Nursing Students' Perceptions of Learning Psychomotor Skills: A Literature Review

The effect of an educational orientation tour on anxiety of nursing students before their first clinical training: a quasi-experimental study

BACKGROUND

The first clinical experience in a hospital setting can be highly stressful for nursing students, often leading to significant anxiety. Addressing this issue requires effective interventions to help students transition smoothly into their clinical practice. This study aimed to evaluate the impact of an educational tour on preclinical anxiety among first-year nursing students.

METHODS

This quasi-experimental study was conducted in 2024 in Tehran. A total of 72 s-semester nursing students were selected through convenience sampling and assigned to either the control group (n = 37) or the intervention group (n = 35). Before the start of clinical training, the intervention group participated in an educational tour of the hospital, conducted by the researcher, while the control group received no intervention. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI) one week before the clinical training and after its completion.

RESULTS

After completing the clinical training, the mean trait anxiety score was 34.28 ± 7.89 in the control group and 31.30 ± 6.70 in the intervention group. However, an independent t-test revealed that the difference in post-intervention trait anxiety scores between the two groups was not statistically significant (p = 0.089). In contrast, the mean state anxiety score after the intervention was 36.14 ± 7.38 in the control group and 31.21 ± 6.86 in the intervention group, demonstrating a significant reduction in anxiety levels among students who participated in the educational tour (p = 0.005).

CONCLUSION

The findings suggest that an educational tour can effectively reduce preclinical anxiety among first-year nursing students, making it a valuable strategy for improving their transition into hospital-based clinical training.

Effect of moulage on nursing students' endotracheal suctioning knowledge and skills

AIM

The study compares knowledge, skills, anxiety, satisfaction and self-confidence regarding suctioning between students trained using a partial task trainer with moulage and those using a low-fidelity simulator.

BACKGROUND

Moulage application in simulation has been used in nursing skills training, such as intravenous therapy, pressure ulcer and burn care, but not for suctioning.

DESIGN

A randomized controlled study with pre-test, post-test design.

METHODS

The study conducted in a nursing school in Turkey with 77 nursing intern students from 2020 to 2022. Students completed a two-hour theoretical course and four-hour skills training. The experimental group practiced with a task trainer with transparent lungs and moulage, while the control group used a low-fidelity simulator.

RESULTS

Pretest suctioning knowledge scores were similar between experimental and control groups (10.54 ± 3.81 vs. 10.85 ± 2.96; p > 0.05). Posttest knowledge scores showed no significant difference (11.48 ± 3.47 vs. 10.35 ± 3.98; p > 0.05). On the other hand, the experimental group had higher skills scores (36.37 ± 2.69 vs. 29.17 ± 4.78; p < 0.001), greater anxiety before skill training (59.83 ± 8.96 vs. 59.72 ± 7.99; p < 0.05), evaluation (63.51 ± 9.32 vs. 58.77 ± 9.39; p < 0.05), higher satisfaction (4.69 ± 0.46 vs. 4.37 ± 0.74; p < 0.05) and self-confidence in learning (4.60 ± 0.46 vs. 4.23 ± 0.69; p < 0.05).

CONCLUSIONS

Moulage significantly enhanced students' skill performance, satisfaction and self-confidence. Although knowledge scores were similar between groups, the experimental group experienced higher anxiety levels before training and evaluation, likely reflecting greater engagement and careful application of skills. These results suggest that students were engaged in learning and applied the skills more carefully. Moulage, which enhances fidelity, should be incorporated into nursing curricula to improve students' learning experiences and outcomes.

Systematic review: Self-efficacy and skill performance

AIM

The aim of this systematic review was to investigate the relationship between self-efficacy and skill performance in undergraduate student nurses.

BACKGROUND

Across higher education, self-efficacy is an important predictor of student success in skill-based learning. Nursing students are required to demonstrate skills prior to caring for hospitalized patients. Understanding the relationship between self-efficacy and nursing student skill performance may support patient safety.

METHODS

Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic search was conducted of four databases: CINAHL, Medline, Psychinfo, and Web of Science. Quantitative, peer-reviewed studies published in English were included with no limitation on year. Hands-on skill performance had to be performed in laboratory or simulation settings and evaluated by an expert. Identified studies were assessed for methodological rigor using Joanna Briggs Institute's Critical Appraisal Tools.

FINDINGS

A total of 2,450 items were identified by database search and screened, resulting in 20 eligible studies. Most of the studies included novice first- or second-year students. Self-efficacy was operationalized as either a general or skill-specific measure, while the type of skill and associated instrumentation varied widely. Sixteen (80%) of the included study reports showed weak to no correlation between self-efficacy and skill performance. The remaining 4 reports noted a moderate-to-strong relationship.

CONCLUSION

Our findings conflict with existing research in other higher education disciplines where self-efficacy is a significant predictor of performance success. Explanations for this contradiction likely center around how self-efficacy was operationalized and rigor of the included studies.

IMPLICATIONS FOR NURSING

Larger studies controlling for confounding variables are needed to understand this relationship with a goal of developing more consistent approaches to teaching and learning skills within prelicensure curriculums.

Implementing a Trauma-informed approach in undergraduate nursing student clinical education: Strategies for clinical nurse educators

AIM

To discuss strategies for clinical nurse educators to integrate a trauma-informed approach while supporting undergraduate nursing students' learning in the clinical environment.

BACKGROUND

Undergraduate nursing students' risk of exposure to clinical related critical incidents coupled with their higher rates of personal traumas such as adverse childhood experiences, adds to the complexity of experiential learning. Clinical related critical incidents may compromise nursing students' academic abilities and their well-being. The implications of clinical related critical incidents may extend to future nurse retention and recruitment as students question the perception of the profession's identity. The cumulative effect from trauma may impact nursing students' mental health making them vulnerable to trauma-related symptoms and disorders.

DESIGN

A discussion paper is used to support the application of a trauma-informed approach throughout clinical learning experiences.

METHOD

With relevant literature, a trauma-informed approach is emphasized for developing and maintaining safe environments that foster learning and optimize the health and well-being of nursing students.

RESULTS

The key assumptions and principles of a trauma-informed approach as outlined by the Substance Abuse and Mental Health Services Administration underpinned the proposed strategies that clinical nurse educators may use while preparing for clinical, during, and after experiences.

CONCLUSION

A trauma-informed approach may encourage undergraduate nursing students to adopt key tenets into their future clinical practices so they can effectively support patients, families, and their colleagues.

Developing Formative Strategies to Support Undergraduate Nursing Student's Learning in the Lab

BACKGROUND

Undergraduate nursing education consists of supporting students' learning about psychomotor skills. There is variation in strategies used to facilitate learning in the lab setting because there is no single accepted or preferred educational approach.

METHOD

Formative learning strategies were integrated into lab courses throughout a nursing curriculum for undergraduate students at a Canadian university. These strategies included developing and implementing guidelines, a rubric, and an addendum.

RESULTS

Students enrolled in lab courses that used these strategies received ongoing verbal and written feedback from their instructor and were provided with an opportunity to engage in reflective practice and refine clinical judgment skills.

CONCLUSION

Using consistent and effective formative strategies to support students' learning in the lab requires further empirical exploration and consideration. [J Nurs Educ. 2024;63(8):560-563.].

The effectiveness of high-fidelity simulation methods to gain Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students: A randomized controlled trial

BACKGROUND

The use of high-fidelity simulation (HFS) methods provides probable benefits and advantages for nursing students to retain knowledge, acquire skills, improve satisfaction, and gain self-confidence in a safe, realistic and supportive environment.

OBJECTIVES

To evaluate the effect of HFS methods to develop Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students when compared to low-fidelity simulation (LFS). The specific aim was to examine the effects of outcome variables between the intervention group and the control group, through multi-group path analysis.

DESIGN

A randomized controlled trial was designed.

SETTINGS AND PARTICIPANTS

80 nursing students were randomly assigned to the HFS group (high-fidelity manikin and scenario) and the LFS group (female catheterization simulator) at a nursing faculty between May and July 2019 in Türkiye.

METHODS

The intervention group experienced HFS and the control group experienced LFS in order to learn Foley catheterization. Students' knowledge was evaluated before and after the intervention, while affective and psychomotor skills, and satisfaction and self-confidence in learning were evaluated after the intervention.

RESULTS

The HFS group had better skill performance and significantly higher self-confidence in learning than the LFS group. While each group had a high level of knowledge, affective skills and satisfaction, there was no significant difference between the groups' mean scores.

CONCLUSIONS

The HFS and scenario improved the knowledge, affective and psychomotor skills, satisfaction and self-confidence of novice nursing students on Foley catheterization. When compared to LFS, HFS had more advantages for the development of psychomotor skills and self-confidence in learning.

Clinical experience of omani undergraduate nursing students: Qualitative study

Background

Commencing clinical practice is a main milestone in the educational journey of undergraduate nursing students as it indicates the beginning of their professional life. The clinical training experience is frequently described as stressful and challenging for nursing students.

Objective

s: This study was conducted mainly to examine, explore and interpret nursing students' perceptions of the challenges they faced as nursing students during their clinical experience.

Setting

College of Nursing at Sultan Qaboos University, Oman.

Participants

A total of 32 undergraduates nursing students who were enrolled in the nursing program and had finished at least one clinical course from their study plan.

Method

Data were collected using focus group discussions. A total of 32 participants were recruited and six focus groups were conducted. Data was transcribed and it was analyzed using thematic analysis.

Result

Two main themes were identified, and under each theme, several subthemes were merged. The two main themes are: challenges that hindered self-directed learning, which included instructor approach and nurse approach, and challenges that hindered experiential learning, which included theory-practice gap, insufficient practice, lack of confidence and evaluation methods.

Conclusi

on: This study provided insights into the challenges that hindered the effectiveness of clinical nursing education. Several recommendations were proposed to maximize the benefits of clinical practice and to create less stressful environments.

Knowledge and Awareness of Non-Technical Skills Over the Course of an Educational Program in Nursing - A Repeated Cross-Sectional Study

Background

Non-technical skills (NTS) play an important role in preventing adverse events during hospitalization. Knowledge, awareness and mastery of NTS becomes important key factors in preventing errors. Current status of students and supervisor's knowledge and awareness of NTS are needed in order to construct an educational plan for improvement.

Purpose

To examine knowledge and awareness of NTS over the course of continuing education of nurse anaesthetists, emergency care nurses, critical care nurses, and operating room nurses.

Methods

A descriptive, repetitive cross-sectional design with a questionnaire was used to evaluate knowledge and awareness in students and their supervisors about NTS at two different time points during the educational program. Cross tabulations were used in comparisons across specialties and between students and supervisors, frequencies to identify the levels of self-reported knowledge/importance/focus in clinical practice/ impact on adverse events.

Results

The results showed that there was a numeric difference between the reported knowledge/focus in clinical practice on the one hand and importance/ impact on adverse events on the other, and that this gap was reduced after 12 months of education with special focus on NTS. There was no difference across specialties. Supervisors had higher focus on NTS in clinical practice and on the impact on adverse events, than students at both measurements.

Conclusion

These data suggest that NTS may have important potential for improvement if included into learning programs both in education and clinical practice. Integration of NTS in various learning activities seems to strengthen students' competence about NTS.

The impact of unsuccessful resuscitation and manikin death during simulation on nursing student's resuscitation self-efficacy: A quasi-experimental study

BACKGROUND

There has been considerable debate about whether it is appropriate to let the manikin die during simulation teaching. Simulations are used in high-risk industries to recreate rare and potentially catastrophic events. In healthcare, there has been a reluctance to allow scenarios to progress to a catastrophe because of the potential impact on the individual if they were to then encounter the situation in real life. In healthcare, witnessed resuscitation has an overall success rate of around 23.9 %, therefore making every simulation situation successful results in an altered perception of reality.

OBJECTIVE

The researchers aimed to examine whether the manikin's death during a simulation adversely affects the resuscitation self-efficacy of nursing students.

DESIGN

Quasi-experimental design.

SETTING

Univesity of Sunderland, United Kingdom.

PARTICIPANTS

Students were invited to participate (n = 120) and 106 consented to take part in the study.

METHODS

A pre-and post-test of the nursing student's self-efficacy during a resuscitation scenario. The scenario related to a patient admitted to the emergency room with chest pain who then went into cardiac arrest. The experimental group's resuscitation was unsuccessful, and the control group's resuscitation was successful. Self-efficacy was measured using the validated Basic Resuscitation Skills Self-efficacy scale (BRS-SES). The data were analysed using a paired sample t-test.

RESULTS

Overall, both groups showed improved self-efficacy as a result of the simulation session and the death of the manikin in the experimental group did not result in a reduced level of self-efficacy related to resuscitation.

CONCLUSION

The death of the manikin during the simulation involving resuscitation had no impact on student resuscitation self-efficacy.

Effect of gamified flipped classroom on improving nursing students’ skills competency and learning motivation: a randomized controlled trial

Background

Flipped learning excessively boosts the conceptual understanding of students through the reversed arrangement of pre-learning and in classroom learning events and challenges students to independently achieve learning objectives. Using a gamification method in flipped classrooms can help students stay motivated and achieve their goals. 

Methods

This study adopted a randomized controlled study design with a pre-test and post-test and involved 128 nursing students at Mansoura University. This study randomly divided the students into the study and control groups. Data were collected at three time points using six tools. In the intervention group, Moodle was gamified for 6 weeks. 

Results

A significant difference in the students’ self-confidence (p = 0.021), skills knowledge (p < 0.001), intensity of preparation (p < 0.001), and motivation (p < 0.001) was observed between the two groups; however, no difference in the students’ skills performance (p = 0.163) was observed between the two groups after using gamified flipped classrooms.

Conclusions

Compared with the traditional flipped classrooms, gamified flipped classrooms improved nursing students’ motivation, intensity of preparation, skills knowledge, and self-confidence during laboratory clinical practice. Thus, gamification is a learning approach that can be implemented in conjunction with the flipped classroom model to motivate students to participate in the learning process.

Trial registration.

Prospectively registered with ClinicalTrials.gov on 26/04/2021; registration number NCT04859192.

Effect of Progressive Muscle Relaxation Exercise on Anxiety Reduction Among Nursing Students During Their Initial Clinical Training: A Quasi-Experimental Study

The study is to examine the effect of progressive muscle relaxation exercise on anxiety of nursing students during their initial clinical experience. A quasi-experimental, pre-post study was carried out in the Arab American University. A convenience sample consists of 90 first-year nursing students were chosen. A progressive muscle relaxation exercise for five days per week was conducted on one group of nursing students. Students’ anxiety was measured by S-anxiety scale (STAI Form Y-1) at pre and post the intervention. The severity of anxiety reduction was greater post the exercise (t (89) = 30.783, P = .001).

The effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students psychomotor skills learning

BACKGROUND

The aim of this study was to determine the effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students' psychomotor skills.

METHODS

This semi-experimental study was carried out in the one-group pretest-posttest design. Students performed the psychomotor skills in the Non-Simulated Clinical Skill Laboratory and Simulated Hospital Environment. The skill performances of the students were evaluated with the Objective Structured Clinical Assessment form. At the same time, students' views on both environments were received.

RESULTS

Students' mean Objective Structured Clinical Assessment score in the Simulated Hospital Environment (69.42 ± 10.94) was significantly higher than their mean score in the Non-Simulated Clinical Skill Laboratory (57.07 ± 10.05) (p < 0.05). The differences in scores were particularly significant in the stages of meeting the patient, performing the procedure in accordance with the steps and ending the procedure. The majority of the students stated that they could not do some applications in the Non-Simulated Clinical Skill Laboratory in a similar way to the hospital clinic (85.9%), and they felt like they were in a real hospital clinic in the Simulated Hospital Environment (100%).

CONCLUSIONS

The results showed that students developed psychomotor skills more fully in a learning environment designed in a similar way to a real hospital clinic setting.

The effect of progressive muscle relaxation and nature sounds on blood pressure measurement skills, anxiety levels, and vital signs in nursing students

PURPOSE

The aim of this study was to determine the effect of progressive muscle relaxation (PMR) and nature sounds (NS) on students' blood pressure measurement skills, anxiety levels, and vital signs.

DESIGN AND METHODS

This randomized controlled study conducted at the nursing department of a university in February 2020. During skill training, one group was given PMR and one group was given PMR + NS. The routine teaching procedure was applied to the control group.

FINDINGS

The PMR (37.80 ± 10.1) and PMR + NS (31.19 ± 6.15) groups had lower mean postintervention anxiety scores compared with the control group (40.86 ± 9.13). The PMR + NS group had higher mean postintervention knowledge test score than other.

PRACTICE IMPLICATIONS

PMR + NS and PMR helped reduce nursing students' anxiety levels and pulse rates. PMR + NS helped increase their blood pressure knowledge test scores.

"Finding My Own Way": The lived experience of undergraduate nursing students learning psychomotor skills during COVID-19

Background

Little is known about how nursing students learned psychomotor skills during the COVID-19 pandemic.

Aims

What is the lived experience of undergraduate nursing students learning psychomotor skills during the COVID-19 pandemic?

Methods

Using a phenomenological approach, eight undergraduate nursing students were interviewed about their experiences learning psychomotor skills during the pandemic.

Results

Thematic analysis revealed three main themes. “Finding My Own Way” described adapting learning styles and advocacy for learning. Sub-themes included perseverance and comradery. “Learning the Skills” described modifications to skills learning. Sub-themes included grace by professors, smaller group sizes, less practice, and “my brain is split in half,” describing the challenges of giving dual attention to COVID-19 and skills learning. “Stress of the Pandemic” described the stress of quarantine, isolation and online learning.

Discussion

Findings of this study may help nurse educators understand the challenges of learning skills during the pandemic. Implications are discussed.

Evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning: A cross-sectional, descriptive study

AIM

This study evaluated the evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional, descriptive, survey design was used. Nursing students' knowledge level was measured using the Suctioning Knowledge Questionnaire, and emotions were assessed using the Clinical Stress Questionnaire.

SETTING

University undergraduate nursing programme.

RESULTS

The study included 445 undergraduate nurses. Students' mean knowledge score was 36.86 ± 14.45, and 85.8% of the total knowledge scores were 50 or less indicating a low level of knowledge. The mean score of the students who had experienced the suctioning procedure (44.5%, n = 198) was statistically higher than that of the students without experience (38.78 ± 12.62 and 35.32 ± 15.62, respectively) (p < 0.05). Students who performed the suctioning procedure expressed their emotions relating to suctioning as follows: I felt nervous (79.3%), worried (77.8%), frightened (70.2%), daunted (53.0%) and disgusted (51.0%).

CONCLUSION

The majority of nursing students' knowledge levels were insufficient. That they felt frightened or disgusted performing the procedure was noteworthy. Students should be given the opportunity to perform endotracheal suctioning and express their feelings about the procedure.

The effectiveness of scenario-based learning to develop patient safety behavior in first year nursing students

The aim of this study was to examine the effect of scenario-based learning (SBL) compared to traditional demonstration method on the development of patient safety behavior in first year nursing students. During the 2016-2017 academic year, the Fundamentals of Nursing course curriculum contained the teaching of demonstration method (n=168). In the academic year 2017-2018 was performed with SBL method in the same context (n=183). Objective Structured Clinical Examination (OSCE) that assesses the same three skills was implemented in both academic terms to provide standardization so that students could evaluated in terms of patient safety competency. It was found that students' performance of some of the steps assessed were not consistently between the demonstration and SBL methods across the three skills. There was a statistically significant difference between demonstration method and SBL method for students' performing the skill steps related to patient safety in intramuscular injection (p<0.05) Our results suggest that the integration of SBL into the nursing skills training may be used as a method of teaching in order to the development of patient safety skills.

Professional identity and hospital-based registered nurses: A phenomenological study

INTRODUCTION

Nurses continue to struggle to define their role as professionals in the hospital-setting often being represented in media as less competent than other health care providers. Paradoxically, an annual poll of the public consistently identifies nursing as the most trusted profession. This dichotomy of simultaneously being considered incompetent yet holding a high level of trust leads nurses to question their own professional identity. A gap exists in the literature about the professional identity of nurses who work directly with patients in the hospital environment.

METHODOLOGY

Therefore, the aim of this interpretive phenomenology study was to describe the lived experience of nurses working with patients in the hospital environment and the meaning of this phenomenon as it relates to their professional identity.

RESULTS

Four themes were identified: (a) being validated as an expert by providers within the healthcare system; (b) working well as a valued member of a team; (c) advocating for the patient's needs despite opposition; and (d) Valuing human-ness in the patient.

IMPLICATIONS

The findings provide a deeper representation of the practice of hospital-based nurses and implications for Anchornurses to be empowered in their workplace.

Differences in Psychomotor Skills Teaching and Evaluation Practices in Undergraduate Nursing Programs

AIM

The purpose of this study was to understand the methods faculty use to teach and evaluate psychomotor skill performance in associate and baccalaureate nursing programs, resources available to students to master these skills, and policies and procedures related to summative evaluation of psychomotor skills.

BACKGROUND

Despite the importance of psychomotor skills competency in registered nursing programs, published methods for teaching and evaluating competency vary. The literature does not support a particular strategy for teaching or evaluation.

METHOD

In this primarily quantitative descriptive study, participants completed a 28-item questionnaire developed by the authors based on a review of the literature and personal teaching experience.

RESULTS

All respondents indicated that their institutions conducted summative assessment of psychomotor skills; however, the methods for teaching and evaluation varied widely.

CONCLUSION

Well-designed control studies and consensus guidelines from professional nursing education organizations would assist faculty in implementing consistent, effective, evidence-based strategies.

An Unfolding Case Study: Supporting Contextual Psychomotor Skill Development in Novice Nursing Students

Background

Nursing students learn psychomotor skills in the nursing lab, removed from the context of real patient care. As a result, students experience challenges linking client conditions with pertinent assessments and the performance of skills in the clinical setting. To address this gap, we created an unfolding case study for the nursing lab that provides context and supports students to use assessment and theory to guide skill performance in practice.

Method

Faculty and student focus groups were conducted to elicit feedback on the use of an unfolding case in the nursing lab with novice nursing students as they transition to clinical practice.

Results

Impacts that emerged from the faculty and student focus groups included knowledge synthesis, transferability to practice, and increased clinical competence.

Conclusions

The unfolding case study successfully supported students’ transition to acute care practice. Both faculty and student participants expressed a desire for use of this dynamic method in all nursing lab courses.

A systematic review of qualitative studies exploring peer learning experiences of undergraduate nursing students

BACKGROUND

Peer learning experiences have been reported in previous qualitative studies, however individual findings could limit practical leverage due to small sample size. Thus it is necessary to integrate invaluable findings from various qualitative studies to consider appropriateness and acceptability of peer learning in professional nurse education.

OBJECTIVE

To identify and synthesize qualitative evidence of peer learning experiences of undergraduate nursing students so as to understand their perceptions on peer learning experiences.

DESIGN

A qualitative systematic review was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement.

DATA SOURCES

Database searching was conducted on electronic databases such as Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and MEDLINE that published from 2007 to 2017.

REVIEW METHODS

Qualitative studies were appraised using the Critical Appraisal Skills Programme (CASP). Thematic analysis was used to analyse the data using line by line coding, organising coding into descriptive themes, and interpreting further to generate new insights.

RESULTS

Six studies were included in this review. The most common themes identified were integrated into two new insights including personal development and professional development.

CONCLUSION

This review has revealed that peer learning experiences contribute to the learning process of undergraduate nursing students in preparing them to become professional nurses through personal development and professional development.