الفهرس 
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Abstract
nursing students acquire the necessary skills in the 21st century. It is an educational process, in which learning is centered on problems. Furthermore, Scenario-Based Learning promotes students ability to take decision, increase motivation, better critical thinking, elevate students ’self -efficacy and the integrate knowledge and problem-solving skills.
Moreover, Scenario Based Learning (SBL) utilizes an authentic context in which problems are presented in certain sequence and choices offered that enable the learner to reach an outcome. Scenario-based learning (SBL) is a methodology which aims to promote deep learning and awareness by involving participants in realistic critical incidents where they are forced to consider a wide range of factors, make decisions and reflect on the outcomes and what they have learned from this. Moreover, SBL is a learning principle that puts more emphasis on context rather than content. It supposes that competencies are best realized when learning takes place in the context in which it will be applied.
Aim of the Study
The study aims to:
- Determine the effect of scenario based learning on self-efficacy, knowledge acquisition and decision making skill for nursing students.
Research hypothesis
1- Students who attend scenario based learning session exhibit higher level of self-efficacy than those who do not.
2- Students who attend scenario based learning session acquire more knowledge than those who do not.
3- Students who attend Scenario based learning session exhibit sound decision making skills than those who do not.
Research design
Quasi experimental research design was utilized.
Setting
The study was conducted at El Kabary Institute of Nursing, affiliated to the Ministry of Health in Alexandria. The program is covered in 5 years. The obstetric nursing course in this institute includes 9 units in one academic year and is distributed as follows:
- The theoretical takes 2hrs/week for 60hours.
- The clinical training takes 12 hrs /week for 120 hours.
- The study unit is post -partum hemorrhage was taking in 4 hours for theory and 12hours for clinical.
Subjects
The subjects of this study was comprise all fourth year nursing students enrolled in the obstetric course during the first semester of the academic year 2016-2017. The subjects (60 students) were assigned randomly into two equal groups; study and control (30 students for each).
Tools
Three tools were used for data collection:
Tool I: Scenario Based Learning Self-efficacy scale (SBLSE scale)
It was developed by the researcher after thorough reviewing of the related literature to measure nursing students’ self-efficacy in solving problems during the scenario-based learning. It consisted of 20 statements measured on 3 points Likert scale ranging from strongly disagree (1) to strongly agree (5). Total score ranging from 20-80, was the higher score, the higher level of self-efficacy.
Tool II: Nursing Students’ Knowledge test
It was developed by the researcher after thorough reviewing of the related literature, used to assess knowledge of the study group related to obstetric course.
The questions covered the following dimensions: Definition, types, the risk factors, causes, signs and symptoms, nursing role toward the post-partum hemorrhage and treatment suitable for each type of post-partum hemorrhage.
It consisted of two parts, the first part consisted of 15 true and false question, the second part consisted of 15 items of multiple choice questions.
The total scores of this test were 30 marks with the following categories: from (24-30marks) > 85% for excellent, (20-23 marks) >75% for very good, (16-19 marks) > 65% for good and (10- 15marks) >50% for accept.
Tool III: Nursing Student’s Decision Making Skills test:
This tool was developed by the researcher after reviewing of related literature to measure nursing students ’decision making skill and their ability to transfer learning to new situations regarding patients with post-partum hemorrhage .Students were asked to design a nursing care plan for scenario, and were evaluated following the steps of problem solving approach using nursing process.
Scoring was according to following description: (10 marks) assessment ”analysis of data”; (5 marks) nursing diagnosis or problems list; (10marks) goals and outcome criteria; (25 marks) nursing orders and intervention.
Phase I: Preparation phase
During this phase the researcher prepared herself, the content, the scenario and the students
A- Preparation of researcher and the lesson
- The researcher was trained about writing the scenarios under the guidance of expert educators in Obstetric Nursing and Education fields.
- The predetermined unit ”post-partum hemorrhage” is one of the topics covered in Obstetric Nursing book that is developed by the Ministry of Health.
- The objectives of the lesson were prepared by writing the general and specific objectives.
B- Development of problem based learning scenarios
- Two scenarios in Obstetric Nursing were developed using the obstetric nursing book of the Ministry of Health. (One of the scenario was used for teaching to cover the objectives of postpartum hemorrhage and another scenario was used for evaluating the students’ ability to make decisions as a final end product of problem solving techniques.
C-Preparation of students
- Explanation of the purpose of the study and steps of scenario-based learning.
- Explanation of the rules of scenario based learning.
- Explanation of the roles of students in each group.
Phase II: Implementation phase
The study group was divided randomly into 6 sub-groups 5 students for each. Both groups were oriented about the study content including steps, and aim of scenario based learning. Control group, consisted of 30 nursing students, who learned by the traditional educational strategy (lecture).
- Teaching scenario will took 2 days as follows
On the first day the scenario was introduced to students of each sub-group of the study group. Students in each sub-group interacted with each other in the presence and under guidance of the researcher to explore their knowledge, define the problems and analyze the scenario. The students had brainstorming to generate hypotheses related to the problem, then identified and gathered resources that would utilized and help them in solving the problem that took about 2 hours of library and web search group work.
On the second day the students of each sub-group of the study group will interacted with each other, to discuss the information acquired related to the problems and compare among alternatives of decisions with the rest of the group. Each sub-group of the study group discussed and debated the information alternatives and achievement they acquired with other sub-groups to the best decision. The researcher ensured that the content was covered and objective is achieved. This session took about 2 hours.
Phase III: evaluation phase
• Self- efficacy was measured for both groups will be test before and after strategy using tool I, Scenario Based Learning Self-efficacy scale (SBLSE scale).
• Knowledge acquisition of students in both groups was test before and after strategy using tool II, Nursing Students’ Knowledge test.
• Decision making skills of students in both groups were test before and after strategy using tool III,(Nursing Student’s Decision Making Skills test)
Ethical considerations
- Written informed consent was obtained from each student before he/she participates in the study after explaining the aim of the study and the right to refuse to participate and withdraw from the study at any time without any penalties.
- The student was assured about confidentiality of data.
- The student ’privacy was assured.
This study it can be concluded that
This study concluded that SBL strategy is an effective and valuable teaching strategy. It has important role in developing and improving nursing students’ decision making skills. Moreover, this study evidenced that use of SBL is an effective teaching strategy that enhances the acquisition of post-partum hemorrhage knowledge compared to those who used traditional teaching method. Furthermore, nursing students’ self-efficacy showed significant increase in such study by the use of SBL either self-efficacy which is related to individual activity or that which is related to group activity.
Based on the current study results, the following recommendations are offered
1- Scenario-based learning should be recognized as an effective teaching strategy in nursing teaching.
2- Applying scenario-based learning strategy in different courses of nursing at the Faculty of Nursing
3- Educational workshop should be conducted to all nursing educators to increase their knowledge and competencies about designing scenario and applying scenario based learning.
4- Teachers should employ scenarios in their evaluating of nursing students as an evidence of achieving higher order learning nursing objectives in Bloom Taxonomy.
5- Application of scenario-based learning within in service training programs held for health care team in health care institution.
6- A study to compare the effect of scenario based learning versus lecture-case based learning on students’ on students’ critical thinking skill and self-direction.
7- A study to explore the challenges and benefits of scenario based learning as perceived by nurse educators is needed.