Effect of high-fidelity clinical simulation on anxiety and stress in undergraduate nursing students

The high fidelity clinical simulation is an active methodology that allows the experience of almost actual situations of patient care, using mannequin with physiological responses. It favors the development of skills and competencies of students in health area before they have contact with actual patients. The objective of this research was to evaluate the effect of high fidelity clinical simulation on anxiety and on the perception of the stressors of undergraduate students in nursing. A randomized clinical trial was carried out with undergraduate students in nursing of fourth period from a public university in the southern region of Brazil. Participants were allocated into two groups: (a) control group (CG), which performed a conventional laboratory practice class, followed by clinical practice in a hospital environment; and (b) experimental group (EG), which performed clinical simulation of high fidelity, followed by clinical practice in a hospital environment. Participants were evaluated for stress factors through Kezkak, and for anxiety, by the Trait-State Anxiety Inventory at the moments before and after the laboratory practice, and at the first clinical practice in a hospital environment. The sample consisted of 52 participants, of whom 25 were in the CG and 27 in the EG. There was predominance of female young adults. The CG presented a reduction in the perception of the stressors after the conventional laboratory practice class and after the contact with patient, while in the EG there was increase in the perception of the stressors after the simulation and decrease after the contact with patient. Also, before the lab practice, most the CG participants considered four items, related to lack of competence and the relationship with teachers and classmates as very stressful, while the EG pointed only two, both regarding to the lack of competence. Both groups presented a reduction in the perception of these items as stressors after contact with patient. CG had a significant increase in anxiety before the hospital environment, and it was maintained after that. The EG had a significant increase after the laboratory practice and a significant decrease after the first contact with patient. Thus, it was concluded that the strategy of teaching with simulation of high fidelity provoked an increase in the perception of the stressors factors by the nursing student and a decrease in anxiety before the first contact with the actual patient. The increase in the perception of the stressors by the students was related to the increase of their capacity for self-evaluation and critical reflection regarding their responsibility to the learning and to the patient.