four-year course at two nursing universities participated in this study. In this study, the simulated patient was a 53-year-old man who had undergone gastrectomy for the treatment of gastric cancer. The scenario was that the patient had completely recovered consciousness in the operating room, and his tracheal tube had been removed one hour before the students examined him. Stress while simulation training was evaluated with heart rate variability. Anxiety was evaluated by the STAI after the simulations were complete.

RESULTS

Personal simulation practice (personal group; n = 50) and peer simulation practice (peer group, n = 59) was conducted. The personal group included 7 male students, and the peer group included 12 male students; the difference in male proportion was not significant. At the first patient assessment phase, stress of heart rate variability components at the peer group significantly increased relative to that of the personal. In addition, the personal had a significantly higher state anxiety score after simulation than the peer.

CONCLUSION

This study shows that in the face-to-face scene involving vital sign measurements, the presence of peers did not objectively alleviate stress.

Metodologias ativas no cateterismo periférico venoso: desenvolvimento de habilidades com simulador de baixo custo

RESUMO Objetivo Conhecer a percepção de estudantes de enfermagem sobre a contribuição do uso do simulador de baixo custo no desenvolvimento de habilidades técnicas para o cateterismo periférico venoso. Método Estudo descritivo de abordagem qualitativa, realizado em universidade pública do sul do Brasil com 25 estudantes de enfermagem. Os dados foram coletados em 2019, por meio de questionário acerca do cateterismo periférico venoso, desenvolvido com apoio de simulador de baixo custo. Para análise, seguiu-se a proposta operativa de Minayo. Resultados A partir dos dados, surgiram duas categorias. 1) Desenvolvimento de habilidades para cateterismo periférico venoso: os estudantes apontaram que o uso do simulador possibilita compreender cada etapa do procedimento e identificar onde precisam aperfeiçoar a técnica, preparando-os para o contato com o paciente. 2) Dificuldades encontradas na utilização do simulador de baixo custo. Os estudantes destacaram a baixa fidelidade do simulador e a limitação do treinamento por simulação sem comunicação. Conclusões e implicações para a prática Os estudantes percebem o simulador de baixo custo como uma relevante ferramenta para o desenvolvimento de habilidades do cateterismo periférico venoso, sugerem seu aperfeiçoamento para aumentar a fidelidade e a incorporação da comunicação no momento da punção para o maior realismo da experiência simulada.

Measuring stress in podiatric students in Spain: psychometric validation and adaptation of the KEZKAK questionnaire

Objective

The study aim was to develop a linguistic-cultural adaptation of the KEZKAK questionnaire to be completed during the practicum of podiatric medical students in Spain, to validate the questionnaire and to evaluate its psychometric properties.

Methods

The cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation; 2. Clinimetric validation based on assessments of interobserver reliability, test-retest reliability and internal consistency. The participants were podiatric medical students at the universities of Malaga and Miguel Hernandez, Alicante (Spain) and were recruited during the period February–October 2019. The following inclusion criteria were applied: aged at least 18 years, studying the third or fourth year of a university degree in Podiatry. All gave signed informed consent and completed the State-Trait Anxiety Inventory and the Podiatry version of the KEZKAK questionnaire. No sampling was performed and thus the entire eligible population was included in the study.

Results

The analysis was based on 205 participants (33.5% male, 66.5% female), with a mean age of 23.05 (SD 5.37) years. Internal consistency was excellent, with a Cronbach’s alpha of 0.95. This version of the questionnaire had five factorial structures (61.18%). No floor/ceiling effect was observed in any item. The KEZKAK presented high test-retest reliability after 21 days, with an overall ICC of 0.95 (95% CI [0.93–0.98]).

Conclusion

For university students of podiatry in Spain, the KEZKAK Podiatry version questionnaire is a valid, reliable instrument for measuring stressors during the practicum.

The art of balancing: the facilitator's role in briefing in simulation-based learning from the perspective of nursing students - a qualitative study

Background

Facilitators plays a key role in nursing student’s learning when briefing them for simulation scenarios. However, few studies have explored the importance of the facilitator’s role in preparing students from the students’ perspective. The aim of this study was to explore undergraduate nursing students’ perspectives of the facilitator’s role in briefing.

Methods

An explorative, qualitative approach was used. Four focus group interviews with a total of 30 nursing students constituted the data source. Data collection took place in December 2017 and in May 2018. The data was analysed using systematic text condensation.

Results

Two main categories were identified: “The importance of framing the subsequent scenario” and “The importance of instructing students how to execute nursing actions in the subsequent scenario”. The first category consisted of three subcategories: providing predictability, providing emotional support and providing challenges. The second main category also consisted of three subcategories: providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin.

Conclusion

A briefing is more than a general introduction to a simulation scenario, learning objectives, roles, simulation environment and medical equipment. The information provided in a briefing is important for nursing students’ understanding of what they will encounter in the simulation scenario and what is being simulated, as well as possibly being a prerequisite for mastery. The facilitator’s role in the briefing is complex and requires a high level of educational expertise to balance the diversity of students’ learning approaches. Students have to learn how to simulate before the briefing. Therefore, we suggest separating the concepts of prebriefing and presimulation from the concept of briefing, introducing prebriefing and presimulation preparation before briefing, and possibly dividing students into groups based on their learning approach. Such interventions will make it possible for facilitators to balance between students’ needs and the time available for briefing.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12912-020-00493-z.

Teaching cardiovascular physical examination in nursing: clinical simulation

OBJECTIVE

To evaluate, in Nursing students, the effect of clinical simulation as an educational strategy for learning about the cardiovascular physical examination.

METHODS

Quasi-experimental study, with the placement of 30 undergraduate nursing students, from a public university in Northeast Brazil, in two groups - intervention and control. The educational intervention consisted of a clinical simulation applied to the intervention group. The control group received only the usual class. Pre-test and post-test were applied with questions about cardiovascular physical examination for both groups. In the inferential analysis, we used chi-square or Fisher's exact tests for categorical variables; and the Student's t-test for independent samples.

RESULTS

The results showed that the difference in correct answers between the intervention and control groups was statistically significant, with a value of p of 0.05.

CONCLUSION

We concluded that the applied educational strategy had a positive effect on undergraduate nursing students to learn the cardiovascular physical examination.

Aspectos positivos e negativos da simulação clínica no ensino de enfermagem

Resumo Objetivo descrever os aspectos positivos e negativos da simulação clínica no ensino de enfermagem na perspectiva dos graduandos. Método estudo transversal descritivo de abordagem qualitativa, desenvolvido em uma universidade federal do Rio de Janeiro. A coleta de dados ocorreu após a realização da simulação clínica acerca do exame físico do paciente, onde se sucedeu uma discussão com os alunos acerca de suas percepções. O conteúdo textual decorrente das entrevistas foi submetido à análise lexicográfica, utilizando-se o software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires (IRAMUTEQ). Resultados os aspectos positivos da simulação clínica no ensino de enfermagem versam sobre a importância da simulação na preparação dos alunos para a prática clínica, favorecendo a correlação entre teoria, prática e o desenvolvimento do raciocínio crítico. Dentre os negativos, destacaram-se o nervosismo e a dificuldade em realizar as ações com os demais colegas observando. Conclusão e Implicações para a prática a simulação demonstrou ser uma ferramenta significativa e viável para o ensino em enfermagem. Recomenda-se que esta estratégia seja adotada a fim de contribuir na formação de profissionais reflexivos e aptos para prestar os cuidados sem erros, contribuindo para a segurança do paciente.

TRAINING OF CAREGIVERS OF CHILDREN WITH SPECIAL HEALTHCARE NEEDS: SIMULATION CONTRIBUTIONS

ABSTRACT Objective: to know the contributions of simulation regarding the training of caregivers of children with special healthcare needs, in the preparation for hospital discharge. Method: descriptive-exploratory study, with qualitative approach, carried out with caregivers of children with special healthcare needs. The study was developed in a simulation center of a public university in the South of Brazil, in partnership with a state reference children's hospital. The training program was based on simulations, using low, medium and high fidelity simulators, in which 15 caregivers participated. Data were collected through semi-structured interviews and submitted to content analysis, in its thematic modality. Results: two categories emerged: simulation as a learning strategy and implications of training for home care. The simulations allowed the improvement of procedural skills and coping with possible complications in the home setting. Feelings of fear and anxiety were initially triggered, especially in the high fidelity simulation. However, after the training, the caregivers felt relieved, self-confident and satisfied with their performance, highlighting the importance of the support provided during the simulations. They reported having greater confidence to perform the procedures on the child and face the challenges of home care. Conclusion: the simulation was considered a valid strategy for the training of caregivers, stimulating empowerment and self-confidence in the face of complex care required by a child with special healthcare needs. The study innovates by exploring the potentialities of simulation in this context, bringing important contributions to qualify the home care of this clientele.

Associations of stress, self-esteem, and collective efficacy with flow in simulation among nursing students: A descriptive cross-sectional study

BACKGROUND

Simulation-based learning was developed to enable nursing and medical students to obtain clinical experience in a safe and controlled environment. The extent to which students concentrate in simulation situations can influence their educational outcomes. However, there are no studies yet on the factors that influence flow in simulation practice. Understanding which factors influence flow might help in achieving better simulation-based learning outcomes.

OBJECTIVES

The purpose of this study was to identify the factors related to flow in simulation practice, including stress, self-esteem, and collective efficacy.

DESIGN

This was a descriptive cross-sectional study.

SETTING

A university in South Korea during the 2015 academic year.

PARTICIPANTS

This study was conducted with 84 senior nursing students. Their average age was 23 years old and >90% were female.

METHODS

The stress, self-esteem, and collective efficacy of senior nursing students were measured before simulation practice, while flow in simulation practice was measured after simulation.

RESULTS

Flow during simulation practice was positively correlated with self-esteem and collective efficacy, but negatively correlated with stress. Furthermore, only collective efficacy was a significant predictor of flow during simulation.

CONCLUSIONS

Nursing education must be oriented to help emphasize collective efficacy to improve students' outcomes from simulation-based learning.