The Effect of Simulation versus Video-based training for Nursing Management of Normal Vaginal Delivery on Students' Practical Achievement and Satisfaction

Introduction

Nursing education faces the challenges of drastic budget cuts and an ever increasing culturally diversestudent population, yet nursing education is also faced with the challenges offaculty shortages, limited clinical placement sites and experiences, nursing shortages thatdemand more nursing graduates, and higher expectations from employers,Nursing students often report lack of self-confidence and apprehension when they areexpected to meet performance criteria.⁽¹⁾

The ultimate goal of undergraduateclinical nursing education is to create competent and safe entry-level practitioners. In order to do this, educators must provide students with the opportunity to learn in a safe environment. The use of simulation as an effective educational methodology is well-recognized and its use is now widespread in the training of health professionals worldwide, including nursing.⁽²⁾

Today, fewer nursing students have the opportunityto use their skills to provide comfort measuresand give supportive care for laboring women.Changes in the way women give birth can present adilemma for professors teaching in this area as wellas for the students whoare being prepared to carefor childbearing women⁽³⁾.

Nursing students today have limited opportunitiesto experience the normal labor.The opportunity for hands-on learning takes place in the care of postpartum patients and in the care of newborns in the nursery.^{( 4 )} 

The World Health Organization (WHO) defines normal birth as "spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth, mother and infant are in good condition.⁽⁵⁾

Simulation is potential tools that may help the nursing educators to prepare the future nurses to practice in a real environment. It is a teaching strategy that provides students with artificial representation of a complex real-life for enablingthem to learn in a safe environment; based on its degree of realism it ranges from low to high fidelity. Low fidelity simulation refers to that is used in teaching the physical assessment and psychomotor skills, while medium fidelity reflects more realism than that of low fidelity. Yet, high fidelity simulation refers to that which mimics the reality of a human patient in clinical environment.⁽⁶⁾

Simulation presents an opportunity for students to begin to learn and develop a nursing habitus. The opportunity to experience and act in a range of complex clinical situations through simulation enables healthcare students to learn the skills and practices of their discipline. Simulation also facilitates the development of an understanding of a clinical situation requiring specific responses and professional interactions while fostering the growth of professional identity.⁽⁷⁾

People learn effectively from multimedia instructions, and they are of particular importance for medical education. Furthermore, educational videos afford us “to capitalize on the ability of moving images to teach procedures requiring skilled techniques and specialized physical examination.” Accordingly, video demonstrations of clinical skills have shown to improve learning of clinical skills and medical students appreciate the availability of such learning resources.⁽⁸⁾

Studies have shown the positive effects of audio visual aids in comparison with traditional methods on consciousness, satisfaction and stress reduction ,Video is an important medium of learning through the use of videotapes ,video cassette records, made its appearance available at any time ,that help to enhance education ,these can be replayed and watched whenever necessary ,video technology has made ahead way of education. .⁽⁹⁾

Significance of the study

The landscape of nursing education has changed dramatically in the past two decades resulting in a transformation of how nurse educators educate, Due to the severe nursing shortage along with a declining economy and increasing unemployment rate, schools of nursing are instituting creative ways to increase student proficiency.⁽¹⁾

The World Health Organization (WHO, 2016) has provided standards for nursing education and recommends the use of simulation. Simulation is a necessary technique in nursing education because it helps students to apply clinical skills while keeping patients safe and offers students the opportunity to practice clinical skills until they become proficient in performing certain tasks, Limited research is available on effectiveness and outcomes when using simulated scenarios in nursing education. With emphasis on safe and accurate care to patients, using simulators allows for practice in a non-threatening environment.⁽¹⁰⁾

The National League for Nursing (NLN), endorsed simulation use to prepare students for complex clinical and critical thinking skills. Despite an increasing number of nursing education programs that use simulation, there is a lack of researchinvestigating its effect on nursing students’ learning. ^{( 9 )}

Aim of the Study

This study aimed to compare the effect of simulation versus video-based training, for nursing management of normal vaginal delivery among nursing students' practical achievement and satisfaction.

Research Hypotheses:-

• Nursing students who will   receive simulation training for nursing management for normal vaginal delivery will have a higher score  level of (a) practical achievement and (b) satisfaction than nursing students who will receive a video-based training.

Subjects and Methods

Research Design:

Quasi experimental design was used to fulfill the aim of this study.

Setting

Obstetrics and Gynecological Nursing Labs at the Faculty of Nursing- south valley University, Qena. ,and Qena general hospital at which the  clinical evaluation was conducted.

Sample:-

A convenient sample of 87 nursing students Participated in the study, who were enrolled in the third year of baccalaureatenursing program; when they assigned to the obstetric and gynecological nursing course during the 2^nd semester of the academic year 2017-2018 they were divided randomly in to three groups (simulation video and control group ) each group had 29 student.

Inclusion Criteria:-

Students who didn't receive labor and delivery simulation training, video based training, or clinical experience in labor and delivery nursing management before the enrollment, and who agreed to participate in the study.

Data Collection Tools:

Tools for the study was developed by the researcher after extensive review of literature and similar studies conducted elsewhere. After developed tools by researcher for data collection .Tools will be revised by panels of five expertises in obstetrical and gynecological nursing staffs. The data collection tools consisted of three tools:

Tools of the Study:

The first tool (self-administered Questionnaire):- included the socio-demographic data of the students including name, age, and residence.

The second tool: (Observational checklist)

An observational checklist was used to assess the students’ practical achievement in nursing management of normal labor. Tool was mostly developed from a checklist which supported by USAID 2008 and from the literature. ⁽¹¹⁾.

Scoring System:

It consisted of (20) items: (5) items focused on preparation for spontaneous vaginal delivery (3) items focused on supportive care, (3) items focused on maternal-fetal monitoring, (9) items focused on performing basic nursing actions The students answers related to checklist was scored and calculated.Each item had (3) scores if was competently performed; (2) scores if was incompletely performed, and (1) score if the task wasn't performed. Total score ranged from 20 to 60, the higher score indicated the better achievement. These scores were converted into a percent score (poor practical achievement scored <50%, average practical achievement 50%- <75% and good practical achievement scored 75% or more).

The third tool: - (Students’ satisfaction scale)

Safaa Ashry Students’ satisfaction with the training experience was assessed using a scale developed by the National League for nursing (2005). ^{( 12 )}

Scoring System for student satisfaction

It consisted of five items, to measure the students’ satisfaction with the two assigned training experiences either simulation or video based training and also the satisfaction of the control group (traditional lecture). Each item had scores using a 5 point Likert scale. strongly agree had score 5, agree  had  score 4, undecided had score 3, disagree had score 2, while Strongly disagree  had score 1. Total score ranged from 5 to 25, the higher score indicated the higher satisfaction .The students answers related to the satisfaction scalewere scored and calculated,these scores were converted into a percent score (poor satisfaction scored <50%,average satisfaction 50%- <75% and satisfaction scored 75% or more).

Tools Validity and reliability

Tools were submitted to a panel of 5 experts in the field of Women Health & Obstetric Nursing in Minia and Assiut university and confirmed it^,s validity, modifications on the tools were done according to the panel judgment in relation to appropriateness of the content and accuracy of items. Tools of the study were tested for their reliability using Cronbach's alpha test

Pilot study:

A pilot study was conducted on 10% of the Nursing students, was equal to 9 students, to ascertain the clarity and comprehensiveness of the tools as well as to estimate the appropriate time required for procedure and to test study process. Results of the pilot study illustratedthat no any refinements and modifications were needed so the subjects were included to the actual sample.

Ethical Consideration:

A written initial approval was obtained from the research ethical Committee of the Faculty of Nursing, Minia University,Approval to conduct the study was obtained from the dean of the faculty of Nursing, south valley university.And oral consent was obtained from  students that were willing to participate in the study, after explaining the nature and purpose of the study.Participants were informed that their participation in the study was completely voluntary andacceptance of participants was obtained.

Data collection procedure:

• The researcher Prepared (the Noelle birth simulator) and the required facilities and, equipment needed for a spontaneous vaginal delivery, and the students were randomly divided to three groups, the simulation –based training group, video-based training group, and the control group each group had 29 students...
• The simulation group received the simulated delivery room classes at the obstetric and gynecological nursing labs before attending the clinical training at the real labor and delivery room (Hospital). Simulated delivery room classes were provided over a six weeks period in small groups. Each group spent 30-45 minutes to perform the task , the simulation training was conducted in the first three days of the week after the end of the lectures and the sections of each day .and the students were divided in to smaller groups each group consisted of four students ,two students assumed the role of managing the labor process while the other two assumed the role of nurse that performing the newborn care ,and then they changed the roles ,so that all students received the simulation training.
• The simulation training sessions repeated more than once to make sure that all students not needed more training.
• The video-based training group received the training on management of normal vaginal delivery at the obstetrics and gynecological nursing labs by using video recording with the data show projector. The training was gone on 30 minute, without attending the simulation classes, the students in this group were divided in to smaller groups also.
• The Control group also received the traditional lecture on  management of Normal vaginal delivery as what was used to be done ,it had been considered as apart from theoretical lectures ,the control group wasn’t received either the simulation training or the vedio based training in this phase of work.
• The training of the students and the clinical evaluation were performed from March through May2018.
• All the three groups were evaluated after finishing the training by two weeks usingfull observational checklist during management of normal vaginal delivery in the department of obstetrics and gynecology inQena general hospital, and students satisfaction was evaluated using the satisfaction scale and the results of the threegroups of simulation and video -based training, and the control group were compared to determine difference between the groups.
• After finishing the training and the clinical evaluation of the three groups, the rest of the groups also received the simulation training for the vedio based and control group, and also they received vedio training for the simulation and the control group.

Statistical analysis

The data were tested for normality using the Anderson-Darling test and for `homogeneity variances prior to further statistical analysis. Categorical variables were described by number and percent (N, %), where continuous variables described by mean and standard deviation (Mean, SD). Chi-square test and fisher exact test used to compare between categorical variables where compare between continuous variables by t-test \and ANOVA TEST. A two-tailed p < 0.05 was considered statistically significant. Person Correlation was used to appear the association between scores .All analyses were performed with the IBM SPSS 20.0 software .

Results: The results of this study are presented as the following headings:

Part І: Socio-demographic characteristics of the studied sample (Table 1)

Part IІ: Practical achievement scores of the student groups (Table 2)

Part IІІ: Satisfaction scale scores of the student groups (Table 3).

Part ІV: Multiple Comparisons between student groups according to Practical achievement scores and Satisfaction scale scores (Tables 4).

Part V: Correlation co efficient between Practical achievement scores and Satisfaction scores (Tables 5).

Part VI: Relationship between mean of practical achievement scores of the students with their Socio demographic data (Tables 6).

Part VII: Relationship between mean of satisfaction scores of the students with their Socio demographic data (Tables 7)

I  - Socio  demographic characteristics.

Table (1) Distribution of the students regarding to their sociodemographic  characteristics

- Chi-square test, ** Significant difference at p. value<0.01   Anova test

Data in Table (1) Illustrates distribution of the studied students regarding to their socio demographic characteristic, regarding to age present study was noticed that the majority of the students their age ranged between 20-22 years, regarding to their residence the majority of the students were living in rural areas, and regarding to their sex, it was observed that two thirds of the students were females while one third of the students were males.

II- Practical achievement scores of the students.

Table (2) Comparison between studnt groups according to practical achievement.

- Anova – test ** Significant difference at p. value<0.01

Table (2): Reveals Comparison between student groups according to practical achievement, shows that there was highly statistically significant difference between student groups regarding to total mean of scores of practical achievement, with mean of the practical achievement of the students in the simulation group (55.9±4.89 ) compared to total  mean scores of (45.14±4.95, 43.97±5.9) in the vedio and control groups, p value<0.001** 

Table (3) Comparison between student groups according to satisfaction scale scores of the students.

- Anova – test ** Significant difference at p. value<0.01 

Table (3):  Illustrates comparison between student groups according to Satisfaction scores, and also shows that the mean of the total satisfaction of the students in the simulation group was (24.24±0.69) ,compared to (22.21±3.83) and (17.1±4.59) in the vedio and the control group ,that mean There was highly statistically significant difference between the groups regarding to total mean of the satisfaction scoresp value<0.001**.

 .

Table ( 4) Multiple comparison between student groups according to  mean of practical achievement scores and  mean of satisfaction scores

- Anova – test ** Significant difference at p. value<0.01 

P. value :- comparison between all group

P1:- comparison between simulation& Video

P2:- comparison between simulation& Control

P3:- comparison between Video & Control

As shown in table (4)   :  It illustrated Multiple comparison between student groupsaccording to  mean of practical achievement score and satisfaction scores, it showed  that the mean of the total practical achievement score of the simulation group (55.9±4.89 ), compared to (45.14±4.95, 43.97±5.9 )  in the vedio and control group .and in the satisfaction the mean  in the simulation group was (  24.24±0.69 ) compared to (22.21±3.83,  17.1±4.59 ) in the vedio and control group ,that mean There was highly statistically significance between the simulation group and the other two groups (vedio training, control ) .

Table ( 5 )Correlation co efficient between  mean of practical achievement  scores  and mean of satisfaction scores .

** Statistically Significant correlation at p. value<0.01

Data in Table (5): Illustrates that the correlation coefficient between mean of practical achievement and mean ofsatisfaction, it showed that there was positive correlation between the practical achievement score and the satisfaction, and also better practical achievement, the more satisfaction of the students. And there was statistically significant correlation p value<0.003**.

Table (6) Relationship between mean of  practical achievement scores of the students with their sociodemographic variables

Independent T- test  - Anova – test

Data in Table (6): Illustrates that the relationship between socio-demographic characteristic of the students and the mean of practical achievement scores and also showed that there was no statistically significance between practical achievements of the studentsand their age and residence.

Table (7)Relationship between  mean of satisfaction scores of the studentswith their socio demographic variables

Independent T- test  - Anova – test .

Table (7) :): Illustrates that the relationship between socio-demographic characteristic and the mean of satisfaction scores of the students and also show that there was no statistically significance between satisfaction scores of the students and their age and residence.