Introduction

Simulation is a promising strategy in health education, with evidence of importance for learning, but the available systematic reviews are still inconclusive about the effect of the strategy on stress, anxiety, and self-confidence of nursing students, which impact the adherence to and sustainment of this strategy. Thus, better evidence is needed of the impact of simulation on these competences, essential for health professional education.

Objective

To evaluate the effect of simulation-based experiences on stress, anxiety, self-confidence and learning of undergraduate nursing students compared to conventional teaching strategies or no intervention.

Design

Systematic review with meta-analysis and meta-regression.

Data sources

The databases used included: CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, SCOPUS and Web of Science. Additional searches occurred in PQDT Open (ProQuest), BDTD, Google Scholar and journals with a specific scope in clinical simulation.

Review methods

This study was conducted by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Experimental and quasi-experimental studies that compared the effects of simulation on stress, anxiety, and self-confidence of nursing students were included. Study selection and data extraction steps were performed independently by two reviewers. Critical appraisal of the studies was managed by means of the risk of bias tools RoB 2 and ROBINS-I, and quality of evidence by means of the GRADE tool. Data summarization was performed by qualitative synthesis with descriptive analysis and quantitative synthesis by meta-analytic methods and meta-regression.

Results

Sixty-two studies were included covering an overall sample of 4570 undergraduate nursing students. When comparing simulation with other teaching strategies, simulation showed small effect size for anxiety (d = − 0.33; 95% CI: − 0.66–0.002; p = 0.051) and medium effect size for self-confidence (d = 0.71; 95% CI: 0.46–0.95; p < 0.001); there was no difference in the effect-size for stress (d = 0.04; 95% CI:-0.91–0.99; p = 0.90). Subgroup analyses showed an effect of methodological characteristics of the studies on students' anxiety and self-confidence. A positive relationship between self-confidence and learning was identified by meta-regression (p = 0.018; R² = 20.96%).

Conclusion

Simulation is an effective strategy for reducing anxiety and increasing self-confidence compared to conventional teaching strategies. Results are still inconclusive for stress. The use of simulation-based experiences in nursing education obtains positive results on anxiety and self-confidence in students, providing support for its implementation in undergraduate curricula to improve the education of qualified nurses.

Registration number

CRD42020206077.

Tweetable abstract

Simulation is an effective teaching strategy for reducing anxiety and increasing self-confidence in learning.

中文翻译：

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模拟对护生压力、焦虑和自信的影响：荟萃分析和荟萃回归的系统评价

介绍

模拟在健康教育中是一种很有前途的策略，有证据表明它对学习很重要，但现有的系统评价对于该策略对护理学生的压力、焦虑和自信的影响仍然没有定论，这会影响坚持和维持这个策略的。因此，需要更好的证据来证明模拟对这些能力的影响，这对于卫生专业教育至关重要。

客观的

与传统教学策略或无干预相比，评估基于模拟的体验对本科护生的压力、焦虑、自信和学习的影响。

设计

采用荟萃分析和荟萃回归进行系统评价。

数据源

使用的数据库包括：CENTRAL、CINAHL、Embase®、ERIC、LILACS、MEDLINE、PsycINFO®、SCOPUS 和 Web of Science。在 PQDT Open (ProQuest)、BDTD、Google Scholar 和具有特定临床模拟范围的期刊中进行了其他搜索。

审查方法

本研究是根据 Cochrane Handbook for Systematic Reviews of Interventions 的建议进行的。包括比较模拟对护理学生压力、焦虑和自信的影响的实验和准实验研究。研究选择和数据提取步骤由两名评审员独立执行。通过偏倚风险工具 RoB 2 和 ROBINS-I 对研究进行严格评估，并通过 GRADE 工具对证据质量进行管理。通过描述性分析的定性综合和元分析方法和元回归的定量综合进行数据汇总。

结果

包括 62 项研究，涵盖 4570 名本科护理专业学生的总体样本。在将模拟与其他教学策略进行比较时，模拟显示焦虑的效果较小（d = -  0.33；95% CI：-  0.66–0.002；p = 0.051），而自信的效果中等（d = 0.71；95% CI : 0.46–0.95; p < 0.001); 压力的影响大小没有差异（d = 0.04；95% CI：-0.91–0.99；p = 0.90）。亚组分析显示研究的方法学特征对学生的焦虑和自信有影响。元回归确定了自信与学习之间的正相关关系（p = 0.018；R ²  = 20.96%）。

结论

与传统的教学策略相比，模拟是减少焦虑和增加自信的有效策略。压力的结果仍然没有定论。模拟体验在护理教育中的应用在提高学生的焦虑和自信心方面取得了积极的效果，为其在本科课程中的实施提供了支持，以提高合格护士的教育水平。

注册号码

CRD42020206077。

可推文摘要

模拟是减少焦虑和增加学习自信心的有效教学策略。