Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
o. 7, 278–284 & Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved.
F E A T U R E
A R T I C L E
Integrating
Previous research has suggested that a teaching
Problem-Based strategy integrating problem-based learning and
simulation may be superior to traditional lecture.
Learning and The purpose of this study was to assess learner
motivation and life skills before and after taking a
Simulation course involving problem-based learning and
simulation. The design used repeated measures
with a convenience sample of 83 second-year
Effects on Student Motivation and nursing students who completed the integrated
Life Skills course. Data from a self-administered question-
naire measuring learner motivation and life skills
were collected at pretest, post–problem-based
YOUNG SOOK ROH, PhD, RN learning, and post-simulation time points. Repeated-
SANG SUK KIM, PhD, RN measures analysis of variance determined that the
mean scores for total learner motivation (F = 6.62,
P = .003), communication (F = 8.27, P G .001),
problem solving (F = 6.91, P = .001), and self-
directed learning (F = 4.45, P = .016) differed
significantly between time points. Post hoc tests
Nurse educators must determine the best possible inno- using the Bonferroni correction revealed that total
vative teaching strategies to support quality and safety learner motivation and total life skills significantly
education for nurses.1,2 Of these strategies, problem-based increased both from pretest to postsimulation and
learning (PBL) and simulation are increasingly prevalent in from post–problem-based learning test to post-
simulation test. Subscales of learner motivation
health profession education, with close links to the prin-
and life skills, intrinsic goal orientation, self-efficacy
ciples of constructivism and collaborative learning.3 A recent for learning and performance, problem-solving
meta-analysis demonstrated that PBL is more effective skills, and self-directed learning skills significantly
than traditional methods in terms of learning and student increased both from pretest to postsimulation test
satisfaction, and PBL has a moderate to large effect on the and from post–problem-based learning test to
development of cognitive, affective, and psychomotor skills.4 post-simulation test. The results demonstrate that
A meta-analysis also found that technology-enhanced sim- an integrating problem-based learning and sim-
ulation training, in comparison with other instructional ulation course elicits significant improvement in
modalities, is associated with better learning outcomes. Dif- learner motivation and life skills. Simulation plus
ferences were significant for satisfaction, knowledge, pro- problem-based learning is more effective than
cess skills, and product skills.5 problem-based learning alone at increasing in-
trinsic goal orientation, task value, self-efficacy for
Although PBL and simulation in isolation have educa-
learning and performance, problem solving, and
tional merit, merging these pedagogies has the scope to self-directed learning.
link aspects of learning that further enhance and trans-
form knowledge.6 However, some studies have revealed KEYWORDS
Motivation & Patient simulation &
Author Affiliation: Red Cross College of Nursing, Chung-Ang University Problem-based learning & Problem solving &
(CAU) Seoul, Korea.
Self-directed learning
Ethical approval was granted by the institutional review board.
The authors have disclosed that they have no significant relation-
ship with, or financial interest in, any commercial companies pertaining that learning is enhanced with the use of simulation
to this article.
Corresponding author: Sang Suk Kim, PhD, RN, 84 Heukseouk-Ro,
compared with PBL. Steadman et al7 found that simula-
Dongjak-Gu, Seoul, 156-861, Korea (kss0530@cau.ac.kr). tion led to improved acquisition of assessment and man-
DOI: 10.1097/CIN.0000000000000161 agement skills compared with PBL in medical students.
Life skills were measured using the Life Skills Ques- Problem-based learning. Four PBL sessions (2 hours
tionnaire for Korean college students and adults.23 It con- per session per week) were held for students to gain core
sists of three subscales: communication skills (49 items), competence in nursing care of patients with chest pain and
problem-solving skills (45 items), and self-directed learn- dysrhythmia. Problem-based learning scenarios were de-
ing skills (45 items). Each item is scored on a 5-point Likert- veloped using actual patient situations at a cardiovascular
type scale, from 1 (very uncommon) to 5 (very frequent), intensive care unit of a university hospital in Korea. The
with higher scores indicating a higher level of life skills. PBL scenario was evaluated by two experienced clinical
Alpha coefficients reported for the Life-Skills subscales nurses who served as subject matter experts. The scenarios
are .80 for the communication skills subscale, .94 for the included a 65-year-old male patient with chest pain and a
problem-solving skills subscale, and .93 for the self-directed diagnosis of acute myocardial infarction.
learning skills subscale.23 In the current study, ! coeffi- Simulation-based learning. After the PBL session, six
cients for the Life-Skills subscales ranged from .84 to simulation sessions (2 hours per session per week) were
.91 for the communication skills subscale, from .93 to led by two faculty members to help the students acquire
.96 for the problem-solving skills subscale, and from .92 cardiopulmonary resuscitation (CPR) skills. Participants
to .95 for the self-directed learning skills subscale. had a 4-hour ‘‘hands-on’’ session of instructor-led CPR
skills training before a weeklong session of simulation
Procedure testing in November 2012. Instructor-led CPR skills train-
ing was defined in the study as simulation-based resusci-
An integrated circulorespiratory course was designed based tation training in patient assessment, chest compressions,
on the framework of PBL combined with simulation.24 This ventilations, defibrillation, medication, and other actions
course aimed to improve core nursing competence in necessary to treat a patient with cardiac arrest due to ventric-
the circulorespiratory (ie, cardiovascular and hematologic ular fibrillation. Participants were given time to practice
care in respiratory system) nursing care area through in- protocols and procedures and received structured educa-
tegration of PBL and simulation. The three-credit course tion from two experienced instructors. All sessions took place
consisted of two credits of lectures (30 hours) and one in a nursing simulation center at a college of nursing. The
credit of small-group sessions (15 hours), based on the credit 2-hour testing session was followed by a three-step simula-
regulation of the school of nursing. The course was de- tion process consisting of briefing, simulation, and debriefing.
livered as a 4-hour lecture and a 2-hour small-group tutorial A team of four nursing students was tested at each session.
each week. The nursing students were assigned to three While one student directed resuscitation efforts, another
teams of 30 students each. Each team had five groups with student performed CPR or other tasks on the human patient
five or six students each. Nursing students were assigned to simulator, SimMan (Laerdal, Stavanger, Norway). As described
a team based on random selection by choosing a number, in the Advanced Cardiovascular Life Support guidelines,
and they were informed that their team assignments would nursing students were expected to (1) obtain a history, (2)
remain the same throughout the course. Two faculty mem- perform a physical examination, (3) attach noninvasive mon-
bers acted as tutors for the three teams. itoring, (4) administer medications, (5) perform procedures
T a b l e 1
Effects of PBL With Simulation on Learner Motivation and Life Skills (n = 83)
Bonferroni
Variable Baseline (A) Post-PBL (B) Post-simulation (C) F P Correction
Learner motivation 5.03 T 0.63 4.88 T 0.96 5.21 T 0.77 6.62a .003 A, B G C
Intrinsic goal orientation 4.94 T 0.97 4.83 T 1.06 5.27 T 0.92 6.90a .002 A, B G C
Extrinsic goal orientation 5.25 T 0.99 5.05 T 1.00 5.29 T 1.01 2.53b .079
Task value 5.28 T 0.85 5.11 T 1.11 5.45 T 0.90 5.20a .009 A, B G C
Control of learning beliefs 5.18 T 0.70 4.87 T 1.14 5.26 T 0.82 7.41a .001 BGC
Self-efficacy for learning and performance 5.06 T 0.89 4.97 T 1.16 5.30 T 0.98 5.08a .010 A, B G C
Test anxiety 4.48 T 1.04 4.42 T 1.07 4.59 T 0.96 1.23b .294
Life skills 3.43 T 0.32 3.46 T 0.41 3.57 T 0.40 8.89b G.001 A, B G C
Communication skills 3.42 T 0.29 3.50 T 0.36 3.57 T 0.39 8.27b G.001 A G C
Problem-solving skills 3.44 T 0.42 3.45 T 0.52 3.61 T 0.45 6.91b .001 A, B G C
Self-directed learning skills 3.44 T 0.45 3.45 T 0.52 3.55 T 0.48 4.45a .016 A, B G C
a
When the sphericity assumption for the variance was not satisfied, the corrected F test (Huynh-Feldt) was applied.
b
When sphericity assumption for the variance was satisfied, the F test was used.