Simulation has been internationally recognized as an effective and innovative teaching approach in nursing education. It provides a safe, active, and hands-on experience for learners. For nursing students, simulation experiences not only reduce their level of anxiety, but also significantly increase their self-confidence. Moreover, due to the shortage of clinical settings in Japan, simulation serves as an ideal replacement for clinical practices in which students will have more opportunities to learn knowledge and skills they need.
The effectiveness and importance of simulation in nursing education has been rapidly acknowledged in Japan, and currently many nursing programs has incorporated some aspects of simulated activities into their classes. After reviewing related literature, we found that simulation courses in Japan are mainly provided for either sophomore or junior year nursing students and these courses emphasize the instruction of communication and technical skills of adult health nursing. There was no study addressing the simulation instruction for freshman students currently. Furthermore, although there was a study indicating the promising use of a pediatric nursing simulation course on promoting students’ caring ability, the researchers of this study did not intend to design this course as a “caring-ability building” course.
In this study, we attempted to develop a simulation scenario for first-year nursing students to help them learn the fundamental nursing skills required for ensuring patients’ safety and improve their caring ability. Since the simulation was designed for freshmen, its emphasis was primarily placed on enhancing their awareness about the patient and the environment. Participating students were expected to broaden their nursing perspectives after receiving the simulation training.
Purpose:
The purpose of this study was to demonstrate how we design a simulation activity attempting to integrate caring capacity into fundamental nursing skills as well as to evaluate the effectiveness of the simulation for the first-year undergraduate nursing students in Japan.
Methods:
Participants:
A hundred and twenty-one first-year nursing students participated in the study. These students received the simulation training at the end of the first semester in which the courses they took included the Fundamental Nursing Concepts, Human Caring, and Basic Nursing Skills. Prior to this study, participating students did not have any practical experiences in a clinical setting.
Simulation Design;
Learning objectives of the simulation training were addressed from three domains. Specifically, upon completion of the simulation instruction, students will be able to (1) use basic communication skills to understand the condition and environment of a patient and be attentive to his or her safety issues and comfort (affective domain) (2) identify the safety issues regarding a patient’s condition and further intervene effectively to ensure his or her safety and comfort (cognitive and psychomotor domains) : (3) reflect upon the learning that occurred during the simulation scenario and comprehend the importance of caring (affective domain).
We designed several pre-scenario learning activities. First, we offered a basic lecture and practice sessions designed to train students to be aware of hidden dangers, manage to ensure safety for a patient, and provide comfort to a patient in a clinical setting. Second, we provided students with a reading assignment which is a poem named “Listen Nurse” written by a patient to encourage students to ponder the meaning of caring. Students were also requested to analyze whether specific behaviors demonstrated by the nurse in the poem could be viewed as caring and the rationale behind their thoughts. Third, we made a three-minute film using a mannequin as a patient and assigned students to watch it before coming to the simulation. In the film, there were lots of situational elements regarding safety issues (e.g., placing a patient in a high-raised bed without using side rails, incorrect name on the patient identification plate on the bed, displacing a nurse call button far from a bed) or the lack of caring for the patient (e.g., placing an empty glass or leaving meals on a bedside table). Students were asked to identify the conditions that may endanger a patient’s safety and comfort and discuss potential interventions.
In this study, we developed two simulation scenarios, both of which included 7-8 conditions. Among these conditions, some were presented in accordance with the plots in the poem or the film used for the assignments so that students could apply what they have considered and discussed earlier to the simulation. In terms of the actual simulation, we used a standardized patient who acted as an 80-year-old male patient who is diagnosed with pneumonia and bedridden.
Simulation Learning Sessions:
Approximately 60 students attended each simulation session. These students were divided into 10 groups with each one consisting of 6 students. To reduce students’ anxiety resulted from their first simulation training, we randomly selected two groups to perform the demonstration. Specifically, two students in each group were designated to play the role of nurse, while the other four participated as an observer providing suggestions. In the meantime, the rest of nine groups of students observed the simulation demonstration and joined a group discussion in a debriefing session.
Research Design:
A descriptive qualitative research with content analysis methods was employed in this study.
Data Collection and Analysis:
After the simulation, there was a post simulation assignment which requested students to reflect on their simulation learning experiences and thoughts about caring. We analyzed the contents of each student’s assignment using the Text Mining Software to explore the critical perspectives regarding their learning experiences, such as what they have learned in the class, what they thought of their strengths and weaknesses, and how they expect themselves to improve nursing skills.
Results:
Analysis of the data has been in progress and will be completed by spring 2019.
Implications:
This is our first attempt to design a simulation scenario aimed at promoting nursing students’ caring ability and basic nursing skills that ensure patients’ safety. We expect that results of this study would not only contribute to the theory and practices of simulation education characterized by its integration of cognitive, psychomotor, and affective objectives, but also improve first-year nursing students’ expertise and caring ability. The teaching model provided in this study would also serve as an important reference that helps researchers to build an effective and powerful simulation training for undergraduate nursing students in Japan.
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