Using on-line video clips to enhance self-efficacy toward dealing with difficult situations among nursing students
Introduction
A key issue in training nursing students is developing patient care skills. Nursing students need to learn how to make clinical judgements of patients’ needs and be able to communicate this knowledge in an appropriate way. Neary (1997) argued that students are not able to effectively care for patients simply by having knowledge and skills; they must learn to apply those skills in real-life situations. These skills tend to be developed through a combination of didactic lectures supplemented by seminars and workshops (Laurillard, 1993). It should be noted that students typically express concern on the effectiveness of classroom-based preparation for practical placements. One strategy to complement traditional teaching methods is through simulating situations that occur in hospitals. Educators have debated whether practical skills to deal with patients should be taught only in the real world situations, although this is potentially a risky approach as poor performance can have damaging effects on the welfare of the patients and /or the well being of students (Neary, 1997). It is argued that students could learn practical skills through simulating real world situations in the classroom, an approach that allows students to make mistakes in a comparatively safe environment. The strength of the debate and the importance of the issue, emphasises the need for research to explore teaching methods to enhance student’s ability to deal with adverse patient care issues.
Recent research has used simulation as part of patient health care with varying degrees of success (Alinier et al., 2004, Cioffi, 2001, Cleave-Hogg and Morgan, 2002, Treadwell and Grobler, 2001). Indeed, Chau et al. (2001) conducted an experiment that involved 83 students completing pre- and post-tests that assessed critical thinking and knowledge. They concluded that improved performance was associated with watching videotaped vignettes. Follow-up interview results alluded to some of the possible mechanisms that could underpin this effect. Students reported perceived heightened focus on the skills needed for success. This explanation suggests that increased performance could be indexed to improved motivation.
A relevant theoretical framework for building students skills, motivation and confidence to deal with adverse patient care issues is self-efficacy (Bandura, 1997). Self-efficacy is defined as the levels of confidence individuals have in their ability to execute courses of action or attain specific performance outcomes (Bandura, 1997). Self-efficacy is the confidence to deal with the demands of a specific situation and is conceptually different to self-esteem, which is a more general estimate of self-worth across all situations (Bandura, 1997). Self-efficacy is linked with successful performance in a range of different domains including academic tasks (Multon et al., 1991, Schunk, 1995, Pajares, 1996), work (Stajkovic and Luthans, 1998) and sport (Moritz et al., 2000). Thus, given sufficient skills, educational methods that enhance self-efficacy could enhance the confidence of trainee nurses to communicate with difficult and delicate patient groups.
An attractive aspect of self-efficacy theory for practitioners is the notion that it is malleable and can be enhanced through training. Self-efficacy is influenced by processing information from four main sources (Bandura, 1997). The first source of self-efficacy is personal performance accomplishments, whereby success raises self-efficacy and failures lowers self-efficacy. The second source of self-efficacy is vicarious experiences, whereby watching successful performances can raise self-efficacy and watching failures can lower self-efficacy. A more powerful effect is observed when there is similarity between the actor and observer, thereby installing the attitude ‘if he can do it, so can I’ (Bandura, 1986). The third source of self-efficacy is verbal persuasion where encouragement can increase self-efficacy. For example, if the lecturer convinces a student of his/her competence on a task, the student’s self-efficacy should improve. The fourth source of self-efficacy is the control of physiological states such as those associated with emotional arousal. Controlling emotional arousal is particularly important when individuals attempt to complete tasks that are personally important as these tasks illicit intense emotional states.
Although self-efficacy theory offers theoretical suggestions for enhancing self-efficacy, implementing intervention strategies is not so straightforward. Educational providers typically teach large numbers of students and thus providing on-going and individual feedback can be difficult. An emergent issue within Higher Education is the use of Technology supported learning. If appropriate video clips were made, Technology Supported Learning would provide students with an opportunity to view on-line role play situations on multiple occasions. Further, Technology Supported Learning has been found to benefit students who struggle to attend face to face lectures and those who are visual, rather than auditory learners. Importantly from a delivery perspective, Technology Supported Learning provides a semi-permanent resource and so students can re-visit the clips, which has the potential to develop a greater understanding of the difficulties of the task. Studies have shown that the use of technology has helped students adopt deeper approaches and learn because they feel less inhibited than if they had to participate in role play in front of a large class (Olaniran et al., 1996, Freeman and Capper, 2000).
Collectively, given the need to enhance the self-efficacy of nurses to cope with a range of difficult and delicate situations, the purpose of the present study was twofold; (1) to develop video clip material for use on an e-learning framework that simulates contextually relevant examples and (2) conduct a preliminary evaluation of the effectiveness of video clip materials on enhancing student’s self-efficacy.
Section snippets
Overview
The research was conducted in a university in which diversity and widening participation are key issues. Nursing modules are typically taught in large class sizes and problems associated with large groups from diverse backgrounds are particularly relevant. For example, English is not the first language of many students. The module used in the research project, attempted to use a teacher-centred approach to learning in which the teacher is responsible for planning and delivering lectures to the
Participants
Volunteer Level 1 nursing students (n = 145; Age range 18–45 years) participated in the research. Students completed an informed consent form in which they agreed for their data to be used in the project. When evaluating teaching methods it is rare to obtain ethical clearance before commencement of the project and therefore the project was not presented to the ethics board. Students who wished not to participate were allowed to access the materials developed for the research. Students in the
Results
Descriptive statistics for self-efficacy scores over time are contained in Table 1. MANOVA to compare differences in self-efficacy over time indicated a significant main effect (Wilks’ Lambda6,277 = 0.96, P < 0.05, Partial Eta2 = 0.04, see Table 1). There was no main effect for gender (Wilks’ Lambda6,277 = 0.99, P > 0.05, Partial Eta2 = 0.01) and no interaction effect (Wilks’ Lambda6,277 = 0.99, P > 0.05, Partial Eta2 = 0.008). Univariate results show that self-efficacy toward having to break bad news to a
Discussion
The present study attempted to enhance self-efficacy to deal with difficult patient care situations. In addition to the traditional lecture, seminar, and tutorial method of teaching, video clips that showed students how to cope successfully and unsuccessfully with a range of difficult situations were developed. The present study builds upon a growing literature that suggests that students can learn by watching appropriate video taped sessions (Alinier et al., 2004, Cioffi, 2001, Chau et al.,
Conclusions
In conclusion, the project successfully developed video clips that simulate real-life scenarios likely to be encountered by nurses during their training and then throughout their career. Results shows that the video clips provide effective support material and successfully increase self-efficacy towards dealing with these situations. Video material provides students the opportunity to re-visit the clips as many times as they wish outside of the classroom environment. Future research should
Acknowledgements
The authors thank the following for their help with developing suitable video clips: Jane Rowley, Ally Fellows, Andrew Bagnall, Maureen Moss, David Jurissic, Alison Littleford, John Adams, Jane Jones, Rodge Byrne, Lesley Hollingshead, Christine Hollingshead, Eileen Brewer, Michael Lee, Meegan Price, J.C. Carthy, Vicki Jackson, Rita Bayley, Alex Johnson, Rose Clark, Yvette Foster, Navin Foolchand, Gary McConville, Charlotte Griffiths, Rachel Seal, John Wiggins, Steve Jeffs, Jeremy Brown, Emma
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