The Impact of Clinical Simulation on Beginning Nursing Students' Self-Efficacy and Learning

Purpose: The use of simulation as an educational tool is becoming increasingly prevalent in nursing education (Yuan et al., 2012). Simulation-based education has been shown to improve communication skills, collaboration, and critical thinking (Bond et al., 2004; Norman, 2012), as well as increase self-efficacy and competency (Bambini et al., 2009). In fact, the National Council of State Boards of Nursing recommends substituting high-quality simulation experiences for up to half of traditional clinical hours (Alexander et al., 2015). Although published studies show improved learning with simulation compared to traditional education, there are few attempts to determine simulation effectiveness in building self-efficacy prior to beginning the clinical experience and/or in the obstetric setting. While all nursing courses adhere to a similar nursing practice basis, the care of the childbearing family is unique in its need to understand normal physiologic functioning as well as the effects pregnancy has on these normal functions.The purpose of the study was to compare the effectiveness of two educational delivery methods for the clinical setting, traditional lecture and high-fidelity human simulation on beginning level nursing students’ self-efficacy. The aim was to determine if a simulated experience would increase self-efficacy of students preparing to enter the obstetrics clinical setting thereby improving the students’ confidence and maximizing learning outcomes.

Methods: A control/experimental design was used for this study. Students enrolled in the clinical courses were either placed in the traditional lecture or simulation group. A pre/post-test was utilized to assess knowledge and a validated self-efficacy instrument (Obstetric Nurse Self-Efficacy) specific to the obstetric setting was used to determine level of confidence. Assessments were linked using specific participant ID numbers and entered into SPSS for analysis.

Results: A total of 150 students participated in the study (control=64, experimental=86). No significant difference was noted in knowledge acquisition between the two groups as expected, but the simulation group had slightly higher confidence scores. Significant difference was noted in groups where faculty followed a standardized procedure during the simulation between all groups and the control/experimental groups (p=.034). Qualitative data collected from students in the simulation group indicated that they felt better prepared to initiate care for the laboring patient, were less anxious about “not-knowing”, and adapted to the new unit quickly. Faculty noted a positive difference regarding students’ initiation of and confidence in care with those in the simulation group.  

Conclusions: Novice students are noted to incur increased anxiety when entering the obstetric course with limited knowledge and skills needed for the care of the obstetric population. Furthermore, patient safety concerns with this vulnerable population limits actual hands-on experience to learn the necessary new skills. The results of this study support the use of simulation to assist in enhancing undergraduate students’ self-efficacy in dealing with obstetric patients as well as their satisfaction with learning. Although simulation may be costly, programs should consider the appropriate, adequate, and timely use of simulation in nursing education and develop policies for standardization throughout the curriculum.