In an increasingly complex health care system, quality clinical judgment can improve patient safety. This is true in all settings in which nurses practice.The development of quality clinical assessment and judgment can be stressful for nursing students in acute care situations as well. In education institutions, clinical judgment is developed throughout training.
Simulation is used, in several countries, to support students in the development of these skills. It allows students to exercise their clinical judgment in a safe setting and in care situations close to real practice. Several studies show that the use of simulation in learning clinical judgment increases students' sense of confidence.
In our institution, for several years, an acute care option module has been offered to students in the third year of their Bachelor's degree. Its objectives are to develop clinical judgment and decision-making skills in the final-year students.
The aim of this study is to evaluate the impact of this module on the students' feeling of confidence in their clinical judgment in acute somatic care situations.
This quasi-experimental single-group before-and-after study was conducted between November 15 and December 16 2021 at the school of Health Sciences (HESAV).
A pedagogical engineering model was developed and is articulated over 5 weeks. It includes targeted theoretical courses, group work in preparation for simulated clinical situations, immersive simulations, debriefings directly after the simulations, as well as remote debriefings for conceptualization-generalization purposes.
A questionnaire measuring students' self-confidence was distributed on the first and last day of the module. In the absence of a validated survey in French, a free translation of the Self-confidence scale was made and used for this study. This 12-item survey focuses on three patient typologies (cardiac, respiratory and neurological symptoms). For each type of patient, the students evaluate their self-confidence in recognizing symptoms, assessing the patient, the nursing interventions to be implemented and the evaluation of these interventions. For each item, students are given a 5-point rating (1 = not at all confident, 5 = very confident).
A pre- and post-intervention distributional analysis was conducted. In order to determine whether the improvement in students' self-confidence after the elective module was statistically significant, a Wilcoxon paired-samples rank test was performed. Each question was analyzed individually.
34 students completed the pre- and post-training questionnaire. For situations with cardiac pathology, a significant improvement in students' self-confidence was observed. This in symptom recognition (median difference between before and after +1.1, z= -4.47, p<0.001), in assessment (+1.2, z=-5.01, p<0.001), in nursing interventions (+1.0, z=-4.68, p<0.001) and in intervention assessment (+1.4, z=-4.76, p<0.001). In the situation with a respiratory pathology an improvement was also noted. In the recognition of symptoms (+ 0.9, z=-4.61, p<0.001), in the assessment (+ 1.2, z= 5.01, p<0.001), in the nursing interventions (+1.3, z= -4.87, p<0.001) and in the assessment of interventions (+1.5, z= -5.09, p<0.001). For a situation with a neurological pathology the improvement of self-confidence in students is statistically significant. In recognition (+0.8, z= -3.86, p<0.001), in evaluation (+1.2, z=-4.08, p>0.001), in interventions (+1.0, z=-4.08, p<0.001) and in evaluation of interventions (+ 1.2, z= -4.75, p<0.001).
The acute care module offered at HESAV seems to allow an improvement in the students' self-confidence when practicing clinical assessment and judgment in all the proposed situations. Our data confirm the results of other studies.
The use of simulation in a module focused on the management of acute somatic care patients should be proposed in the training program for Bachelor's degree nursing students. The use of real-life situations in a safe setting helps to improve their self-confidence in clinical assessment and judgment. This educational practice could be applied to graduate nurses and improve the quality and safety of care.