Effects of community volunteer children on Student Pediatric Assessment Behaviors

Background: According to undergraduate nursing students, clinical experiences produce a high degree of stress and anxiety, especially when those experiences involve children. Simulation has been shown to teach assessment skills, and allow experiential and active learning resulting in an increase in the level of a student's comfort with performance of these skills. However, even with the practice of simulation, only a small number of students report feeling comfortable with assessment. Other experiential opportunities involving standardized patients have been widely used with adult populations; however, there is very little literature describing the use of children as standardized patients. One study with nursing assessment students found that students reported more self-efficacy with community volunteers than high-fidelity simulators. The purpose of this study was to examine the impact of using community volunteer children on physical assessment abilities and comfort levels among undergraduate pediatric nursing students.

Methods: Students were administered the Pediatric Student Comfort and Worry Assessment Tool at the beginning of the semester and following intervention. After a didactic class, students were randomly assigned to two groups. One group practiced assessment on high-fidelity simulators programmed to provide verbal feedback to allow for interaction. The second group practiced assessment on community volunteer children. Students were self-evaluated and faculty-evaluated completing a pediatric assessment using the Effective Noticing and Responding domains of the Lasater Clinical Judgment Rubric.

Results: Overall, students had similar worry and comfort scores regardless of group; additionally, assessment performances were similar. However, students in both groups significantly rated their observations higher than faculty members.

Conclusions: The use of simulation to practice pediatric assessment prior to exposure in the clinical setting is beneficial in reducing student anxiety and stress; however, there may be no difference between practicing assessment on high-fidelity manikins versus community volunteer children. Although one modality did not seem to affect student stress and anxiety over another modality, student satisfaction was positively influenced by working with community volunteers.