Method: The simulation activity was implemented in a pre-clinical health assessment course. Social Cognitive Theory guided the development of the pre-reflection activity and simulation. Using an exploratory qualitative design, students completed a pre-simulation reflection exploring four topics: level of confidence prior to simulation, expectations, concerns, and areas of confidence. The simulation incorporated content from three concurrent non-clinical courses: assessment, pathophysiology, and nursing concepts. Students worked in teams of four to five students to complete the faculty-guided simulation of a client with heart failure, pulmonary disease, and social concerns. To begin the simulation, students interacted with the manikin and obtained subjective and objective assessment data. Faculty members used coaching techniques to help students prioritize assessment techniques and client care needs. Faculty helped students associate assessment findings with pathophysiologic processes and employed Socratic questioning techniques to promote critical thinking. Faculty would role model an assessment skill or offer patient communication and education as time permitted. At the conclusion of the activity, simulation debriefing focused on personal reactions, teamwork approaches, assessment and safety priorities, and take away points. The university Institutional Review Board approved the study.
Results: Junior-level baccalaureate students enrolled in their first semester of the professional nursing coursework provided the convenience sample. The cohort is primarily female (91.6%), White (86.3%) or African-American (4.2%), 20-21 years old (61.1% and 29.5%, respectively), and first-degree students (94.7%). A random sampling of student pre-reflections were analyzed for themes according to the methods of Marshall and Rossman (2016). A random sample of 23/112 student pre-reflections were analysis until saturation was achieved. Four themes and three subthemes emerged. Knowledge is Power described attributes identified as contributing to the confidence levels of pre-clinical nursing students who were preparing for their first ever simulation experience. The subtheme A Whole New World focused on the benefits of simulation and expectations that is be hands-on, challenging, and interactive. Strength in Numbers: A Safety Net described a sense of community among peers and faculty that contributed to increased confidence and decreased anxiety of pre-clinical nursing students. Anxious but Excited reflected students' sense of excitement and confidence about the upcoming simulation activity. in the subtheme Fear of the Unknown, students expressed feeling “nervous” and “anxious” because this was their first simulation experience, but many still were not sure “exactly what to expect”. The subtheme Performance Anxiety centered on feelings of anxiety and nervousness related to a performance aspect of the simulation experience. Uncertainty in Trust of Self or Others emerged out of overlapping subthemes to describe elements of uncertainty or distrust stemming from multiple sources, but contributed to an overall decreased sense of confidence and increased level of anxiety for students.
Conclusion: The identified themes provide key insights for faculty to consider when developing and implementing first simulations for pre-clinical nursing students. Specific examples of how themes have guided future simulations will be discussed.