Managing the Panic: High-Fidelity Simulation Prior to the First Clinical Experience of Undergraduate Nurses

Background: Transitioning from the classroom to the clinical setting can be both exciting and anxiety-provoking for undergraduate nursing students. Nursing educators are tasked with ensuring that students are prepared to integrate and apply newly acquired nursing knowledge into the clinical setting. This preparation often centers on proficiency in nursing skills and didactic course-work, but rarely addresses the anxiety associated with applying nursing knowledge and skills in an authentic clinical setting with “real” patients. Use of multiple clinical simulation experiences that focus on bolstering student confidence in professional communication and fundamental nursing skills may reduce student anxiety prior to their first clinical experience. In a recent study, Ross and Carney (2017) found that undergraduate students who completed one clinical simulation scenario prior to entering the clinical setting significantly reduced student anxiety and increased self-confidence related to clinical decision making. The purpose of this study is to build on the previous study (Ross & Carney, 2017) by examining the effect of multiple clinical simulation experiences on the anxiety associated with clinical-decision making processes among second year baccalaureate nursing students prior to their first clinical experience.

Method: This replication study is a descriptive pre-test and post-test design conducted at a large public university in the mid-Atlantic area of the United States. Participants were a convenience sample of second year undergraduate students (N=88) enrolled in a fundamentals clinical course in a four year baccalaureate nursing program. Three 4-hour clinical simulations were designed for small groups of 7-8 participants and included core nursing objectives such as communication, professionalism, physical assessment, nursing process, and skills application. Course faculty designed three new simulations based on these objectives. To assess anxiety and self-confidence, the Spielberger State-Trait Anxiety Inventory and Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale were administered before and after each of the three clinical simulations. The Institutional Review Board approval was obtained from the site prior to beginning the study.

Preliminary Results: This study will be conducted during the 2017-2018 academic year for all BSN students in their fundamentals of nursing course prior to their first clinical experience. Anecdotal evidence from past fundamentals simulations as well as past simulation research studies from the healthcare literature suggest that conducting the outlined simulations prior to entering the clinical setting will decrease student anxiety and improve self-confidence with clinical decision-making for this population of nursing students.

Conclusions: Evidence from the literature suggest that the initial transition into the clinical setting can be negatively impacted by increased levels of anxiety experienced by undergraduate nursing students. Data from past fundamental clinical course evaluations at this institution suggest that students experience high levels of anxiety that may impede their application of knowledge and emerging critical thinking skills during their first clinical experience. Bridging didactic and clinical courses with authentic simulation experiences creates opportunities for integration and application of fundamental skills in a safe, low-stakes environment and may decrease student anxiety to enhance the clinical learning experience.