Title: The Impact of Simulated Insulin Administration on General Self-Efficacy Scores among First-

Semester Associate Degree Nursing Students

I. Introduction

Background:

According to the World Health Organization diabetes has risen since 1980, making it a global
health concern. The impact of diabetes is not only a health challenge but also an economic
challenge on healthcare systems globally. The increase can be caused by various factors including
bad lifestyles, unhealthy diet habits, genetic tendencies, and age factors. If this disease is not
effectively managed can have a serious effect on human health, such as kidney failure, and
blindness among others. Given the multifaceted nature of diabetes and its potential
complications, effective management is crucial for ensuring the well-being of individuals and
reducing the burden on healthcare systems.

Critical Role of Nurses in Managing Diabetic Patients:

Nurses play an important role in the management and comprehensive care of diabetic patients.
Their involvement is not limited to administering medication but extends to providing education,
and support, and fostering a collaborative approach to diabetes management. Nurses often
serve as frontline healthcare providers, interacting closely with patients and coordinating care
across various healthcare settings. Nurses are responsible for:

I. Medication Administration: Administering medications, including insulin, is a key

responsibility of nurses. Ensuring accurate dosage and proper injection techniques are
essential for effective glycemic control.
II. Patient Education: Nurses educate patients about diabetes, its management, and
lifestyle modifications. They empower patients to make informed decisions regarding
their health, emphasizing self-care and adherence to treatment plans.
III. Monitoring and Assessment: Regular monitoring of blood glucose levels, vital signs, and
potential complications is integral to nursing care. Nurses assess patients' responses to
treatment and adjust care plans accordingly.
IV. Collaboration in Multidisciplinary Teams: Diabetes management often involves
collaboration with other healthcare professionals such as dietitians, physicians, and
pharmacists. Nurses facilitate communication and coordination within the healthcare
team.

Importance of Nursing Students Acquiring Practical Skills, Especially in Administering Insulin:

For nursing students, acquiring practical skills in administering insulin is of paramount

importance. Diabetes management is a dynamic and hands-on aspect of nursing care that
demands proficiency in various skills. Here are key reasons why practical skills, especially in
administering insulin, are critical for nursing students:

I. Patient Safety: Insulin administration requires precision to avoid complications such as

hypoglycemia or ineffective glycemic control. Practical training ensures that nursing students can
perform these tasks safely.
II. Application of Theoretical Knowledge: Nursing education involves theoretical learning, but
practical skills bridge the gap between theory and real-world application. Administering insulin is
a tangible skill that reinforces classroom learning.

III. Enhanced Patient Trust: Proficient insulin administration fosters patient trust and confidence.
Patients are more likely to comply with treatment plans when they perceive competence in their
healthcare providers.

IV. Critical Thinking and Decision-Making: Practical training develops critical thinking skills, enabling
nursing students to assess situations, make informed decisions, and respond appropriately to
unexpected challenges in diabetes management.

a. Preparation for Clinical Practice: Nursing students are future frontline healthcare
providers. Acquiring practical skills in insulin administration equips them with the
challenges they will face in clinical practice, contributing to their overall competence as
healthcare professionals.

Problem Statement:

 The integration of simulation experiences into nursing education has witnessed substantial
growth in recent years, offering a valuable bridge between theoretical knowledge and real-world
clinical practice. However, within the expansive landscape of nursing education research, there
exists a notable gap regarding the specific impact of simulation experiences on the general self-
efficacy scores of nursing students. While the literature extensively explores the benefits of
simulation in enhancing clinical skills and knowledge acquisition, there is a discernible lack of
comprehensive investigations into its influence on the broader construct of general self-efficacy
among nursing students.

 Self-efficacy, as defined by Bandura's Social Cognitive Theory, refers to an individual's belief in

their capability to successfully perform a specific task or achieve a desired outcome. In the
context of nursing education, general self-efficacy encompasses a student's overall confidence in
their ability to navigate the multifaceted challenges presented in the clinical setting. Despite its
acknowledged significance in shaping student success and professional development, the
relationship between simulation experiences and the enhancement of general self-efficacy
remains an understudied aspect.

 This gap in the literature is particularly noteworthy given the transformative nature of simulation
experiences. Simulations offer a controlled yet realistic environment where nursing students can
apply theoretical knowledge, hone technical skills, and develop critical thinking abilities. While
existing research has delved into the impact of simulation on specific clinical competencies, such
as medication administration or patient assessment, the broader influence on the students'
overarching confidence and self-efficacy remains a relatively unexplored terrain.

 Understanding the link between simulation experiences and general self-efficacy is vital for
several reasons. First and foremost, nursing is a profession that demands not only technical
 proficiency but also a high level of confidence and adaptability. A nurse's ability to navigate
complex and dynamic healthcare environments is inherently tied to their self-efficacy beliefs.
Second, as the landscape of healthcare evolves, nursing roles become increasingly diverse and
challenging. Investigating the potential of simulation experiences to positively impact general
self-efficacy can provide valuable insights into the efficacy of current educational methodologies
in preparing nursing students for the complexities of their future roles.

 By addressing this gap in the literature, this research aims to contribute to the ongoing discourse
on nursing education and inform pedagogical practices. It seeks to uncover the nuanced ways in
which simulation experiences, as an educational tool, can influence not only specific clinical
competencies but also the broader self-efficacy beliefs that underpin a nursing student's overall
readiness for professional practice.

Purpose of the Study:

The primary objective of this research is to investigate the impact of simulation experiences,
specifically focusing on the administration of insulin, on the general self-efficacy scores of first-
semester associate degree nursing students. The study aims to explore and understand how
exposure to simulated scenarios involving insulin administration influences the overall self-
efficacy beliefs of novice nursing students who are in the initial stages of their academic journey.

This research seeks to address a critical gap in the existing literature by examining the
relationship between simulation experiences and general self-efficacy within the unique context
of administering insulin. While simulation's efficacy in enhancing technical skills is well-
documented, the potential influence on the broader construct of general self-efficacy,
encompassing a student's confidence in their ability to navigate diverse challenges in the clinical
environment, remains an underexplored area.

Specifically, the study intends to:

1. Assess Self-Efficacy Changes: Examine the changes in general self-efficacy scores among first-
semester associate degree nursing students following exposure to simulation experiences
involving insulin administration.

2. Identify Influential Factors: Investigate potential factors within the simulation experience, such
as realism, feedback mechanisms, and scenario complexity, that may contribute to variations in
self-efficacy outcomes.

3. Compare Simulation and Traditional Learning: Compare the impact of simulation-based insulin
administration experiences with traditional classroom learning methods on general self-efficacy
scores to determine the unique contributions of simulation to self-efficacy development.

4. Inform Educational Practices: Provide insights into how nursing education programs can
strategically incorporate simulation experiences to enhance not only technical proficiency but
also the overall confidence and self-efficacy of first-semester associate degree nursing students.
 By fulfilling these objectives, this research aims to contribute valuable evidence to the field of
nursing education, informing curriculum development and instructional practices. The findings
have the potential to guide educators and institutions in optimizing the integration of simulation
experiences to maximize their positive influence on the holistic development of nursing
students, particularly in terms of bolstering their general self-efficacy beliefs early in their
academic journey.

Research Questions:

1. Main Research Question:

 How does the simulation experience of administering insulin influence the general self-
efficacy scores of first-semester associate degree nursing students?

2. Sub-Questions: a. What are the baseline general self-efficacy scores of first-semester associate
degree nursing students before exposure to simulation experiences involving insulin
administration?

b. How do general self-efficacy scores change immediately after the simulation experience of
administering insulin?

c. Are there sustained changes in general self-efficacy scores over an extended period post-
simulation, and if so, what is the trajectory of these changes?

d. To what extent do specific elements within the simulation experience, such as realism, feedback
mechanisms, and scenario complexity, correlate with variations in general self-efficacy outcomes?

e. How do the changes in general self-efficacy scores following simulation-based insulin

administration compare with those resulting from traditional classroom learning methods?

f. Are there differences in the impact of simulation on general self-efficacy scores based on
demographic factors such as age, gender, or prior healthcare experience?

g. How do nursing students perceive the relevance and effectiveness of simulation experiences in
influencing their overall confidence and self-efficacy in administering insulin?

h. What strategies and aspects of the simulation experience do nursing students identify as most
influential in shaping their self-efficacy beliefs?

i. To what extent does the perceived self-efficacy in administering insulin correlate with subsequent
performance in real-world clinical settings during the course of the nursing program?
j. How can the insights gained from this study inform the development of evidence-based
recommendations for integrating simulation experiences into nursing education to optimize self-
efficacy outcomes?

These research questions are designed to comprehensively explore the multifaceted impact of
simulation experiences on the general self-efficacy of first-semester associate degree nursing
students, considering various dimensions such as immediate and sustained effects, the influence of
specific simulation elements, demographic factors, student perceptions, and the real-world
applicability of enhanced self-efficacy.

II. Literature Review

 Overview:

Review recent (less than 5 years) literature on the use of simulation in nursing education and its
effects on self-efficacy.

 Theoretical Framework:

Bandura's Social Cognitive Theory provides a robust and comprehensive theoretical foundation
for understanding the intricate interplay between simulation experiences, self-efficacy, and the
subsequent behaviors and outcomes of individuals. Albert Bandura's theory posits that
individuals learn not only through direct experiences but also through observation, imitation,
and the influence of social factors. Central to this theory is the concept of self-efficacy, defined
as an individual's belief in their capability to execute specific actions required to attain desired
goals.

Key Components of Bandura's Social Cognitive Theory:

1. Observational Learning:

 Bandura emphasizes the significance of observational learning, where individuals

acquire knowledge and skills by observing the behaviors of others. In the context of
nursing education, this could translate into nursing students learning from observing
expert practitioners, faculty, or peers.

2. Modeling and Imitation:

 The theory posits that individuals are more likely to adopt behaviors they have observed
if the model is perceived as competent and if the observed behavior leads to positive
outcomes. Simulation experiences serve as a platform for modeling and imitation,
providing nursing students with role models and scenarios that mimic real-world
situations.

3. Reciprocal Determinism:
  Bandura introduces the concept of reciprocal determinism, emphasizing the dynamic
interplay between personal factors, behaviors, and the environment. In the case of
nursing students engaging in simulation experiences, their self-efficacy beliefs are
shaped by both personal factors (individual attributes, prior experiences) and
environmental influences (simulation design, feedback mechanisms).

4. Self-Efficacy:

 Self-efficacy is a core construct in Bandura's theory, representing an individual's

confidence in their ability to perform a specific task. The theory posits that higher levels
of self-efficacy lead to increased motivation, effort, and persistence in the face of
challenges. Simulation experiences can influence self-efficacy by providing opportunities
for mastery experiences, vicarious experiences, social persuasion, and physiological and
affective states.

Application to the Study:

In the context of the current study, Bandura's Social Cognitive Theory offers a lens through which
to understand how simulation experiences of administering insulin may impact the general self-
efficacy of first-semester associate degree nursing students. The theory suggests that through
observing, modeling, and engaging in simulated scenarios, students may enhance their self-
efficacy beliefs, influencing their confidence and competence in administering insulin.

Simulation experiences serve as a form of mastery experience, allowing students to practice and
master skills in a controlled environment. Observing proficient models, whether in the form of
instructors or high-fidelity simulations, contributes to vicarious experiences that can positively
influence self-efficacy. Additionally, the feedback mechanisms within simulations and the social
persuasion from instructors can further shape students' self-efficacy beliefs.

By adopting Bandura's Social Cognitive Theory as the theoretical framework, the study aims to
unravel the complex interactions between simulation experiences, self-efficacy development,
and subsequent nursing student outcomes. The theory provides a comprehensive and well-
established foundation for understanding the cognitive and social processes at play in the
learning environment, guiding the exploration of how simulation impacts the holistic self-efficacy
beliefs of nursing students in the specific context of insulin administration.

 Existing Gaps:

The existing literature on simulation in nursing education has made significant contributions to
understanding its impact on various aspects of student learning and clinical competence.
However, there are notable gaps that the current study aims to address:

1. Limited Exploration of Self-Efficacy Outcomes:

 While numerous studies have investigated the effectiveness of simulation in enhancing

clinical skills, there is a distinct lack of comprehensive exploration into the influence of
simulation experiences on the general self-efficacy of nursing students, particularly
 concerning insulin administration. The current study seeks to bridge this gap by
specifically focusing on the broader construct of self-efficacy and its nuanced
relationship with simulation.

2. Insufficient Focus on First-Semester Nursing Students:

 Many studies in the literature have concentrated on nursing students in the later stages
of their education. The unique needs and challenges faced by first-semester associate
degree nursing students have been comparatively understudied. This study aims to fill
this gap by examining the impact of simulation on self-efficacy in the crucial early stages
of nursing education.

3. Lack of Specificity Regarding Insulin Administration:

 While there is research exploring simulation in nursing education, studies often lack
specificity regarding the type of clinical skills being assessed. Insulin administration, a
critical aspect of nursing care, has not been extensively studied within the context of
simulation and its effects on self-efficacy. This study seeks to contribute to a focused
examination of insulin administration, providing insights into a specific and vital nursing
skill.

4. Limited Understanding of Simulation Elements Influencing Self-Efficacy:

 The literature lacks a detailed examination of the specific elements within simulation
experiences that contribute to changes in self-efficacy. Factors such as the realism of
scenarios, the provision of feedback, and the complexity of simulations are often
mentioned but lack in-depth exploration. The current study aims to delve into these
elements to understand their role in shaping nursing students' self-efficacy beliefs.

5. Underemphasis on Long-Term Self-Efficacy Development:

 While some studies have explored the immediate effects of simulation on self-efficacy,
there is a gap in understanding the long-term impact and sustainability of changes in
self-efficacy beliefs. This study aims to provide insights into whether the observed
changes in self-efficacy following simulation experiences persist over time, informing the
durability of the intervention's effects.

6. Limited Examination of Real-World Clinical Performance Correlation:

 Few studies have investigated the correlation between self-efficacy developed through
simulation experiences and subsequent real-world clinical performance. The current
study aims to address this gap by exploring the relationship between self-efficacy in
insulin administration, cultivated through simulation, and subsequent performance in
clinical settings.

By addressing these gaps, the study aims to contribute nuanced and context-specific insights into
the relationship between simulation experiences, insulin administration, and the general self-
efficacy of first-semester associate degree nursing students. This targeted approach seeks to
 advance the understanding of the complex dynamics at play in the early stages of nursing
education, providing valuable information for educators, curriculum developers, and researchers

III. Methodology

 Study Design: Choose an appropriate research design (e.g., quasi-experimental) and justify your
selection.

Study Design: Quasi-Experimental Design

A quasi-experimental design is deemed appropriate for this study for several reasons, taking into
account the nature of the research question, ethical considerations, and practical constraints
associated with nursing education research.

Justification:

1. Ethical Considerations:

 Randomized Controlled Trials (RCTs), while considered the gold standard for establishing
causal relationships, may pose ethical challenges in the context of nursing education. It
may be ethically challenging to randomly assign students to groups that receive or do
not receive simulation experiences due to the potential impact on their learning and
future patient care. Quasi-experimental designs allow for more ethical group
assignments.

2. Practical Constraints:

 Quasi-experimental designs are more feasible and logistically practical in educational

settings, where random assignment of participants to different conditions may be
difficult or impractical. In nursing education, where instructors and students are already
engaged in specific coursework and schedules, a quasi-experimental design allows for
the integration of the intervention (simulation experiences) without disrupting the
natural flow of the educational program.

3. Study Context:

 The study involves assessing the impact of a specific intervention (simulation

experiences of administering insulin) on a specific outcome (general self-efficacy scores)
within a real-world educational setting. Quasi-experimental designs are well-suited for
assessing the effects of interventions in naturalistic settings, providing a practical and
ecologically valid approach to examining the research question.

4. Internal Validity:

 Quasi-experimental designs, when appropriately controlled, can still achieve a high level
of internal validity by implementing strategies such as pre-test/post-test measurements,
matched comparison groups, and statistical controls for pre-existing differences. This
 allows for the examination of changes in self-efficacy scores while considering potential
confounding variables.

5. Causal Inference:

 While not as strong as experimental designs, quasi-experimental designs still permit a

level of causal inference. By comparing the self-efficacy scores of the group exposed to
simulation experiences of administering insulin with a control group (e.g., traditional
classroom learning), the study can make meaningful assessments regarding the impact
of the intervention.

6. Generalizability:

 Quasi-experimental designs enhance the external validity and generalizability of findings

in real-world educational settings. This aligns well with understanding the practical
implications of simulation experiences on the self-efficacy of first-semester associate
degree nursing students.

In summary, the choice of a quasi-experimental design is justified by the ethical considerations

inherent in nursing education research, practical constraints associated with implementing
interventions in educational settings, and the need for a design that balances internal validity
with external generalizability. This approach allows for a rigorous examination of the research
question while respecting the complexities and ethical considerations inherent in nursing
education.

 Participants: Define your target population (first-semester associate degree nursing students)
and describe the inclusion/exclusion criteria.

The target population for this study comprises first-semester associate degree nursing students
enrolled in a specific nursing program. These students represent a critical phase in their nursing
education journey, experiencing the initial stages of the program and forming foundational
perceptions and skills. Targeting this population allows for an exploration of the early impact of
simulation experiences on general self-efficacy.

Inclusion Criteria:

1. Enrollment Status: Participants must be officially enrolled as first-semester associate degree

nursing students in the designated nursing program.

2. Consent: Participants must provide informed consent to voluntarily participate in the study.
Informed consent will include details about the nature of the study, potential risks and benefits,
and the voluntary nature of participation.

3. Availability for Simulation: Participants should be available for scheduled simulation

experiences during the designated timeframe of the study.
4. Basic Competency: Students must possess the basic competencies required for participation in
simulation activities. This includes a foundational understanding of nursing principles and a
capacity to engage in simulation experiences.

5. Age and Language Proficiency: There are no age restrictions, but participants must be proficient
in the language of instruction to ensure understanding of study materials and assessments.

Exclusion Criteria:

1. Non-Consent: Students who do not provide informed consent or withdraw consent during the
study period will be excluded from the analysis.

2. Ineligibility for Simulation: Students who are unable to participate in simulation experiences
due to medical reasons, scheduling conflicts, or other practical limitations will be excluded.

3. Advanced Placement Students: Students with advanced placement status, transferring from
another nursing program or educational institution with advanced standing, will be excluded to
maintain homogeneity within the first-semester cohort.

4. Previous Simulation Exposure: Students who have had significant prior exposure to simulation
experiences, whether through previous educational programs or clinical work, may be excluded
to minimize the potential influence of previous experiences on self-efficacy outcomes.

5. Language Barriers: Participants with significant language barriers that impede their
comprehension of study materials and assessments may be excluded to ensure accurate data
collection.

By carefully defining the inclusion and exclusion criteria, the study aims to ensure a homogenous
and representative sample of first-semester associate degree nursing students. This allows for a
focused examination of the impact of simulation experiences on general self-efficacy within this
specific cohort, contributing to the validity and reliability of the study findings.

 Intervention: Detail the simulated insulin administration experience and how it will be
integrated into the nursing curriculum.

The simulated insulin administration experience is designed to provide first-semester associate

degree nursing students with a realistic and immersive opportunity to practice and refine their
skills in administering insulin. The simulation will be carefully crafted to mimic authentic clinical
scenarios, incorporating key elements to enhance the students' learning and self-efficacy
development.

Components of the Simulated Insulin Administration Experience:

1. Simulation Scenario Design:

 Development of realistic patient scenarios involving insulin administration. Scenarios will

encompass diverse patient profiles, ensuring students encounter a range of situations
they may encounter in clinical practice.

2. High-Fidelity Mannequins:
  Integration of high-fidelity mannequins that mimic human responses, allowing students
to practice insulin administration techniques in a controlled yet lifelike environment.
These mannequins should offer realistic physiological responses, including the ability to
simulate insulin absorption and potential complications.

3. Simulation Room Setup:

 Creation of a dedicated simulation room equipped with necessary medical supplies and
equipment for administering insulin. The room should mirror a clinical setting, fostering
a sense of realism and familiarity.

4. Instructor Guidance:

 Presence of experienced nursing instructors to provide guidance, answer questions, and

offer constructive feedback during the simulation. Instructors will play a crucial role in
facilitating the learning experience and addressing any concerns or uncertainties raised
by the students.

5. Real-Time Feedback Mechanisms:

 Implementation of real-time feedback mechanisms, such as immediate debrief sessions

or reflective discussions, to provide students with constructive feedback on their
performance. This feedback will focus on both technical aspects of insulin administration
and broader clinical decision-making skills.

6. Integration with Didactic Learning:

 Alignment of the simulated insulin administration experience with concurrent didactic

coursework. Students will receive relevant theoretical knowledge before the simulation,
ensuring a seamless integration of practical and theoretical learning.

7. Progressive Complexity:

 Gradual progression in the complexity of simulation scenarios to challenge students at

an appropriate level. The simulation experiences will evolve, allowing students to build
confidence and competence in insulin administration as they advance through the first
semester.

Integration into the Nursing Curriculum:

The simulated insulin administration experience will be strategically integrated into the first-
semester associate degree nursing curriculum, aligning with the overall educational objectives
and providing a cohesive learning experience. The integration plan includes:

1. Curriculum Mapping:

 Mapping the simulation experience to specific learning objectives outlined in the nursing
curriculum. This ensures that the simulation aligns with the broader educational goals
and contributes directly to the student's skill development.

2. Preparation Sessions:
  Conducting preparatory sessions before the simulation to introduce students to insulin
administration principles, safety protocols, and relevant theoretical knowledge. These
sessions will provide a foundation for the simulation experience.

3. Scheduled Simulation Sessions:

 Incorporating scheduled simulation sessions into the curriculum, with dedicated time
allocated for each student to actively participate in the insulin administration simulation.
This ensures that all students have equitable opportunities to engage in the learning
experience.

4. Debriefing and Reflection:

 Implementing structured debriefing sessions following each simulation to allow students

to reflect on their performance, receive feedback from instructors, and discuss their
observations and experiences.

5. Assessment Integration:

 Aligning the simulated insulin administration experience with formative or summative

assessments within the nursing curriculum. This ensures that the skills practiced in the
simulation are assessed and contribute to the student's overall academic evaluation.

6. Iterative Improvement:

 Incorporating feedback from students and instructors to iteratively improve the

simulation experience over time. This continuous improvement process ensures that the
simulation remains relevant, effective, and aligned with the evolving needs of the
nursing program.

By integrating the simulated insulin administration experience into the nursing curriculum in a
thoughtful and structured manner, the study aims to maximize the impact on students' self-
efficacy while ensuring alignment with educational goals and ethical considerations. This
approach fosters a comprehensive and cohesive learning environment that supports the overall
development of nursing students in their initial semester.

 Data Collection: Explain the tools and methods for assessing general self-efficacy scores,
considering validated instruments.

Data Collection: Assessment of General Self-Efficacy Scores

To assess general self-efficacy scores among first-semester associate degree nursing students,
the study will employ a validated instrument that specifically measures self-efficacy beliefs
across various domains. One widely used and validated tool for assessing general self-efficacy is
the General Self-Efficacy Scale (GSES), developed by Ralf Schwarzer and Matthias Jerusalem.

Instrument: General Self-Efficacy Scale (GSES)

Description: The General Self-Efficacy Scale is a self-report questionnaire designed to measure

individuals' perceived self-efficacy in dealing with a variety of challenging situations. It consists of
10 items, each rated on a Likert scale ranging from 1 (not at all true) to 4 (exactly true). The scale
 assesses an individual's belief in their ability to cope with and successfully perform tasks in novel
or challenging situations.

Sample Items:

1. I can always manage to solve difficult problems if I try hard enough.

2. I can remain calm under pressure.

3. I can handle whatever comes my way.

Data Collection Procedure:

1. Pre-Intervention Baseline Assessment:

 Before the simulated insulin administration experience, participants will complete the
GSES as a baseline assessment. This initial measurement captures their general self-
efficacy beliefs before exposure to the simulation intervention.

2. Post-Intervention Assessment:

 Following the simulated insulin administration experience, participants will again

complete the GSES. This post-intervention assessment will provide insights into any
changes in self-efficacy resulting from the simulation.

3. Follow-Up Assessments:

 To explore the sustainability of changes in self-efficacy over time, follow-up assessments

will be conducted at predetermined intervals (e.g., weeks or months after the
intervention). These assessments will help determine if any observed changes in self-
efficacy persist or diminish over an extended period.

4. Comparison with Control Group:

 If applicable, a control group (e.g., students engaged in traditional classroom learning

without simulation) will undergo the same assessment protocol, allowing for
comparisons between the intervention and control groups.

Data Analysis:

Quantitative data obtained from the GSES will be subjected to statistical analysis using
appropriate methods, such as:

1. Descriptive Statistics:

 Calculating means, standard deviations, and frequency distributions to describe the

participants' self-efficacy scores at different assessment points.

2. Inferential Statistics:

 Conducting inferential statistical tests, such as paired t-tests or analysis of variance

(ANOVA), to determine if there are statistically significant differences in self-efficacy
scores between pre-and post-intervention assessments.
 3. Subgroup Analyses:

 Exploring potential subgroup differences based on demographic variables (e.g., age,

gender) or other relevant factors to identify any differential effects of the intervention.

4. Longitudinal Analysis:

 Employing longitudinal analysis methods to assess changes in self-efficacy over time,

considering follow-up assessments and comparing trajectories between groups.

Validity and Reliability:

The GSES is a widely recognized and validated instrument with established reliability and validity
across various populations. However, it's essential to ensure the specific instrument is suitable
for the study population, and that any translations or adaptations are validated for cultural
relevance.

By utilizing the General Self-Efficacy Scale and implementing a robust data collection procedure,
the study aims to gather quantitative data on changes in self-efficacy among first-semester
associate degree nursing students following the simulated insulin administration experience. The
systematic approach to data collection and analysis enhances the reliability and validity of the
study findings.

IV. Ethical Considerations

Ensuring the ethical treatment of human subjects is paramount in research involving nursing students,
particularly when interventions such as simulated experiences are introduced. The study will adhere to
established ethical principles to safeguard the well-being, autonomy, and rights of the participants.

1. Informed Consent:

 Procedure: Before participating in the study, all nursing students will receive a clear and
comprehensive explanation of the study's purpose, procedures, potential risks, and
benefits. They will be provided with written informed consent documents.

 Voluntariness: Participation in the study will be entirely voluntary, and participants will
have the right to withdraw at any point without consequences.

2. Confidentiality:

 Data Handling: All data collected, including self-efficacy scores and demographic
information, will be treated with strict confidentiality. Data will be stored securely,
accessible only to the research team, and anonymized during analysis.

 Reporting Results: Results of the study will be reported in aggregate form, ensuring that
individual participants cannot be identified from any publications or presentations.

3. Minimizing Harm and Risk:

  Simulation Safety: The simulated insulin administration experience will be designed and
monitored to minimize physical and psychological risks. Instructors will be present to
address any unexpected challenges, and the simulation will be halted immediately if
participants express discomfort or distress.

 Debriefing: A structured debriefing session will follow each simulation to address any
emotional or psychological impact on participants, providing an opportunity for
reflection and support.

4. Well-being of Participants:

 Psychological Support: Recognizing the potential emotional impact of simulation

experiences, the study will ensure that participants have access to psychological support
services if needed.

 Clear Communication: Participants will be informed of the nature of the simulation

experience, its educational purpose, and the separation between simulation and real-
world patient care.

5. Transparent Communication:

 Open Communication Channels: Throughout the study, there will be open lines of
communication between researchers and participants. Participants will be encouraged
to ask questions, seek clarification, and express any concerns they may have.

 Feedback Mechanism: A mechanism for participants to provide feedback on their

experiences will be established, giving them a voice in the research process.

6. Approval from the Ethical Review Board:

 The study will undergo review and approval by the institutional ethical review board,
ensuring that the research design, procedures, and participant protections meet ethical
standards and guidelines.

7. Clear Communication of Findings:

 Findings from the study will be communicated transparently to participants, allowing

them to understand the impact of their participation. This includes sharing any
generalizable knowledge that may benefit the participants or the broader nursing
education community.

8. Continued Monitoring:

 The research team will continually monitor the well-being of participants throughout the
study. If any unexpected issues arise, appropriate measures will be taken to address
them promptly.

By integrating these ethical considerations into the research design and implementation, the study aims
to uphold the principles of respect, beneficence, justice, and autonomy. These principles are
fundamental to ensuring the ethical conduct of research involving human subjects, particularly in the
context of nursing education where participants may be engaged in simulation experiences with
potential emotional and psychological implications.

V. Significance of the Study

1. Insight into Early Nursing Education:

 The study contributes valuable insights into the early stages of nursing education by
focusing on first-semester associate degree nursing students. Most existing research
tends to concentrate on the later stages of nursing education, and this study addresses a
gap by exploring the impact of simulation experiences on self-efficacy in the crucial
foundational phase of a nursing program.

2. Specific Focus on Insulin Administration:

 By honing in on the simulated experience of administering insulin, the research provides

a specific and targeted investigation into a critical nursing skill. Understanding how
simulation influences self-efficacy in this context can have direct implications for
improving insulin administration proficiency among nursing students, thereby enhancing
patient safety in clinical practice.

3. Integration of Self-Efficacy and Simulation:

 While simulation's impact on clinical skills is well-studied, this research uniquely

explores the connection between simulation experiences and general self-efficacy. It
investigates not only the technical aspects of skill acquisition but also how these
experiences contribute to students' broader confidence in their abilities to navigate
various challenges in clinical settings.

4. Identification of Effective Simulation Elements:

 The study seeks to identify specific elements within simulation experiences that
influence self-efficacy outcomes. This contributes practical knowledge for nursing
educators by highlighting the factors within simulations that most positively impact
students' overall confidence and self-efficacy.

5. Longitudinal Exploration of Self-Efficacy Changes:

 The inclusion of follow-up assessments allows for a longitudinal exploration of changes

in self-efficacy over time. This temporal dimension provides a nuanced understanding of
whether any observed effects are immediate, sustained, or subject to decay, offering
insights into the long-term impact of simulation experiences on self-efficacy.

6. Correlation with Real-World Clinical Performance:

 The study aims to investigate the correlation between self-efficacy developed through
simulation experiences and subsequent real-world clinical performance. Establishing
such a connection is essential for validating the real-world applicability of enhanced self-
efficacy, thus bridging the gap between simulated and actual clinical practice.

7. Guidance for Curriculum Development:

  Findings from this research can inform nursing education program developers about the
strategic integration of simulation experiences to not only enhance technical skills but
also foster a broader sense of self-efficacy among early-stage nursing students. This
guidance can contribute to the ongoing improvement of nursing curricula.

8. Contribution to Educational Practices:

 The research outcomes have the potential to influence educational practices by

providing evidence-based recommendations for optimizing the integration of simulation
experiences into nursing education. This may include refining simulation scenarios,
incorporating specific feedback mechanisms, and tailoring simulations to address the
unique needs of first-semester students.

9. Enhancement of Self-Efficacy Assessment Tools:

 The study contributes to the refinement of assessment tools, such as the General Self-
Efficacy Scale (GSES), within the context of nursing education. Understanding how
specific interventions influence self-efficacy can contribute to the ongoing development
and validation of instruments used to measure this critical construct.

In summary, this research enriches the existing body of knowledge in nursing education and practice by
providing targeted insights into the impact of simulation experiences on self-efficacy among first-
semester associate degree nursing students. It offers practical implications for educators, curriculum
developers, and researchers, ultimately contributing to the ongoing improvement of nursing education
programs and the preparation of confident and competent nursing professionals.

VI. Timeline

Phase 1: Preparatory Phase (Months 1-2)

1. Weeks 1-2: Research Proposal Finalization

 Finalize and submit the research proposal, incorporating any feedback from advisors or
reviewers.

2. Weeks 3-4: Ethical Review Submission

 Prepare and submit the research proposal to the institutional ethical review board for
approval.

3. Weeks 5-6: Recruitment Planning

 Develop a recruitment plan, including strategies for participant engagement and

informed consent procedures.

4. Weeks 7-8: Simulation Design and Preparation

 Collaborate with simulation experts to design realistic insulin administration scenarios.

 Coordinate with instructors and simulation facilities for logistical preparations.

Phase 2: Implementation Phase (Months 3-8)

 1. Weeks 1-2: Participant Recruitment and Informed Consent

 Begin participant recruitment, ensuring adherence to inclusion/exclusion criteria.

 Administer informed consent procedures.

2. Weeks 3-4: Baseline Self-Efficacy Assessment

 Administer the General Self-Efficacy Scale (GSES) as a baseline assessment.

3. Weeks 5-10: Simulated Insulin Administration

 Conduct the simulated insulin administration experiences for participants.

 Implement real-time feedback mechanisms and debriefing sessions.

4. Weeks 11-12: Post-Intervention Self-Efficacy Assessment

 Administer the GSEs immediately following the simulated experiences.

5. Weeks 13-16: Follow-Up Self-Efficacy Assessments

 Schedule and conduct follow-up self-efficacy assessments at designated intervals.

6. Weeks 17-18: Data Analysis Preparation

 Begin organizing and cleaning the collected data.

 Explore statistical analysis methods and software tools for data analysis.

Phase 3: Data Analysis and Interpretation (Months 9-11)

1. Weeks 1-4: Quantitative Data Analysis

 Conduct quantitative analysis of self-efficacy scores using appropriate statistical

methods.

 Explore subgroup analyses and identify patterns within the data.

2. Weeks 5-8: Interpretation and Synthesis

 Interpret the quantitative findings in the context of the research questions.

 Synthesize key insights and potential implications.

Phase 4: Reporting and Dissemination (Months 12-14)

1. Weeks 1-4: Manuscript Writing

 Draft the research manuscript, including an introduction, literature review, methodology,

results, and discussion.

2. Weeks 5-6: Feedback and Revisions

 Seek feedback from advisors, colleagues, or peer reviewers.

  Revise the manuscript based on feedback.

3. Weeks 7-10: Final Manuscript Preparation

 Finalize the manuscript, ensuring adherence to formatting and citation styles.

 Prepare supplementary materials, such as tables and figures.

4. Weeks 11-12: Submission to Journals or Conferences

 Submit the manuscript to relevant nursing education journals or conferences for

publication or presentation.

5. Weeks 13-14: Presentation and Defense

 Prepare for any presentations or defenses required by the academic or research

institution.

 Share the findings with the academic community.

VII. Budget

1. Simulation Materials:

 High-Fidelity Mannequins: $10,000 - $20,000

 Invest in high-quality mannequins that provide realistic physiological responses for the
insulin administration simulations.

 Simulation Room Setup: $5,000 - $8,000

 Equip a dedicated simulation room with necessary medical supplies, equipment, and
infrastructure to create a realistic clinical environment.

 Simulation Expert Fees: $5,000 - $8,000

 Allocate funds for expert consultation and assistance in designing and implementing
effective insulin administration simulation scenarios.

2. Data Collection and Analysis:

 General Self-Efficacy Scale (GSES) Licensing: $1,000 - $2,000

 Acquire licensing rights for the GSES to ensure legal and ethical use in the research
study.

 Data Analysis Software: $2,000 - $4,000

 Purchase licenses for statistical analysis software (e.g., SPSS, SAS) to facilitate
quantitative data analysis.

3. Participant Recruitment and Engagement:

 Incentives for Participants: $3,000 - $5,000

  Allocate funds for participant incentives, such as gift cards or small stipends, to enhance
recruitment and retention.

 Recruitment Materials: $1,000 - $2,000

 Develop and distribute recruitment materials, including posters, flyers, and

informational brochures.

4. Ethical Review and Compliance:

 Ethical Review Submission Fees: $500 - $1,000

 Cover submission fees associated with obtaining ethical review board approval for the
research study.

 Training for Ethical Conduct: $2,000 - $3,000

 Provide training for research personnel involved in data collection and participant
interaction to ensure ethical conduct throughout the study.

5. Manuscript Preparation and Dissemination:

 Publication Fees: $2,000 - $4,000

 Allocate funds for potential publication fees associated with submitting the research
manuscript to academic journals.

 Conference Registration and Travel: $3,000 - $5,000

 Budget for conference registration fees and potential travel expenses to present findings
at relevant nursing education conferences.

6. Miscellaneous Expenses:

 Project Management Software: $500 - $1,000

 Invest in project management tools or software to facilitate collaboration and

organization among research team members.

 Contingency Fund: $5,000

 Allocate a contingency fund to address unforeseen expenses or adjustments needed

during the research process.

Total Estimated Budget Range: $40,000 - $70,000**

VIII. Conclusion

1. Introduction:

 Provides an overview of the increasing prevalence of diabetes, emphasizing the critical

role of nurses in managing diabetic patients.
  Highlights the importance of nursing students acquiring practical skills, specifically in
administering insulin.

2. Problem Statement:

 Identifies the potential gap in the literature regarding the impact of simulation
experiences on the general self-efficacy scores of nursing students.

 Stresses the need for research in this area to inform nursing education practices.

3. Purpose Statement:

 Clearly states the purpose of the research: to investigate how the simulation experience
of administering insulin influences the general self-efficacy scores of first-semester
associate degree nursing students.

4. Research Questions:

 Formulates specific research questions related to the impact of simulation on self-

efficacy, guiding the study's focus and analysis.

5. Literature Review:

 Reviews recent literature on the use of simulation in nursing education and its effects on
self-efficacy.

 Identifies gaps in the literature that the current study aims to address.

6. Theoretical Framework:

 Introduces Bandura's Social Cognitive Theory as the theoretical framework underpinning

the study, emphasizing the role of self-efficacy as a key construct.

7. Identification of Gaps:

 identifies gaps in the literature that the study aims to address, including limited
exploration of self-efficacy outcomes, insufficient focus on first-semester nursing
students, and a lack of specificity regarding insulin administration.

8. Study Design:

 Chooses a quasi-experimental design and justifies the selection based on ethical

considerations, practical constraints, and the study context.

9. Participants:

 Defines the target population as first-semester associate degree nursing students.

 Describes inclusion/exclusion criteria to ensure a representative and homogenous

sample.

10. Intervention:
 Details the simulated insulin administration experience, including components such as scenario
design, high-fidelity mannequins, instructor guidance, and integration into the nursing
curriculum.

11. Data Collection:

 Explains the tools and methods for assessing general self-efficacy scores, emphasizing the use of
the General Self-Efficacy Scale (GSES).

 Outlines the data collection procedure, analysis methods, and validity/reliability considerations.

12. Ethical Issues:

 Discusses ethical considerations related to human subjects, ensuring confidentiality, informed

consent, and participant well-being.

13. Contribution to Knowledge:

 Highlights how the research contributes to the existing body of knowledge in nursing education
and practice by providing insights into early nursing education, focusing on insulin
administration, and integrating self-efficacy and simulation.

14. Realistic Timeline:

 Outlines a realistic timeline for different phases of the research, from preparatory work to data
analysis and dissemination.

15. Budgetary Requirements:

 Provides an outline of budgetary requirements, including resources for simulation materials,

data analysis tools, participant engagement, ethical review, and dissemination.

Restatement of Significance:

This study holds significant implications for nursing education and practice by addressing critical
gaps in the literature and contributing nuanced insights into the impact of simulation
experiences on the general self-efficacy of first-semester associate degree nursing students. By
focusing on the specific context of insulin administration, integrating Bandura's Social Cognitive
Theory, and utilizing a quasi-experimental design, the research aims to inform educational
practices, enhance curriculum development, and ultimately contribute to the preparation of
confident and competent nursing professionals. The study's outcomes have the potential to
shape the future of nursing education, emphasizing the importance of targeted simulation
experiences in fostering self-efficacy and preparing students for the complex challenges of
clinical practice.