The primary purpose of this study was to test a hypothesized model describing the direct effects of learning variables on anxiety and cognitive learning outcomes and the mediating effects of anxiety on cognitive learning outcomes in a high-fidelity human patient simulation (HPS) experience. The secondary purpose of this study was to explain and explore student perceptions concerning the qualities and context of human patient simulation affecting anxiety and learning that may be amenable to intervention.
This study used a mixed methods QUAN dominant explanatory design with simultaneous qualitative data collection to examine variables affecting learning in undergraduate, beginning nursing students (n=124) enrolled in a fundamental nursing course. Data were collected using an investigator constructed Factors Affecting Learning Questionnaire, as well as, a Learner and Lifestyle Questionnaire, Elsevier Evolve custom parallel pre- and post-tests, the Building Excellence Survey, the State-Trait Anxiety Inventory, and a semi-structured group discussion.
A path analysis identified relationships between cognitive learning and anxiety, readiness to learn, preparation for simulation, and learning styles. Both readiness to learn (β = -.31, p < .01) and preparation for simulation directly affected anxiety (β = .22, p < .01). Anxiety and cognitive learning outcomes were directly affected by having a strong auditory-verbal learning style (β = .21, p < .01) and (β = .27, p < .01), respectively. A hands-on learning style mildly influenced cognitive learning outcomes (-.17, p < .05). The standardized indirect effect between anxiety and cognitive learning outcomes was .08; indicating anxiety did not mediate cognitive learning outcomes as theorized. Dissonance was found between the quantitative and qualitative data. Students reported increased levels of anxiety, which negatively affected their learning.
A gap exists in the literature involving variables affecting learning outcomes in simulation experiences. Filling this gap in the literature is the strength of this study. This study advances nursing education science by providing evidence concerning variables affecting learning outcomes in high-fidelity HPS. Using a mixed methods design provided a complete representation of student perspectives concerning the qualities and context of human patient simulation affecting anxiety and learning.