Clinical Case Study Workshops (CCSWs) are an evaluation modality unique to first year nursing students in a collaborative nursing degree program. These are used to evaluate the comprehension, application of knowledge, skills, and critical thinking related to foundational nursing competencies.
CCSWs include two components. Part one, comprises of four clinical case scenarios, which students perform for their peer group and instructor. Students must achieve a satisfactory performance before being admitted to their first clinical practice setting. Part two, is the submission of a corresponding written care plan worth 5%.
Existing strategies for student preparation are that faculty post on a learning management system and discuss instructions. Open labs and peer led labs are also available. Historically, CCSWs created much anxiety for students. Prior to their CCSW evaluation, students reported a lack of adequate preparation and exhibited the following behaviors: seeking faculty demonstration, instruction, and reassurance. During CCSW performance evaluation, behaviors included: crying, panic, and inability to perform. Nevertheless, CCSWs have a 95% student success rate. Faculty felt it necessary to better enable student comfort and confidence with the evaluation preparation process in order to improve overall student performance.
Methods:
To reduce student anxiety and enhance self-efficacy for the previous year’s cohort, faculty initiated a new strategy with an additional lab that included instruction, case scenario practice demonstration, and feedback. Students reported feeling more prepared for CCSWs, and faculty observed a reduction in anxious behaviors, such as fewer questions and improved performance.
A preliminary literature search was undertaken to determine what affects student anxiety and self-efficacy in relation to clinical case evaluation, and what role the faculty may have during student preparation.
Results:
Literature suggests that student anxiety and self-efficacy in clinical skill performance is affected in a variety of ways, including faculty effectiveness and relationship, student engagement, and practice opportunities.
Rowbotham and Owen (2015) examined the relationship between student self-efficacy and instructor effectiveness. They found that self-efficacy increased when faculty engaged in the following: identified student strengths and weaknesses, communicated expectations, frequently observed students, and gave feedback without belittling. Bandura’s work (as cited in Rowbotham & Owen, 2015) also supports that a person’s belief that they can be successful is influenced by the feedback they receive.
Similarly, in 2016, Omer found that faculty competence, teaching methods, and sensitive feedback improved student self-confidence. Students reported high rates of satisfaction with faculty approaches to teaching, including the importance of timely feedback, clarity of expectations, availability and openness to questions, and having expert knowledge.
From their integrative review, Johnston, Weeks, Shuker, Coyne, Mitchell, and Massey, (2017) suggest curriculum design is critical to minimize anxiety in students during the preparation for Objective Structured Clinical Examination (OSCE) testing. Measures to reduce anxiety include the following: unambiguous scenarios, clear instructions of what is required, enough time to practice, practice with time limits, and ensure adequately prepared assessors. Massey et al. (2017) implemented video exemplars that improved OSCE related preparation anxiety and self-confidence, while Uysal (2016) found that adding clinical based scenarios during skill laboratory preparation benefitted student engagement and developed their sense of readiness. Abdelaziz, Hany, Atwa, Talaat, and Hosny, (as cited in Johnston et al., 2017) recognize the resource implications of providing capacity for students to prepare effectively, but argue that returns for resources are associated with better student performance.
In their research pilot, Henderson et al. (2018) examined student engagement in learning outcomes and self-efficacy using a check-in and check-out (CICO) learning approach. The CICO approach illustrates that a collaborative partnership between faculty and students creates a positive learning relationship, which enhances self-efficacy. The CICO approach is comprised of three interdependent processes: check-in (CI) or briefing process; clinical process (CP) which helps students engage in their learning and practice of clinical skills; and a check-out, or debriefing process. These authors highlight that positive learning relationships are built on teaching staff support in all aspects of the student learning experience, while students actively engage in the management of their learning.
Conclusion:
It is apparent that more can be done to reduce student anxiety and enhance self-efficacy for CCSW preparation. Further strategies are suggestive of the following: reflection of faculty competence, student engagement and practice, and additional faculty led instruction, demonstration, and feedback. Based on the literature and our preliminary research observation, it is clear that more research on the topic of nursing student anxiety and self-efficacy in relation to clinical evaluation will shed some light on the research gaps.