Nursing Students Conception of Clinical Skills Training Before and After Their First Clinical Placement. Solveig Struksnes RN, MSc Senior lecturer

Transcription

1 Nursing Students Conception of Clinical Skills Training Before and After Their First Clinical Placement Solveig Struksnes RN, MSc Senior lecturer

2 INTRODUCTION Nursing education in Norway: 50 weeks of clinical practice 10 weeks of practice in nursing homes in their first year Educational institutions have a responsibility to ensure that nursing students possess a certain expertise in relation to basic nursing skills when they start their first clinical practice Basic skills are rehearsed through mandatory exercises in the simulation laboratory (15ECTS) 2

3 SIMULATION IN HEALTH CARE Constructed experiences that mimic processes or conditions that can or should not be experienced for the first time in clinical practice, because of risk to the patient (Morton,1996) 3

4 A phenomenon or activity that mimics a clinical setting, in which one can practice procedures, decision-making and critical thinking by using role play, video or simulators (Jeffries, 2005) Simulation within health care can consequently be anything from using high fidelity patient simulators, partial task trainers, role play or to solving a case 4

5 Few studies deal with basic skills training in nursing and care Few examples of studies of relevance to community health services 5

6 Simulation exercises cause some anxiety and frustration among students, with some individuals requesting exemptions Are learning outcomes by experiencing the patient role so important that it legitimizes exposing students to this seemingly unpleasant experience? Are learning outcomes by this learning activity a better way than using a human patient simulator? 6

7 Even the relatively "simple" care dolls are expensive, and there is a need for many of them to offer all students the opportunity to practice Therefore, the application of this type of simulators should be carefully assessed Against this background, it was desirable to examine students' perceptions about this learning activity and the learning outcomes from it 7

8 AIMS AND PURPOSES To examine nursing students conceptions of a skills training situation, (sponge bath), and compare their experiences both immediately after the training and after their clinical placement in nursing homes 8

9 Five research questions: 1. Do nursing students conceive the experience of being patient and nurse in the simulated patient situation as a useful preparation for their clinical practice? 2. Do their conception of the utility of the exercise change after clinical practice? 3. Do students experience the simulated patient situation as relevant for their self-confidence and performance in clinical practice? 4. Do full-time and part-time students have different conceptions of the learning outcome of the exercise? 5. Do students with previous experience from health services have different conceptions than students without such experience? 9

10 DESIGN AND METHOD Quantitative, cross-sectional and evaluative design The sample consisted of full- and part-time students in their first year of a Bachelor of Nursing degree Out of 194 students (152 full-time and 42 part-time), the sample was reduced to 187 (96%) immediately after the simulation exercise The class had been supplemented by five students who had not participated in simulation exercise at the same time as their fellow students, but who instead had attended training at a previous point of time There were no exclusion criterias, but students who did not pass the clinical practice did not participate in the second round of data collection after the internship 10

11 SAMPLE 4 quit 9 quit Full time Part time into clinical placement 139 completed 47 into clinical placement 43 completed 5 added 4 quit 114 respondents 39 respondents 11

12 SAMPLE Before Experience No experience Unanswered N n (%) n (%) n (%) n (%) Full time (98) 100 (67) 44 (30) 5 (3) Part time (91) 28 (74) 10 (26) 0 (0) Total (96) 128 (68) 54 (29) 5 (3) After No Unanswered Experience experience N n (%) n (%) n (%) n (%) Full time (82) 64 (56) 24 (21) 26 (23) Part time (91) 23 (59) 6 (15) 10 (26) Total (84) 87 (57) 30 (20) 36 (24) 12

13 METHODS The simulated patient situation is "Sponge bath of bedridden patient" Learning activity follows the steps in simulation methodology, with preparation through lectures and reading, briefings, simulations and debriefings (Jeffries, 2005). Students first look at a video for demonstration Groups of three students working together Everyone will experience the role of "nurse," "assistant" and "patient" Following the exercise, students reflect on their experiences in a systematic way (debriefing) 13

14 First data collection conducted in September 2012 for full-time students and in December 2012 for part-time students The content and organization of the teaching and practical training was similar for the two groups Data collection took place in the simulation laboratory at the university college Questionnaires were placed on bedside tables at each bed, and after the exercise the respondents put the questionnaire into a mailbox The second data collection was conducted after 10 weeks of clinical studies in nursing homes, in June 2013 for full-time students and in October 2013 for the part-timers 14

15 QUESTIONNAIRE Part 1 Age, full- or part-time, experience in health care or not Part 2 Developed by the National League for Nursing in 2005 Permission to translate the form into Norwegian (Tosterud et al., 2013) Seven statements related to students "satisfaction with the learning situation" and "self-confidence and learning" Likert scale with five response options from "strongly agree" with the statement to "strongly disagree" with the statement 15

16 DATAANALYSIS SPSS statistics IBM version 20 The respondents mean-score is described, as well as frequencies and percentages Respondents divided into full- and part-time students, and students with- and without any previous clinical experience. To test for the differences between subgroups parametric testing (student t-test) was conducted with a p-value of p<0.05 considered appropriate 16

17 Being patient and nurse -a useful preparation for clinical practice? The overall impression is that students found the simulation exercise useful for learning outcomes, both immediately after the exercise and the internship Most positive immediately after the exercise A majority find that both the patient role (85%) and nursing role (79%) provide useful experience when asked after the internship 17

18 Do the students conception of the utility of the exercise change after clinical practice? 18

19 Comparison mean scores all respondents, before and after clinical placement Before After T- test Satisfaction with Current Learning n Mean SD n Mean SD p 1. The teaching methods used in this simulation were helpful and effective The simulation provided me with a variety of learning materials and activities to promote my learning of the curriculum 3. The teaching materials used in this simulation were motivating and helped me to learn 19

20 Do students experience the simulated patient situation as relevant for their self-confidence and performance in clinical practice? 20

21 Before After T-test elf-confidence in Learning n Mean SD n Mean SD p. I am confident that I am mastering the content of the simulation activity that my instructors presented to me. I am confident that this simulation covered critical content necessary for the mastery of the curriculum. I am confident that I am developing the skills and obtaining the required knowledge from this simulation to perform necessary tasks in a clinical setting. It is my responsibility as the student to learn what I need to know from this simulation activity

22 Do full-time and part-time students have different conceptions of the learning outcome of the exercise? 22

23 No significant differences between the groups,.exept question 7: «It is my responsibility as the student to learn what I need to know from this simulation activity Part time students score significantly higher (Mean 4.67, p 0.44) 23

24 Do students with previous experience from health services have different conceptions than students without such experience? 24

25 No significant differences,.with the exception of question 4: Not surprisingly, students with previous experience conceived mastering the contents of the exercise to a significantly larger extent (p=.000) 25

26 Comparison mean scores, students without previous experience before and after clinical placement Before After T Satisfaction with Current Learning n Mean SD n Mean SD p 1. The teaching methods used in this simulation were helpful and effective. 2. The simulation provided me with a variety of learning materials and activities to promote my learning of the curriculum Self-confidence in Learning 6. I am confident that I am developing the skills and obtaining the required knowledge from this simulation to perform necessary tasks in a clinical setting

27 Comparison mean scores, students with previous experience before and after clinical placement Before After T Satisfaction with Current Learning n Mean SD n Mean SD p 1. The teaching methods used in this simulation were helpful and effective. 2. The simulation provided me with a variety of learning materials and activities to promote my learning of the curriculum 3. The teaching materials used in this simulation were motivating and helped me to learn Self-confidence in Learning 4. I am confident that I am mastering the content of the simulation activity that my instructors presented to me 5. I am confident that this simulation covered critical content necessary for the mastery of the curriculum

28 Tendency that the perceptions were less positive after internship: Lower scores with regard to if the teaching method were useful (p=.003), or produced an activity that promoted learning related to curriculum (p=.000) Usefulness of the tools used in the exercise: Students without experience did not change their opinion Students with previous experience had significantly less positive opinions about this after their internship (p=004) 28

29 Perception of self-confidence related to the content of the exercise: Students without experience had no significant change after the internship Students with previous experience indicated a significantly higher perception of coping (p=.034) Views on the exercise s relevance to curriculum: Students without experience did not change their perception Students with previous experience had significantly lower scores on this question after their internship (p=.000) The exercise s significance for the development of skills and knowledge necessary in practice Both groups had significantly lower scores after clinical practice, with p-values of.024 and

30 CONCLUSIONS Being a patient and a nurse in simulation is experienced as a useful preparation to clinical practice (mean before CP 4.30, after 3.91) Students with and without previous experience in health services have different experiences 30

31 Questions emerged that should be further explored? Are there organizational and pedagogical issues in ICP that should be improved to help facilitate a better learning process for students without any previous experience? Should the unexperienced students be better prepared with regard to learning strategies and socialization in the clinical field? Is the learning environment in the clinical practice area better as regards promoting a sense of mastering among students with previous experience, than to meet the needs of students without any experience? Or, is this difference caused by the unexperienced students comparisons with their fellow students with more experience? 31

32 THANK YOU FOR YOUR ATTENTION! 32