Effect of simulation on the ability of first year nursing students to learn vital signs

    Effect of simulation on the ability of first year nursing students to learn vital signs Evrim Eyikara, Zehra G¨oc¸men Baykara PII: DOI: Reference:

S0260-6917(17)30234-4 doi:10.1016/j.nedt.2017.09.023 YNEDT 3634

To appear in:

Nurse Education Today

Received date: Revised date: Accepted date:

26 September 2016 13 September 2017 28 September 2017

Please cite this article as: Eyikara, Evrim, Baykara, Zehra G¨o¸cmen, Effect of simulation on the ability of first year nursing students to learn vital signs, Nurse Education Today (2017), doi:10.1016/j.nedt.2017.09.023

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The title of the paper: Effect of Simulation on the Ability of First Year Nursing Students to

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Learn Vital Signs

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Author names: Evrim Eyikara, Zehra Göçmen Baykara

Author’s affiliation:

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First author:

Evrim Eyikara, MsN, RN, Research Assistant, Research Assistant, Gazi University Faculty of Health Science Department of Nursing, Fundamentals of Nursing, Ankara.

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e-mail: [email protected] Telephone: +905435061405

Second author:

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Zehra Gocmen Baykara, RN, PhD, Instructor, Gazi University Faculty of Health Science

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Department of Nursing, Fundamentals of Nursing, Ankara.

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e-mail: [email protected] Telephone: +905056801421

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Correspondence author’s address: Evrim Eyikara, Research Assistant, Gazi University Faculty of Health Science Department of Nursing Ankara, Turkey E-mail: [email protected]

Keywords: nursing education, simulation, teaching method, vital signs

Acknowledgements We would like to thank the all first year nursing students who participated in the study.

ACCEPTED MANUSCRIPT Abstract Background: The acquisition of cognitive, affective and psychomotor knowledge and skills

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are required in nursing, made possible via an interactive teaching method, such as simulation.

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Objective and design: This study conducted to identify the impact of simulation on first-year

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nursing students’ ability to learn vital signs.

Setting and participants: A convenience sample of 90 first-year nursing students enrolled at a University, Ankara, in 2014–2015.

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Method: Ninety students enrolled for lessons on the fundamentals of nursing were identified

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using a simple random sampling method. The students were taught vital signs theory via traditional methods. They were grouped into experimental 1, experimental 2 and control group, of 30 students each. Students in the experimental 1 group attended sessions on

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simulation and those in the experimental 2 group sessions on laboratory work, followed by simulation. The control group were taught via traditional methods and only attended the

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laboratory work sessions. The students’ cognitive knowledge acquisition was evaluated using a knowledge test before and after the lessons. The ability to measure vital signs in adults

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(healthy ones and patients) was evaluated using a skill control list. Results: A statistically significant difference was not observed between the groups in terms of the average pre-test scores on knowledge (p > 0.050). Groups exposed to simulation obtained statistically significantly higher scores than the control group in post-test knowledge (p < 0.050). The ability of the groups exposed to simulation to measure vital signs in healthy adults and patients was more successful than that the control group (p < 0.050). This was statistically significant. Conclusion: Simulation had a positive effect on the ability of nursing students to measure vital signs. Thus, simulation should be included in the mainstream curriculum in order to effectively impart nursing knowledge and skills.

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Keywords: nursing education, simulation, teaching method, vital signs

ACCEPTED MANUSCRIPT Introduction Nurses have to contend with rapid changes in technology and ways of managing

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complex illness in today’s dynamic healthcare environment. This requires the application of

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an innovative approach in education (Dil et al., 2012). Students learn 10% of what they read,

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20% of what they hear, 30% of what they see, and 90% of what they hear, touch and tell (Demirel, 2012, p.53). These rates support the use of interactive learning methods, including advances in technology and the promotion of learning by experience (Harder, 2009). In this

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respect, simulation is an effective teaching method that can be used to realise the main goals

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of nursing education (Eyikara and Baykara, 2017).

In the past, specific type of nursing practice were taught using simulation. Administering injections into an orange and suturing pieces of cloth are examples (Harder,

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2009; Ziv et al., 2003). However, in these practices with low fidelity, it is not exactly known how students feel and the response of the object in the position of the patient (Bradley, 2006).

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Simulation provides an opportunity to acquire experience by making mistakes without causing damage and learning from this in a safe environment. Thus, students can easily

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integrate their knowledge and apply it to real patients (Baillie and Curzio, 2009; Eyikara and Baykara, 2017; Lestander et al., 2016; Ricketts, 2011). “Vital signs” is an essential topic in nursing education, involving the acquisition of cognitive and psychomotor skills. It is commonly assumed that first-year students will easily learn how to measure vital signs (Gordon et al., 2013). However, to do so, it is necessary to acquire numerous physical examination skills, including inspection, palpation, and auscultation. Therefore, there is a high probability that students will take incorrect measurements initially (Wilford and Doyle, 2006). Generally, until students start clinical practices, they can only acquire experience by measuring vital signs in their student friends. Vital signs of healthy adults can generally be

ACCEPTED MANUSCRIPT measured more easily within normal range compared to patients (Karadağ et al., 2012). Thus, prior to working in clinic, the probability of students encountering abnormal vital signs is low.

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In addition, taking readings from fellow students will not fully correspond to the experiences

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they will have when taking measurements from patients. A more realistic learning

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environment can be created with the use of simulation. Simulation make possible for students to feel a pulse, observe chest movements, hear respiration sounds, measure blood pressure, and evaluate results, thus allowing students to practice with concrete examples of various

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conditions (Clark, 2007; Seybert and Barton, 2007). In addition, simulation allows students to

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make mistakes as they learn how to intervene (Ziv et al., 2003). This ensures that the students start their clinical practice having already taken measurements of vital signs in different kinds of cases. Via repeated practice during simulation, students get a chance to identify and correct

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their mistakes, and be more confident when providing patient care in clinical practice (Bradley, 2006). By providing a realistic environment, simulation allows students to improve

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their cognitive, affective and psychomotor skills and make fewer medical errors, thus contributing to the protection of patient rights.

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The related literature suggests that groups that work with simulation will more effective results. This research addresses nursing theory and skill development in Turkey. With it, we would like to compare the effects of traditional teaching methods (laboratory work) with simulation separately and with the two methods combined. In this context, this research will contribute to the literature.

Background Nursing is an integral discipline, requiring competency in cognitive and psychomotor skills (Elbaş et al., 2010; Tuzer, 2016). The positive contribution to the development of such

ACCEPTED MANUSCRIPT skills and facilitation of the ability to learn vital signs is provided by simulation, of which there are various examples in the literature.

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Clark (2007) stated that simulation mirrors the real-life scenario as pulses can be sensed,

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chest movements can be seen and respiration sounds can be heard. In a study by Seybert and

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Barton (2007), a significant improvement was seen in students’ knowledge and ability to accurately determine blood pressure following simulation (p < 0.050). Radhakrishnan et al. (2007) demonstrated that participation in clinical simulation improved students’ ability to

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assess and monitor basic vital signs in their study. Kaddoura (2010) demonstrated that simulation is especially effective in assessing vital signs and laboratory results and learning

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clinical skills. It was reported in a study by Karadağ et al. (2012) that the use of simulation as a teaching-learning method should continue.

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The ways in which cognitive and psychomotor skills are acquired, in conjunction with the measurement of vital signs in adults (healthy and patients) with measurement of

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knowledge scores have not been considered in any studies in the literature. Thus, the objective of this intervention study was to identify the effect of simulation on the ability of first year

this study:

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nursing students to learn how to measure vital signs. The following hypotheses were tested in

H1: There are differences between simulation and traditional method in acquisition of vital signs cognitive knowledge. H2: There are differences between simulation and traditional method in measurement of vital signs from healthy adults. H3: There are differences between simulation and traditional method in measurement of vital signs from patient adults.

ACCEPTED MANUSCRIPT METHOD

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Study design and participants

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An intervention design was used in this study. The study population comprised 257

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students enrolled for the first year at the Nursing Department, Faculty of Health Sciences, in a University, Ankara, Turkey, in the 2014–2015 academic year. Ninety students who were volunteer and achieved similar mid-term scores for the “Fundamentals of Nursing”

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examination were selected. One of the students received a number. A random sampling

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method by lottery assigned students to one of three groups: experimental 1, experimental 2, and the control group. No significant difference was observed in the average examination

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scores (p = 0.323). Each group comprised 30 students.

Ethical approval

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Permission to conduct the study was obtained from the Gazi University Clinical Research Ethics Committee (Number: 25901600/3456). Written permission was attained from

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the Gazi University Dean of the Faculty of Health Sciences and the Chief Physician of the Health Research and Application Centre at Gazi University. Students and patients were informed of the aims and methods of the study via the researchers and their verbal consents and written permission were acquired. Students and patients were informed that their personal informations would be used for research purposes only, remain confidential, and not be shared with anyone.

Measuring tools The study data were collected using a demographic information form, vital signs control list (VSCL) and vital signs knowledge test (VSKT). The VSCL and VSKT were developed by

ACCEPTED MANUSCRIPT the authors based on the literature (Kozier et al., 2000, p.497-529; Smith et al., 2004, p.234269; Smith, 2005, p.4-34). The VSCL and VSKT were evaluated by five academic members

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with specialist knowledge of the “Fundamentals of Nursing” and one academic member who

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had specialized in “Measurement Assessment and Turkish Language”. The necessary

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adjustments were made, depending on the specialist recommendations.

The demographic information form contained five questions on the sociodemographic characteristics of the students, such as age, gender.

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Their practical skills were assessed using the VSCL. The VSCL was prepared by the researcher according to the literature and comprised 35 items. Each item was scored

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according to responses of “true” (2 points), “wrong or missing” (1 point), and “not observed” (0 point). The VSCL contained two sub-control lists. “Implementation Steps for Measuring

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Pulse from the Radial Artery and Respiration” included 12 items (with a minimum potential score of 0 and a maximum score of 24). “Implementation Steps for Measuring Blood Pressure

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from the Brachial Artery” contained 23 items (with a minimum potential score of 0 and a maximum score of 46). VSCL contained steps for the students' psychomotor skills concerning

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the measurement of vital signs. It also contained guidelines for other practices such as hand hygiene, communication and recording. Theoretical knowledge was measured using a 20 item VSKT (with a minimum potential score of 0 and a maximum score of 100). The VSKT, prepared by the researcher according to the literature, comprised questions on the pulse (six questions), respiration (five questions), and blood pressure (seven questions). To evaluate the feasibility of the VSCL, 20 second-year nursing students measured one another’s vital signs. The students were observed concurrently by three observers. The observers marked each student’s VSCL. Positive and above-average compatibility was determined in the pulse-respiration control list and positive and high-level compatibility in the

ACCEPTED MANUSCRIPT blood pressure control list. Agreement was attained on items which were determined to have a low association. An approved preliminary investigation, using the VSKT, was made with

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respect to 100 second-year nursing students. It was determined that the VSKT had medium

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strength based on the preliminary investigation results.

Implementation of the study

Vital signs were taught to students by the researcher using lecturing methods via a

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PowerPoint® presentation and videos. After the theoretical presentation, the students were

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applied VSKT (pre test). Thereafter, the researcher made demonstration of vital signs in a healthy individual. Following the delivery of the theoretical presentation and demonstration, the students were placed into three groups as experimental 1, experimental 2 and control

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groups.

Students in the experimental 1 and 2 groups were exposed to SimMan®, an advanced

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patient simulator. After ensuring the adaptation of the students with the simulator and the environment, experimental 1 group (n = 30) attended the simulation session. Experimental 1

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group worked with researcher on SimMan® to measure vital signs. Each student measured the pulse rate, respiration rate and blood pressure of the simulator under observation. Experimental 2 group (n = 30) attended both the laboratory work and then simulation session. The simulation sessions for the experimental groups lasted for four class hours. Temperature and pain scores cannot be measured using the simulator and thus were excluded from the study. After the simulation, the experimental 1 and experimental 2 groups participated to debriefing. Students shared their opinions of the simulation and their own performance. The control group (n = 30) continued to learn via the traditional teaching methods and only attended sessions on laboratory work. Students in the control group measured one

ACCEPTED MANUSCRIPT another’s vital signs under observation. Students in the control group were provided feedback regarding to their performance after laboratory work.

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On completion of the practical exercises, the students measured the vital signs in

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healthy adults, followed by those in adult patients at the clinic two weeks’ later. Observers

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were assigned an equal number of students from each group, selected using a simple random sampling method. The observers were not told from which group the students came. The observers took their own measurements of the subjects’ pulse rate, respiration rate, and blood

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pressure using a dual head stethoscope. The students’ measurements evaluated using the

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VSCL in both healthy and patient adults. On completion of taking the relevant measurements for the healthy adult, the students took the VSKT (post test). An overview of the steps taken

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in the study is provided (Figure 1).

Data analysis

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The data were analyzed using Statistical Package for Social Science ® version 15. A pvalue of 0.050 was considered to represent statistical significance. The t-test was used for

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unrelated and related measurements for the normally distributed variables. The Mann Whitney-U and Wilcoxon signed-rank tests were employed for variables that were not normally distributed in a comparison of two groups for the purposes of problem analysis. One-way analysis of variance was used for the data analysis. The t-test and Kruskall-Wallis test were used to calculate related measurements in a pre- and post-test comparison.

ACCEPTED MANUSCRIPT RESULTS

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See Table 1

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92.22% of the students were female, with an average age of 18.50 ± 0.79 years. 83.33%

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of the students were content to be nursing students, 81.11% reported that they voluntarily chose nursing as a profession, and 63.33% that they regarded nursing as their ideal profession. A statistically significant difference between the characteristics of the groups was not

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apparent (p > 0.050) (Table 1).

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See Table 2

A pre- and post-test (VSKT) comparison was made between the groups. No significant difference was observed in the average pulse rate, respiration rate, blood pressure and total

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scores of pre-test VSKT between the groups (p > 0.050). However, the average pulse rate, respiration rate, blood pressure, total scores of post-test VSKT in the experimental 1 and

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experimental 2 groups were statistically significantly higher than the control group (p < 0.050). Moreover, no significant difference was observed in the average pulse rate, respiration

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rate, blood pressure and total scores of post-test VSKT between the experimental 1 and experimental 2 groups (p > 0.050) (Table 2). A pre- and post-test comparison was made of the measurements taken for the groups. A significant difference was not observed with regard to the average pulse rate, respiration rate, blood pressure and total pre- and post- test VSKT scores for the control group (p > 0.050). However, the average pulse rate, respiration rate, blood pressure, and total post-test scores of VSKT for the experimental 1 and experimental 2 groups were statistically significantly higher than average pre-test scores (p < 0.050) (Table 2). See Table 3

ACCEPTED MANUSCRIPT The average scores obtained by the groups for the VSCL were compared. The average pulse-respiration rate, blood pressure, and total VSCL scores for the experimental 1 and 2

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groups were statistically significantly higher than those for the control group, for both the

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healthy adults and patients (p = 0.000). No significant difference was observed in the average

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pulse-respiration rate and total VSCL scores between the experimental 1 and experimental 2 groups, for both the healthy adults and patients (p > 0.050). However, blood pressure VSCL scores for the experimental 2 group was statistically significantly higher than those for the

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experimental 1 group, for healthy adults (p < 0.050) (Table 3).

DISCUSSION

The present study was carried out on 90 first-year nursing students and investigated the

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effect of simulation when teaching vital signs to students. The simulation method resulted in gains in knowledge and skills with regard to how to measure vital signs.

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In our study, the average post-test (VSKT) scores of the experimental groups were significantly higher than those for the control group (p < 0.050). Moreover, the experimental

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groups made significant progress in post-test scores compared to the pre-test scores (p < 0.050) (Table 2). Our results are consistent with the results of other studies. For example, in the study by Seybert and Barton (2007), students were given a written examination prior and after the course to assess their knowledge of blood pressure assessment. The knowledge level of students with regard to measuring blood pressure improved following the simulation (p < 0.050). Brannan et al. (2008) conducted assesments in various scenarios, one of which was vital signs. In the study, simulation group scored significantly higher knowledge test scores than did students who received the traditional lecture teaching method. Tokunaga et al. (2010) conducted assessments in various scenarios, one of which was monitoring vital signs. It was reported that the knowledge levels of the students about vital signs improved significantly

ACCEPTED MANUSCRIPT after being taught via simulation (p < 0.010). In the study by Tuzer et al. (2016), group 1 practiced on high fidelity simulation and group 2 practiced with standardized patient for the

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cardiac and respiratory scenarios. It was reported that, after simulation practices the students

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in both groups achieved similar test scores in the post-test (the scores in group 1 and group 2

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respectively; 72.79 ± 9.13, 73.80 ± 11.28). Similarly, in our research there was no significant difference was observed in the average scores of post-test VSKT between the experimental 1 and experimental 2 groups (p > 0.050) (Table 2). In our study, the students measured both

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normal and abnormal vital signs in the simulator numerous times, and had an opportunity to

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observe the symptoms associated with normal and abnormal vital signs. Simulation offers many benefits, including being able to identify mistakes, reinforce accurate information, enhance memorability, observe symptoms, and transfer knowledge into practice. It is believed

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that simulation improves the memorability of theoretical knowledge in students for these reasons. As can be seen in these studies, the knowledge levels of students of vital signs

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measurement improves in practice sessions involving simulation. In our study, ability of the experimental groups who worked with simulation to measure

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vital signs in healthy adults was greater than that of the control group (p < 0.050) (Table 3). Simulation offers clinical condition and vital signs measurement that the students can feel, hear and see, which is important for the development of psychomotor skills. Our findings are consistent with those reported in other studies. For example, in a study by Radhakrishnan et al. (2007), the intervention group participated in simulation exercises and sessions on clinical requirements. The control group completed the sessions on clinical requirements, but did not receive any simulation training. As a result, the intervention group obtained significantly higher scores than the control group in assessing vital signs (p = 0.009). The experimental group in the study by Karadağ et al. (2012) measured vital signs in simulation, while students in the control group took measurements in one another. It was determined that the

ACCEPTED MANUSCRIPT experimental group heard blood pressure and respiration sounds statistically significantly better than the control group (p < 0.050). In a study by Ballard et al. (2012), the experimental

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group worked one hour longer in simulation than the control group. The experimental group

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obtained statistically significantly more accurate results with regard to systolic blood pressure

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measurements (p = 0.017). The translation of basic knowledge into practice remains a primary concern in nursing education today. Simulation, facilitates the integration of cognitive information into practice, by allowing implementation in a real-like environment (Brien et al.,

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2017; Cato, 2012, p.5; Kaddoura, 2010). This develops psychomotor skills. As the

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measurement of blood pressure, in particular, is complex skill, the students may fail to develop this skill sufficiently if they practice only on one another. Therefore, we expected to

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in the measurement of vital signs.

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find that the experimental groups using the simulator and real patients would have better skills

In our study, the ability by the experimental groups who worked with simulation to

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measure adult patients’ vital signs was greater than the control group (p < 0.050) (Table 3). In a study by Donoghue et al. (2010), the group worked with high-fidelity simulation in various

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scenarios. The group reported that the practices were similar to those encountered in a patient environment because the movement of the chest wall and cyanosis could be seen, the pulse could be sensed and respiration sounds could be heard. The intervention group in the study by Gordon et al. (2013) worked in simulation for two hours longer than the control group. The students measured blood pressure in healthy adults and then in patients. The intervention group reported on its self-rated technical ability to take blood pressure measurements correctly the first time (p = 0.010). However, this difference wasn’t observed between the groups on completion of the clinical practice (p > 0.050). In the study by Tuzer et al. (2016), group 1 practiced on high fidelity simulation and group 2 practiced with standardized patient for the cardiac and respiratory scenarios. It was reported that, the skill scores significantly

ACCEPTED MANUSCRIPT higher compared to those obtained in the post simulation performance skill scores in both techniques (p < 0.001). And also the students in both groups achieved similar performance

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skill scores in the real patient assesment. In our research, experimental groups had similar

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levels of success when working with adult patients (Table 3). However, experimental group 2

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performed better than experimental group 1 in the measurement of the blood pressure of healthy individuals. These findings show that combined use of different teaching methods would be more effective in teaching complex skills. Use of simulation together with other

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teaching methods, in particular, is very important in terms of basic skills that are difficult to

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teach.

During simulation, students also learn about the importance of basic skills such as communicating with patients, providing information and protecting privacy. In our research,

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the experimental groups were thus able to repeat their successful performance in simulation when they worked with patients, as well. Although vital signs is a practical topic that is often

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one of the first to be taught to students, it takes a long time for accurate measuring skills to be acquired (Shepherd et al., 2010). It is also a critical skill to learn as it constitutes the first

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practical clinical experience by students when they touch a patient for the first time. The fact that students are able to experience both normal and abnormal vital signs, and monitor them on a screen during simulation makes them feel as if they are in a clinic environment (Clark, 2007; Gordon et al., 2013). Skill enhancement (in this case, being able to accurately measure a patient’s vital signs) in the experimental groups was a concrete indicator in our study that simulation helped students to familiarise themselves with patients and the clinical environment. The findings of our study support the use of simulators in preparation for a reallife clinical experience.

ACCEPTED MANUSCRIPT Limitations of the Study Several limitations are noted. The participants in the study were first-year nursing

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students, all from the same university. The study examined students’ vital signs skills only in

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context of the measurement of pulse rate, respiration and blood pressure. Another limitation

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of the study is that there was a two week gap between students’ measurement of vital signs in healthy and patients.

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CONCLUSION

A significant improvement in the knowledge and psychomotor skills needed to measure vital signs was demonstrated by the test scores of nursing students in this study following

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their experience with simulation. It is especially difficult to develop the necessary skills in today’s nursing environment in which an excessive number of students and a shortage of

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clinical opportunities feature. On the other hand, high levels of knowledge and skills are expected in the nursing profession and qualified nurses are increasingly sought. In this

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respect, the integration of an interactive learning method, such as simulation in a nursing programme, is important as it results in the development of more qualified, skilled members of the nursing profession. Simulation is believed to be an important alternative to traditional teaching methods, offering a safe learning environment and facilitating transition into clinic practice. Thus, hypotheses H1, H2 and H3 were accepted (Table 2, Table 3). Based on these results, it is recommended that simulation should be included in the current nursing education curriculum with respect to teaching vital signs and mainstream simulation.

ACCEPTED MANUSCRIPT Funding This research did not receive any specific grant from funding agencies in the public,

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commercial, or not-for-profit sectors.

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ACCEPTED MANUSCRIPT Figure 1. The research steps

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Theoretical Lesson

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Demonstration

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VSKT (Pre Test)

EXPERIMENTAL 1

EXPERIMENTAL 2

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CONTROL

Simulation

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Laboratory Work

1 Week

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2

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VSCL (Healthy Adults) + VSKT (Post Test)

2 Weeks VSCL (Patient Adults)

Laboratory Work

+ Simulation

ACCEPTED MANUSCRIPT

Table 1 Student characteristics Experimental 1 Experimental 2 n

%

28

93.30

28

93.30

%

n

%

90.00

83

92.22

US

2

6.70

3

10.00

7

7.77

27

TE D

90.00

25

83.30

75

83.33

23.30

3

10.00

5

16.60

15

16.66

26

86.70

23

76.70

73

81.11

6.70

Content

23

76.70

Discontent

7

24

Contentment with being a nurse

AC

Conditions for choosing nursing as a profession

80.00

MA N

27

2

Involunatry

n

CE P

Male

Voluntary

IP

%

P

CR

n Gender Female

Total

T

Control Characteristics

0.856

0.383

0.602

6

20.00

4

13.30

7

23.30

17

18.88

17

56.70

21

70.00

19

63.30

57

63.33

Reasons for choosing nursing as profession Ideal profession

0.563 Concerns about employment and family 13 pressure

43.30

9

30.00

11

36.70

33

36.66

ACCEPTED MANUSCRIPT

̅ X = 18.60 ±

̅ X = 18.46 ±

̅ X = 18.50 ±

0.72

0.96

0.68

0.79

CE P

TE D

MA N

US

CR

IP

T

̅ X = 18.43 ±

AC

Age (Vyears)

0.800

ACCEPTED MANUSCRIPT Table 2 Vital signs knowledge pre- and post-test result comparisons in and among the groups

p = 0.655

16.00 17.00

5.63 4.84

p = 0.375

7.16 7.56

D

22.33 23.50

TE

Blood pressure Pre test Post test Pre- and post-test comparison of group

p = 0.527

AC

CE P

Total Pre test Post test Pre- and post-test comparison of group

69.67 73.17

15.25 13.29

p = 0.226

6.87 4.30

T

24.00 27.33

24.67 28.33

IP

6.25 5.53

Experimental 2 SD 𝐗

SC R

23.83 24.33

Experimental 1 SD 𝐗

p = 0.002

NU

Pre- and post-test comparison of group Respiration Pre test Post test Pre- and post-test comparison of group

Control SD 𝐗

16.17 23.83

MA

Vital signs knowledge test Pulse Pre test Post test

5.68 2.52

p = 0.000

20.67 28.50

8.17 5.44

p = 0.000

67.17 88.67

17.10 8.70

p = 0.000

5.40 3.56

0.860 0.003*

p = 0.000

16.67 21.83

5.31 5.17

0.889 0.000*

p = 0.000

20.17 28.67

7.01 6.01

0.503 0.003*

p = 0.000

66.83 88.17

13.49 10.71

p = 0.000

Note. SD = standard deviation * There was no statistically significant difference between the average scores of the experimental 1 and experimental 2 groups (p> 0.050).

pvalue

0.738 0.000*

ACCEPTED MANUSCRIPT

NU

5.04 5.06

p = 0.088

43.23 44.37

MA

36.73 39.10

p = 0.088

53.90 56.40

7.92 7.30

TE

Comparison of measurements in healthy and patient Total Healthy group Patient group

p = 0.892

D

Comparison of measurements in healthy and patient Blood pressure Healthy group Patient group

SC R

IP

T

Table 3 Comparison of vital signs control list applied to healthy and ill adults in and among the groups Control Experimental 1 Experimental 2 pVital signs control list value SD SD SD 𝑿 𝑿 𝑿 Pulse-respiration Healthy group 0.000* Patient group 0.000* 17.17 4.53 21.57 2.60 22.13 3.17 17.30 3.56 22.70 2.15 21.87 2.08

p = 0.038

64.80 67.07

3.80 4.24

p = 0.043

44.63 44.83

1.90 1.26

0.000** 0.000*

p = 0.615

66.77 66.70

4.78 3.04

0.000* 0.000*

p = 0.940

CE P

Comparison of measurements in healthy p = 0.206 and patient Note. SD = standard deviation

1.65 2.24

p = 0.625

* There was no statistically significant difference between the average scores of the

AC

experimental 1 and experimental 2 groups (p > 0.050). ** The scores recorded for experimental group 2 were statistically significantly higher than those for experimental 1 group (p < 0.050).

ACCEPTED MANUSCRIPT RESEARCH HIGHLIGHTS In this research, Simulation had a positive effect on the ability of nursing students to measure vital

T

 

Groups exposed to simulation obtained statistically significantly higher scores than the

SC R

control group (p < 0.050) in post-test knowledge.

The ability of the groups exposed to simulation to measure vital signs in healthy adults

CE P

TE

D

MA

NU

and patients was more successful than that for the control group (p < 0.050).

AC



IP

signs.