Really, Now What Do I Do? A Multiple Patient Simulation to Teach Leadership Skills

Tuesday, 31 October 2017: 8:20 AM

Joanie Weigel, MSN, BSN1
Kathy Jean Roth, MSN, BSN2
Kara C. Vollrath, MSN, BSN3
Margie J. Hair, PhD, BSN3
(1)Division of Nursing, Univeristy of Mary Bismarck ND, Bismarck, ND, USA
(2)Divison of Nursing, University of Mary, Bismarck, ND, USA
(3)Division of Nursing, University of Mary, Bismarck, ND, USA

Students are sheltered from a professional nurse workload, and are unprepared for the transition into the workforce. Prioritization, delegation, communication, teamwork, and leadership skills are essential to provide safe care to patients. Due to the limitation of clinical settings and lack of multiple-patient assignments, undergraduate nursing students often lack the opportunity to develop essential leadership skills. Incorporating a multi-patient simulation into the curriculum may provide a new teaching strategy for leadership skills. The purpose of this study was to gain insight into the students’ perceptions of leadership skills developed through a chaotic, real world, multiple-patient simulation scenario.

Superior patient outcomes depend on collaboration, yet there is little interactive approached to teaching teamwork, delegation, prioritization, and communication (Fewster-Thuente, 2014). Research strongly supports simulation as an effective teaching strategy. However, there is gap in the research addressing the benefits of multiple patient simulation focusing on leadership skills of senior nursing students. Multiple patient simulations may facilitate opportunities for students to gain expertise and confidence in a complex environment of today’s healthcare setting (Chunta & Edwards, 2013). The use of standardized patients is another area where research is lacking. Research shows that the use of standardized patients improves student’s leadership skills, however, the risk of faculty losing control over the simulation is high, leading to a chaotic and overwhelming experience for the student (Oh, Jeon, & Koh, 2015). Standardized patients present an actual patient problem in a clinical relevant and realistic way (Oh et al., 2015). Utilizing a consistent pre-briefing and de-briefing process along with the PEARLS method can change a student’s perceived overwhelming and chaotic experience into a positive learning experience (Cheng et al., 2016).

A challenge facing nurse educators is preparing nursing students to function safely and effectively as new graduate nurses (Frontiero & Glynn, 2012). The expectations placed on new graduates are not at the same level as their clinical experiences (Nowell, 2016). In today’s rapidly changing healthcare environment, increases in patient co-morbidity, acuity, and demand for safety require nurses who can integrate leadership skills in patient care (Nowell, 2016). Many new graduate nurses are not prepared for entry-level practice and clinical judgement regardless of education preparation and credentials (Frontiero & Glynn, 2012). In multiple-patient simulations, students can safely apply their knowledge and skills for training in the simulated work setting which facilitates transfer of theory into practice in order to enhance independence, prioritization, critical thinking, communication, patient safety, and delegation skills (Botma, 2014).

Senior nursing students in a Baccalaureate nursing program participated in a multiple patient simulation as a teaching strategy to provide leadership opportunities as an effective teaching strategy to provide a real world experience. A non-experimental descriptive quantitative study was conducted. Forty two students were given the opportunity to participate in the study following their simulation experience. The sample consisted of 39 out of 42 students elected to participate in the study. The NLN Student Satisfaction and Self-Confidence in Learning survey tool was utilized along with four open ended questions. Students overwhelming found the multi patient simulation a positive experience with 100% either agreeing or strongly agreeing that the simulation allowed them the opportunity to prioritize nursing assessment and care. Following reflective debriefing, all students felt that the simulation allowed them to analyze their behavior and actions. During this activity the students were giving a consistent pre-briefing and debriefing where they were given the opportunity to reflect and analyze their performance. Utilizing a consistent pre-briefing and de-briefing process along with the PEARLS method changed the student’s perceived overwhelming and chaotic experience into a positive learning experience.

The majority of students indicated that they felt anxious and overwhelmed during the simulation experience. They recognized the value of prioritization, delegation, teamwork, and communication in nursing practice. After the debriefing experience, students overwhelmingly recognized that the multiple patient simulation was the best opportunity for integrating the real world experience of nursing into the curriculum. Recommendations for academia include incorporating a multi-patient simulation to assist in teaching leadership skills by providing a real word experience to best prepare students for entry into professional nursing practice.