First Advisor

Candyce Reynolds

Date of Publication

Spring 6-3-2013

Document Type


Degree Name

Doctor of Education (Ed.D.) in Educational Leadership: Postsecondary Education


Educational Leadership and Policy




Nursing -- Study and teaching -- Simulation methods, Nursing students -- Psychology, Nursing students -- Mental health



Physical Description

1 online resource (vii, 176 pages)


The use of simulation as a clinical learning activity is growing in nursing programs across the country. Using simulation, educators can provide students with a realistic patient situation using mannequins or actors as patients in a simulated environment. Students can practice multiple aspects of patient care without the risk of making mistakes with real patients, and faculty can reinforce course objectives and evaluate student learning. Because of the technology, the environment, and the methods by which simulation is implemented, it may cause anxiety in learners, which may interfere with the learning process. Anxious students may miss an opportunity for learning valuable aspects of nursing care that are reinforced in simulation.

This paper will describe a study of the student perspective on simulation, particularly related to the anxiety experienced by many learners. Nursing students in a baccalaureate program who participate in simulation in their clinical courses were recruited for the study, which consisted of a survey and a focus group. Participants were asked to rate nineteen aspects of simulation in regards to the feelings they elicit, from confidence to anxiety. The survey, completed by 73 of the 178 eligible participants, also included open-ended questions in which students could elaborate on their responses. A focus group was held after the survey, during which nine volunteer participants were asked further questions about their feelings and reactions in simulation, specifically as related to their effect on learning. During a facilitated discussion, they also offered suggestions for interventions that they believed would decrease their anxiety and improve the learning environment in simulation.

After an analysis of the data, a "comfort-stretch-panic" model (Palethorpe & Wilson, 2011) emerged as a useful framework for understanding the student perspective. Students in the "stretch" zone, in which they perceived a manageable amount of stress, were motivated to perform and experienced optimal learning from the simulation session. The student suggestions for interventions which would aid their learning may be useful for transitioning them into the "stretch" zone, and should be considered as potential tools in simulation practice.


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