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.

Élaboration de stratégies pour l’enseignement de la pensée critique dans les cours de philosophie au collégial

Les enseignantes et les enseignants du collégial accordent beaucoup de valeur au développement intellectuel de leurs élèves. La pensée critique représente l'idéal d'une pensée accomplie et son développement est un des buts de la formation générale au cégepl. Les professeurs de philosophie savent d'expérience que leur discipline se déploie souvent selon un mode conceptuel abstrait, étrange pour plusieurs élèves, novices dans la vie intellectuelle. En philosophie, la pensée critique est reconnue pour sa capacité à développer une réflexion rationnelle en profondeur et à structurer les concepts nécessaires à l'élaboration d'une pensée autonome. Les enseignantes et les enseignants de philosophie du collégial savent bien que les élèves qui pratiquent ou qui développent la pensée critique peuvent acquérir une formation philosophique de base, intéressante et pertinente. Mais, qu'arrive-t-il à ceux et celles qui ne la possèdent pas ? Notre position est qu'avec une perspective pédagogique, l'ensemble des élèves peut parvenir à développer des habiletés de pensée critique qui leur permettent d'accéder à une réflexion de haut niveau. Afin de poser le problème de recherche, nous avons débuté par l'examen de plusieurs difficultés liées à l'enseignement de la pensée critique. Ce qui frappe d'abord, c'est l'ampleur d'un problème conceptuel; la pensée critique est un terme générique attrayant, mais inconsistant et qui se révèle ambigu à l'usage. Ensuite, il faut reconnaître la présence d'un problème pédagogique : pour enseigner la pensée critique, les professeurs de philosophie ont besoin de ressources et d'une pratique pédagogique propre à la discipline. Après l'examen de quelques manuels utilisés dans les cours de philosophie au collégial, nous avons noté que leur orientation n'est pas dirigée vers le développement de la pensée critique. On peut alors se demander ce que peuvent faire les professeurs pour développer la pensée critique des élèves lorsque celle-ci s'avère insuffisante. Un relevé sommaire de la documentation nous a permis de découvrir que l'enseignement de la pensée critique pouvait être fondé sur plusieurs modèles théoriques. Nous en avons examiné quatre qui vont soutenir le choix du cadre de référence de notre recherche : 1) une sensibilité à la métacognition, 2) un enseignement par infusion, 3) une enculturation à la pensée critique, et 4) une épistémologie développementale. Nous mentionnons ensuite les problèmes concernant l'évaluation de la pensée critique : pour certains auteurs, les instruments d'évaluation ne sont pas assez sensibles pour rendre compte de changements graduels et subtils à l'intérieur d'une session. Malgré cette difficulté, on trouve tout de même dans les écrits plusieurs stratégies d'enseignement qui pourraient avoir des effets sur le développement de la pensée critique des élèves. Un bref inventaire de ces stratégies nous conduit à choisir l'approche de Bean (2001) comme cadre de référence et comme modèle pour l'enseignement de la pensée critique. Dans son ouvrage, Engaging ideas: The professor's guide to integrating writing, critical thinking, and active learning in the classroom, Bean (2001) intègre l'enseignement de la pensée critique à l'appropriation d'un contenu disciplinaire. L'auteur distingue quatre phases de développement de la pensée critique, inspirées de Kolb : l'expérience concrète, l'observation réflexive, l'abstraction conceptuelle et l'expérimentation active. Il présente pour chacune des phases des activités d'écriture qui pourraient être transférables ou applicables au niveau collégial. Ce choix nous amène à formuler notre objectif de recherche : produire un répertoire de stratégies pédagogiques pour l'enseignement de la pensée critique dans les cours de philosophie au collégial sur le modèle proposé par Bean (2001). Ainsi, l'approche de la recherche développement nous sert bien à atteindre cet objectif. Selon cette approche, nous avons conçu un répertoire de stratégies pédagogiques à l'intention des professeurs de philosophie, en nous inspirant des activités d'écriture proposées par Bean (2001). Ce répertoire a ensuite été soumis à quatre professeurs de philosophie pour validation. Ces experts avaient la tâche d'évaluer le matériel pédagogique et de soumettre des avis pour l'améliorer. La version validée du répertoire constitue le document que nous soumettons pour supporter les professeurs qui ont à coeur de développer la pensée critique dans les cours de philosophie au collégial. Cette recherche devrait contribuer à mieux comprendre la problématique du développement de la pensée critique, à envisager des perspectives pour l'enseigner et à saisir les enjeux pour son enseignement dans les cours de philosophie. Ces avenues devraient intéresser particulièrement la communauté collégiale.

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.

Clickers in the nursing classroom.

Traditional teaching methods in the classroom also limit opportunities for student engagement due to large class sizes and the desire to ensure students receive all of the material required in a particular session. It has been documented that the use of Information Technolgy (IT); in particular «clickers», can increase student participation, improve knowledge retention and assist in stimulating critical thinking in a classroom setting. However, the introduction of IT, on top of normal teaching demands, can be probelmatic as it requires changes to course planners, IT training, support staff and additional funding, all of wich have been documented in research. Wolski and Jackson (1999) have postulated that success is a function of the usefulness and the ease of use of a particular technology for faculty members. Research has shown that classroom technology is simply a tool to be used by educators as one of many. Those who tend to use it well are already innovative and technically adept (Zhao, Pugh, Sheldon & Bryers, 2002).||Résumé : Les méthodes d'enseignement traditionnelles en cour magistral ont aussi tendance à limiter l'engagement et la participation des étudiants dû à la taille souvent excessive des classes, mais aussi à cause du désire de l'enseignant de vouloir s'assurer de la transmission du contenu pédagogique complet. Il est bien documenté que l'usage des nouvelles technologies, en particulier les télévoteurs («clickers», peut accroître la participation des étudiants, améliorer la rétention de l'information mais aussi de stimuler, dans le contexte académique, la pensée critique. Malheureusement, tel que démontré par la recherche, l'introduction de ces nouvelles technologies pose problème lorsqu'additionné aux contraintes normales d'enseignement puisque qu'elle nécessite des changements à la planification des cours, requiert une formation spécifique, un support additionnel ainsi que le financement nécessaire. Wolski and Jackson (1999) ont postulé de plus que le succès de l'implantation d'une nouvelle technologie était en fonction de son utilité et de sa facilité d'utilisation par les membres de la faculté. Il a aussi été démontré que la technologie de l'enseignement en classe n'était en fait qu'un outil de plus à la disposition des enseignants, et que ceux qui avaient tendance à bien l'utiliser étaient de fait inoovateurs, possédant des capacités techniques (Zhao, Pugh, Sheldon et Bryers, 2002).