The influence of anxiety on student nurse performance in a simulated clinical setting: A mixed methods design

• Published in: International journal of nursing studies 2019-10, Vol.98, p.57-66
• Main Authors: Al-Ghareeb, Amal, McKenna, Lisa, Cooper, Simon
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety - physiopathology; Chest; Clinical nursing; Clinical performance; Debriefing; Emergency; Employment; Experiential learning; Fidelity; Health care; Heart Rate; High-fidelity; Hormones; Humans; Medical education; Medical personnel; Mixed methods research; Novice nurses; Nursing; Nursing education; Patient scenario; Patient Simulation; Physiology; Problem-Based Learning; Questionnaires; Self Efficacy; Short term memory; Simulation; Standardized patients; Students; Students, Nursing - psychology; Variability
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2019.06.006

Anxiety has a powerful impact on learning due to activation of anxiety hormones, which target related receptors in the working memory. Experiential learning requires some degree of challenge and anxiety. Patient simulation, as a form of experiential learning, has been an integrated component of health professional education internationally over the last two decades, especially in undergraduate nursing education. Little information is available to determine if and how anxiety impacts nursing students’ clinical performance during simulation. To investigate physiological and psychological anxiety during emergency scenarios in high-fidelity simulation and understand the effect of anxiety on clinical performance. First2Act was the model for the simulation intervention. Second and third year undergraduate nursing students attended a two-hour simulation session and completed a demographic questionnaire plus pre-simulation self-reported psychological anxiety scale. A heart rate variability monitor was attached to each student’s chest to measure heart rate variability (as a sign of anxiety) before engaging in two video-recorded simulated emergency scenarios (cardiac and respiratory) with a professional actor playing the patient. Performance was rated by a clinician followed by video-assisted debriefing. Finally, heart monitors were removed and students repeated self-reports of psychological anxiety. Students’ psychological anxiety was high pre-simulation and remained high post-simulation. With regard to physiological anxiety, students were anxious at the start of the simulation but became more relaxed toward the end as they gained familiarly with the simulation environment (p