2.3. Variables, Data Collection Tools, and Procedures

At baseline, a semi-structured questionnaire was used to collect the following sociodemographic characteristics: sex (male/female), age (years), upper-secondary school attended (classical/science or other schools), upper-secondary school grade (total), employment as a nurse (yes/no), employment in a critical care ward (yes/no), Basic Life Support and Defibrillation Certification (yes/no), and previous participation in a high-fidelity simulation learning experience (yes/no).

The four Kirkpatrick levels for evaluating training programs (results, behaviors, learning, and perceptions) were used as the reference framework to assess the impact of the modified educational model experimented in this study [25]. Its ultimate intent consisted of enabling participants to improve respiratory failure outcomes in critically ill patients (results). To achieve this goal, students needed to possibly change their current behaviors and apply advanced nursing skills in clinical practice (behaviors). However, the prerequisite was that they must know what to do and how to do it, which means that they must achieve knowledge, skills, and positive attitudes (learning) to promote new clinical behaviors. Furthermore, to be motivated to learn, students must favorably react to the educational model and demonstrate a high level of satisfaction and positive lived experiences (perceptions).

According to the abovementioned Kirkpatrick framework, an adaptation of the Italian 10-item General Self-Efficacy Scale [26], the 13-item Student Satisfaction and Self-Confidence in Learning [27], and an ad hoc Group Performance Structured Checklist based on the guidelines of the Italian Society of Anesthesiology, Analgesia, Resuscitation, and Intensive Therapy [28] were used to document the learning outcomes.

Agreeing to Bandura’s theoretical framework, self-efficacy is a person’s belief in their ability to successfully execute the behavior required to produce the expected outcome [29]. The level of self-efficacy referred to a specific clinical scenario that can impact future behaviors of participants when they are faced with similar clinical conditions. The adapted General Self-Efficacy Scale is a four-level Likert instrument (1 = not at all true; 4 = totally true) that provides a score ranging from a minimum of 10 to a maximum of 40 points [19,30]. A higher self-efficacy score denotes greater student’s belief to be able to cope with a similar clinical problem (respiratory failure).

Satisfaction in learning is the perception of students about the teaching experience. Investigating satisfaction is important since a positive perception of simulation activities can motivate students to learn [25].

Self-confidence refers to an individual’s perception about their level of sureness to be equal to the task [31]. Like self-efficacy, the level of self-confidence was considered a proxy of behavior application in clinical practice.

The Student Satisfaction and Self-Confidence in Learning is a five-level Likert instrument (1 = strongly disagree; 5 = strongly agree) designed to measure students’ satisfaction with the simulation activity (five items), as well as self-confidence about the skills practiced and knowledge about caring for the type of patient presented in the simulation (eight items). This scale provides a score ranging from five to 25 for satisfaction and eight to 40 for self-confidence. For both scales, a higher score denotes greater satisfaction and self-confidence in learning.

The 20-item performance checklist identified all key actions that nurses were expected to perform when caring for a patient in a life-threatening clinical condition, such as acute pneumonia or arrhythmia. For each action performed by a group during the simulation, one point was assigned, leading to a maximum achievable performance score of 20.

In this study, any possible change in the learning and perceptions of students was exclusively observed.

Following a phenomenological approach, an audio-recorded face-to-face in-depth interview was utilized to document the lived experience of participants. The interview was guided by a series of questions utilized in a previews research experience [20].

Data related to self-confidence and self-efficacy were collected before (T1 and T3) and after (T2 and T4) each educational experience. The performance was measured independently by two faculty members in the control room during each simulation session. Any disagreement was resolved by rewatching the video recordings. The satisfaction in learning was measured at the end of each leaning experience (T2 and T4).