Optimizing Simulation as Meaningful Learning Experiences for Postgraduate Paediatric Nursing Students

Purpose:

The use of simulation in nursing education embodies the principles of adult learning as defined by several educational theorists. Nurse educators involved in simulation-based education are usually concerned with making the learning experience as authentic as possible. However, effective education of adults through simulation requires a sound understanding of adult learning theories and best practices on how to facilitate adult learning (Zigmont, Kappus & Sudikoff, 2011). Apart from adult students being more mature than most undergraduate students, they commonly share at least four non-traditional attributes: financial independence, full-time employment, having dependants and studying part-time (Kenner & Weinerman, 2011). Professional nurses who engage in further education not only share these attributes; they also bring clinical and life experiences to the educational environment.

Closely linked to simulation is Kolb’s experiential learning theory of concrete experience, reflective observation, abstract conceptualisation and active experimentation (Kolb, 1984). Ericsson’s (2008) thesis, that deliberate practice activities that are clearly focused on improving some aspect of performance are necessary in order to acquire expertise, was applied throughout the study.

Most nurse educators regard students who enter postgraduate studies as adult learners that are capable of self-direction and independent learner behaviour. Contrary to our expectations, the students that registered for a postgraduate diploma in paediatric nursing were dependent learners with low self-directedness. The mismatch between the nurse educator’s expectation of adult learners and mature learner conduct resulted in disappointment and even frustration for both educator and learner. Consequently the educators had to adjust their approach to simulation as teaching and learning activity. The purpose of this presentation is to discuss the findings of an action research process that aimed to improve simulation as a meaningful learning experience for mature students who did not exhibit the characteristics of adult learners.

Methods:

Action research which is predominantly a qualitative mode of inquiry was used because it allowed the researcher to combine her work as a nurse educator with the research in an ongoing fashion (Zuber-Skerrit & Fletcher, 2007) and possibly create new knowledge by answering ‘how can we improve...’ or ‘what can we change in order to improve...’ questions (McNiff & Whitehead, 2006). A recognised strength of action research is that findings are easily translated into practice while some other research approaches may leave the practical application of findings as recommendations (Hien, 2009).

The researcher viewed herself as an active member of the action research process as opposed to only being an onlooker and data gatherer. The other participants were the 15 – 20 students who enrolled for the one year, postgraduate paediatric nursing programme in both 2013 and 2014.

Qualitative data were collected by means of a self-reflective journal and field notes made by the researcher who is also the educator. To gather data from the students the researcher used the nominal group technique, focus group interviews, and audio-tapes of simulation debriefing sessions. Quantitative data were collected when students completed a module assessment tool. Data were collected through three cycles.

Electronic software was used to analyse qualitative data in an inductive and deductive manner. A co-coder was used to promote methodological rigour. Descriptive data analysis were done on the quantitative data by the researcher and was triangulated with the qualitative data.

Results:

Aspects contributing to meaningful learning are the simulation environment, cognitive processes and student performance. Each of these aspects has sub-themes that contributed to making the learning experience meaningful. Performance anxiety, unfamiliar environment, unpreparedness, responsive simulator and lack of guidance decreased the meaningfulness of the learning experience. However some hindering aspects were also identified as contributing to the meaningfulness of the learning experience, for example the responsive simulator.

Conclusion:

While striving to improve her educational practice, the nurse educator gained insight in herself and consequently changed her interaction with the students as well as her approach to simulation as a learning experience. By adapting her facilitation of the reflection on action (debriefing) process, students became more independent and exhibited self-directed learning behavior towards the end of the programme.