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Impact of Metacognitive Ability on Learning
Achievement and Skill Performance in Nursing
Simulation Learning
Hye-Kyung Oh,1
1 Dept. of Nursing, Division of Health-Nursing, Daegu University
33 Seongdang-ro 50-gil, Namgu, Daegu, 705-714, Republic of Korea
Abstract. This was a descriptive study investigating the potential positive
effect of metacognitive ability on learning achievement and skill performance.
The participants’ average metacognitive ability score was 3.40, with 24
participants having high ability (29.6%), 25 moderate ability (30.9%), and 32
low ability (39.5%). At posttest, no significant differences in learning
achievement by metacognitive ability group were observed (F = 0.96, p =
0.3873). In contrast, at posttest for skill performance, I found significant
differences by metacognitive ability group (F = 3.69, p = 0.029). Post-hoc
analysis demonstrated that the high metacognition group had higher skill
performance scores than did the moderate group.
Keywords: Metacognition, Nursing, Simulation, Skill, Learning
1 Introduction
Traditional education is centered on lectures and repetitive training, which cultivates a
passive learning environment and thereby fails to provide sufficient training for
nursing students to be able to respond appropriately to various real-life situations. In
other words, it is limited in its ability to help competent nurses achieve the skills
required for actual nursing practice. To resolve these problems, the use of simulation
training is increasing, as it can supplement the limitations of real practice while
conveying knowledge, techniques, and appropriate attitudes to students during the
course of their study [1].
Many preceding studies have confirmed that simulation learning for nursing
students improves their problem-solving skills.
In simulation learning, metacognition is the fundamental driving force behind the
cognitive activities governing the learner’s problem-solving processes [2].
1 Dept. of Nursing, Division of Health-Nursing, Daegu University
33 Seongdang-ro 50-gil, Namgu, Daegu, 705-714, Republic of Korea
Advanced Science and Technology Letters Vol.128 (Healthcare and Nursing 2016), pp.83-88
http://dx.doi.org/10.14257/astl.2016.128.17
ISSN: 2287-1233 ASTL Copyright © 2016 SERSC
Learners require self-motivation and initiative to accurately perform simulation
learning, where in they must share opinions and establish new knowledge [3]. In this
way, simulation learning requires metacognitive ability.
Metacognitive ability can be an important precursor of problem-solving skills, as it
helps individuals apprehend and control their own thought processes [4].
Thus, metacognition has a positive correlation with problem-solving skills, and
therefore serves as a promotion strategy for improving critical thinking and problem-
solving skills. So far, the vast majority of research on metacognition has focused on
critical thinking, problem solving, self-directed learning ability, and learning flow;
currently, research on how metacognition influences academic achievement and skill
performance in nursing simulation learning remains inadequate.
The present study aimed to clarify whether metacognitive ability, which has been
demonstrated to improve the problem-solving skills of nurses in a simulated clinical
situation, positively influences these nurses’ learning achievement and skill
performance.
In doing so, I intended to determine the effect of nursing simulation learning on
skill performance, and thereby provide basic research data for the development of
learning methods for improving metacognition in simulation learning.
2 Method
2.1 Design
This was a descriptive study in which I analyzed the effect of metacognition on
nurses’ learning achievement and skill performance in nursing simulation learning.
2.2 Participants
The participants of the study were 81 nursing students in their 4th year of college in
city A. The students were all enrolled in the simulation common curriculum,
understood the purpose of the study, and agreed to participate.
2.3 Study Tools
2.3.1 metacognition
Metacognition is a strategy for applying appropriate knowledge in problem solving,
which is achieved by recognizing (metacognitive knowledge) and controlling
(metacognitive control) one’s own thought processes [5]. The survey in this study
utilized Yi’s version [7] of Printrich et al.’s Motivation Strategies for Learning
Advanced Science and Technology Letters Vol.128 (Healthcare and Nursing 2016)
84 Copyright © 2016 SERSC
Questionnaire (MSLQ) [6], which was modified and supplemented to ensure its
adaptation to Korean culture. The questionnaire comprises a total of 31 items,
including 4 rehearsal items, 6 elaboration items, 5 critical thinking items, and 12 self-
regulation items.
Each item was rated on a 5-point Likert scale, with total scores ranging from 31–
155. Higher scores indicated greater metacognitive ability. In Yi’s study [7], the
Cronbach’s α was .74, whereas in this study, it was .88.
2.3.2 learning achievement
Learning achievement refers to the evaluation of what and how much a learner has
learned after a series of educational activities [8]. In this study, the participants’
learning achievement was evaluated using a written examination comprising 10 short-
answer questions. These questions assessed the knowledge regarding nursing
abdominal pain and hip arthroplasty. One evaluator gave each participant a score
ranging from 0 to 20 based on the evaluation criteria. The validity of the
examination’s contents was confirmed by a professor of adult nursing.
2.3.3 skill performance
This study assessed participants’ blood transfusion skill under a simulated scenario
using the evaluation criteria of the Core Basic Nursing Skills developed by the
Korean Accreditation Board of Nursing Education [9]. There was a total of 28
performance items to be assessed for the blood transfusion skill, and each was scored
from 0 to 2. The range of the total score was 0–100, with higher scores indicating
higher skill performance.
2.4 Data Collection
Prior to the study, the participants signed a consent form indicating their consent to
participate. The form thoroughly outlined the purpose and procedure of the study, as
well as its adherence to confidentiality. A research assistant distributed the
questionnaire before and after the simulation practice, after giving out verbal
instructions. The participants were informed in advance that their participation was
voluntary and that they had the right to withdraw at any time without penalty.
The study ethical considerations included obtaining participants’ consent and
explaining their rights to anonymity and confidentiality. Data collection involved a
pretest and a posttest given before and after the high-efficiency simulation learning,
respectively. Data were collected from April to June 2015.
2.5 Data Analysis
All data were analyzed using SAS 9.2. The sample characteristics, metacognitive
ability, learning achievement, and performance skill were analyzed using real
Advanced Science and Technology Letters Vol.128 (Healthcare and Nursing 2016)
Copyright © 2016 SERSC 85
numbers, percentages, means, and standard deviations. Learning achievement and
skill performance were compared among metacognitive ability groups before and
after the nursing simulation learning using ANOVAs. Scheffé’s method was used for
post-hoc analysis.
3 Results
3.1 Participant Characteristics and Metacognitive Ability
Table 1 shows participants’ characteristics by their metacognitive ability. The average
age of the participants was 22.05. Most (69.1%) responded that they were good at
adapting to situations, and the majority (97.5%) took classes associated with critical
thinking.
The average score for participants’ metacognitive ability was 3.40. Based on this
average, participants with scores of 3.40 or above were classified as having high
metacognitive ability; those with scores of 3.40–3.10 had moderate metacognitive
ability; and those with scores below 3.1 had low metacognitive ability. In this study,
24 participants (29.6%) had high, 25 participants (30.9%) moderate, and 32
participants (39.5%) low metacognitive ability.
Table 1. Participant Characteristics by Metacognitive Ability
Metacognitive ability
Low (n = 32) Moderate (n = 25) High (n =24)
Age (years)
21 18 (56.3) 15 (60.0) 15 (62.5)
22 9 (28.1) 4 (16.0) 6 (25.0)
23 4 (12.5) 3 (12.0) 1 ( 4.2)
24 1 (3.1) 2 ( 8.0) 2 ( 8.4)
46
1 ( 4.0)
Adaptation
to situations
Very good 1 (3.1) 2 ( 8.0) 1 ( 4.2)
Good 16 (50.0) 16 (64.0) 20 (83.3)
Moderate 13 (40.6) 7 (28.0) 3 (12.5)
Not 2 (6.3)
Never
Taking classes
associated with
critical thinking
Yes 31 (96.9) 24 (96.0) 24 (100.0)
No 1 (3.1) 1 (4.0)
Advanced Science and Technology Letters Vol.128 (Healthcare and Nursing 2016)
86 Copyright © 2016 SERSC
3.2 Differences in Learning Achievement by Metacognitive Ability
Table 2 shows the differences in learning achievement scores by participants’
metacognitive ability. At pretest, there were no significant differences in
metacognitive ability between the groups (F = 1.56, p = 0.2165). Similarly, there were
no such differences at posttest (F = 0.96, p = 0.3873).
Table 2. Differences in Learning Achievement by Metacognitive Ability
Meta-
cognitive
Ability
Pretest Posttest
M ± SD F p Scheffé’s M ± SD F p Scheffé’s
Low 11.9 ± 2.5
1.56 0.216
16.0 ± 3.1
0.96 0.387
Moderate 11.6 ± 2.8 16.8 ± 1.2
High 13.0 ± 3.0 16.4 ± 1.2
3.3 Differences in Skill Performance by Metacognitive Ability
Table 3 shows the differences in skill performance by participants’ metacognitive
ability.
At pretest, there were no significant differences in skill performance scores
according to metacognitive ability group (F = 0.08, p = 0.923).
However, at posttest, the analysis of the skill performance differences by
metacognitive ability group revealed significant differences (F = 3.69, p = 0.029).
Post-hoc testing indicated that the high metacognitive ability group had higher skill
performance scores than did the moderate group.
Table 3. Differences in Skill Performance by Metacognitive Ability
Meta-
cognitive
Ability
Pretest Posttest
M ± SD F p Scheffé’s M ± SD F p Scheffé’s
Low 70.7 ± 10.7
0.08 0.923
79.1 ± 8.7
3.69 0.029*
High >
Moderat
e
Moderate 70.0 ± 10.4 77.0 ± 7.5
High 69.6 ± 9.1 83.3 ± 8.6
Advanced Science and Technology Letters Vol.128 (Healthcare and Nursing 2016)
Copyright © 2016 SERSC 87
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Advanced Science and Technology Letters Vol.128 (Healthcare and Nursing 2016)
88 Copyright © 2016 SERSC
