The Impact of a Simulated Clinical Experience on CEGEP Nursing Students’ Perceptions of Self-Efficacy and Achievement

Abstract : Providing high-quality clinical experiences to prepare students for the complexities of the current health-care system has become a challenge for nurse educators. Additionally, there are concerns that the current model of clinical practice is suboptimal. Consequently, nursing programs have explored the partial replacement of traditional in-hospital clinical experiences with a simulated clinical experience. Despite research demonstrating numerous benefits to students following participation in simulation activities, insufficient research conducted within Québec exists to convince the governing bodies (Ordre des infirmières et des infirmiers du Québec, OIIQ; Ministère de L’Éducation supérieur, de la Recherche, de la Science et de la Technologie) to fully embrace simulation as part of nurse training. The purpose of this study was to examine the use of a simulated clinical experience (SCE) as a viable, partial pedagogical substitute for traditional clinical experience by examining the effects of a SCE on CEGEP nursing students’ perceptions of self-efficacy (confidence), and their ability to achieve course objectives. The findings will contribute new information to the current body of research in simulation. The specific case of obstetrical practice was examined. Based on two sections of the Nursing III-Health and Illness (180-30K-AB) course, the sample was comprised of 65 students (thirty-one students from section 0001 and thirty-four students from section 0002) whose mean age was 24.8 years. With two sections of the course available, the opportunity for comparison was possible. A triangulation mixed method design was used. An adapted version of Ravert’s (2004) Nursing Skills for Evaluation tool was utilized to collect data regarding students’ perceptions of confidence related to the nursing skills required for care of mothers and their newborns. Students’ performance and achievement of course objectives was measured through an Objective Structured Clinical Examination (OSCE) consisting of three marked stations designed to test the theoretical and clinical aspects of course content. The OSCE was administered at the end of the semester following completion of the traditional clinical experience. Students’ qualitative comments on the post -test survey, along with journal entries served to support the quantitative scale evaluation. Two of the twelve days (15 hours) allocated for obstetrical clinical experience were replaced by a SCE (17%) over the course of the semester. Students participated in various simulation activities developed to address a range of cognitive, psychomotor and critical thinking skills. Scenarios incorporating the use of human patient simulators, and designed using the Jeffries Framework (2005), exposed students to the care of families and infants during the perinatal period to both reflect and build upon class and course content in achievement of course objectives and program competencies. Active participation in all simulation activities exposed students to Bandura’s four main sources of experience (mastery experiences, vicarious experiences, social persuasion, and physiologic/emotional responses) to enhance the development of students’ self-efficacy. Results of the pre-test and post-test summative scores revealed a statistically significant increase in student confidence in performing skills related to maternal and newborn care (p < .0001) following participation in the SCE. Confidence pre-test and post-test scores were not affected by the students’ section. Skills related to the care of the post-partum mother following vaginal or Caesarean section delivery showed the greatest change in confidence ratings. OSCE results showed a mean total class score (both sections) of 57.4 (70.0 %) with normal distribution. Mean scores were 56.5 (68.9%) for section 0001 and 58.3 (71.1%) for section 0002. Total scores were similar between sections (p =0.342) based on pairwise comparison. Analysis of OSCE scores as compared to students’ final course grade revealed similar distributions. Finally, qualitative analysis identified how students’ perceived the SCE. Students cited gains in knowledge, development of psychomotor skills and improved clinical judgement following participation in simulation activities. These were attributed to the « hands on » practice obtained from working in small groups, a safe and authentic learning environment and one in which students could make mistakes and correct errors as having the greatest impact on learning through simulation.

Journalisation dans un Programme de carrière en nouveaux médias : Le rôle de la réflexion par l’action

The purpose of this case study is to report on the use of learning journals as a strategy to encourage critical reflection in the field of graphic design. Very little empirical research has been published regarding the use of critical reflection in learning journals in this field. Furthermore, nothing has been documented at the college level. To that end, the goal of this research endeavor was to investigate whether second-year students in the NewMedia and Publication Design Program at a small Anglophone CEGEP in Québec, enrolled in a Page Layout and Design course, learn more deeply by reflecting in action during design projects or reflecting on action after completing design projects. Secondarily, indications of a possible change in self-efficacy were examined. Two hypotheses were posited: 1) reflection-on-action journaling will promote a deeper approach to learning than reflection-in-action journaling, and 2) the level of self-efficacy in graphic design improves as students are encouraged to think reflectively. Using both qualitative and quantitative methods, a mixed methods approach was used to collect and analyze the data. Content analysis of journal entries and interview responses was the primary method used to address the first hypothesis. Students were required to journal twice for each of three projects, once during the project and again one week after the project had been submitted. In addition, data regarding the students' perception of journaling was obtained through administering a survey and conducting interviews. For the second hypothesis, quantitative methods were used through the use of two surveys, one administered early in the Fall 2011 semester and the second administered early in the Winter 2012 semester. Supplementary data regarding self-efficacy was obtained in the form of content analysis of journal entries and interviews. Coded journal entries firmly supported the hypothesis that reflection-on-action journaling promotes deep learning. Using a taxonomy developed by Kember et al. (1999) wherein "critical reflection" is considered the highest level of reflection, it was found that only 5% of the coded responses in the reflection-in-action journals were deemed of the highest level, whereas 39% were considered critical reflection in the reflection-on-action journals. The findings from the interviews suggest that students had some initial concerns about the value of journaling, but these concerns were later dismissed as students learned that journaling was a valuable tool that helped them reflect and learn. All participants indicated that journaling changed their learning processes as they thought much more about what they were doing while they were doing it. They were taking the learning they had acquired and thinking about how they would apply it to new projects; this is critical reflection. The survey findings did not support the conclusive results of the comparison of journal instruments, where an increase of 35% in critical reflection was noted in the reflection-on-action journals. In Chapter 5, reasons for this incongruence are explored. Furthermore, based on the journals, surveys, and interviews, there is not enough evidence at this time to support the hypothesis that self-efficacy improves when students are encouraged to think reflectively. It could be hypothesized, however, that one's self-efficacy does not change in such a short period of time. In conclusion, the findings established in this case study make a practical contribution to the literature concerning the promotion of deep learning in the field of graphic design, as this researcher's hypothesis was supported that reflection-on-action journaling promoted deeper learning than reflection-in-action journaling. When examining the increases in critical reflection from reflection-in-action to the reflection-on-action journals, it was found that all students but one showed an increase in critical reflection in reflection-on-action journals. It is therefore recommended that production-oriented program instructors consider integrating reflection-on-action journaling into their courses where projects are given.

Une comparaison des journaux non structurés et des journaux structurés rédigés par les étudiants en hygiène dentaire

The Canadian Dental Hygienists Association (CDHA) has indicated that there is a need for research in education in the field of dental hygiene. It seems that when compared to the nursing profession, the profession of dental hygiene is only in the earliest stages of investigating ways of teaching critical thinking. The faculty of the dental hygiene program at John Abbott College has always valued the skill of self-assessment in the students, yet there are few specific learning activities provided whereby the students can learn how to perfect and work on this invaluable skill of self-reflection in order to better self-assess. Although self-assessment is required of the students upon the completion of each clinical experience in Clinic 1, 2 and 3, a modest amount of clinical time is allotted to reflect upon this most important skill. It appears that more could be done to prepare our students to assess their learning and clinical practice. Self-reflection as an essential element of practice has a valid place in professional education. The purpose of conducting this study was to find out whether unstructured or structured self-reflective journal writing is a sound pedagogical technique to encourage dental hygiene students’ self-assessment through self-reflection. The research design for the project was a single case study. The paradigm for the study was chosen with a purposeful selection of participants, involving twenty-seven, third-year dental hygiene students at John Abbott College. The students were arbitrarily enrolled in two sections, which for the purpose of this study were referred to as Group A and Group B. Three duplicated coded anonymous journal entries from each student were collected over a ten-week period during the Fall 2009 semester. To examine the students’ level of self-reflection, two methods were used. First a content analysis of reflective journals was used to ascertain the level and substance of the reflections from their clinical experiences with the intent of looking more specifically at the students’ self-assessment. The journal entries were coded and analyzed after the grades were submitted at the end of the school term. This was followed by the distribution of an anonymous questionnaire to the students in both sections. The responses of the questionnaire were tabulated and analyzed. An analysis was done on the data collected in order to determine whether age, education and or mother tongue of the students in both Groups A and B had an influence on their perceptions of journal writing, as well as the student’s opinions about the value of journal writing. This questionnaire included two open-ended questions to assist in gathering additional data on the student’s thoughts on writing journals. A content analysis of the qualitative data collected from the open-ended questions in the questionnaire was also analyzed. Results indicated there were very few differences in the level of self-reflection leading to self-assessment. However, students in Group B who were assigned structured journals showed more evidence of deeper learning. Taken as a whole, the journal entries clearly showed the students were involved in ‘reflection-on-action’ of their clinical experiences (Schon 1987, as cited in Asadoorian & Batty, 2005). The quality of the responses for the most part indicated the students took the time and effort to record their perceptions of their clinical experiences. It is important to note that the results do indicate that students did show a need to self-reflect and assess. The students did in fact validate the importance of reflection through journal writing, even though they did not particularly like it as an added assignment. The journals were found to be very helpful to the research in getting to know what the issues were that held the students’ attention. They explained how and to what extent the students developed relationships with their clients. It was obvious that clinicians have an impact and influence on student learning. The students value the help, role modeling, patience, encouraging words and or gestures, positive reinforcement, and understanding provided by their clinicians. This research provides some evidence that students do believe that self-reflection through structured journal writing helped them better prepare for future clinical sessions with their clients. Our goal as educators should be to encourage dental hygiene students to self-assess through written self-reflection as an established practice for deeper learning.