Nursing expertise and self-efficacy following high fidelity simulation-based training

Abstract

The use of simulation in healthcare education has dramatically increased in popularity over the last two decades. It is thought to provide a standardised way of exposing learners to clinical situations where they can safely learn from mistakes. However, there is a lack of evidence to suggest whether simulation-based training offers significant benefits for clinical care over more traditional educational techniques, especially when the objective is a clinical judgement or diagnosis rather than a practical skill. This thesis explores whether the use of a high-fidelity patient simulator during training has an effect on the self-efficacy beliefs and clinical practice of learners, and whether this varies according to learners’ prior experience with simulation training or the clinical topic. Data were collected through semi-structured interviews with 16 qualified nurses, all of whom had attended a simulation-based training programme designed to improve clinical judgement skills. Analysis and data collection were iterative. Using a social constructionist epistemology, a thematic analysis approach was employed. High-fidelity simulation was perceived to be valuable by participants, who reported that it helped them to contextualize their knowledge and feel more confident about relevant clinical judgements. The reported impact on self-efficacy varied according to how much personal experience learners had in either the relevant clinical domain or with simulation as a training technique. However, greater belief in personal clinical judgement skills did not necessarily change reported clinical behaviour. The need for psychological fidelity during training appeared to be inversely related to clinical experience, reflecting the importance of contextual sensitivity in the planning of simulation-assisted training. Future research should examine whether these findings are reproducible in other settings, and consider whether simulation fidelity should be tailored to specific learner profiles.