Assessing dietetics students’ change in perceived knowledge and perceived codence in feeding tube insertion using patient simulation

It was noted in 2000 that computer-based simulations showed promising impact as a supplement to science-related didactic instruction to students. Computer simulations were able to provide varied experiences to prepare more entry-level practitioners (Turner, William, Bennett-Wood, Lehman, & Peck, 2000). Since that time, the simulation experience in education has evolved to create environments with some dramatic effects. Healthcare simulations include patients that can speak, have a pulse, and even spit blood. Simulations allow educators to create a safe environment for students to become competent without the risk to real clients (Song, Yun, Kim, Ahn, & Jung, 2015). Dietetics education, as accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND), requires documentation of educational approaches like simulation (ACEND, 2016). Although simulation provides educators with new opportunities, the potential use of simulation for competency testing needs to be strategic (Decker, Sportsman, Puetz, & Billings, 2008).

To test the hypotheses, quantitative data was analyzed using paired samples t-test to compare the pre- and postsurvey results of participants in a small-bowel feeding tube placement simulation. Perceived knowledge was computed with four pairs. The results indicated that there was a statistically significant increase in perceived knowledge between the pre- and postsurvey results for all four of the knowledge statements (p ≤ .05) (see Table 1) supporting our first hypothesis. Additionally, similar results were found for student perceived confidence. Each of the six perceived confidence statements were found to have a statistically significant increase from the presurvey to the postsurvey supporting our second hypothesis (p ≤ .05) (see Table 2).

Qualitative data were collected related to participants’ level of confidence before going into the simulation experience and after the experience. Students were asked to respond in an open-ended response format to the presurvey question, “What is your level of confidence going into this experience?” Of the eight responses, five included statements about having “very low confidence” or “not being very confidence” prior to the simulation lab. The other three responses exemplified that the students were “excited to learn” through the simulation lab. As one student stated: “I'm really excited to learn about this procedure but it is also a little scary knowing I could possibly do it for real in the future.” The postsurvey question read, “Do you feel your level of confidence has increased now that you have experience with bedside Tube Feeding? Please explain your answer.” Participants unanimously stated that their level of confidence increased after experiencing the bedside Tube Feeding simulation. As one participant shared: “Yes, after extensively learning, observing and then practicing the procedure, I feel like I have much more confidence than I previously had.” Specific comments to the open-ended confidence question before and after the simulation experience can be found in Table 3.

Additionally, participants were asked to respond to the open-ended question on the postsurvey, “Do you feel as though this experience was valuable? Please explain why or why not.” Participants unanimously stated that yes, the simulation experience was valuable to their learning. Three respondents reported specifically that their confidence increased because of the simulation. One noted: “Absolutely! I feel that I went from knowing very little about tube feeding placement to feeling very confident in my abilities if I would have to show someone else how to place a tube feeding.” Several mentioned the hands-on application of knowledge as adding value to their experience. On participant shared: “Absolutely! It is the closest thing that we have had during our education that replicates an actual serious hospital setting.” A complete list of responses relating to the value of the simulation experience are found in Table 4.

The use of simulation to assess the change in perceived knowledge and perceived confidence in the ability of dietetics graduate students to place bedside small bowel feeding tubes in simulation patients was explored during this mixed-methods survey research. Results are discussed below and provide support for the research questions and hypotheses.

Prior to this study, minimal research existed among dietetics students and patient simulation. With ACEND's standards requiring documentation of simulation, research is warranted on the benefits of simulation in dietetics education. In addition to bridging the gap between theory and practice, this study supports the use of simulation to increase students’ perceived knowledge and confidence with feeding tube placement. Dietetic educators could utilize a similar method to instruct students with hands-on competencies such as nutrition-focused physical assessments and patient education and counseling.

The authors declare no conflicts of interest.