Effects of high-fidelity human patient simulation on self-efficacy, motivation and learning of first semester associate degree nursing students.

University of Minnesota Ph.D. dissertation. June 2009. Major: Work/Community/Family Education. Advisor: Theodore Lewis, PhD. 1 computer file (PDF); xi, 212 pages, appendices A-G.One of the newest methodologies in nursing education is high-fidelity human patient simulation (HPS). Many nursing educators have embraced the method as it offers a strategy to facilitate cognitive, affective, and psychomotor outcomes. Despite their popularity, however, HPS systems are costly and, in an era of cost containment and tuition increases, research must be employed to determine its effectiveness and guide its utilization. The purpose of this study is to determine how associate degree nursing students' self-efficacy, motivation, and learning in the simulated environment compare to nursing educational experiences without simulation. The mixed-method, quasi-experimental design was chosen for the study with a sample of first-semester associate degree nursing students at 2 technical colleges, 54 in the experimental group and 30 in the comparison group. Results indicated measures of self-efficacy and motivation increased throughout the semester for both groups. The simulation group had a statistically significant increase in general self-efficacy but no significant increase in nursing-specific academic and clinical self-efficacy. In contrast, the comparison groups had a significant increase in nursing academic self-efficacy but not in clinical or more general self-efficacy. Motivation measures were relatively consistent between the groups with only the measure of extrinsic motivation declining for the experimental group. When comparing the two groups on differences between pretest and posttest measures of self-efficacy and motivation, there were no significant differences. The experimental group scored significantly higher on the posttest knowledge examination. Results of interviews (n = 16) revealed specific themes, some unique to the simulation group and some common to members of both groups. The simulation students reported the importance of comprehensive skill practice, risk-free practice, group participation, and debriefing and instructor feedback. They were often able to identify a specific learning experience in the simulation lab that had impact on their practice. Technical skill knowledge was highly important for both groups. Students in both groups related the importance of a variety of courses in the first semester curriculum as increasing their nursing knowledge, self-efficacy and motivation. Simulation was found to be an acceptable learning strategy for novice associate degree nursing students