Effects of a Simulation-Based Learning Program on Nursing Students’ Knowledge, Self-confidence, and Clinical Performance in Caring for Pregnant Women with Complications

Abstract

Introduction Caring for pregnant women experiencing complications including preterm labor, gestational hypertension, gestational diabetes, fetal distress, umbilical cord prolapse, retained placenta, shoulder dystocia, and postpartum hemorrhage is a significant challenge for nursing students. Clinical practice in labor rooms remains limited due to students’ stress, anxiety, limited knowledge and skills, and a declining number of childbirth cases. Simulation-based learning, grounded in Kolb’s experiential learning cycle theory, has been adopted to prepare nursing students by enhancing their knowledge, self-confidence, and clinical performance in managing obstetric complications. However, no studies comparing the effectiveness of such programs between students who engage in immediate clinical practice following simulation-based training and those who begin clinical practice one month after completing the program.

Objectives This study aimed to: 1) compare the mean knowledge in nursing care of pregnant women with complications before and after participating in the program between the experimental and comparison groups, 2) compare the mean confidence in providing nursing care for pregnant women with complications before and after participating in the program between the experimental and comparison groups, and 3) compare the mean knowledge, self-confidence, and clinical performance in nursing care of pregnant women with complications between the experimental group, who practiced immediately after the program, and the comparison group, who practiced one month after participating in the program

Design This study is quasi-experimental research with a two-group, pretest-posttest design.

Methodology The participants consisted of 120 fourth-year nursing students enrolled in Maternal–Newborn Nursing and Midwifery II at the Faculty of Nursing in a University. Participants were randomly selected and then assigned into two groups via matching on Grade Point Average and gender, and then randomly assigned the 2 groups into experimental and comparison groups. All participants underwent a simulation-based learning program. The experimental group proceeded to clinical practice in the labor room immediately after the program, while the comparison group began clinical practice one month later. The study duration was three months. Research instruments included a simulation-based learning program and a five-part questionnaire: 1) demographic data, 2) knowledge in caring for pregnant women with complications, 3) self-confidence in caring for pregnant women with complications, 4) clinical performance in caring for pregnant women with complications, and 5) structured interview guidelines. Content validity was assessed by three experts, yielding a scale content validity index of .80 for the program, .89 for knowledge, .80 for self-confidence, and .95 for clinical performance scales. Reliability testing was conducted in 30 nursing students who were not study participants, revealing Cronbach’s alpha coefficients of .93 for self-confidence and .94 for clinical performance. Reliability of the knowledge scale was assessed using KR-20, yielding a coefficient of .72. Data were analyzed using descriptive statistics, Fisher’s exact test, Independent t-test, and Paired t-test, with a significance level set at .05.

Results The mean age of participants in the experimental group was 22.25 years (SD = 2.03), while that of the comparison group was 22.27 years (SD = 1.61). There were no significant differences between the two groups in terms of gender, age, grade point average, monthly expenses, or underlying health conditions (p = 1.000, .960, .902, .419, 1.000, respectively). Before participating in the program, the mean knowledge of the experimental group (M = 19.450, SD = 4.086) and the comparison group (M = 19.567, SD = 4.634) did not differ significantly (p = .884). Similarly, self-confidence in caring for pregnant women with complications was not significantly different between the experimental group (M = 3.638, SD = 0.448) and the comparison group (M = 3.672, SD = 0.448) (p = .684). After participating in the program, both groups demonstrated significantly higher in knowledge and self-confidence. The experimental group showed increased knowledge (M = 30.950, SD = 4.869) and confidence (M = 4.248, SD = 0.459) (p < .001), as did the comparison group, with higher knowledge (M = 32.300, SD = 3.514) and self-confidence (M = 4.160, SD = 0.509) (p < .001). However, no statistically significant differences were found between the two groups in terms of knowledge and self-confidence after the program (p = .084, .329). When comparing clinical performance in caring for pregnant women with complications, the experimental group demonstrated significantly higher performance (M = 3.513, SD = 0.359) than the comparison group (M = 3.080, SD = 0.510) (p < .001).

Recommendation The simulation- based program designed to enhance nursing students’ readiness for caring for pregnant women with complications through simulated scenarios is effective in improving their knowledge, self-confidence, and clinical performance. Immediate clinical placement following completion of the program contributed to favorable outcomes in clinical performance.