Improving performance amongst nursing students through the discovery of discrepancies during simulation

https://doi.org/10.1016/j.nepr.2015.07.003Get rights and content

Highlights

  • Discrepancy discovery can aid learning by identifying aspects of performance which requires development.

  • Discrepancy may be identified either by comparing performance with an occupational standard or by direct comparison with peers.

  • Discrepancy discovery can occur in any context it is especially useful in simulation as this allows the learner and the teacher to explore areas for development.

Abstract

Discrepancy creation is a form of self-regulated learning which can be used to improve individual performance. Discrepancy can be created as a result of comparison against an occupational standard or when an individual strives to achieve higher personal goals. This study explores the process of discrepancy discovery and reduction following simulation sessions. Second year under-graduate nursing students undertook three simulation sessions over a one year period. After each session the participants completed a series of visual analogue scales to rate their own performance and the perceived performance of peers, final year student and a newly registered nurse. Once discrepancy had been identified, participants were asked to produce a short written action plan on how the discrepancy could be addressed and to work on this action plan between sessions.

A total of 70 students completed discrepancy scores for all three scenarios. The most common areas of discrepancy were understanding physiology, understanding medicines and pharmacology, patient assessment and handover (hand off). Wilcoxon Signed Ranks suggested a statistically significant difference between student scores in all areas with the exception of team-work. All of the participants used peers as their comparator when identifying discrepancy. There was also a statistically significant difference in the scores following each simulation session suggesting improved performance.

Section snippets

Introduction/background

Discrepancy creation is a concept articulated by Organizational Psychologists to describe how employees strive to improve their individual performance. Phillips et al. (1996) describe how discrepancy creation involves either the measurement of current performance against a standard (negative discrepancy creation) or by driving achievement when an individual sets higher personal goals (positive discrepancy creation). Phillips et al. (1996) argue that until an individual has achieved the level of

Results

Participants in the study included 67 female student nurses (average age 24 years range 19–48 years) and 3 male student nurses (average age 25 years range 20–31 years). A total of 70 participants completed discrepancy discovery tools for all three simulation scenarios. All but one student identified discrepancies in their own performance during the simulation sessions. This data revealed a statistically significant difference between the students' self-reported performance and that of the

Discussion

The first research question in this study related to whether the structured de-brief following simulation allowed for the discovery of discrepancies in student performance. The results show that the most frequently identified discrepancies across all of the scenarios based on students selecting areas to action plan were awareness of anatomy and physiology, understanding of pharmacology and patient assessment and hand off (handover). A study by Dunn et al. (2012) explored the influence of

Conclusion

Discrepancy discovery can act as a catalyst for student learning with students appearing to prefer peer comparators over comparisons with students at a more advanced stage or qualified nurses. Given the limited opportunities for peer comparison within many contemporary nursing education programs, simulation can provide a useful vehicle for discrepancy discovery. While tools incorporating visual analogue scales may be useful in identifying performance and knowledge discrepancies their use

Conflicts of interest

None.

References (38)

  • P.A. O'Keefe et al.

    The role of interest in optimizing performance and self-regulation

    J. Exp. Soc. Psychol.

    (2014)
  • F. Timmins

    Take time to facilitate self-directed learning

    Nurse Educ. Pract.

    (2008)
  • R. Amerson

    Making a case for the case study method

    J. Nurs. Educ.

    (2011)
  • J. Archer

    State of the science in health professions education: effective feedback

    Med. Educ.

    (2010)
  • P. Benner

    From Novice to Expert: Excellence and Power in Clinical Nursing Practice

    (1984)
  • H. Burke et al.

    Social cognitive theory, metacognition and simulation learning in nursing education

    J. Nurs. Educ.

    (2012)
  • D. Carless et al.

    Developing sustainable feedback practices

    Stud. High. Educ.

    (2010)
  • M.L. Cato et al.

    Nursing students' self-assessment of their simulation experiences

    Nurs. Educ. Perspect.

    (2009)
  • L. Cohen et al.

    Research Methods in Education

    (2007)
  • K.T. Dreifuerst

    The essential of debriefing in simulation learning: a concept analysis

    Nurs. Educ. Perspect.

    (2009)
  • S.E. Dreyfus et al.

    A Five Stage Model of the Mental Activities Involved in Directed Skill Acquisition

    (1980)
  • K.E. Dunn et al.

    Exploring the influence of students' attributions for success on their self-regulation in pathophysiology

    J. Nurs. Educ.

    (2012)
  • R.M. Fanning et al.

    The role of debriefing in simulation-based learning

    Simul. Healthc.

    (2007)
  • D. Hasson et al.

    Validation and findings comparing VAS v Likert scales for psychosocial measurements

    Int. Electron. J. Health Educ.

    (2005)
  • B. Hesketh et al.

    Enhancing performance through training

  • B.,S. Issenberg et al.

    Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

    Med. Teach.

    (2005)
  • A.K. Koch et al.

    Self-Regulation Through Goal Setting

    (2008)
  • S.M. Lambert et al.

    Gymnasts in training: the differential effects of self- and coach-set goals as a function of locus of control

    J. Appl. Sports Psychol.

    (1999)
  • S. Mantha et al.

    A proposal to use confidence intervals for visual analog scale data for pain measurement to determine clinical significance

    Anaesth. Analg.

    (1993)
  • Cited by (10)

    View all citing articles on Scopus
    View full text