title: An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students.
abstract: BACKGROUND
  While numerous theoretical and conceptual models suggest social evaluation anxiety would likely influence performance in simulation-based learning environments, there has been surprisingly little research to investigate the extent to which this is true.
  
  
  METHODS
  Final-year Bachelor of Science (Nursing) students (N=70) were randomly assigned to complete one of three clinically identical simulation-based scenarios designed to elicit varying levels of social evaluation anxiety by manipulating the number of other people present with the student during the simulation (1, 2 or 3 others). Rises in acute stress were measured via continuous heart-rate and salivary cortisol. Performance scores were derived from the average of two independent raters' using a structured clinical checklist (/16).
  
  
  RESULTS
  Statistically different increases were found within the first minute of the simulation between those students with one versus three other people in the room (+4.13 vs. +14.01beats-per-minute respectively, p=0.01) and salivary cortisol measures suggested significantly different changes in anxiety between these groups (-0.05 vs. +0.11μg/dL respectively, p=0.02). Independent assessments suggested students with only one other person accompanying them in the simulation significantly outperformed those accompanied by three others (12.95 vs. 10.67 respectively, p=0.03).
  
  
  CONCLUSIONS
  Students accompanied by greater numbers during simulations experienced measurably greater anxiety and measurably poorer performances. These results demonstrate the ability to manipulate social evaluation anxiety within high-fidelity simulation training of undergraduates in order to help students better acclimatise to stressful events prior to practising in real clinical settings.
authors.affiliation: Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia. Electronic address: b.mills@ecu.edu.au.
authors.forename: Brennen
authors.initials: B
authors.lastname: Mills
authors.affiliation: Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia. Electronic address: o.carter@ecu.edu.au.
authors.forename: Owen
authors.initials: O
authors.lastname: Carter
authors.affiliation: Office of the Deputy Vice-Chancellor (Strategic Partnerships), Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia. Electronic address: cobie.rudd@ecu.edu.au.
authors.forename: Cobie
authors.initials: C
authors.lastname: Rudd
authors.affiliation: School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia. Electronic address: l.claxton@ecu.edu.au.
authors.forename: Louise
authors.initials: L
authors.lastname: Claxton
authors.affiliation: Melbourne Medical School, University of Melbourne, Level 2 West, Medical Building (181), Victoria 3010, Australia. Electronic address: rpobrien@unimelb.edu.au.
authors.forename: Robert
authors.initials: R
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D008297:Male; D000066908:Simulation Training / Q000379:methods; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D013338:Students, Nursing / Q000523:psychology*; D014904:Western Australia; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: Acute stress; Clinical performance; Experimental; Nursing; Simulation-based learning environments; Social evaluation stress