Elsevier

Nurse Education Today

Volume 69, October 2018, Pages 142-148
Nurse Education Today

Modeling the antecedents of clinical examination performance: Task characteristics and psychological state in nursing students

https://doi.org/10.1016/j.nedt.2018.07.016Get rights and content

Highlights

  • Clinical examinations can be used to understand students’ care skill performance and to evaluate courses.

  • Students’ simulation learning effectiveness in the laboratory was positively associated with three task characteristics during clinical examinations.

  • Task variety, identity, and significance is a particularly important situational antecedent to students’ skill performance in clinical examinations.

Abstract

Background

Objective structured clinical examinations can be used to understand students' care skill performance and to evaluate courses. Thus, identifying antecedents to improved skill performance in these examinations is crucial for improving students' future care ability.

Objectives

This study examined the antecedents of clinical skill performance in nursing students and determined whether perceived task load and anxiety mediate the relationships between task characteristics and skill performance.

Methods

A quantitative approach was conducted. The questionnaire for this study was comprised of five measures: Simulation Learning Effectiveness Scale, Task Characteristic Subscale, Task Cognitive Loading Scale, State-Trait Anxiety Inventory, and a clinical practice examination.

Finding

Structural equation modeling revealed that students' simulation learning effectiveness was positively associated with three task characteristics (task autonomy; task variety, identity, and significance; and task feedback) during clinical examinations. Further, the effect of learning effectiveness on task feedback was greater than on task autonomy, variety, identity, and significance. In addition, task load mediated the relationship between task variety, identity, and significance and clinical examination performance, whereas anxiety mediated the relationships between all three task characteristics and clinical examination performance.

Conclusion

Promoting nursing students' simulation learning effectiveness is crucial for improving feedback in regard to the task. Further, those who perceived the task as having more variety, identity, and significance were more likely to perceive the task as having a higher cognitive load and to experience anxiety, which, in turn, led to poorer performance. Interventions should, therefore, managers' aim to reduce students' perceived load and anxiety before they participate in clinical skill examinations.

Introduction

Nursing education is extremely important for the quality of clinical practice, and it is imperative that the task design of clinical practice examinations is conducive to nurturing optimal learning and performance in students. In recent years, the task design of clinical performance examinations has emerged as a topic of central importance within nursing education, particularly how to promote task correctness and effective completion rate.

According to the Job Characteristics Model (JCM; Hackman and Oldham, 1975) and Cognitive Load Theory (Sweller et al., 1998), performance is strongly related to the perceived characteristics of a task or job and an individual's psychological state. Previous studies have shown that there is a positive relationship between job characteristics and job performance (Badawy and Essawy, 1992; Duke and Sneed, 1989; Sneed and Herman, 1990) and that psychological factors mediate the impact of the work environment on performance (Cotton et al., 2002).

Little research, however, has focused on the task characteristics and clinical examinations of nurses or on the relationships between these task characteristics and clinical nursing skill performance. In this study, we empirically examined the antecedents of clinical skill performance in nursing students, using the JCM (Hackman and Oldham, 1975) and Cognitive Load Theory (Sweller et al., 1998). First, we examined whether learning effectiveness was positively associated with the perceived task characteristics of clinical examinations. Then, we determined whether task load and anxiety mediated the relationships between various task characteristics and clinical examination performance. We expect that this study's findings can provide clinical nursing educators with an understanding of the antecedents of effective clinical skill performance, including the relationship between task characteristics and clinical examination performance, as well as the role of psychological states in clinical skill performance. Further, our findings can be used by nursing educators to develop an intervention to improve students' performance in a clinical examination.

Section snippets

Task Characteristics of Work Design and Skill Performance

According to Hackman and Oldham's (1975) Job Diagnostic Survey (JDS), there are five core job characteristics: autonomy, skill variety, task identity, task significance, and feedback. Studies have verified that there is a positive relationship between these job characteristics and job satisfaction (Badawy and Essawy, 1992; Duke and Sneed, 1989; Sneed and Herman, 1990). Other research also has shown that there is a relationship between task characteristics and organizational climate. For

Research Framework

Based on the above Literature Review, as well as on JCM (Hackman and Oldham, 1975) and Cognitive Load Theory (Sweller et al., 1998), there is a relationship among learning experience, task characteristics, psychological states, and job outcomes. In this study, learning experience refers to students' learning self-effectiveness in a clinical simulation situation; task characteristics refers to students' perceived “task autonomy,” “task variety, identity, and significance,” and “feedback” about

Descriptive Statistics of Variables

As shown in Table 1, the factor loadings of all observed variables and items were adequate, ranging from 0.54 to 0.98 (p < .001). Further, the six exogenous (simulation learning self-effectiveness; task autonomy; task variety, identity, and significance; feedback; task cognitive load; and anxiety) and one endogenous (clinical examination performance) variable all had composite reliability and Cronbach's alpha values of above 0.80. Table 2 shows the average variance extracted (AVE) for each

Discussion

The main aim of this study was to examine a conceptual model that depicts the role of simulation learning self-effectiveness, task characteristics, and psychological states in predicting nursing students' clinical examination performance (Fig. 1). Specifically, we explored the mediating role of psychological states (task cognitive load and anxiety) in the relationships between task characteristics (task autonomy; task variety, identity, and significance; and feedback) and clinical examination

Conclusion and Relevance to Clinical Practice

These results highlight the importance of anxiety in students' performance and extend previous research (Arkin et al., 1982; Coy et al., 2011; Hammermaster, 1989; Sarason, 1984; Zarantonello et al., 1984). Specifically, we determined the relationship between each task characteristic and psychological state and expanded previous research findings on psychological factors that positively mediate the impact of work environment on performance (Cotton et al., 2002).

In the practice of clinical

Limitations and Future Directions

A main limitation of this study, however, is its cross-sectional design. Although this study provides an understanding of how students' learning self-effectiveness, task characteristics, load, and anxiety relate to performance, as well as the mediating effects of task cognitive load and anxiety, we believe that qualitative and longitudinal studies will be necessary to allow for a more comprehensive understanding of the direction of the relationships. In addition, to enhance the

Ethical Considerations

The study protocol was approved by the Institutional Review Board Chung Shan medical University Hospital (CSMUH No: CS2-16018). Written informed consent was obtained from all participants.

Acknowledgments and Source of Funding

We wish to thank Professor Haw-Jeng Chiou and Ms. Chia-Yin Liao, who provided the scales for this study. We also thank all participants of this study. In addition, we would like to thank the Ministry of Science and Technology, Taiwan for funding this study (MOST 105-2511-S-040-002).

Contributors

H-C Pai was responsible for the study conception and design, and in drafting of the manuscript, made critical revisions to the paper for important intellectual content. C-F Wei, S-L Chen, S-M Tsai, and W-J Yen performed the data collection. H-C Pai performed the data analysis and supervised the study.

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