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.

The influence of nursing student characteristics on performance in the Quebec licensing exam.

This study examines whether certain academic, demographic or psychosocial characteristics of students can be indicators of future success on the Provincial Nursing Licensing exam. A cohort of 42 third year Nursing students was the study sample. Data were collected using a self-reporting questionnaire, academic marks, and graduate interviews. Academic variables that were studied included: first year nursing marks, college biology marks, final year nursing marks, and literacy level. Demographic variables that were studied included : age, gender, socioeconomic status and level of life responsabilities, academic motivation (hours spent studying) and hours worked at unrelated employment. Lastly, psychosocial variables that were studied included: test taking anxiety, stress and overall confidence level in terms of success on the upcoming exam. A comparison was then undertaken between the two groups-students that passed and students that failed the Licensing exam on their first sitting-with respect to specific student characteristics. The conceptual framework for this study is based on Leinbach and Jenkin's model of the correlation of milestones to momentum points in the educational experience. Results of this study suggest that exam anxiety and content review in the months that follow graduation seem to affect exam performance. Also, certain demographic characteristics such as age and financial strain seemed to be good indicators of future success.||Résumé : Cette étude tente d'établir si certaines caractéristiques liées aux études ainsi que des caractéristiques démographiques ou psychosociales des étudiantes et des étudiants peuvent être indicatives du succès futur à l'examen professionnel provincial d'admission à la profession infirmière. Une cohorte de 42 étudiantes et étudiants de troisième année en sciences infirmières formait l'échantillon de l'étude. Les données ont été recueillies au moyen d'un questionnaire d'autoévaluation, des résultats scolaires et d'entrevues avec les infirmières et infirmiers gradués. Les variables liées aux études examinées ont été les résultats de la première année d'études en sciences infirmières, les résultats en biologie au collégial, les résultats de la dernière année d'études en sciences infirmières et le niveau de littératie. Les variables démographiques étudiées ont été l'âge, le sexe, le statut socioéconomique, le niveau de responsabilités sociales, la motivation dans les études (les heures passées à étudier) et les heures consacrées à un travail non lié aux études. Enfin, les variables psychosociales examinées ont été l'anxiété devant l'examen, le stress et le niveau général de confiance quant à la réussite de l'examen à venir. Une comparaison des deux groupes d'étudiantes et d'étudiants, soit ceux qui ont réussi l'examen et ceux qui l'ont échoué à leur première tentative, a ensuite été faite en tenant compte des caractéristiques particulières à chacun. Le cadre conceptuel de cette étude repose sur le modèle de la corrélation entre les jalons (milestones) et les accomplissements (momentum points) dans l'expérience des études de Leinbach and Jenkin. Les résultats de cette étude laissent entendre que l'anxiété devant l'examen et la révision de la matière dans les mois suivant l'obtention du diplôme semblent avoir un effet sur le rendement à l'examen. Aussi, certaines caractéristiques démographiques comme l'âge et les difficultés financières semblaient être indicatifs du succès futur.