Effectiveness of an adventure-based training program in enhancing competence, resilience and self-efficacy in nursing students preparing for clinical practicum : a randomised controlled trial

Abstract

Abstract. Clinical practice is a vital component of nursing education that provides students with real-life opportunities to practice in hospital settings. Nevertheless, with the increasing complexity of the health care system, accountability for patient care and expectations for higher-quality service from the general public, the clinical practicum can be a very stressful experience for nursing students that requires the development of competence, resilience and self-efficacy in school. Competence can be described as the command of pertinent knowledge and skills, which means that a competent person possesses not only the requisite competencies but also the ability to use them and to make appropriate decisions and judgements according to the context. Enhancement of resilience is beneficial for further clinical practice through the development of skills. Nurses with a high degree of self-efficacy can set appropriate goals and attempt various strategies and will thus make an easier transition from student to nursing professional. Adventure-based training has been found to be effective in promoting resilience and self-efficacy in primary and secondary school students, but large-scale studies of its effectiveness remain scarce. It is unclear from the literature whether an adventure-based training programme could enhance nursing students’ competence, resilience and self-efficacy in preparation for their clinical practicum, so rigorous empirical scrutiny of its effectiveness is needed. Aim. To examine the effectiveness of an adventure-based training programme in enhancing competence, resilience and self-efficacy in Year Two nursing students in preparation for their clinical practicum. Methods. Before the main interventional study, a pilot study was conducted to determine the feasibility of the study protocol, its acceptability by the participants and the appropriateness of the evaluation tools. A randomised controlled trial was then conducted (i.e., the main interventional study). Of 146 Year Two nursing students between 19 and 25 years of age recruited from a Hong Kong institution of higher education, 74 were randomly assigned to the experimental group to participate in two sessions of a 1-day adventure- based training programme, and 72 were assigned to the wait-list placebo control group to receive a placebo intervention. All subjects were assessed for competence, resilience and self-efficacy at the baseline and at 3 and 6 months after the intervention began. Results. Statistically significant differences in competence, resilience and self-efficacy were seen between the groups. The results of mixed between-subjects and within-subject analysis of variance show that the participants in the experimental group reported significantly higher levels of competence, resilience and self-efficacy than those in the wait-list placebo control group. The partial eta squared value indicated a large intervention effect size. Conclusion. This is the first randomised controlled trial to examine the effectiveness of an adventure-based training programme for nursing students in preparation for their clinical practicum. The overall results provide evidence that such training is effective in enhancing competence, resilience and self-efficacy in nursing students in preparation for their clinical practicum. Implications for practice. Adventure-based training has major implications for practice. This study provides greater insight for nursing educators regarding methods to support their students’ success in the clinical practicum.