Design and setting
This quasi-experimental study was conducted with a pretest-posttest two-group design in nursing department of Kerman University of Medical Science in Iran from 2017 to 2019. Kerman University of Medical Science is the biggest university in the Southeast of Iran. The university trains undergraduate, postgraduate and PhD nursing students. In this study, 115 BSc students were eligible, and the research population consisted of 105 BSc nursing students who met the inclusion criteria. Ten participants were excluded because of absence in training sessions.
Students were selected by using convenience sampling and were then randomly divided into control and intervention groups by drawing lots. The inclusion criteria included the 7th- and 8th--semester nursing students who were not educated by simulation-based mastery method previously.
In addition, students passed the theoretical and practical courses such as medical surgical, pediatric nursing, community health nursing, intensive care, psychology-nursing courses. A single-blind method was used, so that the students involved in this study were not informed of the type of teaching methods and how they were placed in each group.
In nursing department of KMU, all nursing students must pass prerequisite courses before taking internship course. Prerequisites include theoretical and practical courses. Theoretical course includes the workshop on patient communication, nosocomial infections, nursing ethics, and a practical course includes common nursing skills trained in skill laboratory, where award with advanced special moulage and other equipment are available for nurse students to practice the special nursing skills.
Students will take the practical course after completing the workshops. In addition, taking the internship course depends on passing (80 percent of the checklist) the clinical exam. All students of nursing department must take the same curriculum.
The team researchers selected nursing skills commonly used in nursing, and agreed on the following four practical skills: suction, naso gastric tube feeding, packed cell transfusion, change of fluid box.
Procedure
First, the study goals were explained to the participants. The students participated in the study with full consent and agreement. They were explained that attending or not participating in the study would not affect their educational process. Before starting the intervention, the demographic characteristic questionnaire and checklist skills were completed by the instructor in the two groups. Before the intervention, common nursing skills were assessed in two groups by a checklists.
Control group
Control group was trained by routine teaching, in which common nursing skills were trained to the students in skill laboratory two sessions a week for six weeks.
The routine teaching method was as follows: the students were divided into groups of three individuals, and clinical skills were performed on the advanced moulage under the supervision of the instructor. In case of any question or mistake, the instructor would address it. In addition, the instructor was as a facilitator. In this method, the instructor taught students according to time-based and summative evaluation with little feedback.
In this study, the intervention group experienced simulated mastery learning method.
Intervention group
The intervention began on the second day. The members of the intervention group experienced a simulation-based mastery intervention in four common clinical skills (suction, nasogastric tube feeding, packed cell transfusion, change of fluid box).
First, the instructor performed each skill on the advanced moulage in skill laboratory. Then, the students practiced these skills and were assessed by the instructor, who could identify whether the students learned the skill or not (diagnostic feedback) and what they needed to learn better (prescriptive feedback).
The students’ mistakes were identified and presented as a list to the relevant instructor and student. The instructors set specific goals for each student based on the deficiencies identified in the first stage. In this program, the instructor used supervisory and observational methods. The instructor observed students and completed checklists every day. The instructor re-evaluated the students through a checklist and re-identified some deficiencies listed in the checklist daily for 12 days (two days a week). In addition, students who initially fail to demonstrate the skill, have three more opportunities to pass the course.. At the end of the course, the clinical skill scores were checked.
For determining the accuracy of the observer's judgment on the examination based on the checklist, the inter-rater reliability of the assessors' scoring was assessed by using two observers at each of the skills.
Measurement Instruments
The demographic information questionnaire and the checklist were used in this study to collect the data.
The demographic questionnaire contained information about age, sex, scale median, passed units, average of last semester.
The researchers used four nursing skill checklists for both groups (control and intervention). The checklists were extracted from the fundamental of a nursing book, Skill checklist for Tylor's clinical nursing skill [26]. Suction checklist, the nasogastric tube feeding checklist, the packed cell transfusion checklist, and change of fluid box checklist contain 19, 19, 13, and 21 items, respectively. Each item on the checklists is rated using three scales: unsatisfactory (score: 0), satisfactory (score:1), and excellent (score:2). The suction, nasogastric tube feeding, packed cell transfusion, change of fluid box were scored 0-38, 0-38, 0-26, and 0-42, respectively. The total score ranges between 0-144.
The content validity of the checklists was confirmed by the broad consensus, and their reliability was assessed using a pilot study and calculated through the Cronbach's alpha coefficient of 0.82 showing a good reliability.
In addition, medical surgical nurses, pediatric nurses and intensive care nurses in Kerman have attempted for five months to prepare and select nursing skill checklists.
Data analysis
The collected data were analyzed using descriptive (frequency, percentage, mean and standard deviation) and inferential statistics. According to the results of the Kolmogorov–Smirnov test, the data of this study had a normal distribution. Thus, parametric tests were used. Furthermore, independent-t test was employed to compare the mean scores of skills between the intervention and control groups before and after the intervention. The paired samples t-test was also used to compare the mean scores of skills in each group before and after the intervention. P-values was considered statistically significant.