Preparing Nursing Students to Manage Acculturative Stress Experienced During Study Abroad Experiences: Novel Use of Immersive Simulation and Cognitive Behavioral Strategies

Authors

  • Theresa G. Schnable College of Nursing, Marquette University
  • Christine A. Schindler College of Nursing, Marquette University and Medical College of WI, Department of Pediatrics
  • Jeffrey D. Roche Counseling Center, University of Northern Colorado
  • Karli Webster Office of International Education, Marquette University
  • Chris Larkee Opus College of Engineering, Marquette University
  • Maharaj Singh College of Nursing, Marquette University
  • John F. LaDisa Medical College of Wisconsin

DOI:

https://doi.org/10.36366/frontiers.v36i1.812

Keywords:

Anxiety, immersive simulation, mixed reality, nursing education, virtual reality

Abstract

This pilot study adds to the understanding of interventions to manage acculturative stress experienced during undergraduate study abroad programs. It was designed to evaluate the impact of cognitive behavioral strategy training combined with intentional practice during mixed reality (MR) simulations on acculturative stress. Participants included a convenience sample of undergraduate nursing students enrolled in a faculty-led study abroad course. Students participated in two MR simulations within a virtual environment over back-to-back days. Simulations were written by nursing faculty experts to reproduce realistic clinical situations students may encounter while studying in Peru. The Generalized Self-Efficacy Scale, State-Trait Anxiety Inventory, and Slater-Usoh-Steed questionnaire were administered. Quantitative biometric indices assessed during simulations included estimates of heart rate, blood pressure, respiratory rate, oxygen saturation and alterations in sweat gland activity reflective of changes in emotional state (galvanic skin response). There were changes in biometric indices within each simulation, but indices were not different between pre- and post- cognitive behavioral strategy training. Intentional reflective writing before, during, and after the study abroad program demonstrated an iterative cycle of reflection on action and mindfulness. These qualitative data suggest that pre-departure cognitive based behavior stress management strategies paired with simulated practice prior to departure may be one way to help nursing students deal with acculturative stress during study abroad experiences.

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Author Biographies

Theresa G. Schnable, College of Nursing, Marquette University

Theresa G. Schnable, PhD, RN, CNE, is a clinical instructor in the College of Nursing at Marquette University. Her nursing education expertise includes healthcare simulation, population health, and global health study abroad. She leads several global health faculty-led study abroad programs, and her research investigates how nursing students incorporate the social determinants of health into their patient plan of care.

Christine A. Schindler, College of Nursing, Marquette University and Medical College of WI, Department of Pediatrics

Christine A. Schindler, PhD, RN, CPNP-AC/PC, has a joint appointment between Marquette University and the Medical College of WI where she serves as a member of the nursing faculty and practices as a pediatric nurse practitioner in the pediatric intensive care unit at Children’s WI. She leads several global health faculty-led study abroad programs and her research is focused on patient safety and leadership.

Jeffrey D. Roche, Counseling Center, University of Northern Colorado

Jeffrey Roche, PhD, L.P., is a licensed psychologist who currently serves as the Director of Training for the Counseling Center at the University of Northern Colorado. He has worked in five different university counseling centers, supporting the mental health needs of students for over ten years. As a university-based psychologist, Dr. Roche serves others in a variety of capacities, be it through direct clinical care, supervision and training, outreach, or collaborative projects and interventions such as this.

Karli Webster, Office of International Education, Marquette University

Karli Webster, MS, has been an international education professional since 2004. She became the Manager of Education Abroad at Marquette in 2014 and the Director of the Office of International Education in 2022. Her main responsibilities focus on emergency response and risk management, as well as management of the Sibanye Cape Town program and oversight of Marquette's various education abroad options. She also oversees exchange student mobility and serves as an ARO.

Chris Larkee, Opus College of Engineering, Marquette University

Chris Larkee, BFA, is the technology specialist for the Visualization Laboratory at Marquette University. He has 15 years of experience in computer animation, media production, and broadcast engineering. Since 2014, he has served a lead role in Marquette University's Visualization Laboratory, working with faculty and graduate students in the development of customized immersive environment software to implement their concepts for research and learning. Chris's skills include programming, 3-D modelling, and interactive user experience design.

Maharaj Singh, College of Nursing, Marquette University

Maharaj Singh, PhD, serves as an Associate Professor at the College of Nursing, Marquette University. With a rich background spanning over two decades, he specializes in teaching applied statistics courses and offering statistical consultation in biomedical research. His expertise benefits a diverse range of clients, including faculty, students, physicians, and research scientists.

John F. LaDisa, Medical College of Wisconsin

John LaDisa, PhD, was a postdoc at Stanford University for 2.5 years after earning his PhD in Biomedical Engineering. He previously directed the Visualization Laboratory and Laboratory for Translational, Experimental and Computational Cardiovascular Research at Marquette University. He now serves as Director of the Computational Engineering and Visualization Program for the Section of Cardiology in the Department of Pediatrics at the Medical College of Wisconsin.

References

American College Health Association. (2023). American College Health Association- National College Health Assessment III: Reference Group Executive Summary Fall 2022. Silver Spring, MD. https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf

Armstrong, G., Horton-Deutsch, S., Sherwood, G.D., Dreifuerst, K.T. (2017). Reflection in clinical contexts: Learning, collaboration, and evaluation. In S. Horton-Deutsch & G. D. Sherwood (Eds). Reflective practice: Transforming education and improving outcomes (2nd ed., pp.215-238). Sigma Theta Tau International.

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd edition). The Guilford Press.

Bentley, K. H., Boettcher, H., Bullis, J. R., Carl, J. R., Conklin, L. R., Sauer-Zavala, S., Pierre-Louis, C., Farchione, T. J., & Barlow, D. H. (2018). Development of a single-session, transdiagnostic preventive intervention for young adults at risk for emotional disorders. Behavior Modification, 42(5), 781-805. https://doi.org/10.1177/0145445517734354 DOI: https://doi.org/10.1177/0145445517734354

Berry, J. W. (2005). Acculturation: Living successfully in two cultures. International Journal of Intercultural Relations, 29(6), 697-712. https://doi.org/10.1016/j.ijintrel.2005.07.013 DOI: https://doi.org/10.1016/j.ijintrel.2005.07.013

Berryman, D. R. (2012). Augmented reality: A review. Medical Reference Services Quarterly, 31(2), 212-218. https://doi.org/10.1080/02763869.2012.670604 DOI: https://doi.org/10.1080/02763869.2012.670604

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Chen, C.Y. (2014). Examining acculturative stressors of the international student: Following study abroad students in South Korea and Morocco [Honor’s Thesis, University of Dayton]. University of Dayton Ecommons. https://ecommons.udayton.edu/cgi/viewcontent.cgi?article=1013&context=uhp_theses

de Abreu Costa, M., de Oliveira, G. S. D., Tatton-Ramos, T., Manfro, G. G., & Salum, G. A. (2019). Anxiety and stress-related disorders and mindfulness-based interventions: A systematic review and multilevel meta-analysis and meta-regression of multiple outcomes. Mindfulness, 10(6), 996-1005. https://doi.org/10.1007/S12671-018-1058-1 DOI: https://doi.org/10.1007/s12671-018-1058-1

Division 12 of the American Psychological Association (2016). Cognitive and behavioral therapies for generalized anxiety disorder. Retrieved May 5, 2021 from https://div12.org/treatment/cognitive-and-behavioral-therapies-for-generalized-anxiety-disorder/

Dreifuerst, K. T. (2015). Getting started with debriefing for meaningful learning. Clinical Simulation in Nursing, 11(5), 268-275. https://doi.org/10.1016/j.ecns.2015.01.005 DOI: https://doi.org/10.1016/j.ecns.2015.01.005

Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22(4), 716-721. https://doi.org/10.1016/j.janxdis.2007.07.005 DOI: https://doi.org/10.1016/j.janxdis.2007.07.005

Halloran, D. A. (2017). Examining the effect of virtual simulation on anxiety experienced by pediatric nursing students (UMI No. AAI10685634) [Doctoral dissertation, Capella University]. ProQuest.

Hollon, S. D. & Beck, A. T. (2004). Cognitive and cognitive behavioral therapies. In Michael J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 447-492). John Wiley & Sons, Inc.

INACSL Standards Committee, Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021a). Healthcare simulation standards of best practiceTM: The debriefing process. Clinical Simulation in Nursing,58, 27-32. https://doi.org/10.1016/j.ecns.2021.08.011 DOI: https://doi.org/10.1016/j.ecns.2021.08.011

INACSL Standards Committee, Molloy, M., Holt, J., Charnetski, M., & Rossler, K. (2021b). Healthcare simulation standards of best practiceTM: Simulation glossary. Clinical Simulation in Nursing, 58, 57-65. https://doi.org/10.1016/j.ecns.2021.08.017 DOI: https://doi.org/10.1016/j.ecns.2021.08.017

Jimenez, Y. A., Cumming, S., Wang, W., Stuart, K., Thwaites, D. I., & Lewis, S. J. (2018). Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy. Supportive Care in Cancer, 26, 2879-2888. https://doi.org/10.1007/s00520-018-4114-4 DOI: https://doi.org/10.1007/s00520-018-4114-4

Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2006). The complete adult psychotherapy treatment planner (4th ed.). John Wiley & Sons, Inc.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette Book Group, Inc.

Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., Lenderking, W. R. & Santorelli, S. F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149(7), 936-43. https://doi.org/10.1176/ajp.149.7.936 DOI: https://doi.org/10.1176/ajp.149.7.936

Kang, Y. S., Choi, S. Y., & Ryu, E. (2009). The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Education Today, 29(5), 538-43. https://doi.org/10.1016/j.nedt.2008.12.003 DOI: https://doi.org/10.1016/j.nedt.2008.12.003

LaDisa, J.F., Jr., & Larkee, C.E (2020). The MARquette Visualization Lab (MARVL): An immersive virtual environment for research, teaching, and collaboration. Frontiers in Education, 5(38). https://doi.org/10.3389/feduc.2020.00038 DOI: https://doi.org/10.3389/feduc.2020.00038

Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M., & Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013-2021. Journal of Affective Disorders, 306, 138-147. https://doi.org/10.1016/j.jad.2022.03.038 DOI: https://doi.org/10.1016/j.jad.2022.03.038

Marquess, M., Johnston, S. P., Williams, N. L., Giordano, C., Leiby, B. E., Hurwitz, M. D., Dicker, A. P., & Den, R. B. (2017). A pilot study to determine if the use of a virtual reality education module reduces anxiety and increases comprehension in patients receiving radiation therapy. Journal of Radiation Oncology, 6, 317-322. https://doi.org/10.1007/s13566-017-0298-3 DOI: https://doi.org/10.1007/s13566-017-0298-3

Nadeau, C., Snowden, K., Gattamorta, K., & Foronda, C.L. (2020). Use of simulation for global health pre-departure training. Nurse Education Today, 95. https://doi.org/10.1016/j.nedt.2020.104597 DOI: https://doi.org/10.1016/j.nedt.2020.104597

NLN Board of Governors. (2015). A vision for teaching with simulation: A living document from the National League for Nursing NLN Board of Governors. https://www.nln.org/docs/default-source/uploadedfiles/about/nln-vision-series-position-statements/vision-statement-a-vision-for-teaching-with-simulation.pdf?sfvrsn=e847da0d_0

Panagiotopoulou, A. & Paschali, A. A. (2012). Anxiety and depression among university nursing students: Application of prevention programs. Psychology: The Journal of the Hellenic Psychological Society, 19(3), 281-295. https://doi.org/10.12681/psy_hps.23623 DOI: https://doi.org/10.12681/psy_hps.23623

Patel, K., Bailenson, J. N., Hack-Jung, S., Diankov, R., & Bajcsy, R. (2006). The effects of fully immersive virtual reality on the learning of physical tasks. [Presentation]. The 9th Annual International Workshop on Presence, New York, NY.

Ratanasiripong, P., Park, J. F., Ratanasiripong, N., & Kathalae, D. (2015). Stress and anxiety management in nursing students: Biofeedback and mindfulness meditation. Journal of Nursing Education, 54(9), 520-524. https://doi.org/10.3928/01484834-20150814-07 DOI: https://doi.org/10.3928/01484834-20150814-07

Savicki, V. (2013). The effects of affect on study abroad students. Frontiers: The Interdisciplinary Journal of Study Abroad, 22(1), 131–147. https://doi.org/10.36366/frontiers.v22i1.323 DOI: https://doi.org/10.36366/frontiers.v22i1.323

Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In J. Weinman, S. Wright & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio causal and control beliefs (pp. 35-37). Windsor, UK. DOI: https://doi.org/10.1037/t00393-000

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (2nd edition). The Guilford Press.

Slater, M., Usoh, M., & Steed, A. (1994). Depth of presence in virtual environments. Presence: Teleoperators and Virtual Environments, 3(2), 130–144. https://doi.org/10.1162/pres.1994.3.2.130 DOI: https://doi.org/10.1162/pres.1994.3.2.130

Smith, B. D., Ketterer, M. W., Concannon, M. (1981). Bilateral electrodermal activity as a function of hemisphere-specific stimulation, hand preference, sex and familial handedness. Biological Psychology,12(1), 1-11. https://doi.org/10.1016/0301-0511(81)90016-8 DOI: https://doi.org/10.1016/0301-0511(81)90016-8

Sokolowski, D. S. (2014). Human patient simulation: An educational approach toward reduction of stress and anxiety among nursing students preparing for the first clinical (UMI No. 3665394) [Doctoral dissertation, Capella University]. ProQuest.

Song, Y. & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on depression, anxiety, stress, and mindfulness in Korean nursing students. Nurse Education Today, 35(1), 86-90. https://doi.org10.1016/j.nedt.2014.06.010 DOI: https://doi.org/10.1016/j.nedt.2014.06.010

Spielberger, C. D. (2015). State-Trait Anxiety Inventory for AdultsTM (Forms Y1 and Y2) Manual. Mind Garden, Inc. (Original work published in 1983) DOI: https://doi.org/10.1037/t06496-000

Strange, H. & Gibson, H.J. (2017). An investigation of experiential and transformative learning in study abroad programs. Frontiers: The Interdisciplinary Journal of Study Abroad, 29(1), 85-100. https://doi.org/10.36366/frontiers.v29i1.387 DOI: https://doi.org/10.36366/frontiers.v29i1.387

Villanueva, I., Valladares, M., & Goodridge, W. (2016). Use of galvanic skin responses, salivary biomarkers, and self-reports to assess undergraduate student performance during a laboratory exam activity. Journal of Visualized Experiments, 108 (e53255), 1-8. https://doi.org/10.3791/53255 DOI: https://doi.org/10.3791/53255-v

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Published

2024-04-16

How to Cite

Schnable, T. G., Schindler, C. A., Roche, J. D. ., Webster, K., Larkee, C., Singh, M., & LaDisa, J. F. (2024). Preparing Nursing Students to Manage Acculturative Stress Experienced During Study Abroad Experiences: Novel Use of Immersive Simulation and Cognitive Behavioral Strategies. Frontiers: The Interdisciplinary Journal of Study Abroad, 36(1), 229–253. https://doi.org/10.36366/frontiers.v36i1.812

Issue

Vol. 36 No. 1 (2024): April 2024

Section

Research Articles

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Copyright (c) 2024 Theresa G. Schnable, Christine A. Schindler, Jeffrey D. Roche, Karli Webster, Chris Larkee, Maharaj Singh, John F. LaDisa

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