Student Perception and Appraisal of a New Interventional Model to Prepare Them for Entry into Maternal-Infant Clinical Rotations and to Reduce Anxiety

Introduction: Nursing students experience stress and anxiety in clinical rotations; especially in unfamiliar areas.  Specialty nursing courses, such as maternal-infant nursing, often require clinical rotations that are short and intense, laden with complex concepts, new topics, and nursing skills peculiar to the specialty.

Objective: To evaluate the impact of a new interventional model with a clinical simulation upon student perception of readiness for entry into maternal-infant clinical rotations and their level of anxiety.

Method: As part of a course improvement project, 153 senior baccalaureate nursing students who enrolled in the maternal-infant nursing course in two consecutive semesters participated in this study. 110 students were enrolled in the new interventional model and 43 students participated in the traditional model. Traditionally, the first clinical rotation in the maternal-infant course takes place in the acute care setting with students being placed directly at the bedside of neonates, post-partum, and intra-partum clients.  In contrast, in the new interventional model, the first clinical rotation began in the simulation lab, where two sessions, 1A and 1B, were implemented. The purpose of simulation 1A was to expose the students to a normal and basic labor patient and to give the students the opportunity to practice the most common skills, assessment, and communication transactions. The purpose of simulation 1B was to expose the students to a normal and basic postpartum assessment. Therefore, in the new model, students were asked to attend a simulation to assess fetal heart tones (FHT), uterine activity, labor pain, cervix, postpartum physical assessment with an emphasis on fundus and lochia, and practice communication with the client and primary care provider.  

Groups of 6-8 students spent about 30 minutes actively learning from their clinical faculty, 90 minutes practicing and performing essential functions and 30 minutes debriefing at the end of the simulation.  Additionally, simulations 1A and 1B offered faculty the opportunity to annotate the strengths and weaknesses of individual students for further guidance, support and evaluation at a later time.  In both groups, students’ anxiety and perception of readiness were assessed by giving a questionnaire at the end of the semester. In addition, using a Likert scale of 1-4 (1= not helpful, 2 =somewhat helpful, 3=helpful, 4=very helpful), students were asked to indicate how helpful simulations 1A and 1B were in preparing them for entry into maternal-infant clinical rotations.  The specific simulation portions were: assessment of FHT’s, application of fetal monitor on client, assessment of uterine activity, assessment of labor pain, assessment of cervix,  communication with client,  communication with the primary care provider, assessment of the postpartum client, assessment of postpartum fundus, and insertion of indwelling urinary catheter. They also were asked to share any additional information/feedback.

Results: The mean age of contributors was 24.26 (minimum 21 and maximum 44) and %90.5 were female.  Some level of anxiety and discomfort before the initial clinical rotation was reported by 66% and 41% respectively. The most common reasons anxiety and discomfort were “having no or very little experience and knowledge regarding pregnancy and labor“ and “wasn’t sure what to expect.  In the traditional group where clinical rotations began in the acute care setting, students perceived their readiness for the first day of clinical as follows:  assessment of FHT 48%, uterine activity 33%, labor pain assessment 31%, cervical assessment 25%, postpartum assessment 56%, post-partum fundus 50%, and insertion of urinary catheter 14%. The rates were also low for readiness for communication skills with the client (60%) and health care provider (43%).  In contrast, students in the new interventional group found simulation in assessment of FHT, 80%, uterine activity, 83%, labor pain assessment, 69%, cervical assessment, 73%, postpartum assessment, 86%, post-partum fundus, 80%, and insertion of urinary catheter,  84%, as helpful to very helpful in preparing them for clinical.  However, the impact of the simulation on communication skills with the client and health care provider were the same (53%) and not as strong as the other variables.  Overall, 75% found the new interventional model helpful to very helpful in reducing their anxiety and 76% found it helpful in reducing their discomfort. 

Conclusion: Simulation can be considered a viable alternative for preparing students for maternal-infant clinicals; however, more innovative models should be designed to improve nursing students’ communication skills.