High-fidelity simulation promoting self-efficacy in nursing students regarding family systems care in hospitalized adults in palliative situations : a mixed-methods study

Background and purpose: In palliative care, promoting self-efficacy regarding family systems care and holistic symptom management is crucial. High-fidelity simulation positively influences various learning outcomes in nursing education, e.g. self-efficacy. The purpose of the study was to develop a comprehensive understanding how high-fidelity simulation adds to traditional learning methods regarding the promotion of self-efficacy in undergraduate nursing students focusing on family systems care in hospitalized adults in palliative situations. Model / framework: The pedagogical background of the study were the theories of experiential and transformative learning as well as the theory of the sources of self-efficacy. Methods: A convergent mixed methods study was conducted. A high-fidelity simulation intervention regarding a hospitalized adult in a palliative situation (manikin) and her sister (standardized patient) was carried out. In the quantitative study section, a quasiexperimental, repeated measures design measuring self-efficacy with the Family Nursing Practice Scale and the Self-Efficacy-Subscale of the Bonner Palliativwissenstest were used. Descriptive and inductive statistical analyzes were applied. In the qualitative study section, focus group interviews were conducted and analyzed applying inductive content analysis. Mixed methods meta-inferences were generated by a joint display table. Results: 46 undergraduate nursing students of a University of Applied Sciences participated in the quantitative, 22 also in the qualitative study section. The added value of high-fidelity simulation promoting nursing student’s self-efficacy in family systems care of hospitalized adults in palliative situations was confirmed in the quantitative and qualitative study sections. The mixed methods meta-inferences showed expanding of the quantitative and qualitative findings regarding the strengths of high-fidelity simulation. These were the chance to gain new insights regarding the own performance through structured reflection and the integration of family members into the palliative symptom management. Discussion: The expanded findings6 show that high-fidelity simulation allows students to positively experience the integration of family systems care also during the treatment of acute palliative symptoms. The topic of family systems care loses its abstractness: Students can apply the theories learned during the theoretical course in a situation close to reality. They experience that communication with the family systems care approach is not only applicable during a longer round table conversation like they trained in the course, but also during a highfidelity simulation scenario of some minutes. After high-fidelity simulation, family members were seen more as a resource than before. Students mentioned the importance of vicarious observation of the peer-performance for their learning progress. This is also highlighted in the theory of experiential learning, and in the sources of self-efficacy, as well as by various authors in high-fidelity simulation studies. Conclusions and implications: High-fidelity simulation provides added value regarding the promotion of the students’ self-efficacy in family systems care in hospitalized adults in palliative situations. Therefore, high-fidelity simulation should be implemented in nursing curricula.