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 Table of Contents  
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 49-51

Use of simulation among nursing students in learning the management of common pediatric conditions

1 College of Nursing, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

Date of Submission16-Sep-2021
Date of Decision02-Dec-2021
Date of Acceptance19-Dec-2021
Date of Web Publication15-Jun-2022

Correspondence Address:
Poonam Joshi
College of Nursing, All India Institute of Medical Sciences, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jascp.jascp_19_21

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Purpose: The purpose of this study is aimed to assess the impact of simulation in addition to conventional training on knowledge and self-efficacy of the nursing students in handling common pediatric conditions covered under integrated management of neonatal and childhood illnesses. Methods: In a pretest–posttest control group design, 61 nursing students were randomly assigned to an experimental and control groups. The intervention for the control group consisted of 30 h conventional teaching on the management of common pediatric conditions, while the experimental group received additional simulation training of 5 h duration along with conventional teaching. Results: Both experimental (n = 30) and control groups (n = 30) were similar in demographic characteristics and baseline academic qualifications. There was a significant increase in knowledge and self-efficacy scores in both the groups (P < 0.001) with postintervention scores being significantly higher for knowledge (17.8 [2.1] vs. 15.5 [1.9], P < 0.001) and self-efficacy (34.4 [2.5] vs. 32.3 [2.9], P = 0.004) in the experimental group. Conclusion: An add-on simulation-based training to conventional teaching led to better knowledge and self-efficacy level in handling common pediatric conditions.

Keywords: Common pediatric illnesses, integrated management of neonatal and childhood illnesses, simulation

How to cite this article:
Joshi P, Das S, Sharma R, Cecilia M S, Dhochak N, Goel P. Use of simulation among nursing students in learning the management of common pediatric conditions. J Appl Sci Clin Pract 2022;3:49-51

How to cite this URL:
Joshi P, Das S, Sharma R, Cecilia M S, Dhochak N, Goel P. Use of simulation among nursing students in learning the management of common pediatric conditions. J Appl Sci Clin Pract [serial online] 2022 [cited 2022 Jul 4];3:49-51. Available from: http://www.jascp.com/text.asp?2022/3/2/49/347594

  Introduction Top

Traditional clinical teaching based on prolonged didactic lectures and demonstrations can be repetitive and overwhelming for nursing students. Students feel less confident while applying the knowledge from traditional teaching directly to real-life scenarios in wards and emergencies.[1] Simulation-based education is a valuable tool in this regard which helps to mitigate the ethical tensions and practical dilemmas involved in patient care facility.[2] It provides a learning model with the opportunity to perform specific clinical tasks repetitively with immediate feedback to further improve skills and correct mistakes without risk of harm to patients.[3],[4] Integrated Management of Newborn and Childhood Illness (IMNCI) comprises teaching tools aimed at training medical students, nurses, and peripheral HCP for common childhood diseases.[5] Training of nursing students at the preservice level for common pediatric conditions can improve the effectiveness of delivery of health care services in the community, aiming at reduction in the under-five mortality.[6] At our center, 4th year nursing students receive a week-long integrated management of neonatal and childhood illnesses IMNCI training in the form of didactic lectures and videos as part of their curriculum requirement. With the availability of qualified faculty in simulation in our center, we planned to compare the effect of add-on simulation to traditional IMNCI sessions for the training of nursing students in the management of common pediatric conditions.

The study was aimed to evaluate the impact of simulation on the knowledge and self-efficacy of nursing students in handling common pediatric conditions. The secondary objective was to assess the satisfaction of nursing students with simulation technique and their perceived self-efficacy in handling common pediatric conditions.

  Methods Top

In a pretest–posttest control group design, we included 4th year BSc nursing students of a teaching institution. Nursing students willing to participate and available during the study were enrolled and randomly assigned either to the experimental or control group in a 1:1 ratio using a computer-generated table. Ethical clearance was obtained from the institute ethics committee (IEC/561/6/2019). Written informed consent was taken, and confidentiality and anonymity of the students were assured while collecting data.

Pretested and validated demographic sheet (8 items) and knowledge questionnaire (25 items, multiple-choice questions) based on the IMNCI program were used for data collection.[7] Self-efficacy was assessed using a standardized self-efficacy tool (8 items, α =0.92). Self-efficacy was defined as a nursing student's ability to manage common pediatric conditions such as diarrhea, pneumonia, and fever as per the IMNCI guidelines.[8] Satisfaction with simulation was assessed with a semi-structured satisfaction tool for the experimental group (8 items, α =0.92). Measurement of the gains in knowledge and self-efficacy was carried out independently by six IMNCI certified master trainers before and after the intervention. Maximum possible scores for knowledge, self-efficacy, and satisfaction were 25, 40, and 40, respectively.


In a 2-week program, the first 30 h of conventional teaching consisting of didactic lectures, demonstrations, and videos spread over 1 week was given to the students of the control group. At this time, students of the experimental group were posted in the clinical area. Then, in the 2nd week, students of the experimental group received conventional teaching along with 5 h of training on simulation as an add-on strategy and the control group being posted in the clinical area. The first half of simulation training (approximately 2.5 h) for the experimental group included an overview of simulation and some simulated scenarios run by the trainers. The training was provided by six faculty members using low-fidelity manikins and pulse generators. In the later half of the simulation training, students in the experimental group were divided into three small groups (10 in each group), each group was supervised by two trainers. Case scenarios on the management of fever, pneumonia, and diarrhea as per the IMNCI guidelines were run for each group under the supervision of the faculty members. Debriefing was done after the completion of every clinical scenario in each group. During simulation, it was ensured that all students participated in at least one of the given clinical scenarios.

Statistical analysis

Data were collected in a structured pro forma and analyzed using descriptive and inferential statistics by STATA 13 (Stata Corp, College Station, TX, US). Variables were summarized as mean (standard deviation [SD]), or median (interquartile range) for continuous variables, and proportions for categorical variables. Comparison of mean knowledge and self-efficacy scores within the groups and between the groups was done by paired and independent t-test, respectively. The difference in posttest scores between the two groups was adjusted for pretest scores using analysis of covariance. The level of significance was set at 0.05.

  Results Top

We enrolled 61 students and randomized them to experimental (n = 31) and control groups (n = 30). One student in the experimental group missed the session due to emergency leave. Hence, in the final analysis, there were thirty students in each group. Nursing students in both groups were similar in terms of demographic characteristics [Table 1].
Table 1: Demographic profile of nursing students

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There was a significant increase in knowledge and self-efficacy scores following the course in both the experimental and control groups (P < 0.001 for both). However, the experimental group had higher postintervention knowledge mean (SD) (17.8 [2.1] vs. 15.5 [1.9], P < 0.001) and self-efficacy (34.4 [2.5] vs. 32.3 [2.9], P = 0.004) score compared to the control group. The difference in postintervention knowledge and self-efficacy scores was significant between the two groups despite adjustment for preintervention scores by the analysis of covariance (P < 0.001 and 0.005, respectively) [Table 2].
Table 2: Knowledge and self-efficacy of nursing students in handling common pediatric conditions

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The median satisfaction scores of the students in experimental group (EG) varied from 4 to 5 with a mean satisfaction score of 36.4 (2.09). In response to an open-ended question on feedback about simulation, the majority of EG students (80%) responded that simulation reduced their nervousness. None of the students responded to the question about the improvement needed in simulation.

  Discussion Top

In this study, we found that nursing students receiving conventional training along with simulation for common pediatric emergencies had higher knowledge and self-efficacy scores compared to those who received conventional training of didactic lectures and demonstrations.

Simulation-based training is increasingly being used for nursing students. It provides a safe environment away from patient care. Studies comparing simulation-based training of medical students for asthma and critical care teaching showed significant improvement in posttest scores when compared with the group receiving conventional lectures.[1],[9] Our study too had similar findings. Some studies have reported having better enjoyment, interest, ease of understanding, and accessibility to pose questions, higher teamwork behavioral rater score, motivation, and comfort levels in the simulation group as compared to conventional teaching.[1],[7],[9] In our study, students' feedback regarding simulation was good to an excellent level of satisfaction for most aspects. Simulation is associated with less anxiety at the time of patient contact.[8] In our study too, there was significantly higher self-efficacy in students trained by simulation. In the open-end feedback question, the majority of the students trained by simulation in our study reported feeling less nervous about handling common pediatric illnesses.

Limitations of our study include a single-center study and a lack of evaluation of the long-term impact of simulation on actual patient care. Furthermore, simulation-based teaching needs the expertise of trainers in simulation, and training sessions tend to be longer than conventional teaching. Teaching the IMNCI program using simulation is an innovative method of teaching, but we could not compare the satisfaction between the two groups with the teaching methodology used.

  Conclusion Top

An add-on simulation-based training to conventional teaching leads to better knowledge and self-efficacy level in handling common pediatric conditions among the nursing students.


We acknowledge the logistic support provided by the Laerdal Company. We also acknowledge Dr. Arvind, Ms. Muthuselvi, and Ms. Santosh Yadav for their assistance in planning and organizing simulation scenarios.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Oermann MH, Kardong-Edgren S, Odom-Maryon T, Hallmark BF, Hurd D, Rogers N, et al. Deliberate practice of motor skills in nursing education: CPR as exemplar. Nurs Educ Perspect 2011;32:311-5.  Back to cited text no. 4
Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL, et al. Part 11: Pediatric basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S519-25.  Back to cited text no. 5
Million Death Study Collaborators; Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, et al. Causes of neonatal and child mortality in India: A nationally representative mortality survey. Lancet 2010;376:1853-60.  Back to cited text no. 6
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  [Table 1], [Table 2]


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