The Maternal- Newborn Assessment Study: Can Simulation Replicate the Clinical Learning Experience in Undergraduate Nursing Education?

Objective: Simulation is a widely used teaching strategy. Researchers have found simulation increases undergraduate nursing students’ knowledge, skills, self-efficacy, and confidence.  Many simulation researchers have required students to perform as a group, rotate through skill stations, or assume non-nursing roles. Few have described simulation scenarios where students put individual skills learned together into comprehensive practice. No one has specifically evaluated formal knowledge, as this study is designed to test by asking: What is the effect of high fidelity simulation and practice in the clinical laboratory compared to hospital based clinical learning on the ability of undergraduate nursing students to assess, intervene, and critically think in the obstetrical setting?

Design: Quasi experimental, non-equivalent comparison groups, post-test only; power analysis for 3 variables, medium effect size required 76 in each comparison group for a total of 152 participants; Alpha level .05 and power of .8.

Setting: Private University in Pacific Northwest.

Sample: 82 undergraduate, senior nursing students in Maternal-Child course; two withdrew for personal reasons. 39 students in an Obstetrical hospital rotation and 41 students in Pediatric clinical rotation voluntarily participated and comprised the two comparison groups.

Methods: Each student demonstrated simulated postpartum and newborn assessments while an Obstetrical faculty member, trained as an observer evaluated performance using check-off forms. Following and prior to debriefing, students provided written responses to questions designed to assess critical thinking during the simulation.  Questions and items on check-off forms were assigned points to obtain assessment, written, and total scores. Scores <92% required remediation. Check-off forms, developed by study researchers were tested for inter-rater reliability and content validity, and questions were pilot tested.  T-tests were used to compare scores of students completing an Obstetrical hospital rotation vs. those in Pediatric clinical and frequencies for passing assessments calculated.

Results:  No significant difference detected between students in Pediatric clinical who only practiced assessments in the laboratory setting and students completing a hospital based obstetrical rotation in their ability to assess, intervene or critically think.  The p value for comparisons ranged from .41 to .93 (all non-significant); < 1/3 of students passed either assessment.

Conclusion/Implications for nursing practice: Findings indicate simulation was as effective as clinical practice in terms of students’ performance outcomes. Well-designed simulations can replace part of nursing students’ hands-on clinical time with positive learning outcomes. Evaluating individual student performance facilitates design of remediation activities targeting identified areas of weakness. Future researchers should combine simulation with hospital-based clinical experience to determine if student competency improves.

Keywords:  maternal-newborn, undergraduate, nursing students, simulation