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.

Stratégie de participation publique visant l’implantation de projets de piétonnisation porteurs d’acceptabilité sociale à Montréal

L’objectif de cet essai est de proposer pour Montréal une stratégie de participation publique visant l’implantation de projets de piétonnisation porteurs d’acceptabilité sociale dans tous les secteurs de la métropole. En effet, malgré quelques initiatives en faveur des modes de déplacement actif, les intérêts des piétons sont souvent délaissés au profit de ceux des automobilistes qui s’imposent plus facilement. Ainsi, la motorisation en constante croissance sur l’île a pour effet de dégrader l’environnement résiduel disponible pour les personnes. Au contraire, le choix d’aménagements favorisant les modes de déplacement doux comme la marche s’avère profitable, dans toutes les sphères du développement durable, tant sur le plan personnel que collectif. L’étude des pratiques d’aménagement urbain à Montréal démontre que les mécanismes de participation des citoyens à la transformation de l’environnement bâti comportent plusieurs lacunes et participent à cette dévalorisation du piéton. L’organisme responsable de la participation publique, l’Office de consultation publique de Montréal, propose une approche inadéquate pour traiter une question aussi complexe que la piétonnisation. Par conséquent, il n’y a pas de trame cohérente et consensuelle de la piétonnisation en ville. Ainsi les aménagements sont de qualité très inégale d’un arrondissement à l’autre, voire d’une rue à l’autre. La définition des concepts démontre qu’une organisation de l’espace à échelle humaine, soit à échelle piétonne, est incontournable lorsqu’il est question de l’aménagement de collectivités viables. Mettre en place des conditions favorables à la marchabilité permet effectivement de développer une vision structurante, à la base d’un milieu de vie plus sain et d’aborder en amont les problématiques propres à l’urbanisation. Par ailleurs, l’emploi d’une approche participative en urbanisme se présente comme une réponse incontournable dans la conception de projets porteurs d’acceptabilité sociale. La stratégie proposée dans le cadre de cet essai vise la mise en place des conditions nécessaires au partage du pouvoir en accord avec les théories de la gouvernance participative. D’abord, la vision de la piétonnisation montréalaise doit être construite en collaboration avec les membres de la collectivité. Ensuite, les projets doivent être co-construits en partenariat avec les parties prenantes afin de bien s’harmoniser avec le milieu d’accueil. 10 recommandations accompagnent cette stratégie de participation en deux volets. Il est entre autres question de redéfinir la culture de la participation publique à Montréal vers la construction de l’acceptabilité sociale des projets, de favoriser une démarche de participation flexible et de communiquer de manière continue, proactive et mobilisatrice.