Clinical Simulation for Student Self-Efficacy in Learning - Dissertation Example

?The Effect of Clinical Simulation on Self-Efficacy in learning Chapter Introduction ment of the Problem Nursing education has undergone vast changes to appropriately meet the changing needs of medical care. The overwhelming demands placed on nursing students may affect their confidence in carrying out what they have learned in their education into practice. This is expressed by novice nursing students in the study of Bambini, Washburn and Perkins (2009) when they exhibited low self-efficacy in their ability to perform clinical skills. The multiple tasks of professional nurses can be intimidating to nursing students, not to mention that their priority is to provide high quality medical care and nurturance to patients. Cases like these point to the value of clinical simulation in nursing education to help empower such students in being able to handle challenging tasks and situations in their own practice. Clinical simulation is defined by Waxman (2010) as a teaching methodology that provides students with learning experiences closely resembling real-life circumstances that they are likely to encounter in their professional practice. “Simulated clinical experience requires immersing students in a representative patient-care scenario, a setting that mimics the actual environment with sufficient realism to allow learners to suspend disbelief” (p.29). Specific to nursing education is the utilization of a lifelike high-fidelity manikin which provides a high level of interactivity and realism to nursing students during their simulation proceedings (Jeffries, 2007). The integration of simulation in the nursing education curricula is welcomed by nurse educators as a new and effective method that promises to prepare the students better for a future in the nursing profession as competent and confident health workers. Setting up a clinical simulation situation takes much time, planning and effort that draws its information from theories and professional experiences (Waxman, 2010). The complexity of clinical simulation raises the question if it does improve a student’s self-efficacy to be a more efficient professional or leave the student overwhelmed with the probable challenges he or she will face in practice. Self-efficacy is one indicator of an individual’s perception of how well prepared he or she is in being able to successfully accomplish tasks (Bandura, 1977, 1986). Further, Bandura (2004) explains that: “Efficacy beliefs influence goals and aspirations. The stronger the perceived self-efficacy, the higher the goals people set for themselves and the firmer their commitment to them. Self-efficacy beliefs also determine how obstacles and impediments are viewed. Those of high efficacy view impediments as surmountable by improvement of self-management skills and perseverant effort” (p. 145). Topic This study will explore clinical simulation as a new method of learning in nursing education. It will discuss the corresponding cognitive and affective processes that the student undergoes during the simulation and follow through if it is indeed an effective strategy in the improvement of student efficacy. The research problem The research problem posed for this study is “How does clinical simulation affect a student’s self-efficacy in learning in Nursing education?” Background and justification. The current demands of health care necessitate more aggressive training of health care professionals in order to address the growing needs of an industry that is besieged with a multitude of illnesses. More and more diseases come up with symptoms that may be unusual. These may pose a huge challenge to new nurses who have been trained in the traditional approaches of lectures, discussions, role-play and laboratory practice, as these may no longer be effective (Waxman, 2010). A nurse needs to be thoroughly trained in various areas and has amassed enough experiences to be able to carefully discern his or her next moves. Such moves may be crucial to the treatment and safety of the patient and thus, the need for enough practice. Although there are countless scenarios where nurses’ skills and abilities are called for, there are still areas such as pediatrics or obstetrics where clinical experiences may be limited (Lambton, 2008). This is when simulation training can work best, as it would provide the students with opportunities to experience clinical practice in a safe and controlled environment that will not risk the safety of any patient. Jeffries (2005) claim that simulation education includes the use of both low and high fidelity manikins, skill and task trainers, virtual reality trainers, computer-based simulators and scenarios and even standardized patients. It is different from using traditional methods in that specific scenarios are provided for the students to respond to. Nursing educators should be clear on the objectives of each scenario because without a clear simulation design, the expected learning outcomes of critical thinking, self-confidence in performing the necessary tasks, effective performance or satisfaction will not be achieved (Waxman, 2010). That is why it is essential that learning objectives are clear, concise and relevant (Jeffries, 2007). The Bay Area Simulation Collaborative (BASC) is a group of more than a hundred member schools and hospitals that trains health workers through clinical simulation techniques. It employs more than 600 faculty and hospital educators both in practice and in the academe within the 10 counties of the San Francisco Bay Area (Waxman, 2010). The BASC identified six concepts for scenarios for simulation that students should be adept in. These concepts are patient safety, priority setting, leadership and delegation, communication, patient teaching and cultural diversity. The BASC aims to promote simulation as integral to the development of critical thinking skills of nursing students (Waxman, 2010). At best, simulation uses high technology and this is known as Human patient simulation (HPS), a computer-controlled system that uses a manikin designed with human-like responses with functions that are controlled by the instructor through a computer. It allows students to practice nursing interventions such as medication administration, catheterization or oxygen therapy (Bearnson and Wiker, 2005). The instructor is able to direct scenarios that mimic patients’ illnesses and trauma through its interactive physiological systems such as cardiovascular, respiratory and neurological systems (Parker & Myrick, 2010). The advanced technology enables the manikin to speak, breathe, perspire, etc. (Medical Education Technologies, Inc., 2004). In addition to this, the environment is made to replicate a hospital room to complete a reality-based immersive clinical experience (Yeager et al., 2004). Parker & Myrick (2010) explain that after the scenario is completed, the students engage in a debriefing session with their facilitator when they can evaluate their performance in the simulation. The facilitator gives feedback on the student’s performance keying in on the areas of weakness and how this can be amended and highlighting areas of success so these may be reinforced. It is important that during the simulation, the facilitator is a mute observer who allows the student to be autonomous and not intervene when he or she is not doing the task correctly. This is to see exactly how the student will apply all the learning gained from the courses. The facilitator may note down all observations for feedback during the debriefing process (Curran, 2005). Debriefing sessions call for open-ended questions to uncover the rationale behind the decision-making processes that transpired during the simulation session. These questions should be specific to the cognitive, technical and behavioural skills intended for the simulation and are used to gather more information from the participants. The process of simulation engages the student in reflective practice. Loughran (1996) defines reflection to be ‘involving thoughtfully considering one's own experiences in applying knowledge to practice while being coached by professionals in the discipline’ (p. 26). Schon’s (1983) theory outlines two different types of reflection that occur at different time phases: reflection on action and reflection in action. ‘Reflection in action’ is often referred to the colloquial phrase as ‘thinking on your feet’ a term used to being able to assess ourselves within a situation, making appropriate changes and still keeping a steady flow in the process. Reflection on action is when reflection occurs after the event. This is where the practitioner makes a deliberate and conscious attempt to act and reflect upon a situation and how it should be handled in the future (Loughran 1996). During stimulation, students do both kinds of reflection and this is valuable in their learning process. Reflective thinking has now been identified to be crucial in professional development. Mezirow (1997), an advocate of transformative learning theory, claims that adult learners need to develop the skills to become independent, autonomous thinkers. Transformative learning theory focuses on the role of the experience, rational discourse and critical reflection in knowledge development (Imel, 1998). These are precisely the processes that clinical simulation include. Parker & Myrick (2010) contend that HPS-based clinical scenario has constructivist pedagogical underpinnings fostering interpretive, generative learning which is suited to the promotion of transformative learning (Dabbagh & Bannan-Ritland, 2005; Magee, 2006). Through the use of HPS-based scenarios, students engage in concrete experiences likely to be done in their future practice. Reflection on these experiences are processed into abstract conceptualization and new theories or hypotheses derived from such conceptualizations may be tested through active experimentation (Perkins, 2007). Simply stated, reflective processes provide students with ideas they can test in the clinical setting. Successfully performing in the simulation is likely to raise a student’s self-efficacy (Bambini, Washburn and Perkins, 2009; Pike & O’Donnel, 2010; Sears, Goldsworthy and Goodman, 2010). Lacking practical experience, nursing students cannot just rely on their theoretical knowledge gained from school. Faced with a simulated environment, they gain familiarity with situations that they will most probably encounter in their future profession. They get to see the real equipment to be used, the set up in a clinical environment, and get an idea of how it feels like to be in a clinic, hospital room or operating room. Simulation training involves a wide spectrum of scenarios, from effectively communicating with patients (Chen, 2011; Bambini, Washburn and Perkins, 2009) to ensuring medical safety (Sears, Goldsworthy & Goodman, 2010) to medical procedures and other clinical practices (Waxman, 2010). Students may feel awkward at first, being faced with a situation requiring them to use their knowledge in nursing care. They may commit several mistakes that may threaten the patient’s health and safety, but the consolation is that the patient is not a live human being. During the simulation itself, self-efficacy may spiral downwards due to the anxiety of dealing with the situation and the awareness that their instructor may be watching them from afar. They may feel so overwhelmed with the various stimuli present within the simulated setting that they may feel inadequate. After intensive simulation training, students’ self-efficacy may improve due to the learning they have gained from it. Being corrected of their mistakes and wrong judgment during the debriefing process, they know better what to do next time. According to the study of Bambini, Washburn and Perkins (2009), nursing student participants claimed that they learned the importance of communication with patients and their families. Secondly, they admitted that the clinical simulation experience raised their confidence in their psychomotor skills and patient interactions. Finally, they reported learning the importance of clinical judgment. They learned how to prioritize assessment skills, point persons who can intervene, and identification of symptoms and physical assessment findings. Overall, there is much evidence to claim that clinical simulation training raises student efficacy in the field of nursing education. Deficiencies in the evidence The review of literature finds more positive outcomes from the use of clinical simulation in nursing education. However, according to Chen (2011), being mere prototypes of actual clinical encounters, simulations only reflect certain aspects of a true clinical encounter. Cases presented to students are constructed, edited and even simplified so that the learning objectives set by the facilitators may be easier to achieve. In terms of communication training with patients, actors and standardized patients may still be unable to represent the full scope of emotions and responses of actual patients or their family members. For example in a simulated scenario of a nurse delivering unfavorable news to patients and their families, real people may have different needs to what standardized patients and educators perceive as their needs. For instance, the literature reports that patients and families may not be able to process and recall at a later date information communicated during bad news exchange but in training in information delivery techniques delivering negative information is one skill that must be learned in simulation training (Chen, 2011) Chen (2011) recommend students to learn to effectively translate the learning experiences from the simulation environment into their actual clinical practice which could be much different due to multiple distractions present. Audience This study aims to target nursing students and educators as well as the institutions that offer nursing education and their benefactors who sponsor training equipment for the students. It also wants to reach hospital administrators and staff to show them the importance of training of their prospective nurses and the quality of education that should be expected of them upon hiring. Definition of Terms Clinical simulation: a teaching methodology that provides students with learning experiences closely resembling real-life circumstances that they are likely to encounter in their professional practice (Waxman, 2010). Debriefing: A session conducted after simulation that offers the students an opportunity to discuss their perceptions of their performance, problem-solve decisions that they have made, and share in a supportive evaluation process, all of which will assist in reinforcing the learning and knowledge development that has occurred (Rhodes & Curran, 2005). Human Patient Simulation: a powerful technology-based educational tool ideally suited for the application of emancipatory pedagogies in nursing education using a computer-controlled manikin designed to provide practitioners with human-like responses to nursing interventions (Parker & Myrick, 2010). Reflective practice: the essential part of the learning process because it results in making sense of or extracting meaning from the experience (Osterman, 1990). Self-efficacy: indicator of an individual’s perception of how well prepared he or she is in being able to successfully accomplish tasks (Bandura, 1977, 1986). Purpose of the Study The purpose of this study is to explore the method of clinical simulation in the context of nursing education and its corresponding effect on nursing students, specifically in the development of their self-efficacy. References Bambini, D., Washburn, J. & Perkins, R. (2009) Outcomes of Clinical Simulation for Novice Nursing Students: Communication, Confidence, Clinical Judgment, Nursing Education Research, Vol. 30, No. 2. Bandura, A. (1977). Social learning theory. New York: General Learning Press. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ. Prentice-Hall. Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. Bearnson, C.S., & Wiker, K.M. (2005). Human patient simulators: A new face in baccalaureate nursing education at Brigham Young University. Journal of Nursing Education, 44, 421-425. Chen, R.P. (2011) Moral imagination in simulation-based communication skills training, Nursing Ethics Vol.18, No.1 Dabbagh, N., & Bannan-Ritland, B. (2005). Online learning: Concepts, strategies, and application. Upper Saddle River, NJ: Pearson Education. Imel, S. (1998). Transformative learning in adulthood. Retrieved from http://www.ericdigests.org/1999-2/adulthood.htm Jeffries, P.R. (2005). A framework for designing, implementing and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26, 96-103. Jeffries, P.R. (Ed). (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing. Lambton, J. (2008). Integrating simulation into a pediatric nursing curriculum: A 25% solution? Simulation in Healthcare, 3,53-57. Loughran, J.J. (1996) Developing reflective practice: learning about teaching and learning through modeling. Routledge. Magee, M. (2006). State of the field review: Simulation in education.Retrieved from http://ccl-cca.ca/NR/rdonlyres/C8CB4C08-F7D3-4915-BDAA- C41250A43516/0/REV.pdf Medical Education Technologies, Inc. (2004). HPS: Human patient simulator. Retrieved from http://www.meti.com/ downloads/HPSCF.pdf. Mezirow, J. (1997). Transformative learning: Theory to practice. In P. Cranton (Ed.), Transformative learning in action: Insights from practice (pp. 5-12). San Francisco, CA: Jossey-Bass. Osterman, K. F. (1990) "Reflective Practice: A New Agenda for Education." Education And Urban Society 22, no. 2 pp. 133-152. Parker, B. & Myrick, F. (2010) Transformative Learning as a Context for Human Patient Simulation, Journal of Nursing Education, Vol. 49, No. 6 Perkins, G.D. (2007). Simulation in resuscitation training. Resuscitation,73, 202-211. Pike, T. & O’Donnell, V.(2010) The impact of clinical simulation on learner self- efficacy in pre-registration nursing education., Nurse Education Today, Vol. 30 Issue 5, p405-410 Rhodes, M.L., & Curran, C. (2005). Use of human patient simulator to teach clinical judgment skills in a baccalaureate nursing program. Computers, Informatics, Nursing, 23, 256-262. Schon, D. A. (1983) The reflective practitioner: how professionals think in action. New York: Basic Books. Sears, K., Goldworthy, S. & Goodman, W.M. (2010) The Relationship Between Simulation in Nursing Education and Medication Safety, Journal of Nursing Education, Vol. 49, No. 1 Waxman, K.T. (2010) The Development of Evidence-Based Clinical Simulation Scenarios: Guidelines for Nurse Educators, Journal of Nursing Education, Vol. 49, No. 1 Yeager, K.A., Halamek, L.P., Coyle, M., Murphy, A., Anderson, J., Boyle, K., et al. (2004). 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