Comparing Teaching Strategies Utilized to Enhance Self-Confidence Among Novice Nursing Students
AffiliationUniversity of Southern Indiana
TitleComparing Teaching Strategies Utilized to Enhance Self-Confidence Among Novice Nursing Students
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Research Question and Context
Confidence is a professional attribute linked to clinical judgment and decision making, promotes patient safety, and positively impacts patient outcomes (Lundberg, 2008; White, 2009; Blum et al., 2010). Educators are challenged by how best to support the development of self-confidence among novice nursing students. Students enter programs with various levels of self-confidence. Educators play a key role early in the nursing curriculum by creating meaningful active learning opportunities to support the development of confidence among novice students. When students experience repeated successes, their confidence builds resulting in student achievement of learning outcomes and program outcomes (Bulfone et al., 2016; Lundberg, 2008; White, 2009).
This prospective, quasi-experimental pilot study used a convenience sample to compare role-play (RP) and a newly integrated individual high-fidelity simulation (HFS) to determine the impact on the development of confidence among beginning associate degree nursing students preparing for their first patient care experience (Carter, 2020).
The use of simulation provides rich experiential learning in a safe, realistic, and controlled environment, and has been shown to provide meaningful learning similar to the traditional clinical experience (Hayden et al., 2014; Jarvill et al., 2017; Jeffries, 2016). When introduced early in the curriculum, confidence levels can be enhanced (Kimhi et al., 2016). A gap in the literature exists in determining which confidence-building teaching strategy, RP or HFS, best enhances a novice nursing student’s confidence.
Bandura’s (1994) theory of self-efficacy supports the use of simulation in that opportunities for achieving repeated success when performing skills, observing others perform skills, receiving positive feedback, time for deliberate practice, and experiencing positive emotions during skill performance all impact the development of self-confidence.
A pre-test/post-test survey design was used to measure the perceived levels of self-confidence when performing a physical assessment. The convenience sample was assigned according to their clinical day to complete either the historically used RP simulation or a newly designed individual HFS during orientation day. Using Grundy’s (1993) Confidence Scale, a 5-point Likert scale, students were asked to answer five questions to rate how confident they felt in completing the physical assessment before the simulation activity. Students received debriefing after their simulation and opportunities to continue practicing the physical assessment skill. One week later, students completed the Confidence Scale prior to performing a physical assessment on their first assigned clinical patient.
An independent samples t-test (p = .11) showed no statistically significant difference in post-intervention levels of total self-confidence between the RP and HFS groups (Carter, 2020). However, a paired samples t-test within groups revealed statistically significant changes in total levels of confidence from Time 1 (M =18.4, SD =2.70) to Time 2 (M = 20.3, SD = 2.30), t(15) = -3.50, p = .003 (two-tailed) in the RP group. These findings indicate the perceived level of confidence grew from moderate to high in the RP group. The HFS group maintained moderate levels of self-confidence.
Literature heavily recognizes HFS as a best practice. However, HFS is quite costly in terms of both time and financial investment in space, staffing, and equipment. This study positively affirmed that RP as a teaching/learning strategy supports a novice students’ development of confidence.
The results also echo the literature’s suggestion that introducing RP to novice students who lack knowledge, context, or experience may be more impactful in enhancing confidence whereas HFS can be integrated as students progress within the program (Goodstone et al., 2013; Thomas & Mackey, 2012).
Lessons learned from this study reiterate what has been supported in literature: deliberate practice, regardless of the type of simulation, is key in the mastery of skill and development of confidence (Jeffries et al., 2018). Educators play an essential role in supporting students’ success by creating meaningful learning opportunities, and both program outcomes and patient safety may also positively be impacted. Further investigation utilizing novice baccalaureate nursing students should be explored.
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