1. Background

Studies show that simulation activities increase students’ self-confidence, reducing their levels of fear and anxiety during activities [1, 2, 3, 4, 5]. The simulation allows the class participants to feel as many stimuli as possible so that they understand that their work matters, that the profession they have chosen is an independent one, and that the nurse is part of the therapeutic team.

Training using simulation allows students to use the knowledge they have acquired and combine it with practical work in safe conditions for both the learner and the patient. The student participating in simulation activities has the opportunity to experience both positive and negative aspects of caring for patients in various states of health and illness [6]. In addition, he or she has the opportunity to discuss his or her work after working through the scenario. It is important to derive satisfaction from the learning process, as well as satisfaction from the work done during the scenario [7, 8].

The theory of simulation based on the assumptions of the National League of Nursing (NLN) Jeffries Theory model includes elements that allow the design and implementation of the best practices of simulation-based education. These are related to educational practices (feedback, collaboration, high expectations, active learning); simulation design (fidelity, problem-solving, student support/debriefing and objectives of the simulation) and learner outcomes (learning, skill performance, critical thinking, learner satisfaction and self-confidence), among others [9].

According to Jeffries & Rizzolo (2006) satisfaction and confidence are important elements that affect the learning process [1]. In order for nurses to be able to deal with complex clinical problems in their future careers, it is important that they are able to skillfully address the challenges of critical thinking or problem solving from the educational stage. During the implementation of the simulation scenario, students receive support and guidance from the instructor, which already creates the conditions for increased confidence and satisfaction in the learning process. Even if students fail to fully achieve their goals—which may initially lower their motivation—they are likely to repeat the activity many times until they achieve satisfaction.

The Student Satisfaction and Self Confidence in Learning Scale (SSCL) is used to assess students’ contentment/satisfaction with various items related to the simulation activity and their confidence in the context of knowledge and practiced skills during the simulation scenario [1].

So far, the SSCL scale presented has been successfully adapted and validated in countries such as the United States, Hong Kong, Norway, Turkey, Portugal and Spain. According to the literature review of the presented studies, this instrument achieved very high reliability coefficients presented by means of Cronbach’s alpha coefficient. In addition, these studies also described the accuracy of the presented scale by means of CFA and EFA [10, 11, 12, 13, 14]. The use of standardized tools provides an opportunity to assess the simulation in many aspects, including that of technical skills, team communication, or, as in the case of the tool presented here, self-confidence and satisfaction with the learning process. In addition, it is worth noting that in the literature review by Adamson et al. [15] (2013) it was confirmed that the use of already existing research tools increases the motivation to draw on existing knowledge, and thus increases the chances of using and further developing these instruments.

As already mentioned, the SSCL scale is used to assess student satisfaction and confidence in the learning process. It can be used to assess the aforementioned aspects in both medical students, including Nursing, and graduate nurses.

In a study conducted by Guerrero et al. [16] (2022), it was found that after a simulation class on Managing Patient with Pneumothorax and Chest Tube, both students and graduate nurses have opportunities to improve their skills, which translates into job satisfaction and thus the quality of care provided and patients. It is important for both future nursing and professional staff to improve their practical skills, especially in the field of intensive care, where equipment and apparatus are very advanced and require staff, not only specialized knowledge but also technical skills and competence. Simulation creates safe conditions for practice related to, for example, operating a ventilator, caring for a tracheotomy tube or a patient in immediate life or health danger [17, 18]. Perfecting these skills will create an opportunity for high quality care, which will directly increase patient safety.

Currently, there is no tool available for students taking part in simulation classes to assess their level of confidence in the simulation learning process. Accordingly, cultural adaptation and psychometric validation of the SSCL scale were attempted. This scale, in the context of the competencies being assessed, will provide a reliable source of information about the teaching methods used in simulation, the way of learning, or the instructor/teacher’s use of simulation capabilities for the student’s needs.

In conclusion, the validity of the conducted research is significant because the SSCL scale will be the first tool in Poland through which the possibility of monitoring the didactic process will be created, which will allow to adapt it to the needs of both the learner and the teacher. At the same time, most of the schools training future nurses in Poland (e.g., Opole, Krakow, Lublin, Poznań, Krosno) have innovative high-fidelity simulation centers, which will create an opportunity to eliminate the gap between the use of high-fidelity simulation in education and the monitoring of this education.

2. Research question(s)

For the purposes of this study, the following research questions were posed:

What indicators of psychometric properties will the SSCL Polish version achieve?

3. Methods & design

The study was conducted in accordance with the Declaration of Helsinki, considering point no. 7 relating to the conduct of medical research, which is subject to strict ethical standards; after the simulation activity, students were given the SSCL scale questionnaire and answered according to their feelings. Completion of the questionnaire was without the presence of the teacher in charge of the teaching activity being evaluated.

3.2 Procedure

Validation and adaptation of Student Satisfaction and Self Confidence in Learning (SSCL) took place in accordance with World Health Organization (WHO) principles (Fig. 1) [19]. A “forward translation” was made to develop a Polish version of the surveyed tool. This was followed by a “backward translation”, where the final version of the SSCL scale was discussed with the translators and agreed upon. The final step was to test the tool for its psychometric properties.

Fig. 1.Model of adaptation and validation of the SSCL scale according to WHO. SSCL: Student Satisfaction and Self Confidence in Learning.

4. Data analysis

Various methods of data analysis were used, including descriptive analysis (mean and standard deviation) and bivariate statistics (correlation). The standard deviation (SD) represents how the values of a variable are scattered around its mean. Correlation, on the other hand, measures the strength of the presumed linear relationship between two variables and takes a value from −1 to +1. If the correlation value is 0, it is concluded that there is no linear relationship between the variables under study [20].

Cronbach’s alpha coefficient was used to assess the internal consistency of the scale. A score higher than 0.7 was considered acceptable [21]. In addition, the construct’s relevance was tested using Confirmatory Factor Analysis (CFA), for which the following parameters were determined Root Mean Standard Error of Approximation (RMSEA), Comparative Fit Index (CFI), NFI (Normed Fit Index), TLI (Tucker-Lewis Index). The authors of the study interpret the preferred values for these parameters as follows: An RMSEA of less than 0.05 indicates excellent model fit, and a score of less than 0.10 indicates good model fit; CFI, NFI, and TLI ranging from 0 to 1, where 1 denotes a perfectly matched model [22]. Exploratory Factor Analysis (EFA) was also conducted, which is a tool for examining the relationship between variables and the number of underlying factors [23]. Based on EFA, two factors were selected, matching individual Items with a load above 0.30 for each to the corresponding factor.

All calculations were performed using R software (version 3.5.0, R Foundation for Statistical Computing, Vienna, Austria).

5. Results

The study was conducted on a group of 361 second- and third-year nursing students at two academic centers in Poland (a university, higher vocational school). 96.4% of the respondents were women, while men accounted for 3.6%. The average age of the subjects was 21.78 (SD ± 3.19). Non-probability sampling was used with the following inclusion criteria: written consent to participate in the study, major in Nursing, participation in high-fidelity simulation classes, first-degree studies, complete and correct completion of the set of research questionnaires. Exclusion criteria are a field of study other than nursing, second-degree studies, incomplete and incorrect completion of research questionnaires, lack of consent to participate in the study. Demographic data are shown in Table 1.

6. Discussion of findings

As mentioned earlier, the study conducted in Turkey, similar to the Polish study, achieved satisfactory results of Cronbach’s alpha scale coefficient. It was 0.89 for the whole scale, 0.85 for the subscale “Satisfaction with current learning” and 0.77 for the subscale “Self-confidence in learning”. When item 13 was removed from the scale, Cronbach’s alpha coefficient rose to 0.79. Also in this study, the correlation value was over 0.30, except for the aforementioned finding 13 (r = 0.18) [14].

In the southern United States, in a study group of 2200 novice nurses, the presented tool also obtained results indicating high reliability of the tool. Cronbach’s alpha for the overall scale was 0.92 and for “Satisfaction with current learning” and “Self-confidence in learning” 0.92 and 0.83, respectively [11]. However, after removing item 13, the reliability coefficient increased to 0.94. A significant difference in the present study from those presented is the size of the study group, with more than 2000 respondents.

Another country where this tool was adapted was Spain. Among the 489 nursing students who participated in the study, the SSCL scale achieved very good psychometric values. The coefficient of Cronbach’s alpha was 0.88 for the overall scale, with the subscale “Satisfaction with current learning” at 0.84 and the subscale “Self-confidence in learning” at 0.81. The mean response value was M ± 4.2 for the “Satisfaction with current learning” subscale, and M ± 4.2 for the “Self-confidence in learning” subscale [10]. Juxtaposing the results of Spanish students with those of Polish students, they can be considered very close to each other.

Also, in Hong Kong, the SSCL scale was successfully validated and adapted for a group of 300 nursing students. The Cronbach’s alpha for the overall scale was 0.87 and 0.85 and 0.78 for the satisfaction and confidence in learning subscales, respectively. The present study did not find that removing item 13 from the scale would result in an increase in Cronbach’s alpha reliability coefficient [12].

In Norway, on the other hand, in a study group of 105 nursing students, the tested tool achieved the following values of Cronbach’s alpha coefficient: for the total scale 0.88; for the subscale Satisfaction with current learning 0.81; for Self-Confidence in Learning 0.82. When item 13 was removed, as in the Polish or Turkish study, Cronbach’s alpha coefficient increased to 0.89. As in the Polish and Turkish surveys, item 13 had a low correlation score (r = 0.13), while the remaining statements (1–12) had correlations above r = 0.4. Item 1 was rated the highest among the respondents (M ± SD: 4.76 ± 0.450), it refers to the methods used during simulations and their effectiveness [13].

In addition, analyzing the results of the Polish study with the American study by Franklin [11], the Turkish study by Unver [14], and the Norwegian study by Reierson et al. [13] where an exploratory factor analysis (EFA) was conducted, a binary model was extracted in which Item 13 was not included (“It is the instructor’s responsibility to tell me what I need to learn of the simulation activity content during class time”). As the authors [13, 24] suggest when analyzing this problem, it can be surmised that Item 13 does not fully address the student’s level of satisfaction and confidence. Simulation-based learning (SBL) is designed to activate the student, so transferring responsibility from learner to instructor is not quite in line with the perception of students at SBL. According to other researchers, the use of a scale of 12 items should be considered. This is because the removal of item 13 increases the reliability of the measurement, resulting in an increase in the accuracy of the tool used [11, 14]. In addition, the Norwegian binary EFA model explained 56% of the variance, the Turkish 51.02%, and the Chinese 50.11% [12, 13, 14].

7. Implications

The value of this study is to provide empirical evidence of the feasibility of using the SSCL Polish version both in the process of student learning during simulation activities and for scientific research. Moreover, the use of the SSCL scale in the Polish version will allow an international discussion related to education based on the medical simulation method. In addition, such an important issue as the student’s satisfaction with the learning process and confidence during the implementation of simulation activities will create an opportunity to implement better and better educational practices.

8. Limitations

This study was conducted at two nursing student training centers in Poland using a high-fidelity simulation method, which may be a limitation of the study. In the future, it would be advisable to expand the study to other academic nursing training centers, using the high-fidelity simulation method. Future research using this scale will probably help solidify the psychometric values of the scale and increase its potential use.

9. Conclusions

The purpose of the study was to validate and culturally adapt the “Student satisfaction and self-confidence in learning” scale, in Polish conditions, and to analyze its reliability and accuracy. Its Polish version of the language reads: “Student Satisfaction and Confidence in Learning”.

The statistical analysis used in this study achieved fully reliable results and confirms the validity of using the SSCL scale questionnaire in the Polish version both to assess the quality of education and to conduct scientific research. Moreover, that investigation confirmed that individual country scale adaptation is possible and can be performed as a universal approach.

Availability of data and materials

Not applicable.

Author contributions

KS—designed the study, wrote original draft, reviewed and edited; DZ—wrote original draft, reviewed and edited; JZ—designed the study, reviewed and edited; KS, DZ, JZ—reviewed and edited.

Ethics approval and consent to participate

The study was approved by the Bioethics Committee of the Medical University of Lublin (KE-0254/348/2018) and was conducted in accordance with the Helsinki Declaration. Informed consent was obtained from all subjects involved in the study.

Acknowledgment

Not applicable.

Funding

This research received no external funding.

Conflict of interest

The authors declare no conflict of interest.