February 12, 2024By Barbara Olander BSN, RN, RHIT

Overcoming Anxiety and Lack of Enthusiasm with 1st Level Clinical Simulation Students

First-level nursing students often experience high levels of anxiety and a lack of enthusiasm when entering a live simulation environment for the first time. While heightened emotions can be beneficial to comprehensive learning, excess anxiety and a lack of enthusiasm can be detrimental to first-level nursing students. Simulation coordinators and nursing instructors acknowledge the value of simulation lab time in meeting student learning outcomes. Simulation coordinators and nursing instructors must utilize resourceful measures to decrease anxiety and increase eagerness for first-level nursing students to promote a positive and inquisitive attitude toward the simulation experience. This HealthySimulation article by Barbara Olander, BSN, RN, RHIT, aims to identify measures to improve the simulation experience for first-level nursing students.

Student Orientation Lays The Groundwork

The simulation coordinator or nursing instructor may provide first-level nursing students with an in-person verbal orientation using a slide presentation to guide the process. The in-person orientation introduces students to the simulation lab and reviews policies and rules. Students are then introduced to the low- or high-fidelity simulator and the availability of equipment to convert the lab environment into a healthcare setting. This orientation and introduction to the simulation lab allows for a complete explanation and demonstration of the simulator’s functionality and an opportunity for the students to interact with the simulator and ask questions to clarify any concerns.

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Another option is to create an online orientation video. Video topics may include an introduction to the simulation lab and simulation team and an introduction to the components of the simulation lab, such as the actual low- or high-fidelity simulators. The mechanical physiology of the simulator should be discussed so that students can learn what to expect and what not to expect. Another important aspect to discuss in the video is the environmental equipment used in clinical simulation.

The video should include the general rules of the simulation lab and the expected simulation process. The online orientation video ends with a required quiz upon completion. Students are not allowed to complete the quiz unless they complete each online orientation component. If students do not meet this requirement, they are not allowed to attend their scheduled simulation lab.

Circular Approach to Skills Development

The QSEN CAROUSEL approach can be used with any concept or skill. These activities allow students to practice on their own and with peers. The term CAROUSEL is used as an acronym to identify and translate the QSEN focus of each station:

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  • C- commitment to safe practice,
  • A- achieving an A in practice by considering knowledge, skills, and professional nursing values, asking and evaluating care within systems;
  • R- role play, simulation, and activities;
  • O- consideration of others and patient-centered care;
  • U- and S- taking care of yourself so that you can be an effective team member;
  • E- finding evidence-based practice using technology and
  • L- legal and ethical implications for documentation using technology.

In a full-day session nursing students begin at different “letters” and rotate through the lab. At each station, a nursing instructor or simulation coordinator guides each student through the station, providing brief feedback that they will bring to the end-of-the day group discussion. Formal evaluation surveys or informal feedback from students provides useful information to determine whether learning outcomes have been met.

Develop a ‘Can Do’ Attitude to Keep Things Positive

Resourcefulness involves the ability to problem solve based upon previous learning experiences and technical skills. First-level nursing students should proactively perform appropriate skills and demonstrate the capability to resolve issues according to their learning objectives. However, a nursing student with any previous exposure to healthcare simulation would have knowledge of how to interact with a low- or high-fidelity simulator. The simulation coordinator and nursing instructor must demonstrate a strong desire for teamwork and respond to nursing students in a calm manner when things go wrong in the simulation lab. During these problematic situations, the simulation coordinator, nursing instructor, and the nursing student demonstrate certain characteristics of a ‘can do’ attitude. These characteristics include:

  • A willingness to learn
  • Being open-minded
  • Self-motivated
  • Positivity
  • Continuous improvement
  • Takes initiative
  • Inquisitive

Communication between all participants must be mutually respectful and professional. The simulation coordinator and nursing instructor should utilize constructive feedback and offer opportunities for the students to gain additional practice, either with a faculty member or other nursing students. Share with the nursing students that continued practice will promote confidence and help them develop fundamental skills, critical thinking, and communication skills.

View the LEARN CE/CME Platform Webinar STRESSED! Capturing Stress and Anxiety in Healthcare Simulation for Outcomes Improvement to learn more!

Simulation Camp or Bootcamp

Nurse instructors and the simulation coordinator should collaborate and decide whether it is best to have a week-long summer camp, after-school sessions during the fall or spring semester, or weekend sessions. Distribute printed and online flyers that announce information about an upcoming Simulation Camp – post general information on the college’s social media website. Provide application forms for lower-level nursing students interested in participating in the simulation camp.

Seek out nurse instructors and upper-level students to serve as camp coordinators and mentors and to help in the recruitment process. The simulation coordinator, nurse instructors, and upper-level students should develop fun activities to build enthusiasm and participation in the simulation camp. Upper-level students can enthusiastically describe their first-year simulation experiences and highlight the diversity of the simulation lab experiences. Before the simulation camp begins, arrange for upcoming camp participants to pick up material for the camp, such as a schedule of activities, guidelines for lab simulation activities, and additional required materials. Offer simulation camp participants tangible rewards, such as gift cards from the college campus bookstore, to celebrate their participation in and completion of the program.

Anxiety and a lack of enthusiasm are common and expected from first-level nursing students. This recognized and accepted knowledge helps the simulation coordinator and nursing instructors provide constructive simulation planning and positive simulation learning opportunities to improve simulation experiences for first-level nursing students. The effective use of positive attitudes, orientations, Sim camps, and the QSEN CAROUSEL can benefit nursing students throughout a nursing program.

Learn More About Creating Psychology Safety in Clinical Simulation!


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