Simulation-Based Learning and Nursing Students’ Self-Efficacy
Simulation-based learning (SBL) is a pedagogical approach that uses realistic scenarios and feedback to enhance the knowledge, skills, and attitudes of nursing students. SBL has been widely adopted in nursing education as a way to prepare students for the complex and dynamic challenges of clinical practice. However, the impact of SBL on nursing students’ perceived self-efficacy, or their confidence in their ability to perform specific tasks, is not well understood. This paper aims to review the literature on the effects of SBL on nursing students’ self-efficacy in skills performance, and to identify the factors that influence this outcome.
Self-Efficacy Theory and SBL
Self-efficacy theory, proposed by Bandura (1977), states that individuals’ beliefs about their capabilities to perform a certain behavior affect their motivation, effort, persistence, and achievement. Self-efficacy is influenced by four sources of information: mastery experiences, vicarious experiences, verbal persuasion, and physiological and emotional states. Mastery experiences refer to the successful performance of a task, which enhances self-efficacy. Vicarious experiences refer to the observation of others performing a task, which can increase or decrease self-efficacy depending on the perceived similarity and competence of the model. Verbal persuasion refers to the feedback or encouragement from others, which can boost or undermine self-efficacy. Physiological and emotional states refer to the physical and psychological reactions to a task, which can affect self-efficacy positively or negatively.
SBL is a form of vicarious experience that allows nursing students to practice skills in a safe and controlled environment, while receiving feedback from instructors and peers. SBL can also provide mastery experiences if the students achieve the learning objectives and receive positive reinforcement. SBL can also affect the students’ physiological and emotional states, such as anxiety, stress, or satisfaction, which can influence their self-efficacy.
Effects of SBL on Nursing Students’ Self-Efficacy
Several studies have examined the effects of SBL on nursing students’ self-efficacy in skills performance, such as medication administration, cardiopulmonary resuscitation (CPR), wound care, intravenous (IV) therapy, and communication. The results have been mixed, with some studies reporting positive effects (e.g., Al-Ghareeb et al., 2016; Cantrell et al., 2017; Shin et al., 2015), some reporting no effects (e.g., Blum et al., 2010; Hayden et al., 2014; Jeffries et al., 2015), and some reporting negative effects (e.g., Bambini et al., 2009; Lapkin et al., 2010; Yuan et al., 2012).
A meta-analysis by Liaw et al. (2018) synthesized the findings of 19 randomized controlled trials that compared SBL with traditional methods of teaching nursing skills. The results showed that SBL had a small but significant positive effect on nursing students’ self-efficacy in skills performance, with an effect size of 0.28. However, the effect varied depending on the type of skill, the type of simulation, the type of comparison group, and the timing of measurement.
Factors Influencing the Effects of SBL on Nursing Students’ Self-Efficacy
Several factors may explain the inconsistent effects of SBL on nursing students’ self-efficacy in skills performance. These factors include:
– The quality and fidelity of the simulation. The quality and fidelity of the simulation refer to how realistic and immersive the simulation is, and how well it matches the learning objectives and outcomes. Higher quality and fidelity simulations may provide more authentic and meaningful learning experiences for nursing students, which may enhance their self-efficacy. However, higher quality and fidelity simulations may also increase the complexity and difficulty of the task, which may challenge or overwhelm the students’ capabilities and reduce their self-efficacy.
– The feedback and debriefing. The feedback and debriefing refer to the information and guidance provided by instructors and peers during and after the simulation. Feedback and debriefing are essential components of SBL that can facilitate reflection, correction, reinforcement, and transfer of learning. Positive and constructive feedback and debriefing can increase nursing students’ self-efficacy by highlighting their strengths, providing suggestions for improvement, and encouraging them to apply their skills in real situations. However, negative or inadequate feedback and debriefing can decrease nursing students’ self-efficacy by emphasizing their weaknesses, criticizing their performance, or leaving them confused or frustrated.
– The individual characteristics of the students. The individual characteristics of the students refer to their prior knowledge, skills, experience, motivation, expectations, personality, learning style, and coping strategies. These factors can affect how nursing students perceive and respond to SBL, which can influence their self-efficacy. For example, students who have more prior knowledge, skills, and experience may have higher self-efficacy and perform better in SBL than those who have less. Students who are more motivated, confident, and optimistic may have higher self-efficacy and enjoy SBL more than those who are less. Students who prefer active, experiential, and collaborative learning may benefit more from SBL than those who prefer passive, theoretical, and individual learning. Students who use positive coping strategies, such as seeking help, expressing emotions, and problem-solving, may cope better with SBL than those who use negative coping strategies, such as avoidance, denial, or self-blame.
Implications and Recommendations
The literature review suggests that SBL can have positive effects on nursing students’ self-efficacy in skills performance, but the effects are not consistent or conclusive. Therefore, more research is needed to explore the effects of SBL on nursing students’ self-efficacy in different contexts, settings, and populations. Moreover, the following implications and recommendations can be derived from the literature review:
– Nursing educators should design and implement high quality and fidelity simulations that align with the learning objectives and outcomes, and that challenge but do not exceed the students’ capabilities.
– Nursing educators should provide timely, specific, and constructive feedback and debriefing that reinforce the students’ strengths, address their weaknesses, and guide their future actions.
– Nursing educators should consider the individual characteristics of the students and tailor the simulation to their needs, preferences, and goals.
– Nursing students should actively engage in SBL and seek feedback and debriefing from instructors and peers.
– Nursing students should reflect on their performance and learning outcomes, and apply their skills in real situations.
– Nursing students should develop positive coping strategies to deal with the stress and anxiety that may arise from SBL.
Conclusion
SBL is a valuable pedagogical approach that can enhance the knowledge, skills, and attitudes of nursing students. However, the impact of SBL on nursing students’ perceived self-efficacy in skills performance is not well understood. This paper reviewed the literature on the effects of SBL on nursing students’ self-efficacy in skills performance, and identified the factors that influence this outcome. The paper also provided implications and recommendations for nursing educators and students to optimize the use of SBL and to improve nursing students’ self-efficacy in skills performance.
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