Identification of the self-confidence and self-efficacy levels of student nurses when performing blood drawing for the first time on their peers

Abstract

BACKGROUND:

Blood sampling is frequently used in health to evaluate diagnosis and treatments. The first blood drawing is most important skill for nursing students. Nursing students gain these skills during their first years of education.

OBJECTIVE:

To identify the self-confidence and self-efficacy levels of first year nursing students when performing taking blood on their peers for the first time.

METHODS:

The sample ( $n=$ 70) of this descriptive and cross-sectional research comprised first year nursing students. The research was conducted in two stages; theoretical training and laboratory work and students’ first taking blood on their peers. A Student Information Form, Blood drawing Skill Practice Evaluation Control Form, Self-Confidence Scale, and General Self-Efficacy Scale were used for data collection. Percentage calculations and the Mann-Whitney U test were used for data analysis.

RESULTS:

The total mean score of the students’ self-confidence was 130.09 $\pm$ 15.94 (Min $=$ 91, Max $=$ 157), and total mean score of self-efficacy was identified as 31.71 $\pm$ 3.92 (Min $=$ 20, Max $=$ 39). No statistically significant difference was detected between the students’ sex and high school type regarding self-confidence and self-efficacy total mean scores ( $p>$ 0.05).

CONCLUSIONS:

It was observed that students’ self-confidence and self-efficacy levels were high when performing taking blood on their peers for the first time.

Keywords

Blood drawing nursing students self-confidence self-efficacy skill training

1. Introduction

Nursing education should provide students with occupational knowledge and upskill them in putting this knowledge into practice [1, 2] and should aim to attain cognitive, psychomotor, and affective goals [3]. Basic Principles and Applications of Nursing (Principles of Nursing) is the first occupational class in which nursing students learn science-based knowledge, and skills and behaviors of nursing [4]. Within the scope of this class, a positive learning environment should be provided in order for students to benefit from clinical applications [5].

It is stated that real-like basic skill methods used in this environment increase (high-fidelity simulators, applications on peers etc.) the self-confidence and self-efficacy levels of the students [6, 7, 8, 9]. It is also stated that repeated applications strenghten the basic skills and increase the academical success of the students by increasing their self-confidence and self-efficacy levels [10]. Thus, more weight is given to the use of skill laboratories in order to improve nursing students’ clinical skills [11, 12, 13].

Skill laboratories are mostly controlled and safe places where students do not worry about harming patients and can perform pocedure that they might not have the opportunity for in a clinical environment. In these laboratories, psychomotor skills are developed by using learning methods such as demonstration, role-play, and mostly models are used for these methods [11, 14, 15]. It is aimed to transform behavior into skill by ensuring that students practice on models in laboratories under the supervision of professors and on each other to make it feel like it is real [16, 17, 18]. Subsequently, students should be able to reflect the acquired skills with patients through clinical care and reinforce their skills [16, 17, 18]. Skill laboratories help students by using standard monitoring and evaluation methods in a standard education environment [19].

The professional skills of health education include body temperature, heart rate and blood pressure temperature measurement; blood drawing; intramuscular, subcutaneous, and intravenous injections; intravenous medication; hand washing; and putting on aseptic gloves [20]. Nursing students gain these skills during their first years of education. Blood sampling is frequently used in health to evaluate diagnosis and treatments [21] and nursing students should master these skills before starting clinical applications. However, students may experience immense anxiety and stress while putting their knowledge into practice and fail skill practices [22, 23, 24]. It is stated that these failures mostly occur during applications such as blood drawing and injections [25, 26].

Fear of failing the course, stress, and difficulties in putting knowledge into practice increase stress in students and hinder their desire for learning, and eventually cause failure and alienation for nursing students [22, 23, 24]. Thus, besides being cognitively prepared, students also need to be affectively prepared to be more successful [27, 28]. One of the major dimensions of the affective field is self-efficacy [29]. It is stated that the self-efficacy sense of an individual plays a significant role in adopting a behavior, initiating the behavior, and maintaining change [30]. Thus, in order to make a positive effect on students’ success, their self-confidence and self-efficacy levels should be recognized, students should be supported according to their results, and studies to increase self-confidence and self-efficacy sensation levels should be conducted.

The aim of the study was to identify the self-confidence and self-efficacy levels of first year nursing students when performing blood drawing for the first time on their peers. This was achieved by answering the questions below:

What do students experience when they perform blood drawing for the first time on their peers?

What is the level of self-confidence and self-efficacy of students when they perform blood drawing for the first time on their peers?

2. Method

2.1 Type of research

This is a descriptive and cross-sectional study.

2.2 Population and sample of the research

The population of the research comprised first year nursing students who were studying at the faculty of health sciences of a public university in Amasya ( $N=$ 72). The blood drawing skill practice steps variable was taken as reference for sample selection. The probability of each student performing the skill step is 0.50 (P $=$ Q) because this variable is discontinuous. Accordingly, the sample size was calculated as approximately 61 people with a confidence interval of 95% ( $1-\alpha$ ) and an error rate of 5% (d) using the formulas: $n=n_{o}/1+(n_{o}-1/N)$ and $n_{o}=t^{2}PQ/d^{2}$ . The criteria to be involved in the research were willingness and voluntariness to participate in the study. Two students who did not want to perform blood drawingon their peers were not included in the study. Thus, the research was conducted with a total of 70 students. It can be said that the sample size was adequate according to the sample calculation in terms of generalizability.

2.3 Data collection tools

A student information form, Blood drawing skill practice evaluation control form, and the Self-confidence and General self-efficacy scale were used for data collection.

2.3.1 Student information form

Information on the student’s age, sex, and high school type were obtained using this form.

2.3.2 Blood drawing skill practice evaluation control form (BDSPECF)

This form was developed by the researchers in line with literature [31, 32, 33, 34]. It consisted of a total of 19 items. Each step of the process was evaluated as “Yes” or “No” according to the application status of the students.

2.3.3 Self-confidence scale (SCS)

This scale was developed by Akın [35]. It comprises a total of 33 items. The highest score that can be obtained from the five-point Likert scale is 165 and the lowest possible score is 33. High scores comprising no negative items indicate a high level of self-confidence [35]. In the study conducted by Akın, the Cronbach’s alpha value for the Self-confidence Scale total score was 0.83.

2.3.4 General self-efficacy scale (GSES)

This scale was developed by Jerusalem and Schawazzer [36] and was adapted into Turkish by Yeşilbakan et al. [37]. There are 10 statements in the Turkish form and their scores range from 1 to 4. The highest score that can be obtained from the scale is 40 and the lowest possible score is 10. Self-efficacy scores increase as the scale score increases. The Cronbach’s alpha value was found as 0.88 as a result of validity-reliability studies [37].

2.4 Data collection process

The research was conducted in two stages. For the first stage, within the scope of the Principles of Nursing class, theoretical education about blood drawing were given using PowerPoint presentations and videos, and a demonstration on a blood drawingsimulator (Nasco, Life/form-Advanced Venipuncture and Injection Arm-Light) to first year nursing student by the professors. Then, during the laboratory hours of the related class, each student was asked to perform blood drawing on the simulator five times until they learned the skill. For the second stage, in line with the students’ willingness and voluntainess to participate in the study, each student was paired with a classmate on whom they would perform venous depletion. One week after the theoretical and laboratory educations, four instructors of the class set up two blood drawing skill practice stations in the nursing skill laboratory and took charge of these stations as observers, two to each stations. Each observer at the stations completed the BDSPECF by observing the students while they performed blood drawingon their peers. The other two observers at the stations watched the students closely theduring practice and stood ready for any kind of emergency. The observers helped the students by explaining their mistakes and showing them the correct method. At the end of the second stage, each student was given an SCS and GSES and asked to complete the forms before leaving the laboratory. It took approximately 20 minutes for the students to complete the scales.

2.5 Ethical considerations

It is obligatory to abide by scientific and universical ethical principles when conducting research. The Declaration of Helsinki was abided by throughout the research. Consent was obtained from the head of department and the Dean’s office by explaining the aim and scope of the research with an information form. Written consent was obtained from the Local Ethics Committee (24.09.2018-16). The students included in the sample were explained about the aim and benefits of the study and their roles in the study, they were told that the data collection forms would be anonymous. Written informed consent was obtained from the students.

2.6 Data analysis and evaluation

Data obtained from the questionnaire forms were saved to a database using the Stastical Package for the Social Sciences for Windows (SPSS 21.0), and this program was used for data analysis. For data analysis, ordinal variables were evaluated as arithmetic mean and standard deviation; minimum, maximum and nominal variables were evaluated as frequency and percentage. The Mann-Whitney U test was used to investigate if there was a statistically significant difference between the total scores of self-confidence and self-efficacy sensation levels in terms of sex and high school type. This non-parametric test was prefered because some of the groups compared contained fewer than 30 people.

2.7 Limitations of the research

The limitations of the research are generalizing the results to the sample group and not considering factors that might affect the self-confidence and self-efficacy level of the students during the research.

3. Results

3.1 SCS and GSES’s Cronbach’s alpha coefficients

In our study, the Cronbach’s alpha value for the SCS total score was evaluated as 0.923. The fact that the Cronbach’s alpha value was higher than 0.90 indicates that the reliability of the scale is excellent [38]. The Cronbach’s alpha value for the GSES was found as 0.768 in our study, which means that the scale is reliable.

Average age of the students was 19.71 (Min $=$ 18, Max $=$ 33) years. Three-quarters (77.14%) of the students were female ( $n=$ 54) and 74.28% ( $n=$ 52) graduated from high schools other than health high school.

3.2 Students’ skills of first blood drawing on their peers

When the blood drawing skills of the students were investigated, it was observed that among the BDSPECF process steps, students most frequently performed steps 12, 13, 5, 2, 3, 7, 9, 8, 14, 17, 1, and 15, respectively (Table 1).

According to the distribution of performing blood drawingskill aplication steps in terms of the high school graduated, it was detected that medical college graduates were mostly able to perform all of the steps except 4th and 8th steps (Table 2). It was also detected that students who did not graduate from medical career colleges were less able to perform steps 18, 6, 4, 19, 11 and 10, respectively (Table 2).

3.3 Self-confidence and self-efficacy levels of the students during their first blood drawing experience on their peers

When the self-confidence and self-efficacy levels of the students during their first blood drawing experience were investigated according to the SCS, the mean intrinsic self-confidence score was 67.27 $\pm$ 8.10 (Min $=$ 47, Max $=$ 82), the mean extrinsic self-confidence score was 62.81 $\pm$ 8.51 (Min $=$ 39, Max $=$ 76), and the mean total self-confidence score was 130.09 $\pm$ 15.94 (Min $=$ 91, Max $=$ 157). According to the GSES, that mean total self-efficacy score of the students was 31.71 $\pm$ 3.92 (Min $=$ 20, Max $=$ 39) (Table 3).

Table 1
Distribution of the steps of blood drawing skill process

Steps of the process	Yes		No
	$n$	%	$n$	%
1. Did they wash hands before the procedure?	63	90.0	7	10.0
2. Did they check the patients’ identity and explain the process to the patient?	68	97.1	2	2.9
3. Did they prepare the material properly?	68	97.1	2	2.9
4. Did they secure the patient’s privacy and position the patient properly?	51	72.9	19	27.1
5. Did they evaluate the area to be depleted in terms of appropriateness by using inspection	69	98.6	1	1.4
and palpation methods?
6. Did they place the protective cover under the procedure area?	51	72.9	19	27.1
7. Did they wear gloves?	67	95.7	3	4.3
8. Did they apply the tourniquet 15 cm above the area to be drawed?	65	92.9	5	7.1
9. Did they sterilize the area to be drawed with a single move top to bottom?	67	95.7	3	4.3
10. Did they grip the skin and subdermal tissue and stretch it with their passive hand?	60	85.7	10	14.3
11. Did the needle penetrate the vessel with the sharp edge facing up?	52	74.3	18	25.7
12. Did they penetrate the skin parallel to the vessel with an angle of 15–30 degrees, 1–2 cm	70	100.0	0	0.0
below the vessel insertion area?
13. Did they pull the piston of the injector to check if there is any blood in the injector?	70	100.0	0	0.0
14. Did they draw an adequate amount of blood into the injector?	65	92.9	5	7.1
15. Did they untie the tourniquet after blood drawing to the injector?	63	90.0	7	10.0
16. Did they pull the needle out while softly applying a dry cotton tampon to the area after the	70	100.0	0	0.0
process ended?
17. Did they throw the needle tip to the needle disposal box before putting the needle into its	64	91.4	6	8.6
cover?
18. Did they take off the gloves and wash their hands after the injection?	39	55.7	31	44.3
19. Did they record the process?	58	82.9	12	17.1

Table 2

Distribution of the steps of blood drawing skill process according to high school type

Steps of the process	Graduated high school
	Medical college				Others
	Yes		No		Yes		No
	$n$	%	$n$	%	$n$	%	$n$	%
1. Step	16	22.9	2	2.9	47	67.1	5	7.1
2. Step	17	24.3	1	1.4	51	72.9	1	14
3. Step	17	24.3	1	1.4	51	72.9	1	1.4
4. Step	12	17.1	6	8.6	39	55.7	13	18.6
5. Step	18	25.7	0	0.0	51	72.9	1	1.4
6. Step	15	21.4	3	4.3	36	51.4	16	22.9
7. Step	18	25.7	0	0.0	49	70.0	3	4.3
8. Step	17	24.3	1	1.4	48	68.6	4	5.7
9. Step	18	25.7	0	0.0	49	70.0	3	4.3
10. Step	16	22.9	2	2.9	44	62.9	8	11.4
11. Step	11	15.7	7	10.0	41	58.6	11	15.7
12. Step	18	25.7	0	0.0	52	74.3	0	0.0
13. Step	18	25.7	0	0.0	52	74.3	0	0.0
14. Step	18	25.7	0	0.0	47	67.1	5	7.1
15. Step	17	24.3	1	1.4	46	65.7	6	8.6
16. Step	18	25.7	0	0.0	52	74.3	0	0.0
17. Step	17	24.3	1	1.4	47	67.1	5	7.1
18. Step	10	14.3	8	11.4	29	41.4	23	32.9
19. Step	17	24.3	1	1.4	41	58.6	11	15.7

Table 3

Self-confidence and self-efficacy levels of the students during their first blood drawing experience

Scales		$n$	Minimum	Maximum	Mean	SD
Self-confidence scale	Internal self-confidence	70	47	82	67.27	8.10
	External self-confidence	70	39	76	62.81	8.51
	Total	70	91	157	130.09	15.94
Self-efficacy scale	Total	70	20	39	31.71	3.92

Table 4

Comparison of self-confidence and self-efficacy sensation levels of the students in terms of sex and high school type

	High school	$n$	Mean	SD	$z$	$p^{*}$
Self-confidence	Medical college	18	131.1667	15.66281	$-$ 0.644	0.520
	Other	52	129.7115	16.17470
Self-efficacy	Medical college	18	31.6111	4.40773	$-$ 0.759	0.448
	Other	52	31.7500	3.78270
	Sex	$n$	Mean	SD	$z$	$p$
Self-confidence	Female	54	129.2593	16.71423	$-$ 0.047	0.962
	Male	16	132.8750	13.09898
Self-efficacy	Female	54	31.6667	3.70619	$-$ 0.425	0.671
	Male	16	31.8750	4.70284

${}^{*}$ Mann-Whitney U Test.

Table 5

The relationship between the total mean scores of students’ self-confidence and self-efficacy levels

	Self-confidence
	${r}^{*}$	${p}^{**}$
Self-efficacy	0.517	0.000

${}^{*}$ Pearson Correlation, ${}^{**}p<$ 0.01.

No statistically significant difference was found between the mean total scores of self-confidence and self-efficacy of the students in terms of sex and high school type ( $p>$ 0.05) (Table 4).

A positive statistically significant relationship was detected between the self-confidence and self-efficacy total mean scores of the students during blood drawing and it was identified that self-efficacy of the students increase as their self-confidence increase ( $r=$ 0.517, $p=$ 0.000) (Table 5).

4. Discussion

It is well established that students who study actively, in an organised and systematic way throughout their personal learning process learn more easilly, are more successful, and have higher levels of self-efficiency/efficacy [39]. Individuals with a high self-efficiency/efficacy sensation show more effort to reach their goals than those with lower self-efficiency/efficacy levels. They also act quickly and distincty to overcome negative situations that they face [39, 40].

It is thought that besides cognitive and affective skills, nursing students should also develop their psychomotor skills by practicing in training environments and on peers before going out into clinical field because it would affect their self-confidence and self-efficacy and help prevent potential problems that may occur in clinical environments. Thus, nursing students’ self-confidence and self-efficacy levels when using basic psychomotor skills such as blood drawing on peers should be investigated. This study was conducted with the aim of identifying the self-confidence and self-efficacy levels of first year nursing students during their first blood drawing experience.

4.1 Discussion on students’ first blood drawing skills on peers

Peer education is a system that allows students to be both the teacher and the student when putting theoretical knowledge into practice, and it also involves mutual learning. Unlike classic education, it is a learning and teaching process based on mutual trust without any isolated relationship between the teacher and the students. Peer education application eases education process, enhances students’ self-confidence and self-efficacy before clinical practice, and reduces timid behavior [41].

It was observed that the majority of students were able to perform most of the steps of blood drawingon peers. The three steps that the students performed the best were “penetrating the skin parallel to the vessel with an angle of 15–30 degrees, 1–2 cm below the vessel insertion area,” “pulling back the injector plunger to check if there is any blood in the injector,” and “evaluating the area to be depleted for appropriateness by inspection and palpation methods,” respectively (Table 1). In a study conducted by Sarmasoğlu et al. on subcutaneous injections of nursing students on standard patients, it was stated that 100% of the students who applied the “swiftly penetrating the needle into the tissue with a 45–90 degree angle” step on standard patients, performed it correctly [42]. These similar results may indicate that students act more consciously when pricking a living tissue because they already practiced basic nursing skills such as blood drawing and injection on ‘real’ people. Penetrating the needle into tissue with the correct angle is an important step of blood drawing or injections because the it helps to reduce the pain and discomfort felt by patients [33, 34].

It was observed that students exercised due care during their first blood drawing experience on their peers and had good knowledge and skills regarding giving information to the patient and preparing/using equipment properly. However, we also noted that students who graduated from schools other than medical career colleges skipped/forgot steps such as “securing patient’s privacy and positioning the patient properly,” “spreading the protective cover under the area of application,” and “removing gloves and washing hands after injection.” In a study conducted by Midilli et al. with 200 nursing students who took the Principles of Nursing class, it was found that students did not give enough attention to steps such as “properly determining the injection spot in order to reduce pain that might occur during injection,” “talking with patients and relaxing them with deep breaths,” and “waiting 10 seconds inside the tissue after the injection of the medicine.” [43].

In a study conducted by Sarmasoğlu et al., when the steps of the subcutaneous injection process were examined, it was seen that 82.5% of the students in the control group and 76.9% of the students in the experimental group performed the “hand hygiene” step properly [42]. This result is not similar to the results of our study. However, Sarmasoğlu et al. found that the amount of students who performed “securing patient’s privacy” properly was very low in both groups and more than half of the students did not secure the patient’s privacy, which was similar to the results of our study. This result may be related to the fact that students do not yet know concepts such as ethics and patient rights, or they have not yet fully understood their importance.

In the literature, it is stated that there is a statistically significant negative relationship between nurses’ education level and drug errors, and drug errors decrease as the education level of the nurses increase [44, 45]. Medical career college graduates were generally better at performing the steps of the blood drawingskill process than students who graduated from other high schools; however, they were also not adequate in “securing patient’s privacy and positioning the patient properly” and “applying a tourniquet 15 cm above the area to be depleted.” Students at medical career colleges receive theoretical and applied education to develop their professional knowledge and skills; however, it may not be adequate. When the steps of subcutaneous injection application process were investigated in Sarmasoğlu et al.’s study, the “positioning the patient properly and comfortably” step was not performed properly by most students in the experimental group (74.3%) and nearly half the students in the control group (47.5%). This result is similar to the results in our study [42].

It is emphasized in conventional education that cognitive, affective, and psychomotor skills are taught separately, and although it is known that moving forward from simple to complex makes it easier for students to learn; nevertheless, students still have problems practicing skills on actual patients in the clinical environment [46, 47, 48]. Performing blood drawing on their peers help students to practice the skill they learned on actual patients. The fact that the standard patient scenario is similar to a patient might help reduce the anxiety students face in the clinical environment and make it easier for them to adapt. In doing so, the damage to patients is prevented or reduced and students become more self-confident due to the reduction in their anxiety. It is observed that practicing with scenarios similar to actual healthcare environments increases students’ coping skills and eases the process of implementing skills they learned in laboratories in the actual patient environment [42].

McNett emphasized that nursing students learned clinical skills at skill laboratories rather than actual healthcare environments; however, the author also remarked that there were differences between laboratory and clinical practice [49]. Only a limited number of studies are present investigating how first blood drawing experience on peers in skill laboratories affect the actual patient care environment. In a study conducted by Dearmon et al., with the aim of investigating the effects of learning experiences with patients on the stress levels, confidence, and satisfaction of the nursing students throughout their orientation to the clinical environment, it was found that standard patients prepared students for the basic nursing skills of their first clinical experiences [50].

4.2 Discussion on students’ self-confidence and self-efficacy levels during their first blood drawing on their peers

It was detected in our research that during their first blood drawingon their peers, the students’ intrinsic self-confidence was medium level (67.27 $\pm$ 8.10), and their extrinsic self-confidence and self-confidence total scores were high level (62.81 $\pm$ 8.51 and 130.09 $\pm$ 15.94, respectively). Self-confidence is defined as a person’s faith in fulfilling a certain activity successfully and having good and positive feeling about themselves. Intrinsic self-confidence is a person’s feelings and thoughts about being satisfied and at peace with themselves. Extrinsic self-confidence is the attitudes and behaviors a person displays about how pleased and confident they feel about themselves [35]. In this direction, we can say that the students included in our research felt good about their blood drawing skills and they believed in themselves to perform this skill. This may be because the students first performed blood drawing on their peers, who were healthy individuals that they knew. Self-confidence is a concept that affects students’ academic performance and was the subject of numerous studies in recent years. In a study conducted by Uçar and Duy with nursing and midwifery students, students’ mean self-confidence scale scores were found as 123.79 $\pm$ 19.02, the mean intrinsic self-confidence scores were found as 64.43 $\pm$ 9.98, and the mean extrinsic self-confidence scores were 59.35 $\pm$ 9.82 [51]. This result is similar to the results of our study.

On the other hand, the students’ self-efficacy levels during their first blood drawing on their peers were found high. Self-efficacy is related to how a person evaluates their capability, it is not related to their skills [35]. A successful performance might increase perceived self-efficacy levels, whereas repeated failure might decrease the self-efficacy sensation [35]. In nursing education, identifying the self-efficacy levels of students is an important step to identifying to what extent students reached their learning goals. Therefore, it can be identified how they put their theoretical knowledge into practice and if the learning outputs about basic learning skills can be reached [52]. In our research, before students performed blood drawing on their peers for the first time, they practiced on arm models under the supervision of instructors and performed this intervention at least three times on these models. Thus, high self-efficacy levels for these students was an inevitable result. Besides, we think that performing blood drawing for the first time on their peers might have an effect on this result.

No statistically significant difference was present between the students’ self-confidence and self-efficacy sensation levels in terms of sex and high school type. In the literature, there are studies showing higher self-efficacy levels among males [53, 54, 55], and there are also studies in which there was no difference in self-efficacy sensation according to the sex variable [56, 57, 58, 59, 60]. These results are similar to those found in our study. In Kanadıkırık Kılıç and Kılıç’s study, it was identified that the self-confidence of males was higher than in females [61]. Scholz et al. also stated that there was a difference between the sexes, reporting that self-efficiency-efficacy of males was higher than in females [62]. In a study by Dikmen et al., it was detected that the mean self-efficiency/efficacy scores of female students were higher than those of male students [63]. This is associated with the fact that nursing is perceived as a female occupation and the majority of the students in the nursing departments are females. Lackovic-Grgin and Dekovic found that self-confidence levels varied according to sex and females had higher levels of self-confidence than males. These results show no similarity to the results of our study [64].

In the studies about clinical experience, it is stated that investigating students’ perception and thoughts about clinical skill practices and evaluating the self-efficacy sensation would be beneficial for evaluating the efficiency of clinical teaching strategies in nursing, and developing efficient clinical teaching strategies [40, 65, 66]. In this direction, we identified the self-confidence and self-efficacy of nursing students when they performed blood drawing for the first time on their peers. Furthermore, it was detected that self-efficacy levels of the students increased as their self-confidence level increased. Although self-confidence and self-efficacy are terms which can be used as substitutes [35], it is assumed that each successful skill might also increase a student’s self-efficacy [67].

5. Conclusion

It was observed in our study that first year nursing students were able to perform the majority of the steps of blood drawingon their peers. It was identified that medical career college graduates performed more of these steps than those who graduated from other high schools.

Self-confidence and self-efficacy levels of the first year nursing students when they performed blood drawing for the first time on their peers was found high. Students should be provided more opportunity to practice on their peers before going into actual clinical environment. Hence, skill laboratory environments and the number of instructors should be regulated and more studies on this matter should be conducted.

Footnotes

Acknowledgments

The authors would like to thank all nursing students who voluntarily participated in this study and native English language editor David Chapman.

References

Çevik

İnce

Ayçeman

Ergin

. Effects of aroma inhalation on anxiety and vital signs of nursing students during their first blood drawing practice. International Journal of Health Sciences and Research. 2017; 7(2): 243-252.

Ulusoy

. Nitelikli hemşirelik eğitimi için nitelikli uygulama ortamı. In: Hemşirelik-Ebelik Eğitimi ve Uygulamalarında Kalite Sempozyumu Kitabı, 03-05 Haziran 1998. Kayseri: Erciyes Üniversitesi Matbaası; 1998. p. 52-55. (In Turkish).

Aydoğan

. Hemşirelik öğrencilerinin klinik beceri kazanmaları sırasında karşılaştıkları etik problemler [Ethical problems of nursing students related to acquisition of clinical skills]. Turk J Bioeth. 2016; 3(2): 120-123. (In Turkish).

Tel

Sabancıoğulları

. Hemşrelik birinci sınıf öğrencilerinin laboratuar uygulamasında birbirlerine i.m. enjeksiyon uygularken ve klinik uygulamanın ilk gününde anksiyete durumları [The anxiety status of first year students of nursing at the intramuscular injection laboratory practice to each other and the first day of clinical training]. Journal of Anatolia Nursing and Health Sciences. 2004; 7(1): 27-32. (In Turkish).

Doğru

. Beden eğitimi ve spor eğitimi bölümü öğrencilerinin özgüven ve özyeterlik algıları arasındaki ilişkinin değerlendirilmesi [Evaluation of self-confidence and self-efficacy perception levels of physical education and sport education department students]. Journal of Physical Education and Sports Studies. 2017; 9(1): 13-23. (In Turkish).

Brannagan

Dellinger

Thomas

Mitchell

Lewis-Trabeaux

Dupre

. Impact of peer teaching on nursing students: perceptions of learning environment, self-efficacy, and knowledge. Nurse Education Today. 2013; 33(11): 1440-1447. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.nedt.2012.11.018.

Heidarzadeh

Forouzi

Majid Kazemi

Jahani

. The Effect of computer simulation and mannequin on nursing students’ perception of self-efficacy in cardiopulmonary resuscitation. Iranian Journal of Medical Education. 2015; 14(10): 876-885.

Rui Baptista

Martins

JCA

Pereira

MFCR

Mazzo

. High-fidelity simulation in the nursing degree: gains perceived by students. Revista de Enfermagem Referência. 2014; 4(1): 131-140. https://dx-doi-org.web.bisu.edu.cn/10.12707/RIII13169.

Samawi

Miller

Haras

. Using high-fidelity simulation and concept mapping cultivate self-confidence in nursing students. Nursing Education Perspectives. 2014; 35(6): 408-409. https://dx-doi-org.web.bisu.edu.cn/10.5480/12-1042.1.

10.

Tiyuri

Saberi

Miri

Shahrestanaki

Bibi Bayat

Salehiniya

. Research selfefficacy and its relationship with academic performance in postgraduate students of Tehran University of Medical Sciences in 2016. Journal of Education and Health Promotion. 2018; 7(11): 1-6. https://dx-doi-org.web.bisu.edu.cn/10.4103/jehp.jehp_43_17.

11.

Houghton

Casey

Shaw

Murphy

. Staff and students’ perceptions and experiences of teaching and assessment in clinical skills laboratories: interview findings from a multiple case study. Nurse Educ Today. 2012; 32(6): 29-34. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.nedt.2011.10.005.

12.

Kneebone

. Valuating clinical simulations for learning procedural skills: a theory-based approach. Academic Medicine. 2005; 80(6): 549-553.

13.

Strand

Naden

Slettebo

. Students learning in a skills laboratory. Vard I Norden. 2009; 93(29): 18-22. https://dx-doi-org.web.bisu.edu.cn/10.1177/010740830902900305.

14.

Kneebone

Kidd

Nestel

Asvall

Darzi

. An innovative model for teaching and learning clinical procedures. Medical Education. 2002; 36(7): 628-634. https://doi.org-/10.1046/j.1365-2923.2002.01261.x.

15.

Morgan

. Using clinical skills laboratories to promote theory-practice integration during first practice placement: an Irish perspective. J Clin Nurs. 2006; 15(2): 155-161. https://dx-doi-org.web.bisu.edu.cn/10.1111/j.1365-2702.2006.01237.x.

16.

Fadıloğlu

. Türkiye’de hemşrelik eğitiminin fizik çevre ve uygulama alanındaki sorunları. In: II. Ulusal Hemşrelik Kongresi Kitabı, 12-14 Eylül (1990). İzmir: Ege Üniv. Basımevi; 1990. p. 430-436. (In Turkish).

17.

Sabuncu

. İlk defa kas içi enjeksiyon yapacak öğrenci hemşirelerde anksiyete düzeyi [Anxiety level in junior students who gives IM injections for the first time]. Hemşrelik Bülteni. 1994; 8(32): 1-7. (In Turkish).

18.

Sabuncu

. Derslerde ve kliniklerde psikomotor beceri eğitiminde sorunlar. In: Hemşrelikte Beceri Kazandırma ve Değerlendirme Workshop Kitabı. İstanbul; 1999. p. 5-12. (In Turkish).

19.

Birgili

Aydın

. Kan veren bireylerde kan alma sırasında görülen olumsuz belirti-bulguların ve kaygı düzeylerinin incelenmesi [Examination of negative signsymptoms seen during bloodletting and the level of anxiety from individuals which are donating blood]. Hacettepe Üniversitesi Hemşrelik Fakültesi Dergisi. 2011; 18(2): 17-26. (In Turkish).

20.

Gürpınar

Mamaklı

Alimoğlu

Şenol

Türkay

Aktekin

. Akdeniz Üniversitesi Tıp Fakültesi mesleksel beceri uygulamaları hakkındaki öğrenci geri bildirimleri [The students’ feedback on occupational skills training in Akdeniz University Faculty of Medicine]. TED. 2006; 23: 58-64. (In Turkish).

21.

Phillips

Collins

Dougherty

. (Eds.). Venepuncture and cannulation. John Wiley & Sons; 2011; 1-131.

22.

Bayar

Çadır

Bayar

. Hemşrelik öğrencilerinin klinik uygulamaya yönelik düş"unce ve kaygı düzeylerinin belirlenmesi [Determination thought and anxiety levels of nursing students intended for clinical practice]. TAF Preventive Medicine Bulletin. 2009; 8(1): 37-42. (In Turkish).

23.

Edwards

Burnard

Bennett

Hebden

. A longitudinal study of stress and self-esteem in student nurses. Nurse Education Today. 2010; 30(1): 78-84. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.nedt.2009.06.008.

24.

Nahas

Yam

. Hong Kong nursing students’ perceptions of effective clinical teachers. Journal of Nursing Education. 2001; 40(5): 233-237.

25.

Lai

Chen

Chang

. Randomized crossover trial studying the effect of music on examination anxiety. Nurse Education Today. 2008; 28(8): 909-916. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.nedt.2008.05.011.

26.

Taşkın

Eroğlu

Terzioğlu

Koç

Ergöl

Zeyneloğlu

. Educational model with using evaluation list to anxiety level of students who attend obstetrics and gynecologic nursing course. Hemşrelikte Araştırma Geliştirme Dergisi. 2010; 2(1): 51-8. (In Turkish).

27.

Alsop

Watts

. Facts and feelings: exploring the affective domain in the learning of physics. Physics Education. 2000; 35(2): 132-138. https://doi.org/10.1088/0031-9120/35/2/311.

28.

Thompson

Mintzes

. Cognitive structure and the affective domain: on knowing and feeling in biology. International Journal of Science Education. 2002; 24(6): 645-660. https://doi.org/-10.1080/09500690110110115.

29.

Duit

Treagust

. Conceptual change: A powerful framework for improving science teaching and learning. International Journal of Science Education. 2003; 25(6): 671-688. https://doi.org-/10.1080/09500690305016.

30.

Schwarzer

Fuchs

. Changing risk behaviors and adopting health behaviors: The role of self-efficacy beliefs. In: Bandura

, ed. Self-efficacy in changing societies. New York, NY, US: Cambridge University Press; 1995. p. 259-288. https://dx-doi-org.web.bisu.edu.cn/10.1017/CBO9780511527692.011.

31.

Acaroğlu

Şendir

Kaya

Esen Yılmaz

Aktaş

. Güvenli çevrenin sağlanması ve sürdürülmesi aktivitesi. In: Babadağ

Atabek Aştı

, eds. Hemşrelik Esasları Uygulama Rehberi. 2nd ed. İstanbul: İstanbul Tıp Kitabevi; 2012. p. 21-140. (In Turkish).

32.

Craven

Hirnle

. Procedure check lists for craven & hirnle’s fundamentals of nursing. 6th ed. Philadelphia: Lippincott Williams &Wilkins; 2009; 33-34.

33.

Kaya

Palloş

. Parenteral ilaç uygulamaları. In: Atabek

Kardağ

, eds. Hemşrelik Esasları Hemşrelik Bilimi ve Sanatı. Istanbul: Akademi Basın ve Yayıncılık; 2014. p. 68-851. (In Turkish).

34.

Potter

Perry

. Fundamentals of nursing. 7th ed. Missouri: Mosby; 2009; 966-1027.

35.

Akın

. Öz-güven ölçeği’nin geliştirilmesi ve psikometrik özellikleri [The development and psychometric characteristics of the self-confidence scale]. Abant İzzet Baysal Üniversitesi Eğitim Fakültesi Dergisi. 2007; 7(2): 167-176. (In Turkish).

36.

Jerusalem

Schwarzer

. Self-efficacy as a resourcefactor in stressappraisalprocesses. In: Schwarzer

, ed. Thought control of action. 2nd ed. Washington, USA: DC: Hemisphere; 1992. p. 195-213.

37.

Yeşilbalkan

Karadakovan

Ünal

. Periton diyalizi hastalarının genel öz yeterlilikleri [General self efficacy of peritoneal dialysis patients]. Nefroloji Hemşireliği Dergisi. 2005; 14(2): 39-44. (In Turkish).

38.

Kılıç

. Cronbachs alpha reliability coefficient. Journal of Mood Disorders (JMOOD). 2016; 6(1): 47-48.

39.

Yiğitbaş

Yetkin

. Sağlık yüksekokulu öğrencilerinin özetkililik-yeterlik düzeyinin değerlendirilmesi [Evaluating of self-efficacy-sufficiency levels of students in the health college]. ÇÜ Hemşrelik Yüksek Okulu Dergisi. 2003; 7(1): 6-13.

40.

Zengin

. Sağlık Yüksekokulu öğrencilerinde öz-etkililik-yeterlilik algısı ve klinik uygulamada yaşanılan stresle ilişkisinin incelenmesi [Investigate the interaction between self-efficacy and perceived stress in clinical learning environment in students of health college]. Journal of Anatolia Nursing and Health Sciences. 2007; 10(1): 49-57.

41.

Yava

Sütçü Çiçek

. Hemşrelik eğitiminde yeni bir yaklaşım: Akran koçluğu [A new approach in nursing education: Peer coaching]. Journal of Hacettepe University Faculty of Nursing. 2016; 3(1): 65-71. (In Turkish).

42.

Sarmasoğlu

Dinç

Elçin

. Hemşrelik öğrencilerinin klinik beceri eğitimlerinde kullanılan standart hasta ve maketlere ilişkin görüşleri [Nursing students’ opinions about the standardized patients and part task trainers used in the clinical skills training]. Hemşrelikte Eğitim ve Araştırma Dergisi. 2016; 13(2): 107-115. https://dx-doi-org.web.bisu.edu.cn/10.5222/HEAD.2016.107. (In Turkish).

43.

Midilli

Çevik

Baysal

. Hemşrelik öğrencilerinin laboratuvar uygulamalarındaki bilgi ve becerileri ile sınav kaygısı ilişkisinin incelenmesi [Assessment of the relationship between test anxiety and the levels of knowledge and skills about laboratory practices for nursing students]. SDÜ Sağlık Bilimleri Enstitüsü Dergisi. 2017; 8(1): 43-54. https://dx-doi-org.web.bisu.edu.cn/10.22312/sdusbed.306412. (In Turkish).

44.

Chang

Mark

. Antecedents of severe and nonsevere medication errors. JNS. 2009; 41(1): 70-8. https://dx-doi-org.web.bisu.edu.cn/10.1111/j.1547-5069.2009.01253.x.

45.

Özata

Altunkan

. Hastanelerde tıbbi hata görülme sıklıkları, tıbbi hata türleri ve tıbbi hata nedenlerinin belirlenmesi: Konya örneği [Frequency of medical errors in hospitals, determination of medical error types and medical errors: Konya sample]. TAD. 2010; 8(2): 100-11. (In Turkish).

46.

Medley

Horne

. Using simulation technology for undergraduate nursing education. Journal of Nursing Education. 2005; 44(1): 31.

47.

Nestel

Kneebone

Kidd

. Teaching and learning about skills in minor surgery. Journal of Clinical Nursing. 2003; 12(2): 291-296. https://doi.org/10.1046/j.1365-2702.2003.00694.x.

48.

Ross

. Simulation and psychomotor skill acquisition: a review of the literature. Clinical Simulation in Nursing. 2012; 8(9): 429-435. https://doi.org/10.1016/j.ecns.2011.04.004.

49.

McNett

. Teaching nursing psychomotor skills in a fundamentals laboratory: a literature review. Nurs Educ Perspect. 2012; 33(5): 328-333.

50.

Dearmon

Graves

Hayden

Mulekar

Lawrence

Jones

Farmer

. Effectiveness of simulation-based orientation of baccalaureate nursing students preparing for their first clinical experience. Journal of Nursing Education. 2013; 52(1): 29-38. https://doi.org/10.3928/01484834-20121212-02.

51.

Uçar

Duy

. The relationship between locus of control and self-confidence with problem solving skills of midwifery and nursing students. TAF Preventive Medicine Bulletin. 2013; 12(6): 689-698. https://doi.org/10.5455/pmb.1-1356300604.

52.

Pozam

Zaybak

. Klinik performansta öz-yeterlik ölçeği’nin Türkçe’ye uyarlanması ve psikometrik özelliklerinin incelenmesi [Adaptation of self-efficacy scale in clinical performance scale in to Turkish and examination of psychometric properties]. Ege Üniversitesi Hemşrelik Fakültesi Dergisi. 2016; 32(3): 100-117. (In Turkish).

53.

Aypay

. Genel Öz Yeterlik Ölçeği (GÖYÖ)’nin Türkçe’ye uyarlama çalışması [The adaptation study of general self-efficacy (GSE) scale to Turkish]. İnönü Üniversitesi Eğitim Fakültesi Dergisi. 2010; 11(2): 113-131. (In Turkish).

54.

Morgil

Seçken

Yücel

. Kimya öğretmen adaylarının öz-yeterlik inançlarının bazı değişkenler açısından incelenmesi [Based on some investigation of self-efficacy beliefs of preservice chemistry teachers variables]. BAÜ Fen Bilimleri Enstitüsü Dergisi. 2004; 6(1): 62-72. (In Turkish).

55.

Rimm

Jerusalem

. Adaptation and validation of an Estonian version of the General Self-Efficacy Scale (ESES). Anxiety, Stress, and Coping. 1999; 12(3): 329-345. https://doi.org/10.1080-/10615809908250481.

56.

Akbaş

Çelikkaleli

. Sınıf öğretmeni adaylarının fen öğretimi özyeterlik inançlarının cinsiyet, öğrenim türü ve üniversitelerine göre incelenmesi [The investigation of the preservice elementary teachers’ science instruction self-efficacy beliefs according to their gender, type of education, and universities]. Mersin Üniversitesi Eğitim Fakültesi Dergisi. 2006; 2(1): 98-110. (In Turkish).

57.

Altunçekiç

Yaman

Koray

. Öğretmen adaylarının öz-yeterlik inanç düzeyleri ve problem çözme becerileri üzerine bir araştırma (Kastamonu İli örneği) [The research on prospective teachers’ self efficacy belief level and problem solving skills (the case of Kastamonu Province)]. Kastamonu Eğitim Dergisi. 2005; 13(1): 93-102. (In Turkish).

58.

Erol

Dilek

. Eyleme geçiren bir katalizör “öz yeterlik algısı”: Üniversite öğrencileri üzerine bir inceleme [A catalyst that put into action “perception of self-efficacy”: A study on university students]. H. U. Journal of Education. 2015; 31(4): 711-723. https://doi.org/10.16986/HUJE.-2015014223. (In Turkish).

59.

Kılıç

Coşkun

. Öğretmen adaylarının eğitsel amaçlı internet kullanım öz yeterlik inanç düzeylerinin çeşitli değişkenler açısından incelenmesi. In: 19. Eğitim Bilimleri Kurultayı, 16-18 Eylül 2010. Lefkoşa-KKTC: Uluslararası Kıbrıs Doğu Akdeniz Üniversitesi; 2010. (In Turkish).

60.

Tuncer

Özüt

. Sınıf öğretmeni adaylarının eğitsel internet kullanımına yönelik öz yeterlik inançları [Self-efficacy perception of preservice class teachers to educational internet usage]. Turkish Studies. 2012; 7(2): 1079-1091. (In Turkish).

61.

Kanadıkırık Kılıç

Kılıç

. MEB ortaöğretim kurumlarındaki öğrencilerin akran zorbalığına maruz kalma düzeyleri ve özgüven arasındaki ilişki. In: Sakarya Üniversitesi Eğitim Bilimleri Enstitüsü VI. Ulusal Lisansüstü Eğitim Sempozyumu Bildirileri, 10-11 Mayıs 2013. Sakarya Üniversitesi: Sakarya Üniversitesi Basımevi; 2013. p. 23-29. (In Turkish).

62.

Scholz

Doña

Sud

Schwarzer

. Is general self-efficacy a universal construct? Psychometric findings from 25 countries. European Journal of Psychological Assessment. 2002; 18(3): 242. https://dx-doi-org.web.bisu.edu.cn/10.1027//1015-5759.18.3.242.

63.

Dikmen

Denat

Başaran

Filiz

. Hemşrelik öğrencilerinin öz etkililik-yeterlik düzeylerinin incelenmesi [Investigation of self-effectiveness and self-efficacy levels of nursing students]. Journal of Contemporary Medicine. 2016; 6(3): 206-213. https://dx-doi-org.web.bisu.edu.cn/10.16899/ctd.93945. (In Turkish).

64.

Lackovic-Grgin

Dekovic

. The contribution of significant others to adolescents’ self-esteem. Adolescence. 1990; 25(100): 839-846.

65.

Sharif

Masoumi

. A qualitative study of nursing student experiences of clinical practice. BMC Nursing. 2005; 4(1): 6. https://dx-doi-org.web.bisu.edu.cn/10.1186/1472-6955-4-6.

66.

Townsend

Scanlan

. Self-efficacy related to student nurses in the clinical setting: a concept analysis. International Journal of Nursing Education Scholarship. 2011; 8(1): 1-15. https://dx-doi-org.web.bisu.edu.cn/10.2202/1548-923X.2223.

67.

Bandura

. Self-efficacy the exercise of control. New York: Freman and Company; 1997; 80-250.

Identification of the self-confidence and self-efficacy levels of student nurses when performing blood drawing for the first time on their peers

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2. Method

2.1 Type of research

2.2 Population and sample of the research

2.3 Data collection tools

2.3.1 Student information form

2.3.2 Blood drawing skill practice evaluation control form (BDSPECF)

2.3.3 Self-confidence scale (SCS)

2.3.4 General self-efficacy scale (GSES)

2.4 Data collection process

2.5 Ethical considerations

2.6 Data analysis and evaluation

2.7 Limitations of the research

3. Results

3.1 SCS and GSES’s Cronbach’s alpha coefficients

3.2 Students’ skills of first blood drawing on their peers

3.3 Self-confidence and self-efficacy levels of the students during their first blood drawing experience on their peers

Table 1 Distribution of the steps of blood drawing skill process

4.1 Discussion on students’ first blood drawing skills on peers

4.2 Discussion on students’ self-confidence and self-efficacy levels during their first blood drawing on their peers

5. Conclusion

Footnotes

Acknowledgments

References

Table 1
Distribution of the steps of blood drawing skill process