Self-Confidence in Licensed Practice Nursing

¶ … self-confidence in licensed practice nursing students. Nurses are important personnel in the hospital or any medical setting. Despite the training and teaching strategies used in their curriculum, many nurses complain of lack of confidence when it comes to applying their practical knowledge. This research will look into experience of licensed nursing students in order to find a positive correlation between simulation and development of critical thinking and confidence skills. The approach that we are using is the addition of simulated studies and simulated scenarios in some students. A sample of 75 licensed practice nursing students in their third year would be chosen. One group will be provided simulation studies whereas the other will not receive simulation. Analysis will be made through interviews and questionnaires presented to those participating in the study. Since this is a very vast topic, the results gathered from this experiment will set the stage for further exploration and discussion on this topic.

Introduction

The word heal comes from the Anglo-Saxon word haelan which means being or becoming whole and nurses are a crucial part of healing people and helping them fully recover. Role of the nurse looks at helping people and having them attain a proper state of mind, body and spirit (Fitzpatrick, 2003). Where doctors are the one who give medicines and perform surgeries, nurses heal through the relationship that they built with the patient. A nurse is not only a caretaker but a crucial person in the treatment process of any patient. It has been proved that the relationship a nurse has with his or her patient is quite relevant to attain a right balance of health and wholeness. (Fitzpatrick, 2003) Apart from the spiritual relationship, nurses have many responsibilities placed on them. It is up to the nurses to ensure proper delivery of medicines and further treatment. He or she has to be there for the patient and take care of the patient until the patient has recovered. There was an unfortunate time when nurses were only thought to be mere assistants with no knowledge or skill of their own. Nurses are required to be trained and skilled in a proper manner. They not only need to have knowledge but also need to practice it and apply it quite efficiently. In order for nurses to apply their knowledge in the best possible way, they need to develop their self-confidence and critical thinking skills.

Del Bueno (2005) has proposed that a major reason nursing programs are not successful today is due to the fact that a lot of content being taught to them is not being applied. Doctors may have to use their brains to reach a proper diagnosis and a surgeon can use his memory of anatomy to carry out perfect surgeries; however there isn't much memorization in being a good nurse. Surely, nurses do have a lot of knowledge about the disease pathology and the treatment. Nonetheless, the interaction and the relationship they develop with the patient cannot be learned from books alone. Nurses are definitely the primary care provider for a patient in the hospital. They are the first line of defense and they need to know how to handle their job in the best possible way. Simulated studies provide students with better confidence and give them a more hands on experience. The nursing students would be applying these skills more often when they aren't afraid that they are going to hurt or injure someone. Moreover, the environment doesn't remain threatening and the students can think easily and react efficiently as well.

There is, however, a different side to the story. Many times, simulation and unreal scenarios can pose a problem for the students. This sort of problem has not only been experienced by the nursing field but also by medical students as well. A lot of simulation can take the student away from the importance of curing someone. Kneebone (2009) stated that simulation takes away the reality from the students. With regards to use of simulation in teaching gynecology and obstetrics stated that it can have more of a counterproductive effect. He said that simulation takes away and misleads the students from real world care. In his perspective, simulation would only work if it presented the students with the challenges and the messy realities of clinical practice. (Kneebone, 2009)

This can be explained better by the example of a nurse in the emergency room. Regardless of how well timed the student is or how much they follow the protocol, on a subconscious level the student will know that this situation is not real. The student knows that the maximum damage is a bad grade rather than the loss of a life. The problem will arise when in a real emergency, the student has to snap out of the simulation practice and face reality. Therefore, teachers or even examiners can't really say that a person who does well in the simulated scenarios will do as well as in real scenario as well.

Problem Statement

Many nursing students today complain of having low self-confidence and low critical thinking skills. The problem here is that nursing students must have adequate self-confidence and critical thinking skills to be able to resolve the plethora of problems and multifaceted patient issues they will face in real life. This basic query is whether simulation will have any impact on the self-confidence and the critical thinking of licensed practical nursing students. Therefore, the investigator will look at whether more simulated patients, practical situations and scenarios help nurses become more aware and more confident. The investigation will see whether these nurses outperform the ones who have not learned in simulated environments. There have many been researches and studies carried out over the use of simulated patients and clinical scenarios in which medical students and nurses are taught. Even though there is an increased use of simulated patients, there still need to be more studies on whether this would help increase the self-confidence and critical thinking of the nursing students. (Soucy, 2011) Thus the major problem is that nursing students today do not have the skills or the confidence that they should have. The solution proposed is that simulated patients and scenarios need to be incorporated and thus instill these characteristics in these nurses. There has to be a link between better performance by the nurses and good confidence and critical thinking skills. Due to this correlation and relationship, it has become crucial for all nursing student to properly exhibit those qualities.

Significance of the problem

It is true that medical training at some point should make use of live patients to ensure the development of proper skills. This is crucial because all medical personnel have an obligation and a duty towards nurses to be able to provide the best possible management. Practicing with live and actual patients however puts the patients at a risk because these students are merely in training. This is a safety hazard and it can lead to injury or loss of life of the patient. This problem is significant because the nurses need to be able to practice with live patients and be able to supply the best possible management. Simulation-based learning is the solution that has been proposed to solve this problem. This sort of learning can develop the knowledge, skill and attitude that should be present in a nurse. Simulation-based learning can go on to promote the development of these skills and attitudes without putting any patient at risk. Many would think why is it so important to insert the need for simulation and simulated scenarios? Final year nursing students have stated that they lack confidence in fulfilling the responsibilities and expectations required in professional learning. Students, who are just a year or maybe even less than actually practicing, shouldn't be saying all of this. That is something that can hamper their career. Apart from that, they are indirectly attracting law suits and allegations that people have a difficult time dealing with. When a student becomes a practicing and registered nurse, he or she needs to have the proper knowledge to deal with any kind of situation.

Confidence is one thing that renders all learnt knowledge useless if it isn't there. (Lundberg, 2008) it is also seen that without confidence and eventually constant discouragement, these students will be pushed to the verge of performing bad. This shows that when nurses are taught the theory and the management of certain conditions, they need to practice this as well. These final year students feel that they are not confident and they also experience apprehension. (Carson, Kotze & van Rooyen, 2005) Critical thinking and confidence are two skills that are required not only to do well as a nurse and benefit community, but these skills required for a person to maintain their career. It has been proved by Cowin, Craven, Johnson & Marsh (2006) that the early experience can make a big different in the career of the nurses. This means that if they experience defeat and low self-confidence, they would want to quit. Therefore, these skills eventually become the deciding factor between the nurses either staying a nurse or leaving their career. Thus, many things are dependent on how well the nurses know their skills.

Coming back to the major reason why this problem is so important. The way the nurses perform controls and actually decides how well a person recovers. The skills learnt during nursing school and how they are applied will be embedded for the nurse's entire career. Lofmark, Smide and Wikblad (2006) stated that final year nursing students believe their strongest areas are being aware of the ethics, communicating with patients, self knowledge, cooperation and being focused. Sadly, it is not the knowledge that is going to save the patients and heal them. Lofmark et al. (2006) has stated that the students say they have the lowest confidence in how much practical experience they have. Clearly, these students lack critical thinking and self-confidence. When these same nurses are placed in actual situations, they bail out and mess up. When it is a matter of seconds or minutes, nurses, doctors or any medical staff doesn't have room for mistakes. They have to be fast, active and be able to multi-task within seconds. The nurse should be confident enough to carry out his duty and know that he is doing the right thing. In case, the doctors cannot be with them at all times, these fresh graduates should be able to make right decisions and be able to think apart from what is present in the textbooks. The cases that come in the ER aren't always going to be like the ones that are written in textbooks. This shows that the problem is quite significant. These skills need to be instilled one way or another for the benefit of the nurses and the entire medical community.

As stated before, nurses are an important member of the medical community. This study is present so that their teaching would have the best possible strategy and plan. Carrying out simulation is not something simple. It requires complex technology that is quite costly and sophisticated. The teachers and the school staff need to properly know how to incorporate this sort of learning in the curriculum. Thus, there needs to be ample evidence to prove that incorporating simulation will in fact enhance the self-confidence and critical thinking. Apart from the cost, just the entire change of curriculum should be positive otherwise it can be counterproductive. Students are already in a new leaning environment and have a lot of new knowledge being taught to them. With such a crucial career, there is no room for mistakes or wrong grooming. The teaching strategy and any new ideas incorporated need to be checked and confirmed beforehand.

Apart from cost and strategy, it should also see whether simulation will take the nursing students away from the basics of nurses. There is always the apprehension that what if they learn critical thinking and confidence but go on to lose their ethical skills. Ethics and the basics of nursing education are quite essential in the healing of the mind and spirit. Nurses are known for their ability to react in emergency situation but also for their compassion and their ability to connect spiritually with the patient. Therefore, it needs to be researched whether incorporating simulation will not imbalance other aspects of the nursing education.

As mentioned earlier, there are some who think that simulation learning can even make the nurses less competent. This again presents the need to test this question and figure out whether it is the right way to go or not. There could be other ways to enhance these two skills like teaching these students better and having more tasks or requiring them to do more electives. Seeing the different range of ideas out there, this plan needs to be looked into in more detail. This study will therefore see whether simulation does in fact affect the critical thinking and self-confidence of the nursing students.

Purpose of the study

The basic purpose of this study is to discover whether simulation makes an impact on the development of self-confidence and critical thinking in nursing students. Thus by incorporating simulation studies in one group, we will analyze if simulation does in fact affect the development of crucial interpersonal skills and attitudes in the nursing students. We are looking more for the development of critical thinking and self-confidence in these students. Thus, we hope to discover whether simulation studies will affect these skills or not.

Research Questions / Hypothesis

The major objective of the study is to find out whether simulation really works or not. Simulation can be of different sorts. There are examples in which patients present with a certain complaint but don't necessarily give the physical signs of the disease. Here the primary reaction and the management are being tested. In other cases, simulation can mean giving the nurse a patient with the physical signs as well. Of course, if the patient is a simulated patient, he or she cannot present with tachycardia or tachypnea. Therefore, in this instance the patient would actually be an automated patient such as a robot or a mannequin who shows the vitals that an actual patient would. Thus one major question that this study poses is what sort of simulation would be used? Will simulation mean use of technology and mechanical devices or would patient present and act out certain scenarios? As mentioned before, simulated studies are of different kinds. As we look deeper whether simulation improves clinical skills, it should be studied what exactly would the simulation be comprised of.

In the previous days, learning consisted of the students practicing in wards for a certain time in a week. During their time in the wards, the students were guided by their teacher or by their preceptors. They did carry out the tasks a nurse is suppose to know however they were kept under direct supervision for the safety of the patient. Even though the students did attain hands on experience, this sort of learning did have its limitations. With the idea of having a preceptor over your head, the students did not attain the degree of independence that a nursing student should have. Another query that should be looked into is why these skills weren't developed? These questions can be incorporated in the interview and in the survey that would be given to the nursing students. Even though we are looking at better techniques for teaching, we should know what reasons caused the previous strategy to fail.

Regardless, we do know that self-confidence and critical thinking skills were not quite developed in the nursing students. When the nursing students practice with actual patients, they knew they could turn to their facilitator standing in the back. In other words, they were never placed in a situation where they have to think fast, act fast and make a decision about the patient. This therefore hinders the development of critical thinking in these students. This shows that for the development of critical thinking and self-confidence, simulation is quite necessary. Therefore, the discussion merely leads to two hypotheses.

Hypothesis 1: The use of simulation does improve the performance of the nursing students.

As discussed above, the presence of simulated patients and scenarios will lead to the students getting more hands on experience. They will be presented with different situations and will have to deal with them alone. This will therefore cause an increased amount of self-confidence and critical thinking in the nursing students. Therefore, the use of simulation will lead to improvement in the performance of the nursing students.

Hypothesis 2: The use of simulation does not improve the performance of the nursing students.

This is a different side of the story that reveals that simulation actually has a negative impact on the learning of the nursing student. As discussed above, simulation can cause the student to be in a mindset where he or she doesn't really realize the importance of the life of the patient. Many a times, the students are so trained to think and act as if it was simulation all along. These sorts of perceptions will go on to hinder their progress in practical life.

Definition of terms

Critical Thinking

Critical thinking is basically defined as the process of inquiring, analyzing, synthesis, interpretation, inference, deductive and inductive reasoning, intuition, application and creativity. In simpler terms it is the ability of nursing students to act in any situation. Surely, when a nurse is presented with a medical emergency, he or she would have to look at and analyze the situation from their own perspective. In other words, a nurse needs to be able to correctly figure out what the underlying issue is and quickly analyze the situation and figure out the management plan for the situation. The symptoms and the diagnostic results might not mimic the pathology that has been taught to the students. In these instances, the nurses need to be able to use their reasoning skills, their creativity and their intuition and therefore act in the proper way.

Self-Confidence:

Lundberg (2008) stated that the students who have increased self-confidence are more likely to succeed when placed in a clinical setting. Apart from succeeding and progressing, students who have more self-confidence are likely to test and actually use what has been taught to them. (Clark, Owen and Thoicken, 2004) Thus, this shows the major importance for why nurses need to know self-confidence. All the theory and teaching of the nurses will be of no use if they are scared and confused to try their knowledge out in the real life. It is true that no one is perfect and everyone makes mistakes. However, the nursing students should not be afraid to practice what they know. They need to place confidence in the knowledge and skills taught to them. This can only be developed with more and more practice by the nursing students. Self-confidence is required for not only the application but the mastery of all that has been taught to the students.

Simulation: Simulation basically means the operation of a real world system or process over time. This means that a certain model is represented in such a way that it very rightly imitates the real world action or process. The word simulation basically means to stage or to feign something. The main point here is that it is very far away from reality and thus it is fake. Medical simulation is used in a lot of places to train the medical personnel and to teach them as well. This can include human patients, animations, military situations, emergency responses, and educational documents with further simulated animations. This is basically to reduce the chances of accidents or mishaps when the students go on to practice their career in the real life. Along with doctors and health professionals, medical simulation is used for students of sonography, nursing, pharmacy assistants and physical therapy as well.