title: A new strategy in nursing education: From hybrid simulation to clinical practice.
abstract: BACKGROUND
  Various instructional environments are used in nurse education to develop students' psychomotor and communication skills, reduce their anxiety levels, and enhance their satisfaction.
  
  
  OBJECTIVE
  To examine the effect of three different instructional environments on the development of the students' psychomotor and communication skills and their levels of anxiety and satisfaction.
  
  
  METHODS
  A prospective study design was used.
  
  
  METHODS
  The study sample consisted of 60 nursing students. Before the implementation of the study, the students' cognitive skills and trait anxiety levels were evaluated. The students were divided into five groups and five nursing activities (Leopold's maneuvers, teaching breastfeeding, family planning education, teaching vulvar self-examination and teaching breast self-examination) were specified for each group. They implemented these nursing activities under the supervision of a faculty member in the nursing skills laboratory (NSL), standardized patient laboratory (SPL) and clinical practice environment (CPE) respectively. In each instructional environment, the students' psychomotor and communication skills, state anxiety levels and satisfactions were evaluated.
  
  
  RESULTS
  The median scores for psychomotor skills [NSL=73.1;SPL=81.5;CPE=88.6] and communication skills [NSL=64.9;SPL=71.6;CPE=79.0] were found to increase as the students went on practicing in a more complicated environment (p<0.05). Similarly, it was determined that the students' anxiety levels decreased as they were practicing incrementally [NSL=33.0;SPL=32.0;CPE=31.0]. As the instructional environments were getting more similar to the reality, the students' satisfaction levels were found to become higher.
  
  
  CONCLUSIONS
  Students who deliberately practice in the instructional environments until they are competent develop their psychomotor skills while reducing their anxiety levels, and enhancing their communication skills and satisfaction. For that reason, the development of students' competency areas is thought to be effective for enhancement of patients and health care workers' safety.
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: fusun@hacettepe.edu.tr.
authors.forename: Füsun
authors.initials: F
authors.lastname: Terzioğlu
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: cigdemyuc@gmail.com.
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Yücel
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: gulten_isik@hotmail.com.
authors.forename: Gülten
authors.initials: G
authors.lastname: Koç
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: sahika_simsek@hotmail.com.
authors.forename: Şahika
authors.initials: Ş
authors.lastname: Şimşek
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: yasarberil@gmail.com.
authors.forename: Beril Nisa
authors.initials: BN
authors.lastname: Yaşar
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: f_uslu_888@hotmail.com.
authors.forename: Fatma Uslu
authors.initials: FU
authors.lastname: Şahan
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: rabiye_akin@hotmail.com.
authors.forename: Rabiye
authors.initials: R
authors.lastname: Akın
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: symbol_smge@hotmail.com.
authors.forename: Simge Evrenol
authors.initials: SE
authors.lastname: Öçal
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: cansua05@gmail.com.
authors.forename: Cansu
authors.initials: C
authors.lastname: Akdağ
authors.affiliation: Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: melihelcin48@gmail.com.
authors.forename: Melih
authors.initials: M
authors.lastname: Elçin
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: mervemert185@gmail.com.
authors.forename: Merve
authors.initials: M
authors.lastname: Mert
authors.affiliation: Faculty of Nursing, Hacettepe University, 06100 Sihhiye, Ankara, Turkey. Electronic address: yldrmsvda@gmail.com.
authors.forename: Sevda
authors.initials: S
authors.lastname: Yıldırım
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D004508:Education, Nursing, Baccalaureate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D015402:Nursing Education Research; D016544:Patient Simulation; D011446:Prospective Studies; D011597:Psychomotor Performance; D013338:Students, Nursing; D055815:Young Adult
keywords: Anxiety; Clinical practice; Communication; Nursing education; Nursing skills laboratory; Psychomotor skill; Satisfaction; Standardized patient