The use of simulation in nursing curricula is a longstanding method of enhancing clinical experiences for undergraduate nursing students. Nursing students have traditionally enriched their learning process by formulating scenarios and practicing skills in a laboratory setting (Lapkin, Levett-Jones, Bellchambers and Fernandez, 2010). Research indicates that providing pre-licensure nursing students a simulated experience affords preparation and lessens anxiety in acute care experiences (Pai, Ko, Eng and Yen, 2017). Establishing a program of simulation to include four areas of community-based nursing care provides a unique benefit for undergraduate nursing students to explore nursing roles beyond the hospital setting. In this situation, students may feel unprepared and daunted to care for clients in various settings in the community (Pai, Ko, Eng and Yen, 2017). Thus, interactive learning experiences that support transition to the community clinical setting benefit the student, enhance curricular outcomes and support innovation in nursing education.
Methods:
This mixed methods nursing research was conducted in four community-based simulations for senior-level undergraduate students (n=95), to evaluate student performance and perceptions of the simulation experience in relation to clinical practice in home health, school health, occupational health, and correctional health settings. The data collection utilized three instruments to determine the impact of simulation-based learning (SBL). Anxiety was measured quantitatively through the State Trait Anxiety Inventory (STAI) consisting of twenty statements measured on a Likert scale to self-rate feelings of anxiety and a visual analog scale (VAS) used to assess the students’ feelings of self-efficacy in entering clinical experiences in the four community-based settings (Spielberger, 1970; Crichton, 2001). Lastly, the qualitative portion of the research was completed by a survey and the debriefing portion of SBL to identify common themes related to the experience.
Results:
Using the Wilcoxon-signed rank test analysis, the results of the study revealed statistical significance (p < 0.05) in the STAI for those students in correctional health, school health and home health indicating a reduction of anxiety following SBL. Additionally, the VAS under the same quantitative analysis indicated statistical significance (p < 0.05) in all four simulation settings for increased preparedness and confidence in clinical practice. Qualitative data revealed clear themes of the importance of communication with clients and focused assessments in new practice settings.
Conclusion:
This research for undergraduate nursing students using SBL to decrease anxiety and improve a sense of self-efficacy prior to the entry into the clinical setting has demonstrated constructive reflection on learning. This provides a transformative learning process that is valuable to the undergraduate nursing student in new clinical settings for community health (Thanaraj, 2017; Frankland, 2019).