The Use of a Skills Simulation Boot Camp to Increase Self-Confidence in Prelicensure BSN Students

To determine the overall impact of an orientation skills boot camp on the confidence of nursing students to perform skills, the research team designed a study based on a quasi-experimental pre- and post-design. The faculty research team attained organizational Institutional Review Board (IRB) approval at the small, private, health sciences college and the large tertiary care parent organization associated with the college. Ninety-two senior year nursing students in the Bachelor of Science in Nursing senior 1 clinical course were eligible to participate. Students submitted pre- and post-surveys electronically via Blackboard Learning Management System. The orientation skills boot camp included rotations through the following stations: Physical assessment, post-surgical abdominal wound with sterile dressing change, chest tube and tracheostomy care, insertion of intravenous catheter and nasogastric tube, and administration of intravenous medications. The measurement tool selected for use was the National League for Nursing (NLN, 2005) Student Satisfaction and Self-Confidence in Learning, 13-item instrument. NLN grants permission to use this tool for non-commercial use (NLN, 2005). By using a 5-point Likert scale, the tool measures student satisfaction and self-confidence in learning (NLN, 2005). A description of the tool includes reliability testing using Cronbach’s alpha: satisfaction = 0.94; self-confidence = 0.87 (NLN, 2005). The tool was adapted for this study to include questions measuring student confidence on the individual skills performed at the stations. This ongoing study incorporates results over a period of 3 non-consecutive clinical semesters. Results from the first two semesters compare mean scores from the student surveys and show an increase in confidence on the post-surveys. Fifty additional students will complete the boot camp study during fall 2017. Results from the three semesters will be compared by paired t-testing and completed for the conference poster.

Simulation in nursing provides a safe environment to develop judgment and hone skills essential for practice (Robinson & Dearmon, 2013; Liaw, 2011). The use of simulation allows students the opportunity to apply concepts and skills learned within the nursing curriculum (Robinson & Dearmon, 2013). Additionally, the simulated environment provides a nonthreatening milieu for application of clinical judgment without the risk of actual patient harm (Robinson & Dearmon, 2013). It is suggested that simulated learning environments are a modern-approach to learning and are preferred over the traditional classroom by students who are accustomed to technology (Bland, Topping, and Wood, 2011; Harder, 2010; Robinson & Dearmon, 2013). The NLN fully supports a myriad of simulation strategies for use within nursing programs and endorses that these experiences may substitute for up to 50% of clinical hours (Rutherford-Hemming, Lioce, Kardong-Edgren, Jeffries, & Sittner, 2016). According to the Virginia Board of Nursing (2013), nursing education programs may incorporate up to 20% of total clinical hours as simulation experiences.

Medical education frequently utilizes clinical boot camps for resident training but the use of this strategy with nursing education is sparse (Yaylaci & Kitapcioglu, 2015). Hogewood, Smith, Etheridge, and Britt (2015) wrote about the development and implementation of an OB/PEDS Boot Camp for nursing students including a description of the different educational stations employed, however this article did not incorporate a study of its effectiveness. Few studies link simulation interventions to specific clinical skills, however Valizadeh, Amini, Fathi-Azar, Ghiasvandian, and Akbarzadeh (2013) report an increase in student confidence to perform peripheral venous catheterization on pediatric patients. This team utilized a group-based simulation where the students practiced catheter insertion on infant manikins, role playing, and critical thinking application of a written scenario.

Liaw and colleagues (2012) show an increase in student confidence to perform skills after participating in a simulation-based learning experience (Liaw, Scherpbier, Rethans & Lainin-Yobas, 2012). Kimhi et al. (2016) found that simulation education increased confidence in nursing students regardless of whether the intervention occurred prior to or after a student’s clinical experience. Dearmon et al. (2013) revealed that by incorporating a 2-day simulation-based orientation for beginning nursing students, confidence as well as knowledge increased. Additionally, the team found that students reported a decrease in anxiety, contributed to the non-threatening practice environment and learning about instructor expectations. Thomas and Mackey (2012) relayed that when student confidence was elevated they were more apt to perform skills and reach their clinical objectives. Simulation is most effective in the more advanced student due to their higher knowledge level of theory, potentially impacting their clinical decision-making (Thomas and Mackey, 2012).

Utilizing the NLN Student Satisfaction and Self-Confidence in Learning tool, Lewis and Ciak (2011) found positive results for self-confidence and satisfaction, as well as an increase in knowledge following a pediatric and obstetric simulation experience. Working under the auspices of the NLN, Jeffries developed the Nursing Education Simulation Framework (NESF) (Schlairet, 2011). The NESF cites self-confidence as one of the crucial student outcomes of simulation along with learning, skill performance, satisfaction, and critical thinking (Schlairet, 2011).

The influence of simulation on nursing student’s self-confidence to perform specific skills and the use of orientation boot camps in student nurse education warrants further study. Literature supports and validates the incorporation of simulation-based experiences into nursing education programs with support at a national and state level. This study is of benefit to healthcare organizations as they plan orientation programs for nurse graduates as well as simulation-based training for new skills and technologies. The concepts of this study will assist the implementation of evidence-based practice into the clinical setting and benefit nursing praxis.