Influence of simulation design on stress, anxiety and self‐confidence of nursing students: Systematic review with meta‐analysis

Abstract

AimTo evaluate the simulation design characteristics that may influence the stress, anxiety and self‐confidence of undergraduate nursing students during learning.DesignSystematic review with meta‐analysis.Data SourcesSearchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation.Review MethodsThis review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi‐experimental studies that compared the effect of simulation on stress, anxiety and self‐confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta‐analytical methods.ResultsEighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta‐analysis, the presence of prebriefing, duration of more than 60 min and high‐fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high‐fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self‐confidence.ConclusionsDifferent modulations of simulation design components imply reduction of anxiety and increased self‐confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions.Relevance to Clinical PracticeThese findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice.No Patient or Public Contribution.

Interventions for psychiatric disorders among university students: An umbrella review of systematic reviews and meta-analyses

“… First-author, year No. of participants Intervention Comparison Mental disorders Outcomes Effect metrics Overall Rating Gong et al., 2023 ( Gong et al., 2023 ) 447/461 MBCT Inactive (waitlist) Depression, anxiety, stress Depression, anxiety, stress SMD Moderate Oliveira Silva et al., 2023 ( Oliveira Silva et al., 2023 ) 609/574 Simulation; compared conventional educational strategies with simulation Conventional educational interventions Stress, anxiety Stress, anxiety SMD High Chandler et al., 2022 ( Chandler et al., 2022 ) 6558/6356 CBT-I-based interventions Waitlist or treatment as usual (passive) Alternative intervention (active) Sleep disturbance, anxiety, depression Sleep, anxiety, depression SMD Low Du et al., 2022 ( Du et al., 2022 ) 369/332 Taijiquan intervention Regular physical activity group Depression, anxiety Depression, anxiety SMD Low Huber et al., 2022 ( Huber et al., 2022 ) 320/312 Active intervention Active animal control Active other control No-treatment control Acute anxiety, acute self-perceived stress, negative affect Acute anxiety, acute self-perceived stress, negative affect SMD High Lin et al., 2022 ( Lin et al., 2022 ) 712/714 Qigong exercise Original sports exercise practices, relaxation training or maintaining the original lifestyle without any intervention Depression, anxiety, mood Depression, ...…”

“…Of the 19 included systematic reviews, 26 % ( n = 5) ( Bolinski et al., 2020 ; Huber et al., 2022 ; Lin et al., 2022 ; Luo, Zhang, Liu, Ma & Jennings, 2022 ; Oliveira Silva et al., 2023 ) studies were rated as “high”, 26 % ( n = 5) ( Gong et al., 2023 ) ( Yang, Guo, Cheng & Zhang, 2022 ) ( Harrer et al., 2019 ; Huntley et al., 2019 ; Ma, Zhang & Cui, 2019 ) as “moderate”, 37 % ( n = 7) ( Chandler et al., 2022 ; Du et al., 2022 ) ( Chen et al., 2021 ; Lo et al., 2018 ; Luan et al., 2022 ) ( Huang, Nigatu, Smail-Crevier, Zhang & Wang, 2018 ; Song, Liu, Huang, Wu & Tao, 2021 ) as “low” and 11 % ( n = 2) ( Regehr, Glancy & Pitts, 2013 ; Zhang, Li & Wang, 2022 ) as “critically low” quality with the AMSTAR2 scoring system. Supplementary Table 1 presented the details of the quality of each included study evaluated using the AMSTAR2 tool.…”

“…A meta-analysis achieved suggestive strength of evidence suggesting that mood and anxiety intervention (MAI) had positive effects on anxiety (Hedges'g = −0.198, 95 % CI: −0.302, −0.094, P-random effects<0.01). Furthermore, 11 meta-analyses were supported by weak evidence, which suggested other interventions like simulation (SMD: −0.415, P-random effects: 0.86) ( Oliveira Silva et al., 2023 ), present control intervention (Hedges'g: 0.417, P-random effects:<0.01) ( Harrer et al., 2019 ), acceptance, commitment training (SMD: −0.552, P-random effects:<0.01) ( Chen et al., 2021 ) and attention/perception modification (SMD: −0.530 to −0.494, P-random effects: 0.01) ( Huang et al., 2018 ) could have effects on university students with mental health problems including depression, anxiety and stress.…”

Rigorous simulation design grounded in best practice reduces learner anxiety

“…The systematic review was conducted to answer the PICO (Population, Intervention, Comparison and Outcome) shaped research question ‘What is the impact of the characteristics of simulation design on stress, anxiety and self-confidence of undergraduate nursing students compared with another or no educational intervention?’ 2. The review was done using recommendations from the Cochrane Handbook for Systematic Review of Interventions and recorded using the PRISMA (Peferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.…”

“…Facilitators of SBL use a variety of strategies to enhance the learning experience, many of which are intended to decrease learner’s anxiety. This systematic review with meta analysis by Oliveira Silva et al 2 analysed different components of simulation design that can have an impact on learner stress, anxiety and self-confidence. These components included prebriefing, length of the simulation session, debriefing, type of simulator, fidelity and modality 2…”