2025 Theses Doctoral

Effect of High-fidelity Simulation on Competence and State Anxiety Related to IV Medication Administration in Baccalaureate Nursing Students

Souffrant, Iesha S.

Background
Medication administration is a significant responsibility of nurses, yet it remains one of the most challenging skills for nursing students to master. Students have limited experiential clinical learning opportunities during which to learn medication administration, specifically administering IV medication. These limited opportunities could possibly contribute to student anxiety and influence their medication administration competence. The purpose of this study was to explore the effects of High-Fidelity Simulation (HFS) versus unstructured practice sessions (UPS) on competence and state anxiety related to IV medication administration in baccalaureate nursing students.

Methods
A two-group pre-posttest interventional quasi-experimental study was implemented to explore the impact of a high-fidelity simulation based on the Constructivist Learning Theory on competence and state anxiety. Competence was assessed using the Medication Safety Critical Element Checklist (MSCEC), and state anxiety by the State-Trait Anxiety Inventory-Y1 (STAI-Y1). Twenty-nine full-time baccalaureate students enrolled in a nursing pharmacology course at a large private university participated. Students were excluded if they were repeating this course or were part-time. Participants were assigned to an intervention group (n = 11) or a comparison group (n = 18). Twelve students were in the accelerated nursing program [15 months], while 17 students were in the traditional program [4 years.]

Data were collected between March 12 and April 5, 2024. Students had the opportunity to participate in nine practice sessions over a three-week period. All students practiced IV medication administration 2-3 times a week. Students in the intervention group participated in one high-fidelity simulation during which they administered IV medications via primary or secondary lines, partook in a 30-minute simulation experience, and were required to attend the immediate debriefing. The comparison group attended unstructured practice sessions of IV medication administration 2-3 times a week or more without the simulated experience or debriefing.

Three instruments were used: The MSCEC objective measure by which the trained evaluators assessed student competence, the STAI-Y1 to assess state anxiety, and a demographic data form. Students completed the demographic questionnaire and the STAI-Y1 before participating in practice sessions. Student competence was evaluated by trained evaluators using the MSCEC at Week 1 and Week 3 [the first and last weeks of the study.] Students completed the posttest MSCEC and STAI-Y1 during the last week of the study.

Results
There were no statistically significant differences between groups (p > .05) for competence (Independent = t(27) = -.258); the mean posttest competence score for the intervention group was 8.63 (SD = 1.91), while the mean posttest competence score for the comparison group was 8.83 (SD = 2.03). There were no statistically significant differences between groups (p > .05) for anxiety (Independent = t(27) = -1.50); the mean posttest state anxiety score for the intervention group was 29.72 (SD = 7.39), while the mean posttest state anxiety score for the comparison group was 34.27 (SD = 8.18). Inspection of paired t-test results for the intervention group indicated their state anxiety decreased from a mean of 32.90 (SD = 9.32) before the intervention to a mean of 29.72 (SD = 7.39) following the intervention; conversely, state anxiety in the comparison group increased from a mean of 30.16 (SD = 6.2) to 34.27 (SD = 8.18). However, neither increase nor decrease in state anxiety was statistically significant.

There were no statistically significant differences in outcome variables by type of educational program. The mean posttest competence score for accelerated students was 8.08 (SD = 2.31), while the mean posttest competence score for traditional students was 9.23 (SD = 1.56). The mean posttest state anxiety score for accelerated students was 30.66 (SD = 7.02), while the mean posttest state anxiety score for the traditional students was 33.88 (SD = 8.69).

Conclusion
While sample size is a limitation, the finding that anxiety decreased in the intervention group could lend support for adding a high-fidelity simulation experience to existing student learning activities. High-fidelity simulation aligns with the constructivist principles of immersing learners in realistic or interactive scenarios, thus allowing the student to engage in problem solving, decision making, and teamwork. fix presents realistic scenarios with which students can interact safely and provides students with the opportunity to reflect on their performance. It is possible that incorporating time for reflection outside of the HFS experience may help decrease student state anxiety.