Presentation for Indiana Perinatal Networ

Ball, Sonita

Hensel, Desiree

IUScholarWorks

This work was done in conjunction with the Fairbanks 
Simulation Institute. Using the NLN simulation model as a 
framework(Jeffries, 2005), the purpose of this pilot study was to 
determine how two perinatal simulations supported learning, 
satisfaction, and confidence  among BSN students and to 
determine if outcomes varied by simulation group size.  
 
 
 
Simulation has been proposed as a safe way for nursing 
students to gain clinical experience that they might not 
otherwise receive, but there are many unanswered questions on  
how best to implement this teaching and learning strategy. In a 
multi-site simulation trial, Jeffries and Rizzolo (2006) found that 
when student were assigned to the role of an observer in a 
simulation group of 4, they learned as much as the students 
assigned to more active roles. Those researchers felt an 
additional student could easily participate in a simulation as an 
observer without compromising learning. Still nursing instructors 
supervise up to10 students at a time in the clinical setting 
(Indiana State Board of Nursing, 2008). For those instructors, 
implementing simulations with groups of even 5 students poses 
the problem of what to do with the remaining students. What 
remains unknown is if simulations can still produce  effective 
learning when entire clinical groups of 10 students participate 
Surveys were returned by 52 students. Three surveys were missing more 
than 10% of data and were excluded from the study . All participants were 
single females with a mean age of 21.1 years (SD=.62). Most participants 
reported being Caucasian (96%).  
 
Mean scores for  all study variables were >4  on 5-point scales indicating 
both simulations were well received by all participants.  Table 1 shows the 
smaller groups rated three design elements higher  than the larger groups 
for the postpartum hemorrhage scenario. No significant differences were 
found on the importance scale . Table 2 shows that for the high -risk 
newborn scenario, the smaller groups  rated every design scale item 
higher than the larger groups except for the element of support. Table 3 
shows satisfaction was higher in smaller groups, but self-confidence did 
not differ significantly. 
 
This IRB approval study used a convenience sample of 54 
BSN students enrolled in a maternal-newborn clinical course. 
All students participated in the nursing lab in a postpartum 
hemorrhage simulation using a Vitalsim manikin and a high-
risk newborn simulation using a CPR style manikin. Twenty-
nine students were  assigned to participate in groups of 9-10 
with up to 7 observers. Twenty -five students were assigned to 
groups of 5 with 2 observers. Data were collected on the NLN   
Simulation Design Scale (Student version), and the NLN 
Student Attitudes toward Current Instructional Methods Using 
Simulation tool . Data were analyzed using independent t-tests 
on PASW version 17.   
Purpose 
Background 
Method 
Results 
Table 3. Attitudes toward Current Instructional 
Method Using Simulation 
Table 1. Simulation Design Scale Scores for the 
Postpartum Hemorrhage Scenario   
Discussion 
Table 2. Simulation Design Scale Scores for the 
High-Risk Newborn Scenario 
Simulation Design Elements N Mean SD t df Sig (2-tailed) 
Objectives/ 
Information 
Group  5 24 4.56 .35 3.413 47 .001*** 
Group 10 25 4.18 .41 
Support Group  5 24 4.21 .68 1.066 46 .292 
Group 10 24 4.02 .57 
Problem 
Solving 
Group 5 23 4.35 .39 1.158 46 .253 
Group 10 25 4.21 .43 
Feedback/ 
Reflection 
Group 5 23 4.89 .18 2.896 46 .006** 
Group 10 25 4.59 .46 
Fidelity 
(Realism) 
Group 5 23 4.73 .42 2.171 46 .035* 
Group 10 25 4.38 .68 
Perceptions of  Importance  N Mean SD t df Sig (2-tailed) 
Objectives/ 
Information 
Group  5 24 4.66 .44 1.645 47 .107 
Group 10 25 4.44 .51 
Support Group  5 24 4.22 .80 -.211 47 .834 
Group 10 25 4.26 .66 
Problem 
Solving 
Group 5 23 4.44 .51 1.400 45 .168 
Group 10 24 4.25 .43 
Feedback/ 
Reflection 
Group 5 23 4.69 .39 1.587 45 .120 
Group 10 24 4.51 .42 
Fidelity 
(Realism) 
Group 5 23 4.73 .51 1.847 45 .071 
Group 10 24 4.43 .59 
Contact  Information 
) 
“ 
Simulation Design Elements N Mean SD t df Sig (2-tailed) 
Objectives & 
Information 
Group  5 24 4.45 .45 2.945 47 .005** 
Group 10 25 4.05 .48 
Support Group  5 24 4.41 .53 1.381 47 .174 
Group 10 25 4.19 .60 
Problem 
Solving 
Group 5 24 4.52 .40 2.998 45 .004** 
Group 10 23 4.15 .43 
Feedback/ 
Reflection 
Group 5 24 4.76 .37 2.432 46 .019* 
Group 10 24 4.45 .48 
Fidelity 
(Realism) 
Group 5 24 4.68 .43 2.120 46 .039* 
Group 10 24 4.35 .63 
Perceptions of importance  N Mean SD t df Sig (2-tailed) 
Objectives & 
Information 
Group  5 24 4.69 .35 2.430 47 .019* 
Group 10 25 4.36 .57 
Support Group  5 24 4.63 .42 2.025 47 .049* 
Group 10 25 4.33 .60 
Problem 
Solving 
Group 5 24 4.56 .37 2.552 46 .014* 
Group 10 24 4.24 .48 
Feedback/ 
Reflection 
Group 5 24 4.81 .32 3.370 46 .002** 
Group 10 24 4.41 .47 
Fidelity 
(Realism) 
Group 5 24 4.77 .51 2.529 46 .015* 
Group 10 24 4.41 .45 
*p<.05, **p<.01, ***p<.001 
*p<.05, **p<.01, ***p<.001 
 
Simulation Model
 
Post-Partum Hemorrhage N Mean SD t df Sig (2-tailed) 
Satisfaction with 
current 
learning 
Group  5 24 4.65 .39 2.806 47 .007** 
Group 10 25 4.29 .48 
Self-confidence 
In learning 
Group  5 24 4.24 .34 1.094 47 .279 
Group 10 25 4.11 .45 
High-Risk Newborn  N Mean SD t df  Sig(2-tailed) 
Satisfaction with 
current 
learning 
Group 5 24 4.62 .41 2.675 46 .010** 
Group 10 24 4.27 .48 
Self-confidence 
In learning 
Group 5 24 4.31 .33 46 .042 .246 
Group 10 24 4.06 .47 
*P<.05,**p<.01,***p<.001 
References 
THE EFFECTS OF GROUP SIZE ON OUTCOMES OF PERINATAL SIMULATION AMONG STUDENT NURSES 
Desiree Hensel, PhD, RNC-NIC, CNE & Sonita  Ball, MSN, RN 
Indiana University School of Nursing 
1.Indiana State Board of Nursing (2008). A complication of the Indiana code and administrative code retrieved from 
 http://www.in.gov/pla/files/ISBN_2008_EDITION.pdf  
 2. Jeffries, P. R., & Rizzolo, M. A. (2006). Designing and implementing models for the innovative use of simulation  to t
 each nursing care of ill adults and children: A national, multi-site, multi method study. Retrieved February 8, 2009, 
 ffom National League for Nursing Web Site: http://www.nln.org/research/LaerdalY2End.pdf 
3. Jeffries, P. R. (2005). A framework for designing, implementing, and evaluating simulations used in nursing 
 education. Nursing Education Perspectives, 26 (2) , 96-103.  
  
 
•This study found that students viewed both simulations as effective 
teaching and learning methods even though lower fidelity equipment  was 
utilized in an open room not specifically designed for simulation.  
 
* Good outcomes were seen in  all groups suggesting that instructors can 
feel good about student learning even when scheduling may require that 
entire clinical groups must participate in a given simulation. 
 
* Students expressed in the debriefing that the high-risk newborn 
simulation was more difficult as they had very limited exposure to 
newborns. The higher simulation design scores for the smaller high-risk 
newborn groups suggest that smaller groups may be most helpful  when 
learning is new or challenging, but more research is needed.  
 
* Video streaming allows live feeds to even larger groups. More studies are 
needed on learning outcomes of observers in and out of  simulation room. 
 
 
 
  
 Desiree Hensel, PhD, RNC-NIC, CNE   Sonita Ball, MSN, RN 
 Assistant Professor      Adjunct Clinical Faculty   
 Indiana University, Bloomington   Indiana University, Bloomington ,   
 Office: 812- 855-7089     E-mail: slball@indiana.edu 
 Email: dehensel@indiana.edu 
           Permanent Link: http://hdl.handle.net/2022/17193 
 


The Effects of Group Size on Outcomes of Perinatal Simulation Among Student Nurses

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The Effects of Group Size on Outcomes of Perinatal Simulation Among Student Nurses

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