.: ORİJİNAL ARAŞTIRMA
Senaryo Temelli Standart Hasta Simülasyonunun Hemşirelik Birinci Sınıf Öğrencilerinin İlk Gün Klinik Uygulama Deneyimlerine ve Anksiyete Düzeylerine Etkisi
The Effect of Scenario-Based Standardized Patient Simulation on Freshmen Nursing Students' First-Day Clinical Experience and Anxiety Levels
Turkiye Klinikleri J Health Sci. 2020;5(3):603-15
doi: 10.5336/healthsci.2019-65898
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Çalışmada senaryo temelli standart hasta simülasyonunun hemşirelik birinci sınıf öğrencilerinin ilk gün klinik uygulamalarına ve anksiyete düzeyine etkisini incelemek amaçlanmıştır. Gereç ve Yöntemler: Yarı deneysel tipdeki araştırmanın örneklemini 29 girişim, 37 kontrol grubu birinci sınıf hemşirelik öğrencisi oluşturmuştur. Girişim grubuna hastayla tanışma senaryolarını içeren standart hasta simülasyon uygulamaları yaptırılmıştır. Kontrol grubu öğrencilerine standart müfredat uygulanmış, teorik ve laboratuar uygulamalarını tamamladıktan sonra klinik uygulamaya çıkmışlardır. Simülasyon öncesi ve sonrası girişim grubu öğrencilerin anksiyete düzeyleri 'Durumluk Anksiyete Skalası' ile ölçülmüştür. Hem deney hem kontrol grubu öğrencilerinin klinik uygulamanın ilk günü hastayla karşılaşmadan önce ve günün sonunda anksiyete düzeyleri aynı ölçüm aracıyla yeniden ölçülmüştür. Her iki grup öğrencileri klinik uygulamanın ilk günkü deneyimlerini içeren açık uçlu üç sorudan oluşan 'Klinik Uygulama Değerlendirme Formu'nu doldurmuşlardır. Çalışmada elde edilen bulgular SPSS 23 paket programı ile değerlendirilmiş ve anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Çalışmaya katılan tüm öğrencilerin yazılı ve sözlü onamları alınmıştır. Bulgular: Çalışmada hem deney hem de kontrol grubunun klinik uygulama öncesi (deney 49.00; kontrol: 49.00) vesonrası (deney: 40.00; kontrol: 40.50) anksiyete puanlarının orta düzeyde ve her iki grubun klinik öncesi ve sonrası anksiyete puanları arasında anlamlı fark bulunduğu (p<0,05), ancak grupların klinik öncesi ve sonrası puan-larının karşılaştırılması sonucunda anlamlı fark bulunmadığı (p>0,05) belirlenmiştir. Deney grubu öğrencilerinin simülasyon öncesi (42.00) ve sonrası (31.00) anksiyete düzeylerinde anlamlı düzeyde farklılık olduğu görülmüştür (p<0,05). Simülasyon deneyimi sonrası öğrenciler debrifieng aşamasında çok heyecanlandıklarını, klinik uygulamada sakin ve özgüvenli olmaya çalışacaklarını belirtmişlerdir. İlk klinik deneyim öncesi deney grubu öğrencileri en fazla oranla heyecanlandıklarını (%44,8), çekindiklerini (%24,3) ve anksiyete yaşadıklarını (%13,8) bildirirken, kontrol grubu öğrencileri en fazla oranla heyecanlandıklarını (%60,4) ve korktuklarını (%10,4) bildirmişlerdir. Sonuç: Standart hasta ile simülasyon deneyimi yaşayan öğrenciler ile bu deneyimi yaşamayan öğrencilerin ilk günkü klinik uygulama anksiyeteleri orta düzeydedir. Grupların karşılaştırılmasında klinik öncesi ve sonrası anksiyete düzeyleri arasında farklılık olmamakla birlikte; her iki grup öğrencilerin hastayla ilk karşılaşma öncesi ve sonrası anksiyete düzeylerinde anlamlı düzeyde azalma olmuştur. Öğrenciler standart hasta deneyiminin klinik uygulama sürecine hazırlanmada etkili bir öğrenme yöntemi olduğunu belirtmişlerdir. Ayrıca deney grubu öğrenciler, tekrarlı simülasyon uygulaması yapabilseler gerçek uygulamada çok daha iyi olacaklarını da bildirmişlerdir.
Anahtar Kelimeler: Hemşirelik öğrencisi; standart hasta; simülasyon; klinik deneyim; anksiyete
Amaç: Çalışmada senaryo temelli standart hasta simülasyonunun hemşirelik birinci sınıf öğrencilerinin ilk gün klinik uygulamalarına ve anksiyete düzeyine etkisini incelemek amaçlanmıştır. Gereç ve Yöntemler: Yarı deneysel tipdeki araştırmanın örneklemini 29 girişim, 37 kontrol grubu birinci sınıf hemşirelik öğrencisi oluşturmuştur. Girişim grubuna hastayla tanışma senaryolarını içeren standart hasta simülasyon uygulamaları yaptırılmıştır. Kontrol grubu öğrencilerine standart müfredat uygulanmış, teorik ve laboratuar uygulamalarını tamamladıktan sonra klinik uygulamaya çıkmışlardır. Simülasyon öncesi ve sonrası girişim grubu öğrencilerin anksiyete düzeyleri 'Durumluk Anksiyete Skalası' ile ölçülmüştür. Hem deney hem kontrol grubu öğrencilerinin klinik uygulamanın ilk günü hastayla karşılaşmadan önce ve günün sonunda anksiyete düzeyleri aynı ölçüm aracıyla yeniden ölçülmüştür. Her iki grup öğrencileri klinik uygulamanın ilk günkü deneyimlerini içeren açık uçlu üç sorudan oluşan 'Klinik Uygulama Değerlendirme Formu'nu doldurmuşlardır. Çalışmada elde edilen bulgular SPSS 23 paket programı ile değerlendirilmiş ve anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Çalışmaya katılan tüm öğrencilerin yazılı ve sözlü onamları alınmıştır. Bulgular: Çalışmada hem deney hem de kontrol grubunun klinik uygulama öncesi (deney 49.00; kontrol: 49.00) vesonrası (deney: 40.00; kontrol: 40.50) anksiyete puanlarının orta düzeyde ve her iki grubun klinik öncesi ve sonrası anksiyete puanları arasında anlamlı fark bulunduğu (p<0,05), ancak grupların klinik öncesi ve sonrası puan-larının karşılaştırılması sonucunda anlamlı fark bulunmadığı (p>0,05) belirlenmiştir. Deney grubu öğrencilerinin simülasyon öncesi (42.00) ve sonrası (31.00) anksiyete düzeylerinde anlamlı düzeyde farklılık olduğu görülmüştür (p<0,05). Simülasyon deneyimi sonrası öğrenciler debrifieng aşamasında çok heyecanlandıklarını, klinik uygulamada sakin ve özgüvenli olmaya çalışacaklarını belirtmişlerdir. İlk klinik deneyim öncesi deney grubu öğrencileri en fazla oranla heyecanlandıklarını (%44,8), çekindiklerini (%24,3) ve anksiyete yaşadıklarını (%13,8) bildirirken, kontrol grubu öğrencileri en fazla oranla heyecanlandıklarını (%60,4) ve korktuklarını (%10,4) bildirmişlerdir. Sonuç: Standart hasta ile simülasyon deneyimi yaşayan öğrenciler ile bu deneyimi yaşamayan öğrencilerin ilk günkü klinik uygulama anksiyeteleri orta düzeydedir. Grupların karşılaştırılmasında klinik öncesi ve sonrası anksiyete düzeyleri arasında farklılık olmamakla birlikte; her iki grup öğrencilerin hastayla ilk karşılaşma öncesi ve sonrası anksiyete düzeylerinde anlamlı düzeyde azalma olmuştur. Öğrenciler standart hasta deneyiminin klinik uygulama sürecine hazırlanmada etkili bir öğrenme yöntemi olduğunu belirtmişlerdir. Ayrıca deney grubu öğrenciler, tekrarlı simülasyon uygulaması yapabilseler gerçek uygulamada çok daha iyi olacaklarını da bildirmişlerdir.
Anahtar Kelimeler: Hemşirelik öğrencisi; standart hasta; simülasyon; klinik deneyim; anksiyete
ABSTRACT
Objective: The aim of this study was to examine the effect of scenario- based standardized patient simulation (SPs) on first-day clinical practice and anxiety level of freshmen nursing students. Material and Methods: The sample of this semi-experimental study consisted of 29 experimental and 37 control group freshmen nursing students. Experimental group was given scenarios for meeting the patient during SP simulation application. Standard curriculum was applied to the control group. After completing theoretical and laboratory applications, they started clinical practice. Anxiety levels of the experimental group students were measured using 'State-Trait Anxiety Inventory' before and after the simulation. The anxiety levels of both groups were re-measured with the same measuring tool prior to the encounter with the patient and at the end of the firstday of clinical practice. Students in both of the groups were asked to complete 'Clinical Practice Evaluation Form' which consisted of three open-ended questions about the first-day experiences of their clinical practice. The findings of the study were evaluated with SPSS 23 package program and p <0.05 was considered significant in all analyzes. Written and verbal informed consent was obtained from all students. Results: There was a significant difference between the anxiety levels of both experimental and control groups before (experimental: 49.00; control: 49.00) and after (experimental: 40.00; control: 40.50) clinical experiments and the scores were found to be moderate (p<0.05). However, there was no significant difference (p> 0.05) when the pre-clinical and post-clinical scores of the groups were compared. Also, there was a significant difference between the anxiety levels of the experimental group students before and after the simulation (42.00) and after (31.00) (p <0.05). The students on the experimental group stated that they were very excited during the debriefing stage after the SP experience and that they would try to be calm and confident in clinical practice. Before the first clinical experience, the experimental group students reported that they were mostly excited (44.8%), afraid (24.3%) and anxious (13.8%), while the control group students reported that they were mostly excited (60.4%) and afraid (10.4%). Conclusion: The first-day clinical practice anxiety of the students who had simulation experience with the SP and those who did not have this experience were moderate. Although there was no difference between the anxiety levels of groups pre and post simulation, there was a significant decrease in the anxiety levels of both groups of students before and after the first encounter with the patient. The students stated that SP experience is an effective learning method in preparing for the clinical practice process. In addition, the experimental group students reported that if they could perform repeated simulation applications, they would do much better in real practice.
Keywords: Nursing student; standardized patient; simulation; clinical experience; anxiety
Objective: The aim of this study was to examine the effect of scenario- based standardized patient simulation (SPs) on first-day clinical practice and anxiety level of freshmen nursing students. Material and Methods: The sample of this semi-experimental study consisted of 29 experimental and 37 control group freshmen nursing students. Experimental group was given scenarios for meeting the patient during SP simulation application. Standard curriculum was applied to the control group. After completing theoretical and laboratory applications, they started clinical practice. Anxiety levels of the experimental group students were measured using 'State-Trait Anxiety Inventory' before and after the simulation. The anxiety levels of both groups were re-measured with the same measuring tool prior to the encounter with the patient and at the end of the firstday of clinical practice. Students in both of the groups were asked to complete 'Clinical Practice Evaluation Form' which consisted of three open-ended questions about the first-day experiences of their clinical practice. The findings of the study were evaluated with SPSS 23 package program and p <0.05 was considered significant in all analyzes. Written and verbal informed consent was obtained from all students. Results: There was a significant difference between the anxiety levels of both experimental and control groups before (experimental: 49.00; control: 49.00) and after (experimental: 40.00; control: 40.50) clinical experiments and the scores were found to be moderate (p<0.05). However, there was no significant difference (p> 0.05) when the pre-clinical and post-clinical scores of the groups were compared. Also, there was a significant difference between the anxiety levels of the experimental group students before and after the simulation (42.00) and after (31.00) (p <0.05). The students on the experimental group stated that they were very excited during the debriefing stage after the SP experience and that they would try to be calm and confident in clinical practice. Before the first clinical experience, the experimental group students reported that they were mostly excited (44.8%), afraid (24.3%) and anxious (13.8%), while the control group students reported that they were mostly excited (60.4%) and afraid (10.4%). Conclusion: The first-day clinical practice anxiety of the students who had simulation experience with the SP and those who did not have this experience were moderate. Although there was no difference between the anxiety levels of groups pre and post simulation, there was a significant decrease in the anxiety levels of both groups of students before and after the first encounter with the patient. The students stated that SP experience is an effective learning method in preparing for the clinical practice process. In addition, the experimental group students reported that if they could perform repeated simulation applications, they would do much better in real practice.
Keywords: Nursing student; standardized patient; simulation; clinical experience; anxiety
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