A Student-Centered Methodology to Inform Cultural and Ethical Teaching in Undergraduate Nursing Students

Purpose: This study was under girded by a conceptual framework called Tag Team Patient Safety Simulation and was used to foster learning about delivery of culturally sensitive care to undergraduate nursing students in a large group setting from a baccalaureate program in western Pennsylvania (Levett-Jones and Applegarth, 2017). The hypotheses for this study were: 1) The simulation group will have greater effects on knowledge acquisition than the non-simulation group. 2) Treatment participants will have positive attitudes about the simulation experience. To answer the research questions, a design with a pre-test and multiple post-tests throughout the semester with non-equivalent groups was constructed (N=93). The simulation group (n=63), received the simulation exercise plus lecture, while the non-simulation group (n=30), received only a traditional classroom lecture. Both groups had assigned readings prior to the intervention and attended course lecture on the Code of Ethics for Nurses (ANA, 2015).

Methods: To assess learning, a 10-item knowledge acquisition questionnaire, adapted from (Levett-Jones, et al., 2017) was given to participants via Qualtrics online survey platform before and after the intervention, and in both groups. To assess the simulation experience, a 27-item questionnaire (Cronbach’s alpha of 0.78 for total scale) assessed participants experience with the simulation-i.e., briefing, patient safety, clinical practice, and the debriefing (Levett-Jones, et al., 2011). Demographic data was also collected.

Results: The non-simulation group (n = 29, M = 5.28, SD = 1.623) and the simulation group (n = 54, M = 5.52, SD = 1.691) scored similarly on the pre-test knowledge assessment questionnaire. Results revealed that average scores on the knowledge assessment questionnaire administered on the post-test immediately after the simulation did not significantly improve compared to the pre-test scores for the non-simulation group (n = 16, M = .375, t(15) = 1.192, p = .252, 95% CI (-.296, 1.046) and the simulation group (n = 35, M = .200, t(34) = 1.096, p = .281, 95% CI (-.171, .571), and that scores on the knowledge assessment questionnaire administered at the end of the semester did not significantly improve compared to the pre-test scores for the non-simulation group (n = 16, M = .625, t(15) = 1.464, p = .164, CI (-.285, 1.535)) but they did significantly improve for the simulation group (n = 37, M = .946, t(36) = 3.264, p = .002, CI (.358, 1.534)).

For the participants who completed the questionnaire a repeated measures ANOVA was run demonstrating that there was a significant difference in the average test scores over time (F(2,76) = 6.122, p = .003, η² = .139), but there was no significant difference in the test scores between simulation and non-simulation groups (F(1,38) = 1.016, p = .320, η² = .026), with a 95% confidence interval.

Conclusion: The use of a student-centered approach, TAG TEAM PATIENT SAFETY SIMULATION fosters both engagement and enjoyment while learning and also suggests that retention may be enhanced. The need to measure retention, the implications of our findings, limitations of our study, and directions for future research will be discussed.