disaster simulation’s impact on self-efficacy in clinical

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Disaster Simulation’s Impact on Self-Efficacy in Clinical

Decision-Making

Jacqueline Savory Braham, DNP, MSN, RNDean, Academic Affairs

Chamberlain University, College of Nursing


Background

2

• Nursing graduates feel unprepared (Duchscher, 2009)

• Nursing schools are unable to meet the demand (AACN, 2017)

• A disaster-based simulation can improve senior nursing students’ self-efficacy in making right management decisions when faced with a difficult case

• Hypothesis: There will be a gain in self-efficacy scores for senior students post-disaster simulation


Purpose

3

Examine the impact on self-efficacy scores pre- and post-disaster-based simulation at a multistate university.


Method

4

Quantitative non-experimental retrospective descriptive pre-/post-test design:

• Purposive Sampling; non-probability – One group pre-/post-test study


Simulation Scenario

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Severe tornado: • Several casualties• Victims need to be triaged• First Aid supplies are available


Instrument

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General Nursing Self-efficacy Scale (2015):• Modification of the General Pediatric Self-efficacy

Scale (GPedsSE), which was based on the new General Self-efficacy Scale

• General Pediatrics-specific Self-efficacy (GPedsSE) Scale, (r = 0.54, p < 0.005)


Results

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Nine of the pre-simulation survey responses were “Uncertain” or “Strongly Agree”

• No statistically significant difference in scores for survey questions 1 through 11(p=0.2 to p=1.0)

• Slight increase in response following training for question 9, “I will know when it is time to refer a problem to a practitioner,” (p=0.06)


Results

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Statistical significance noted to Question 12 following training, “In a general patient context, when facing a difficult case, I am certain I can make the right management decisions,”( p=0.008).


Question 12: In a general patient context, when facing a difficult case, I am certain I can make the right management decisions.

Time Range Median (IQR) Mean ± SDWilcoxon

signed rank p-value

Pre-simulation 3-5 4 [4,5] 4.57 ± 0.71 0.008

Post-simulation 4-5 5 [4,5] 4.70 ± 0.47

9

Post-simulation: Agree Post-simulation: Strongly Agree

Pre-simulation: Uncertain 3 (13%) 0 (0%)

Pre-simulation: Agree 4 (17%) 5 (22%)

Pre-simulation: Strongly Agree 0 (0%) 11 (48%)


Question 12: In a general patient context, when facing a difficult case, I am certain I can make the right management decisions.

10

0

2

4

6

8

10

12

14

16

18

Uncertain Agree Strongly Agree

Pre-simulation training Post-simulation training

Num

ber o

f stu

dent

s

3

0

9

7

11

16


Limitations

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• Difficulty recruiting participants– Lack of full engagement

• Pre-exposure to simulation– Students sharing

information

• Hawthorne effect


Important Findings

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• Disaster-based scenario may be used to improve self-efficacy in clinical decision-making

• Repetitive exposure is beneficial– Mastery of skills– Confidence

• Simulation provides adequate learning experiences equivalent to traditional clinical


Future Recommendations

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• What is the impact on senior nursing students?

• Mandatory participation

• General Nursing Self-efficacy Scale

• Explore the simulation’s use all level of students and of nursing courses


References

American Association of Colleges of Nursing. (2014, April). Nursing Shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215.

Bureau of Labor Statistics. (2013). Table 8. Occupations with the largest projected number of job openings due to growth and replacement needs, 2012 and projected 2022(Data file). Retrieved from http://www.bls.gov/news.release/ecopro.t08.htm

Dicle, A., & Ezeer, A.(2013). Examination of Clinical Decision Making Perceptions of Nursing Students. New Educational Review, 132-142

Del Bueno, D.(2005). A crisis in Critical Thinking. Nursing Education Perspectives, 26(5), 278-282.

Dunn, K., Osbourne, C., Link, H. (2014). High-Fidelity simulation and Nursing student self-efficacy: does training help the Little engines know they can? Nursing Education Perspectives, 35(6), 403-404.

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http://www.bls.gov/news.release/ecopro.t08.htm


References

Gillespie, M., & Paterson, B. L. (2009). Helping novice nurses make effective clinical decisions: The situated clinical decision-making framework. Nursing Education Perspectives, 30(3), 164-170

Hutchinson, S., Haynes, S., Parker, P., Dennis, B., Mclin, C., and Welldaregay, W. (2011). Implementing a multidisciplinary disaster simulation for undergraduate nursing students. Nursing Perspectives, 32(4), p. 240-243.

Institute of Medicine (2004). Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press

Kaplan, B., Conner, A., Ferranti, E., Holmes, L., Spencer, L. (2011). Use of an Emergency Preparedness Nursing Students. Public Health Nursing, 29(1), p. 44–5.

Karabacak, U., Serbest, S., Onturk, Z., Aslan, F., & Olgun, N. (2013). Relationship Between student nurses’ self-efficacy and psychomotor skills competence. International Journal of Nursing Practice, 19,124-130.

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References

Morrison, A., & Catanzaro, A. (2010). High-Fidelity Simulation and Emergency Preparedness. Public Health Nursing, 27 (2), p.164–173

Pappas, S. (2008). The cost of nurse-sensitive adverse events. Journal of Nursing Adminstration, 38(5), 230-236.

Pardue, S. (1987). Decision-Making Skills and Critical Thinking Ability Among Associate Degree, Diploma, Baccalaureate, and Master's-Prepared Nurses. Journal of Nursing Education, 26(9), 354-361.

Spector, N., Blegen, M., Silvestre, J., Barnsteiner, J., Lynn, M., Ulrich, B., Fogg, L., Alexander, M.(2015). Transition to Practice Study in Hospital Settings. Journal of Nursing Regulation, 5(4), 24-38.

Yiu, T., Cheung, S., & Siu, L. (2012). Application of Bandura’s Self-Efficacy Theory to Examining the Choice of Tactics in Construction Dispute Negotiation. Journal of Construction Engineering and Management, 331-340.

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disaster simulation’s impact on self-efficacy in clinical

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