Simulation is regarded as an effective educational method for the delivery of clinical scenarios. However, exposure to unfamiliar environments during simulation can cause excessive stress among students, possibly leading to unnatural speech/behavior and poor skill learning (Yerkes-Dodson’s law). Thus, assessing students’ stress in a simulation can provide educators with a better understanding of their mental state. This study sought to clarify stress changes throughout the progression of the simulation by measuring heart rate variability and students’ subjective reactions in 74 nursing students. Heart rate variability was calculated in terms of its high-frequency (HF) and low-frequency/high-frequency (LF/HF) components during 4 phases—the break, patient care, reporting, and debriefing. Students were interviewed about stress experienced during the simulation. The results showed that HF decreased significantly from the break to the patient care and reporting phases. Furthermore, LF/HF increased significantly from the break to the reporting phases. Approximately 55 students felt stressed during the simulation, 24 of whom felt most stressed during the reporting phase. Therefore, the reporting phase involved high objective and subjective stress. It may be possible that the educator’s evaluative attitude increased students’ stress. Therefore, a stress intervention during the reporting phase might further improve students’ performance during that phase. The debriefing phase did not significantly differ from the break phase for objective stress, and students did not report feeling stressed. Thus, in this phase, they were released from the stress of the reporting phase and the unfamiliar environment. During this phase, they might be able to learn what they could not understand owing to high stress in the patient care and reporting phases. This study provides objective and subjective evidence of students’ stress during simulation, and indicates the necessity of providing support during the reporting phase and the importance of debriefing when using clinical scenarios for teaching clinical skills.
Background
The use of high‐fidelity simulation practice as an educational tool is becoming increasingly prevalent in nursing education. Despite the learning effects of simulation practice, students have been shown to experience high levels of stress and anxiety during simulation. In recent years, peer learning has been defined as an acquisition of knowledge and skills through active support and support among equal or equal peers and has been shown to be an effective educational intervention for clinical health science students.
Aim
The purpose of this study was to incorporate peer learning into simulation learning and to clarify the differences between stress and anxiety during personal and peer simulations.
Method
Third‐grade undergraduate students in a four‐year course at two nursing universities participated in this study. In this study, the simulated patient was a 53‐year‐old man who had undergone gastrectomy for the treatment of gastric cancer. The scenario was that the patient had completely recovered consciousness in the operating room, and his tracheal tube had been removed one hour before the students examined him. Stress while simulation training was evaluated with heart rate variability. Anxiety was evaluated by the STAI after the simulations were complete.
Results
Personal simulation practice (personal group;
n
= 50) and peer simulation practice (peer group,
n
= 59) was conducted. The personal group included 7 male students, and the peer group included 12 male students; the difference in male proportion was not significant. At the first patient assessment phase, stress of heart rate variability components at the peer group significantly increased relative to that of the personal. In addition, the personal had a significantly higher state anxiety score after simulation than the peer.
Conclusion
This study shows that in the face‐to‐face scene involving vital sign measurements, the presence of peers did not objectively alleviate stress.
This report attempts to ascertain the current state of, and outstanding issues relating to, nursing diagnosis, as taught in nursing education in Japan, and to obtain basic resources that will allow the improvement of said nursing diagnosis training. A self-completed, anonymous survey was carried out in regard to teaching staff responsible for classes in "nursing process" or "nursing diagnosis" at 183 university institutions involved in nursing education nationwide. Responses were received from 82 people, which clarified the following three points. 1) Of the 63 universities teaching nursing process as an independent subject, approximately 62% included nursing diagnosis. 2) A diverse range of educational materials were used in nursing diagnosis training, including NANDA-I nursing diagnosis. 3) In implementing nursing process using nursing diagnosis, issues raised included the following: the limitations of education "on paper", using theoretical patients, insufficient skills among teaching staff, the difficulty of realizing practical training in a clinical setting, and the tendency to try to make a simple diagnosis fit the circumstances. In the future, this study suggests that it may be important to create a set of guidelines guaranteeing a minimum level of educational content in relation to nursing diagnosis, which must be learned before graduation.
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