The Influence of Low- and High-Fidelity Simulations on Nursing Students’ Self-Confidence, Knowledge, and Satisfaction

Purpose: Simulated patient care experiences are increasingly important in undergraduate nursing education as they provide a safe environment where students can learn from their mistakes. They are highly controlled, assuring that all students can engage in the same experiences without the unpredictability that is seen in a “live” clinical environment and the variability that is inherent in working with human beings. “Educators can replicate many patient situations, and students can develop and practice their nursing skills (cognitive, motor, and critical thinking) in an environment that does not endanger patients (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014, p. 3). Finally, simulations help reduce student anxiety and lead to improved performance when moving into a “live” setting (Cant & Cooper, 2017; Foronda, Liu, & Bauman, 2013). Simulations can be low to high fidelity. Low fidelity simulations are those conducted with plastic manikins who are unable to exhibit any human physiologic functions and do not speak, whereas high fidelity simulations use sophisticated computerized manikins who can manifest nearly all aspects of human physiology and are able to speak. The purpose of this study was to seek understanding of how simulation experiences influenced student perceived self-confidence, knowledge about how to care for a patient with a particular condition, and satisfaction with learning using this pedagogy.

Methods: Following University Committee on Human Research approval, students enrolled in their first required clinical course in an undergraduate nursing curriculum (n=92) engaged in two weeks of simulated patient experiences; week one with a low fidelity manikin and week two with a high fidelity simulator. Students completed the 13-item online NLN Student Satisfaction and Self-Confidence in Learning Survey (2015) post-simulations, as well as a 10-item knowledge inventory pre and post-high fidelity simulation.

Results: Greater than 70% of students reported confidence (eight questions) and satisfaction (five questions) when completing the NLN Student Satisfaction and Confidence Learning Survey (2015) post low and high fidelity simulation, with the exception of confidence with “mastering content” in the simulations, ~ 55%. A paired-samples t-test indicated that the difference in the post-assessment mean of the 10-item knowledge inventory (M = 80.20, SD = 20.84) and the pre-assessment mean (M = 70.00, SD = 25.81) was statistically significant, t(9) = -3.17, p = .011. Therefore, the post-simulation knowledge inventory revealed that the high fidelity simulation was effective in raising students’ scores.

Conclusion: Simulation appears to improve knowledge in the short term, therefore, it would be important to track knowledge retention and use in “live” patient experiences at multiple points in the future (Victor, Ruppert, & Ballasy, 2017). Additionally, confidence levels were high after both low and high fidelity simulations. Future research may include measuring baseline confidence levels to ascertain whether novices are generally overconfident (Partin, Payne, & Slemmons, 2011). Lastly, students reported high satisfaction with low and high fidelity simulation, further supporting the need for simulation and the importance of allowing faculty to maximize teaching effectiveness with what is available (Hayden et al., 2014).