Is there a relationship between the number of years of nursing experience and self-confidence in AGACNP students’ based on the number of years of nursing experience as measured by the demographics and the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©)?

Framework

            Nursing schools provide students with the opportunity to work in a clinical setting and gain real-world patient experience. Prior to graduating, students may not have encountered all patient situations. To ensure that students encounter clinical experiences with different patient situations, simulations are commonly used to replicate clinical scenarios that foster the development of their critical thinking and clinical reasoning skills without any risk to the patient (Coomes, 2019). After participating in the simulation, students embark on another learning adventure known as debriefing. Research suggests that debriefing is the most important component of simulation and a well-executed debrief can identify learning gaps and improve practice (Jeffries, 2005, Eppich & Cheng, 2015, Coomes, 2019). Therefore, a debriefing session is included in all simulation-based learning experiences (SBLE) to better educate and train participants for future experiences (INACSL, 2016). Debriefing is also a reflective process in which participants think about and reflect on what occurred during the simulated experience.

The debriefing process allows for rigorous reflection, during which they address clinical and behavioral dilemmas and areas of confusion raised by the simulation experience. Despite its significance, debriefing is a source of concern for many instructors, who differ in their degree of experience and knowledge on how to conduct a debriefing session properly. Furthermore, if a debrief is incorrectly performed, the learner could be adversely affected, rendering simulation an inadequate learning modality. As a result, the Promoting Excellence and Reflective Learning in Simulation (PEARLS) debriefing tool was developed to provide a scripted language to guide instructors through an effectively executed debriefing process (Eppich & Cheng, 2015).

The PEARLS debriefing tool has four phases: reactions, description, analysis, and summary phases (Eppich & Cheng, 2015). The reaction phase gives an opportunity to express how they feel following the simulation. When performing an end-of-life simulation, the reaction phase is critical because you want to ensure that the participants feel comfortable discussing any feelings that might arise. In the description phase, the researcher digs deeper into the learner’s perception of what they felt during the simulation experience and then transition to the analysis phase to examine the case scenario. This analysis phase integrates three educational strategies based on the learning objectives and the time available during debriefing. The three methods are learner self-assessment, facilitation of focused discussion, and knowledge provision in the form of directive input and teaching (Eppich & Cheng, 2015). This blended framework shared by all three teaching strategies was that the debriefing session is active, learner-based, and collaborative (Eppich & Cheng, 2015). The summary phase is the final phase of the debriefing process in which the teacher or learner may provide a concise description of the main takeaways.

The PEARLS debriefing approach is being used to ensure that the PI of this translational project can efficiently guide the debriefing process by using a debriefing script that supports the simulation learning objectives. Furthermore, using this scripted debriefing framework will enable students to carefully consider and explore the rationales that influenced their responses during the end-of-life simulation experience.

Research Questions

1. Will there be a statistically significant difference in AGACNP students’ perception of their self-confidence as it relates to clinical decision-making who have completed an end-of-life standardized participant simulation as measured by the pre-and post-test Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©)?
2. Will there be a statistically significant difference in AGACNP students’ perception of their anxiety as it relates to clinical decision-making who have completed an end-of-life standardized participant simulation as measured by the pre-and post-test Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©)?
3. Is there a relationship between the number of years of nursing experience and self-confidence in AGACNP students’ based on the number of years of nursing experience as measured by the demographics and the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©)?