|Year : 2017 | Volume
| Issue : 4 | Page : 99-104
Saudi novice undergraduate nursing students' perception of satisfaction and self-confidence with high-fidelity simulation: A quantitative descriptive study
Maram Abdullah Alammary
Department of Nursing College, Daemen College, Amherst, NY, USA; Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
|Date of Web Publication||18-Jun-2018|
Maram Abdullah Alammary
Department of Nursing College, Daemen College, Amherst, NY; Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh
Source of Support: None, Conflict of Interest: None
Introduction: High-fidelity simulation (HFS) has recently been used for undergraduate nursing students to simplify their learning. The aim of the current study was to explore Saudi novice nursing students perceptions of satisfaction and self-confidence with HFS and to determine if there is any correlation between participants' demographic characteristics and satisfaction and self-confidence learning scale. Methods: A descriptive quantitative study was performed to recruit Saudi participants through Saudi Arabian Cultural Mission (SACM). Data were collected over a 3-month period from February, 2017 to May, 2017 through online survey was posted on SACM's official Facebook page. The survey used the Student Satisfaction and Self-Confidence in Learning tool. A total of (n = 76) Saudi undergraduate nursing students were participated. Data were analyzed using SPSS. Results: The findings revealed that satisfaction and self-confidence had a high mean score which indicates that the majority of the students were satisfied and self-confidence with the HFS experience. No significant correlations were found between the demographic characteristics and student satisfaction and self-confidence except that those who are in the prelicensure program had a significantly higher satisfaction score (P = 0.03) than students who had a bachelor or other degrees. Furthermore, a strong correlation between students' satisfaction and self-confidence in learning was found (P < 0.0001) indicating that these factors were correlated. Conclusions: This study has further confirmed that satisfaction and self-confidence are associated with the HFS experience. HFS prepare novice nursing students for real-life experience and promote the transition to a professional career. Nurse educators should be trained in the use of simulation as a teaching strategy. In addition, nursing faculty needs to consider students perception about the simulation when designing, performing, and evaluating.
Keywords: High-fidelity simulation, nursing students, satisfaction, self-confidence, Saudi Arabia
|How to cite this article:|
Alammary MA. Saudi novice undergraduate nursing students' perception of satisfaction and self-confidence with high-fidelity simulation: A quantitative descriptive study. Saudi Crit Care J 2017;1:99-104
|How to cite this URL:|
Alammary MA. Saudi novice undergraduate nursing students' perception of satisfaction and self-confidence with high-fidelity simulation: A quantitative descriptive study. Saudi Crit Care J [serial online] 2017 [cited 2020 Jun 1];1:99-104. Available from: http://www.sccj-sa.org/text.asp?2017/1/4/99/234636
| Introduction|| |
Confidence in clinical skills and decision-making may directly influence students' abilities to care for patients effectively. Current research indicates that critical-thinking and problem-solving skills need to be introduced in the 1st year of student learning as students are gaining confidence. In the literature, it seems that the majority of studies have focused mainly on the benefits of high-fidelity simulation (HFS) for advanced students. However, the current study supports the use of HFS with the beginning students.,,
In this study, the focus is on exploring Saudi undergraduate nursing students' perception of satisfaction and self-confidence with HFS. It has been signifying that simulation has been used as a tool to enhance student learning and evaluation in nursing education. Literature supports the use of HFS to promote students' confidence and skills, and also to stimulate students' learning in a safe environment.,,,, Furthermore, it has been known as an effective evaluation method for critical thinking and it promotes knowledge acquisition., HFS provides educators with the ability to help students to learn clinical skills and communication.
The recent literature review provided substantial evidence that HFS appears to have a place in nursing practice and therefore, in nursing education programs and improving patient outcomes. HFS has also been found to have a positive impact on the self-efficacy of nurses, which improves their level of confidence and satisfaction, both of which are necessary when doing a comprehensive patient assessment. Failure to analyze students' perspectives about clinical simulation generates a gap in the understanding of simulation labs as a teaching/learning strategy for reaching desired outcomes. It is important to consider student perspectives regarding simulation to help in raising their confidence and satisfaction. To do so, the current study sought to gain a greater understanding of undergraduate Saudi nursing students' perceptions of satisfaction and self-confidence with HFS.
The current study used Benner's theory (1984) along with Tanner's clinical judgment model (2006) as its theoretical framework as a basis to describe beginners' perception of satisfaction and self-confidence to perform necessary tasks in a clinical setting with HFS., Hence, the results will aid in detecting if there are any obstacles that could help to guide the faculty to assist students and identify areas that need improvement.
There was only one study exploring undergraduate nursing students' experience with HFS in Saudi Arabia. This indicated that there was a need to conduct such a study. There is a noticeable lack of literature to support the advantages of HFS in relation to undergraduate nursing students' in Saudi Arabia. Therefore, gaining a better understanding of the perceptions of satisfaction and self-confidence regarding HFS among Saudi undergraduate nursing students can be used to improve nursing education programs. In turn, it will enhance the quality of health care as well as improve patient and provider communication and relationships., The aim of this study was to measure and evaluate Saudi undergraduate nursing students' experiences with HFS to elicit information that may be used to improve education strategies for nursing programs. Nursing educators can utilize the knowledge gained from the study to improve the existing nursing programs for undergraduate nurses in terms of using HFS.
This study attempted to answer the following two research questions:
- What is the perception of Saudi undergraduate nursing students of their satisfaction and self-confidence with the HFS experience
- What is the relationship between student satisfaction and self-confidence and demographic characteristics?
| Methods|| |
Since there was no intervention in this study, a descriptive quantitative study design was appropriate to employ based on the study aims. Participants who met the inclusion criteria were recruited from the Saudi Arabian Cultural Mission (SACM) to participate. SACM is a government agency that provides scholarships for Saudi citizen to study in the USA.
A convenience nonprobability sampling technique was used to recruit Saudi undergraduate nursing students through an anonymous survey which was distributed through SurveyMonkey®.
An online survey was designed to collect data anonymously. A total of 76 Saudi undergraduate nursing students who met the inclusion criteria were participated. The survey incorporated items from the Student Satisfaction and Self-Confidence in Learning Scale, which was developed as part of the 2003 NLN/Laerdal simulation research study. The survey consisted of three sections including demographic information, satisfaction with current learning, and self-confidence in learning. The scale used a five-point Likert scale with 1 being strongly disagree and 5 being strongly agree. Total scores could range from 13 to 65. This instrument allows students to self-report their perceptions and reactions to their simulation experience. Overall, higher scores indicated a higher level of satisfaction and self-confidence with simulation. The NLN reported permission for noncommercial use of the surveys and research instruments (including for theses) is granted free of charge.
Descriptive statistics was used to provide accurate findings and to summarize the data. Demographic data were obtained by measuring the frequency (f) and percent (%). In addition, bivariate correlation statistics were used to determine the significance of participants' demographic characteristics on their perceptions of satisfaction and self-confidence with HFS. Data analysis was conducted using IBM SPSS version 24 (IBM Corp, Armonk, NY).
Institutional ethical approval as well as approval from SACM to distribute the survey on their official Facebook page was obtained. Confidentiality was maintained along with anonymity since the survey only asked basic information without any required personally identifying information or IP addresses. Furthermore, participants were informed that participation was entirely voluntary and withdrawal from the study was permitted at any time. Informed consent was implied by participation in the survey. Furthermore, it was explained that the data of the participants would be stored in a secure place to be destroyed on completion of all stages of the study.
| Results|| |
A total of 76 surveys were used for data analysis using descriptive and bivariate correlation statistics. [Table 1] shows the range of the demographic characteristic for the participants which included gender, age range, highest degree earned, and region of Saudi Arabian residence. The greatest number of participants indicated that they were aged 18–22 years old (n = 32). [Table 2] presents a summary of the responses to the Student Satisfaction and Self-Confidence in Learning Scale. This scale had 13 items under two main concepts, which were satisfaction and self-confidence. Student satisfaction is addressed through the areas of teaching methods, materials, and activities, while self-confidence is addressed through the areas of the students' ability to master the content and apply it to the clinical setting. In addition, the survey examines the students' feelings regarding active learning.
|Table 1: Survey Section 1: Participant's demographic characteristics (n=76)|
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|Table 2: Survey section 2: Satisfaction and self-confidence scores (n=76)|
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Descriptive statistics were used to summarize the items. The overall mean for the satisfaction subscale was 3.76/5 (standard deviation [SD] = 0.88). The mean satisfaction score of each item ranged from 3.64/5 (SD = 1.09) to 3.87/5 (SD = 1.02). The satisfaction subscale item two, “The simulation provided me with a variety of learning materials and activities to promote my learning the medical-surgical curriculum,” had the highest mean score (M = 3.87/5, SD = 1.02), which meant the majority of participants agreed with the statement. Students' responses on item two showed that 58 (76.3%) students reported agreement with the statement. In contrast, the satisfaction subscale item three, “I enjoyed how my instructor taught the simulation,” had the lowest mean score (M = 3.64/5, SD = 1.09).
Furthermore, the overall mean for the self-confidence subscale was 3.70/5 (SD = 0.71). The mean self-confidence score of each item ranged from 3.53/5 (SD = 1.01) to 3.89/5 (SD = 0.87). The self-confidence subscale item eight, “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,” had the highest mean score (M = 3.89/5, SD = 0.87), which meant the majority of participants agreed with the statement. Students' responses on item eight showed that 63 (82.89%) students reported agreement with the statement. On the other hand, the self-confidence subscale item seven, “I am confident that this simulation covered critical content necessary for the mastery of medical-surgical curriculum,” had the lowest mean score (M = 3.53, SD = 1.01).
Bivariate correlations were performed with the Pearson correlation coefficient to explore the relationship between students' demographic characteristics and their perceptions of satisfaction and self-confidence with HFS [Table 3]. In addition, the correlations between students' satisfaction and self-confidence were explored.
|Table 3: Correlations: Demographic characteristics, satisfaction score, and self-confidence score|
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The findings indicated that satisfaction only had a statistically significant correlation with the degree. A strong negative correlation was found (r = −0.238, P = 0.03), indicating a significant linear relationship between the two variables. Students who are in the prelicensure program tend to be more satisfied than students who had a bachelor's degree or other degrees. There was no statistically significant correlation with the other demographic characteristics of gender, age, or region of Saudi Arabian residence. In regards to self-confidence, the findings indicated that there was no statistically significant correlation with any of the demographic characteristics. However, Pearson's correlation coefficient showed a strong correlation between students' satisfaction and self-confidence in learning (P< 0.0001), indicating that these factors were correlated.
| Discussion|| |
Assessing nursing students' satisfaction and self-confidence in learning can aid in developing an educational strategy that improves their knowledge, skills, and attitudes.
The results of this study showed that overall the participants were satisfied with their HFS experience based on the five-point Likert scale. The total frequency of agreement scores was 205, which indicates that respondents mostly agreed with the statements. In addition, the overall mean score of 3.76/5 (SD = 0.88) for satisfaction suggests that the majority of the students were satisfied with the HFS experience. The results of this study were congruent with findings from the previous studies that indicated that there were high levels for students' satisfaction with learning and confidence in their skills after the simulation experience.,,
Furthermore, the findings of this study showed that satisfaction with learning had a statistically significant correlation with educational level (P = 0.03). Students who are in the prelicensure program were more satisfied than students who had a bachelor's degree or other degrees. This was also consistent with a recent study done at Saudi Arabia where the researcher examined nursing students' perception of satisfaction with HFS. The researcher found that respondents felt positive about and satisfied with the HFS. The satisfaction mean score ranged from 3.76 to 4.0 (SD = 0.867–0.621). Furthermore, satisfaction with learning had a statistically significant correlation with educational level (P > 0.01), which is a similar finding to this research. In this study, self-confidence did not have a statistically significant correlation with the demographic characteristics. Thus, the results are consistent with other studies where the findings showed that there was not a statistically significant correlation between self-confidence and demographic characteristics. However, the total frequency of agreement scores for the self-confidence subscale items was 335. This indicates that respondents mostly agreed with the statements. The overall mean score of 3.70/5 (SD = 0.71) for self-confidence suggested that the majority of the students were confident in their ability to perform necessary tasks using HFS.
Looking into the relationship between satisfaction and self-confidence, Pearson's correlation coefficient revealed a significant positive relationship between satisfaction and self-confidence (r = 0.79, P < 0.0001) indicating that these factors were correlated. The result is consistent with the results of another study that showed a positive relationship between satisfaction and self-confidence in learning (r = 0.70, P < 0.01). This study reflects the nursing literature by demonstrating a positive relationship between self-confidence and satisfaction in learning.
The study findings support Tanner's clinical judgment model (2006) of noticing, interpreting, responding, and reflecting. The students' overall perception of HFS was very positive. Using this model along with HFS, nursing educators can provide feedback and training to novice students in areas that may have been identified as having knowledge deficits. This enables students to develop their own clinical thinking and clinical judgment through specific learning activities. In turn, this will encourage students to become accustomed to performing reflection-on-practice. Literature supports self-reflection in addition to continued simulation practice to gain self-confidence with nursing assessment and skill development.
Simulation in nursing has not only been used for clinical education but also it has been used to assess the clinical competencies. The findings of the study will benefit nurse educators in creating educational environments that incorporate simulation in a manner that could promote entry-level nursing students' satisfaction and self-confidence. In addition, lectures should be combined with HSF as a teaching method to increase student knowledge and confidence. Furthermore, it could help to reduce attrition and increase interest in clinical activities. Nurse educators should be trained in the use of simulation as a teaching strategy. Innovative teaching strategies are crucial in engaging students in active learning and bridging the gap between academia and practice. Furthermore, debriefing is an essential part of a simulation. It should occur immediately after simulation since it allows the learners to reflect on the simulation and discuss their experiences. Hence, it will aid learners to use their critical thinking skills to analyze what happened during the simulation.
Furthermore, the findings of this study provide insights for the BSN program in Saudi Arabia to fully integrate HFS into the nursing curriculum for all levels of nursing students, and in turn, improve nursing students' critical thinking skills and clinical judgment directly to enhance the quality of patient care and the practice of nurses. The effective use of simulation requires funding and training. Therefore, the need to detect the cost of using this kind of simulation in an educational program is necessary since it is a cost-effective practice.
Specific limitation was experienced while conducting this study. Access to participants was restricted because only Saudi undergraduate nursing students who had experience with HFS were included in the research, leading to a small sample size. Therefore, study findings cannot be generalized to the entire population of Saudi nurses.
Based on the findings from this study, several areas are recommended for future research. First, replication of the current study utilizing a larger sample size would be beneficial. In addition, this study focused only on two outcomes, self-confidence and satisfaction. Therefore, examining other learning outcomes such as clinical competence, critical thinking, motivation and learning knowledge should be evaluated with all levels of nursing students (freshmen to seniors). Another recommendation is to explore the sustainability of the impact of simulation. While a high level of satisfaction with HFS experience was reported among prelicensure students in this study, the longevity of this satisfaction after the simulation is not known. When students engage in satisfying learning experiences, they may put more effort into learning when the learning environment is demanding. Satisfying learning experiences may assist in increasing students' self-confidence. Furthermore, more research is needed to examine the transferability of the impact from the simulation experience into the clinical setting.
| Conclusions|| |
Simulation in nursing has been considered as an essential part of clinical teaching and learning strategy that may increase a learner's satisfaction and self-confidence. This study showed that the majority of the participants were satisfied and confident in their ability with the HFS experience. This study has further confirmed that satisfaction and self-confidence are associated with the HFS experience. HFS prepares novice nursing students for real-life experience and promotes the transition to a professional career. Quality and Safety Education for Nurses (QSEN) addresses the required nursing competencies to ensure the quality and safety of patient care. Applying QSEN to every simulation experience will guarantee exposure to the different experiences needed to acquire and transfer required skills. The information obtained from this study will serve to stimulate further research and discussion regarding the use of simulation in nursing education. Nursing faculty needs to consider students perception about the simulation when designing, performing, and evaluating. This, in turn, will help to assess their learning experiences, measure their competency regarding knowledge and skills and promote patient safety.,
I would like to express my sincere gratitude to all those who made the completion of this study possible. I especially want to thank my thesis chair Dr. Merriam for all the support throughout this long process of completing this program and thesis. I thank you for your guidance, effort, and vast knowledge that I have learned from you.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Martyn J, Terwijn R, Kek MY, Huijser H. Exploring the relationships between teaching, approaches to learning and critical thinking in a problem-based learning foundation nursing course. Nurse Educ Today 2014;34:829-35.
Blum CA, Borglund S, Parcells D. High-fidelity nursing simulation: Impact on student self-confidence and clinical competence. Int J Nurs Educ Scholarsh 2010;7.
Khalaila R. Simulation in nursing education: An evaluation of students' outcomes at their first clinical practice combined with simulations. Nurse Educ Today 2014;34:252-8.
Megel ME, Black J, Clark L, Carstens P, Jenkins LD, Promes J, et al
. Effect of high-fidelity simulation on pediatric nursing students anxiety. Clin Simul Nurs 2012;8:e419-28.
Ironside PM, Jeffries PR, Martin A. Fostering patient safety competencies using multiple-patient simulation experiences. Nurs Outlook 2009;57:332-7.
Rakshasbhuvankar AA, Patole SK. Benefits of simulation based training for neonatal resuscitation education: A systematic review. Resuscitation 2014;85:1320-3.
Najjar RH, Lyman B, Miehl N. Nursing students' experiences with high-fidelity simulation. Int J Nurs Educ Scholarsh 2015;12. pii:/j/ijnes.
Dunn KE, Osborne C, Link HJ. Research briefs high-fidelity simulation and nursing student self-efficacy: Does training help the little engines know they can? Nurs Educ Perspect 2014;35:403-4.
Nel N, Stellenberg EL. Nursing students' perception of simulation as a clinical teaching method in the Cape Town Metropole, South Africa. Afr J Health Prof Educ 2015;7:176-9.
Richardson KJ, Claman F. High-fidelity simulation in nursing education: A change in clinical practice. Nurs Educ Perspect 2014;35:125-7.
Sundler AJ, Pettersson A, Berglund M. Undergraduate nursing students' experiences when examining nursing skills in clinical simulation laboratories with high-fidelity patient simulators: A phenomenological research study. Nurse Educ Today 2015;35:1257-61.
Burns HK, O'Donnell J, Artman J. High-fidelity simulation in teaching problem solving to 1st
-year nursing students: A novel use of the nursing process. Clin Simul Nurs 2010;6:e87-95.
Basak T, Unver V, Moss J, Watts P, Gaioso V. Beginning and advanced students' perceptions of the use of low – And high-fidelity mannequins in nursing simulation. Nurse Educ Today 2016;36:37-43.
Ann Cordeau M. Special topic: Simulation and human caring The lived experience of clinical simulation of novice nursing students. Int J Hum Caring 2010;14:8.
Benner P. From novice to expert: Excellence and power in clinical nursing practice. Heb Univ Sch Public Health 1981; 8:95-7.
Tanner CA. Thinking like a nurse: A research-based model of clinical judgment in nursing. J Nurs Educ 2006;45:204-11.
Omer T. Nursing students' perceptions of satisfaction and self-confidence with clinical simulation experience. J Educ Pract 2016;7:131-8.
Alfes CM. Evaluating the use of simulation with beginning nursing students. J Nurs Educ 2011;50:89-93.
Lasater K, Nielsen A. Reflective journaling for clinical judgment development and evaluation. J Nurs Educ 2009;48:40-4.
Jaffer U, Normahani P, Singh P, Aslam M, Standfield NJ. The effect of a simulation training package on skill acquisition for duplex arterial stenosis detection. J Surg Educ 2015;72:310-5.
Nuzhat A, Salem RO, Al Shehri FN, Al Hamdan N. Role and challenges of simulation in undergraduate curriculum. Med Teach 2014;36 Suppl 1:S69-73.
Jeffries P, editor. Simulation in Nursing Education. New York: National League for Nursing; 2007.
Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More than one way to debrief: A Critical review of healthcare simulation debriefing methods. Simul Healthc 2016;11:209-17.
[Table 1], [Table 2], [Table 3]