Board #118 - Research Abstract Real Time Quantification of Stress during High-fidelity Human Simulation for a Standardized Learning Experience (Submission #9956)

Abstract

Hypothesis A curvilinear relationship exists between stress and learning, implying that both extremes of high or low stress negatively impacts learning and performance. Stress is a central component of the High-fidelity Human Simulation (HFHS), which is increasingly being used in nursing education as an active learning tool. A degree of stress during participation arises from factors intrinsic to HFHS, including anticipation of the event, requirement for quick clinical decision-making and acuity of the scenario. Additionally, being watched by peers or educators and being afraid of getting embarrassed in front of everyone adds to the total stress experienced. This study investigated how stress level changes on a real time basis during standardized HFHS and if participants with different personality types and learning styles show distinctive patterns of stress evolution. These results will have significant implications for optimizing stress and maximizing learning in HFHS. Methods First-year novice learners, who have no clinical or HFHS experience were included. Nursing students were involved in an hour-long clinical simulation experience, including a pre-brief session a 20-minute simulation session followed by a debriefing session. Salivary cortisol (pre and post simulation) and heart rate variability low frequency to high frequency ratio (LF/HF-HRV) calculated every 5-minute from real time EKG data (pre, during and post simulation) were used for stress quantification. The BIG 5 Personality test and the Honey and Mumford Learning Styles Inventory that were used to assess personality and learning style respectively were completed at a later time. Multiple regression analysis was used to examine the strength of association. Results Salivary Cortisol levels and LF/HF-HRV showed statistically significant increase from pre to post simulation p<0.05. There was a moderate positive correlation between Salivary Cortisol concentration and LF/HF-HRV, r(20) = .371, p < .0005, with LF/HF-HRV explaining 14% of the variation in salivary cortisol concentration. The Neuroticism personality trait and theorist style of learning had significant positive regression weights, indicating students with higher scores on these scales had higher post-simulation stress levels. Moreover, openness personality trait had a significant negative weight, indicating that students with higher scores on openness to experiences had lower post-simulation stress level. Conclusion Optimal level of stress is essential for effective use of HFHS for acquisition and retention of knowledge and skills. Therefore, this pilot study is important as it provides the first data elucidating the pattern of change in stress during a standardized HFHS scenario. Importantly, results show that LF/HF-HRV is a valid tool that can be used to provide stress level on a real time basis giving the researcher a very high temporal resolution for stress quantification that can be used non-invasively and without interfering the scenario performance. Future research should include larger participants with performance assessment.