Development of Program for Delivery Nursing Care Education for Students of Nursing Colleges, and its Educational Effects

Transcription

1 Development of Program for Delivery Nursing Care Education for Students of Nursing Colleges, and its Educational Effects Hong Sun-Yeun Assistant Professor, College of Nursing, Kyungwoon University, 730 Snvdong-myeon, Gangdong-myeon,Gangdong-ro Gumi-si Gyeongsangbuk-do , South Korea. Abstract The intent of this study was to develop a program of delivery nursing care education involving the use of hybrid simulation, and examine how it influenced the knowledge of delivery nursing care, performance competence for delivery nursing care, and problem-solving ability of students. The development of the program proceeded according to the normal delivery procedure, with the highest level of emphasis on in-class practice based on the results of a survey of nursing college students that was conducted in advance. The delivery nursing care education program based on hybrid simulation reflected nursing knowledge and technical and attitudinal aspects required from the first to fourth phases of delivery, and was modified and supplemented through model implementation. In terms of the operation of the program, the delivery scenario developed by utilizing standardized patients and a high-performance simulator on nursing college students was applied. As for the evaluation of the program, knowledge of delivery nursing care and problem-solving ability were evaluated through the survey, and performance competence for delivery nursing care was evaluated by applying actual delivery cases. According to the results of the study, college nursing students who participated in the delivery nursing care education program based on hybrid simulation were found to have a statistically significantly higher level of knowledge and performance competence for delivery nursing care. Based on the aforementioned results, the program for delivery nursing care education based on hybrid simulation was confirmed to be effective in reinforcing the core abilities of nursing college students. In addition, it seems to be feasible to utilize this program in the future as replacement education for clinical practice. Keywords: Hybrid Simulation, Problem-solving Ability, Competence Introduction A. Necessity of the Study The objective of nursing education is to cultivate professional and well-qualified nurses by teaching nursing students the knowledge, skills, and attitudes required in the clinical field through theoretical and practical education. In particular, practical education is considered as determining the future of clinical nursing, since it plays a crucial role in nursing education and also improves practical nursing skills [1]. Practical education is a prerequisite for an improvement of practical skills in nursing[2]. However, it is currently confronting difficulties. Due to a growing emphasis on the Kim Mi-ye Honorary Professor, College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro Jung-gu, Daegu South Korea. kimmiy@knu.ac.kr rights and ethics of patients, the clinical field only provides observation-oriented practice, and there has been an increasing trend of hospitals avoiding providing clinical practice to students. In addition, nursing students have a negative attitude regarding clinical practice due to the complexities of clinical practice and the burden of taking care of patients[3]., and there have been issues related to a lack of effective teaching methods in the area of clinical practice, as well as a lack of specialized clinical educators[4]. In particular, childbirth education in clinical maternity nursing course is currently in more devastated situation in the other area of clinical practice education. Since mothers and guardians do not want to be exposed to procedures of childdelivery and unexpected emergent situations occur, the student practice tends to be limited. Furthermore, considering how the number of deliveries was significantly decreased due to the serious issue of Korea's low birth rate, it is urgent to come up with an education program that can replace clinical practice. Nursing simulation education, which recently has been adopted by nursing education organizations, is considered as an appropriate solution to the need for practical education. Nursing simulation education makes it feasible to provide integrated education and achieve the maximum level of learning effects and outcomes[5]. In particular, a highlyfunctional patient simulator is able to express the physiological reactions of a patient through the operation of a computer and realize various conditions of disease, along with repetitive practice. Therefore, it has been widely used as an educational tool for improving core nursing abilities. However, a nurse is required to find and solve not only the physiological responses of a patient but also the verbal and non-verbal expressions from a patient. As such, there is difficulty in realistically reproducing clinical situations with a simulator alone. To address this issue, a hybrid simulation education that integrates a highly functional simulator that can realize physiological responses of a patient and normal patients educated to act out the condition of certain diseases is perhaps needed. Hybrid simulation is an efficient practical education method in which students are able to learn knowledge and clinical performance capability to reproduce clinical situations in a realistic manner. However, despite such advantages, there are still many conditions to be fulfilled, such as instructors with expertise, well-trained standardized patients, and objectivity of evaluation. In addition, it is needed to bear the highly cost of a patient simulator and also the expenses of education for standardized model of patients. 1121

2 Due to such disadvantages, hybrid simulators have only been used for several subjects. Previous studies of the use of simulation in the field of nursing have utilized highly functional patient simulators and measured knowledge and the effect of clinical competence and problem solving skills in various areas, such as emergency care education[6], critical care nursing education[7] [8], maternal-child nursing education[9][10], and newborn baby emergency care education [11]. However, the results of the various studies have not been consistent. For this reason, it is meaningful to examine how delivery nursing care education influences the core nursing abilities of a nursing student based on hybrid simulation teaching/learning methods. The aim of this study is to develop and apply delivery nursing care education program with a hybrid simulation, to verify its effects and to provide fundamental resources for the operation of practice education. B. Objectives of the Study The objective of this study is to analyze the effect of how a delivery nursing care education program with a hybrid simulation influences delivery knowledge, capability of performing delivery nursing care, and the problem-solving ability of college nursing students. Research Methods A. Study Design This study is a similar type of experiment research applied with a design before and after dealing with a non-equivalent control group that compares the knowledge of delivery nursing care, capability of performing delivery nursing care, and problem-solving ability of an experimental group that participated in hybrid simulation delivery nursing education program with that of a control group. Table 1: Research Design for Experimentation Group Pre-test Intervention Post-test Experimental group E₁ X₁ E₂ Control group C₁ X₂ C₂ E₁ : Pre-test of Experimental Group E₂ : Post-test of Experimental Group C₁ : Pre-test of Control Group C₂ : Post-test of Control Group X₁ : Hybrid Simulation Delivery Nursing Care Education Program X₂ : Self Directory Learning B. Study Tools i. Knowledge of delivery nursing care Knowledge of delivery nursing care was comprised of inquiries developed by a researcher about core knowledge of delivery nursing care according to learning goals and literature on maternity nursing. Validity of contents was approved by 2 of the professors in the maternity nursing area, 2 current nurses with a master's degree or higher with more than 10 years experience in the delivery room, and one obstetrician/gynecologist. When approving the validity of contents, areas in need of modification were changed or supplemented based on the opinions of experts in the field, and CVI score in each item was in the range from 0.8 to 1.0. Cronbach's α of the reliability in the study tools was found to be.81. ii. Capability of performing delivery nursing care Instruments for measuring the capability of performing delivery nursing care were an observation-oriented evaluation tool developed by a researcher based on the learning goals of maternity nursing that was related to delivery nursing. CVI score in each item was in the range from 0.8 to 1.0. Cronbach's α of the reliability in the study tools was found to be.78. iii. Problem Solving Ability In terms of the instrument used to measure the problem solving ability, a tool for problem solving procedures modified and supplemented by Woo (2000) from the Process Behavior Survey created by Lee (1978) was used[12]. Cronbach s α of the reliability in this study was found to be.87. C. Study Procedure i. Development of Hybrid Simulation Delivery Nursing Care Education Program The purpose of the hybrid simulation delivery nursing care education program is to enable nurses to swiftly offer nursing service and appropriately cope with delivery situations that can occur in the clinical field as a program provided for enhancing knowledge of delivery nursing care, capability of performing delivery nursing care, and problem solving ability. According to 10 categories of maternity nursing from the learning goal collections of the Korea Nurses Association, a total of 9 items were determined. An investigation was performed to deal with the need on items for which additional in-class practice was required in the clinical education field on 70 senior students at the college of nursing at K University. As a result, the theme of education was determined with the highest level of needs on delivery health issues. A hybrid simulation delivery education program was developed by considering nursing knowledge, skills and technologies in each of the four stages of delivery. Preliminary education resources were prepared in file in a hwp format by stating the conditions and nursing care in terms of the child-delivery physiology, mechanism of labor, and each of the delivery procedures of normal mothers. In addition, a delivery scenario was developed by considering literature related to simulation education in the fields of medicine and nursing, literature of delivery nursing, nursing textbooks, and clinical cases. To create a realistic scenario, validity of contents was approved by 2 professors in the maternity nursing area, 2 practicing nurses with a master's degree or higher and more than 10 years of delivery room experience, and one obstetrician/gynecologist according to three of the actual cases in the delivery room at hospital Y. In this way, contents of a scenario were modified and supplemented hereof. 1122

3 In the scenario, a normal delivery was feasible, based on a 33-year-old mother pregnant for 39 weeks and 2 days, expressing pain on a regular basis and hospitalized in the delivery room while suffering from early rupture of membranes 2 hours ago, and embryo was in an ROA situation. Nursing activities to be performed according to the changes in the situation of the mother before giving birth were stated, and a checklist was prepared to evaluate the capability of performing nursing. The checklist divided the nursing service to be provided from the 1st stage to the 4th stage of delivery into capability of performing clinical works and relationship between nurse and patient. There were 21 questions, and scores ranged from 2 (good), 1 (normal), to 0 (none) depending on the level of performance. The total score ranged from 42 (highest) to 0 (lowest). Debriefing was comprised of the stage of performance - statement - analysis - application to share and analyze what learners and instructors felt in the education. Stages of performance and statement were performed with verbal debriefing immediately after each of the four stages was completed at the simulation practice room. Stages of analysis and application were performed in the simulation practice room after completing delivery nursing activities. ii. Demonstration, Implementation and Modification The developed scenario was applied to 8 junior students at the college of nursing in D city instead of subjects in this study. Items not considered in advance were supplemented after confirming the location of observation by researchers, bed for mothers, and related devices, and preparing for all of the surgical items. In addition, unexpected inquiries and situations were coped with, reflecting them on the student orientation and education for standardized patients. iii. Selection and Training for Standardized Patients Standardized patients were actors/actresses, including 2 women in their 30s who had experienced the normal process of childbirth and 1 man as the married partner. This researcher provided three training sessions for standardized patients. In the first session of the training, scenario education was provided. In the second session of the training, understanding of the scenario was tested, and acting performance was corrected after the practice. In addition, opinions were exchanged on unexpected situations and inquiries. On the third session of training, simulated training was implemented. iv. Data Collection Objectives and contents of the study were explained to junior students at the college of nursing at K University from March 23 to April , and students who voluntarily participated in and agreed to the study were selected. Subject in the experimental group and control group were matched according to the class rank in the previous semester. Theoretical education on delivery nursing and delivery skill education were provided for 2 hours each, on the entire subject to acquire equivalence. In addition, arbitration of experimental group was implemented after the arbitration of the control group in order to prevent experiment treatment from being applied to other groups. v. Arbitration of experimental group Arbitration of the experimental group had been performed for 27 days. On the first day, March 25, education courses were explained implementing the orientation of the courses and preliminary survey on knowledge of delivery nursing care and problem-solving ability. Knowledge of delivery nursing care and problem-solving ability were measured using a selfreport survey. For two days, April 5 and 6, standardized patients and simulators were used to perform preliminary investigation of capability of performing delivery nursing care. capability of performing delivery nursing care was measured by educating one standard patient and one practical nurse, assigning them in the delivery room, and having each of the students perform normal delivery procedures. As the measuring tool, an observation-oriented device developed by researchers was used, and evaluation was performed by a researcher and a nurse, each with 4 years of experience in the delivery room, and was reflected on the score after comparing them. Particular orientation about hybrid simulation scenarios was performed on 5 teams consisting of 5 to 6 members in each team on April 12 and 13. Students were asked to read an instruction that had a brief description of the situations of mothers. Delivery procedures were divided into four sections, in other words, from 1st delivery stage to 4th stage, and team members would play the role of leader by rotation in each of the sections. A limited time was allowed to them for each section, and immediate verbal debriefing was performed after applying simulation. The role of mother was assigned to a standardized patient. If the team leader was unable to appropriately cope with situations when students performed nursing assessment during the simulation, they were asked in the mutual constructive arbitration to supplement their weaknesses and educated to cooperate with each other for accurate communication and mutual respect. After applying the delivery nurse program to the developed scenario, followup investigation was performed on the 19 and 20 of April. knowledge of delivery nursing care and problem solving ability were measured in the same manner through a preliminary investigation. Furthermore, capability of performing delivery nursing care was estimated. vi. Control Group For the control group, education courses were explained on the first day, March 24, to perform course orientation and measure knowledge of delivery nursing care, capability of performing delivery nursing care, and problem-solving ability. In addition, a preliminary survey about knowledge of delivery nursing care was implemented. Preliminary survey was performed to determine capability of performing delivery nursing care on March 29 and 30 in the same manner as with the experimental group. Groups were divided into 5 sub-groups on April 3 to proceed with self-study. Here, cases of delivery were suggested, seeking nursing issues and arbitration that occurred during the delivery and submitting a group activities report. In addition, related performance were practiced in the simple delivery model. 2 hours were required for self-study. knowledge of delivery nursing care, capability of performing delivery nursing care, and problem solving ability were 1123

4 measured in the same manner, with a preliminary investigation on April 10 and 11. between experimental group and control group (p>.05). Therefore, equivalence between the two groups was confirmed (Table 2). Table 2: Homogeneity test of general characteristics between experimental and control group Experimental Control group (n=26) group(n=26) M SD, n(%) M SD, n(%) or t Motivation Employment rate 8(30.8) 5(19.2) Invite others 9(34.6) 8(30.8) Suitability Considerations 9(34.6) 13(50.0) p Figure 1: Study flow D. How to Analyze Data The SPSS/WIN 20.0 software package was used to process and analyze collected data. General characteristics of subjects and values of each variable were analyzed based on frequency, percentage, average, and standard deviation. Independent t-test was performed for the equivalence and general characteristics of subjects. T-test was used to analyze differences in knowledge of delivery nursing care, capability of performing delivery nursing care, and problem-solving ability before and after arbitration of the experimental group and control group. Cronbach s alpha was calculated to measure the reliability of the measuring tools. E. Ethical Considerations This study was considered by National Bioethics Committee at the Kyungpook National University Hospital (IRB No: ). The objectives and courses of research were explained to the subjects to obtain their voluntary participation. Subjects were told that they were able to withdraw from the study at any time under their own will, even in the middle of the experiment, and that the results of research would not be used for purposes other than the study. For the control group, hybrid simulation education was performed in the same manner as the experimental group after the follow-up investigation, in consideration of the need for equality of education. Results of Research A. Characteristics of Subjects and Equivalence Examination According to the result of an analysis on equivalence between the experimental group and the control group prior to implementing the hybrid simulation delivery nursing education program, there was no significant difference major clinical practice School life interpersonal relationships Gradepoint average 4.0 < 2(7.7) 1(3.8) (38.5) 4(15.4) 3.0~3.5 9(34.6) 15(57.7) 3.0 > 5(19.2) 6(23.1) B Preliminary Verification of Equivalence of the Dependent Variable in the experimental group and Control Group According to the result of analysis on equivalence of knowledge of delivery nursing care, capability of performing delivery nursing care, and problem solving ability between experimental group and control group prior to implementing the hybrid simulation delivery nursing education program, there was no significant difference (p>.05). Therefore, equivalence between the two groups was confirmed (Table 3). Table 3: Homogeneity Test on the Dependent Variables between experimental and control group Experimental group(n=26) M SD Control group(n=26) or t p M SD knowledge of delivery nursing care capability of performing delivery nursing care Problem solving ability It was found that the experimental group who participated in the hybrid simulation delivery nursing education program had a significantly higher level of nursing knowledge, based on the experimental group's score of 17.85(±1.54), and the control group's score of 16.02(±1.57) (Table 4). Table 4: Comparison of knowledge of delivery nursing care 1124

5 between experimental and control group Dependent Groups Pre-test Post-test Difference t p variable Knowledge of Exp(n=26) delivery nursing Cont(n=26) care It was found that experimental group who participated in the hybrid simulation delivery nursing education program had a significantly higher level of nursing knowledge, based on the experimental group's score of 35.85(±4.84), and the control group's score of 26.05(±3.91) (t=-6.87, p=<001)(table 5). Table 5: Comparison of competence of delivery nursing care between experimental and control group Dependent variable Competence of delivery nursing care Groups Exp(n=26) Cont(n=26) Pre-test Post-test Difference t p <.001 It was found that the experimental group in the hybrid simulation delivery nursing education program had not a significantly higher level of problem solving ability, based on the experimental group's score of 3.36(±.36), and the control group's score of 3.30(±.41) (t=-.582, p=.563) (Table 6). Dependent variable Problem solving ability Table 6: Experimental and control groups Groups Exp(n=26) Cont(n=26) Pretest Posttest Difference t p Discussion The experimental group given the hybrid simulation delivery nursing care education program was found to show a significant difference from the control group in terms of knowledge of delivery nursing care. This result was in contrast to the fact that there was no significant difference in knowledge according to the effect of how simulated childdelivery nursing education influenced the skill performance ability, knowledge, and satisfaction with education of college nursing students [13]. Looking at similar studies, Kim & Jang (2011) implemented a simulation-based education on cardiopulmonary emergency care. In their findings, the experimental group consistently showed a higher score of knowledge than the control group [14]. In addition, this result was consistent with the study conducted by Lee & Kim (2011) when implementing practical education on the use of simulations on nursing students [15], and how the nursing knowledge score turned out to be significantly higher in the practical education. This study indicates that nursing issues are found by a hybrid simulation delivery nursing care education program through constructive arbitration between learners, and covers how theoretical grounds are shared on delivery nursing by debriefing sessions. Furthermore, it seems that the feedback provided by instructors, learners, and standardized patients on the weakness of delivery courses helped enhance knowledge. In addition, Kim & Choi (2008) have suggested the response of learners for how instructor-led lecture-based education was not helpful in memorizing lecture contents their study dealing with recognition of each of the PBL learning contents by nursing students and academic achievement [16]. Therefore, it was shown that learner-led education methods were required rather than an instructor-led curriculum to enhance knowledge. Michaelsen, Knight & Fink (2002) have reported on how team-based learning improved knowledge among students in the medicine department[17], and Kim (2012) has reported that a significant enhancement of knowledge was shown after applying team-based learning activities among students in the nurse department[18]. Therefore, this study seems to help enhance knowledge since education was provided based on teams according to the characteristics of hybrid simulation education. There was a significant difference between the experimental group given the hybrid simulation delivery nursing care education program and the control group not given the program in terms of the degree of capability of performing delivery nursing care. This result was consistent with the study conducted by Kim (2014) on how delivery nursing simulation education represented a significant difference in terms of skill performance ability of students in the college of nursing [13], as well as with the study by Eom, Kim, Kim, Sung (2010) on how the nursing performance ability of students in the college of nursing was enhanced in the practice applied to standardized patients[19]. In terms of comprehensive nursing ability and how clinical performance capability plays a competent role in clinical situations, this result shows that hybrid simulation education that both involves nursing skills and interaction between a patient and a nurse was effective. In this study, it is of a result for how the core element of the program, a scenario, was organized to perform a comprehensive nursing service including the entire child-delivery procedures from the 1st stage to 4th stage, and similar situations with clinical setting were realized performing delivery nursing. In addition, it seems that correction made on the missing part from immediate debriefing in the simulation field influenced the effect after applying each of the stages for education. Therefore, delivery nursing care simulation education can improve the ability to perform nursing and become an education method replacing clinical practice. There was no significant difference between the two groups in terms of problem solving ability after the experimental group was given the hybrid simulation delivery nursing care education program. This was consistent with the finding that there was no effect on the problem solving ability in the simulation-based education on cardio-pulmonary emergency care, as well as how there was no effect on problem solving ability in the application of an education program using simulation in the study conducted by Lee (2011) [9]. Since problem solving ability can be improved when cases of patients are repetitively exposed in clinical situations, it implies that there is a need for education hours to be spent on clinical practice. In order to improve problem solving ability, it is necessary to reinforce simulation learning and clinical practice. 1125

6 Based on the aforementioned results, it was confirmed that the hybrid simulation delivery nursing care program was effective in improving knowledge of delivery nursing care and the ability to perform delivery nursing care, and also influenced an enhancement of the core ability in delivery nursing among college nursing students. However, it was found that the hybrid program was not effective in developing problem-solving ability. Therefore, it seems that a follow-up study on this issue is needed. From the perspective of nursing education, the implication for nursing in this study is related to how a hybrid program was confirmed to be a useful practical education method that had the potential of replacing observation-oriented practice in the delivery room by applying it in the delivery nursing care education program. Therefore, it can be utilized for delivery nursing care education in the future. In addition, it seems that the hybrid program can improve clinical adaptability and overcome the fear in delivery nursing as a clinical practice education program to overcome the limitations of practical education in the delivery room from the perspective of the nursing room. Therefore, the hybrid program can be used for the education of new nurses. References [1] Gibbon, S. W., Adamo, G., Padden, D. & Ricciard, R. (2002). Clinical evaluation in advanced practice nursing education: using standardized patients in health assessment. Journal of Nursing Education, 41(5), [2] Hong, S.Y.(2015). Effect of application of Hybrid Simulation for delivery Nursing care. Advanced Science and Technology Letters, Vol.116(Healthcare and Nursing 2015), pp70~73 [3] Ham, Y. L. (2009). Development and evaluation of a simulation educational program using a high-fidelity patient simulator for undergraduate nursing students. Yonsei University Library. [4] Lee, M. S. & Hahn, S. W. (2011). Effect of Simulation-based Practice on Clinical Performance and Problem Solving Process for Nursing Students. The Journal of Korean academic society of nursing education, Vol.17 No.2, [5] Humphreys. (2013). The Role of Developmental Screening Practices in Early Diagnosis of Autism Spectrum Disorders: An Analysis of All-Payer Claims Data in New Hampshire. The University of North Carolina at Chapel Hill Education: Doctorate/Master's in Education. 83. [6] Kim, Y. H. & Jang, K. S. (2011). Effect of a Simulation-based Education on Cardio- pulmonary Emergency Care Knowledge, Clinical Performance Ability and Problem Solving Process in New Nurses. Journal of Korean Academy of Nursing, Vol.41 No.2, [7] Kim, Y. H., Kim, Y. M. & Kang, S. Y. (2010). Implementation and Evaluation of Simulation Based Critical Care Nursing Education Used with MicroSim(R). The Journal of Korean academic society of nursing education. Vol.16 No.1, [8] Jang, S. J., Kwon, E. O., Kwon, Y. O. & Kwon, H. Y. (2010). The Effects of Simulation Training for New Graduate Critical Care Nurses on Knowledge, Selfefficacy, and Performance Ability of Emergency Situations at Intensive Care Unit. The Journal of Korean Academic Society of Adult Nursing, Vol.22 No.4, [9] Lee, S. E. (2011). Evaluation of the Standardized Patients(SP) Managed Instruction for a Clinical Maternity Nursing Course. The Journal of Korean academic society of nursing educatio, Vol.17 No.1, [10] Lee, O. S. & Kim, M. O. (2011). Effects and Adequacy of High-Fidelity Simulation-Based Training for Obstetrical Nursing. Journal of Korean Academy of Nursing, Vol.41 No.4, [11] Yoo, S. Y. (2013). Development and effects of simulation-based education program for newborn emergency care. Ewha Womans University Library. [12] Lee, J. S. (1978). The effects of process behaviors on problem solving performance on various tests. Doctoral dissertation. University of Chicago [13] Kim, K. A. (2014). Effects of a Simulation-Based Labor Education Program on Skill Competence, Knowledge, and Satisfaction for Education in Nursing Students. The Catholic University Of Korea Central Library. [14] Kim, Y. H. & Jang, K. S. (2011). Effect of a Simulation-based Education on Cardio- pulmonary Emergency Care Knowledge, Clinical Performance Ability and Problem Solving Process in New Nurses. Journal of Korean Academy of Nursing, Vol.41 No.2, [15] Lee, O. S. & Kim, M. O. (2011). Effects and Adequacy of High-Fidelity Simulation-Based Training for Obstetrical Nursing. Journal of Korean Academy of Nursing, Vol.41 No.4, [16] Kim, J. Y. & Choi, E. Y. (2008). Learning Element Recognition and Academic Achievement of Nursing Student Receiving PBL with Simulation Education. The Journal of Korean Academic Society of Adult Nursing, Vol.20 No.5, [17] Michaelsen, L. K., Knight, A. B. & Fink, L. D., (2002). Team-Based learning: A transformative Use of Small Groups in College Teaching. [18] Kim, H. R. (2012). Development and Effect of Team Based Simulation Learning Program on Undergraduate Nursing Students. Chosun University Library. [19] Eom, M. R., Kim, H. S., Kim, E. K. & Sung, G. Y. (2010). Effects of Teaching Method using Standardized Patients on Nursing Competence in Subcutaneous Injection, Self-Directed Learning Readiness, and Problem Solving Ability. Journal of Korean Academy of Nursing, Vol.40 No.2,