임상상황에 기초한 의사소통시뮬레이션 모듈 개발 및 타당도 검증 = Development and validation of clinical situation-based communication simulation modules|RISS 상세보기

다국어 초록 (Multilingual Abstract)

The communication skills are one of the learning outcomes that the nursing students should achieve at the time of graduation. It is more desirable to develop the effective communication skills through the practical training that can offer experimental opportunities than through lecture-oriented educational method.
Thus, in this study, we developed the communication simulation module which can be utilized to enhance the communication skills of the nursing students and also verified the practicability of the developed module.

As the initial stage of developing the simulation module, and in order to measure the communication level of the nursing students in simulation education, we adapted and modified the communication measurement tool developed outside the country into Korean to verify its reliability and validity. In the second stage, through the focus group interview with the clinical practitioner, we derived the frequent clinical situations between nurses, nurses and doctors, nurses and patients. Among them, in order to verify the practicability of simulation practice education targeting nursing students, we constructed the module containing nursing education that is focused on the communication between nurses and patients.
As the third stage of the module development, we verified the whole components of the module and the content validity of its content from the expert group consisting of the nursing professors who have experiences in the simulation education.
In order to verify the practicability of the module, we applied the module to the standardized patient utilization group(n=25) and the simple mannequin utilization group(n=27) with senior nursing students who are in their first semester and don't have previous experiences in simulation class. Since the simulation environment was the first time for the nursing students, considering that the anxiety students might experience can affect the learning, we applied the simulation module of three topics over the total of 6 weeks, constructing one scenario to be educated over 2 weeks.
The management of the simulation education including pre-orientation and post evaluation was conducted over a period of 8 weeks. We identified the communication skills and communication self-efficacy of nursing students before and after the application of the simulation module. The communication skill of one student was directly observed and evaluated in the practice education by two instructors and the communication self-efficacy was investigated through the self-reporting questionnaire.
The collected data was analyzed using IBM Statistics SPSS 21.0 for Window program. The changes in communication skills and communication self-efficacy of the group before and after the application of the module were identified using paired t-test and the pre-post differences per item of communication skills of the two groups were analyzed using Wilcoxon signed-rank test. Also, in the case of the standardized patient utilization group, we additionally analyzed the content of self-reflection diary created during the module application process.
The communication simulation module was a 37-year-old woman admitted to the hospital. The module contained three topics of scenarios which were the blood-sugar management of the inpatient diagnosed with the type 2 diabetes, emergency situation of low blood sugar, and nursing education after discharge. According to the verification result of the practicability of the simulation module, no significant difference in pre and post communication skills (t=-1.44, p=.161) and the pre and post self- efficacy(t=.28, p=.779) of the simple mannequin utilization group was found. In the case of the standardized patient utilization group, the improvement of the pre and post communication skills(t=-2.31, p=.030) and the communication self-efficacy (t=-4.80, p=<.001) was found to be statistically significant.

In addition, based on the analysis result of the self-reflection diary, the practical experiences utilizing the standardized patients affected the confidence of nursing students in reflecting their communication skills and communicating with patients. Also, the experiences were reported to be effective for them to recognize the importance of the communication. Consequently, it can be said that the practicability of the communication simulation module based on the clinical situations in the standardized patient utilization group was verified.
The implication of this study lies in identifying the frequent communication situation through the focus group interview with the clinical practitioners, developing specific teaching module that can be utilized in the introductory simulation education, and verifying the practicability of the developed module as well as the reliability and validity of the objective communication skill measurement tool.
Since the communication simulation module developed in this study was based on the relatively simple scenarios focusing on the communication between the nurses and the subjects targeting senior nursing students in their first semester, we think, in the future, it is necessary to develop modules of various settings that can enhance the high level communication capability in much more comprehensive and complex situations such as decision-making and conflict mediation.

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