The Simulated Hospital Environment: Concept and Design

This presentation describes the process of applying space industry technology to design a 96-hour, continuous, simulated hospital environment. Space flight provided a model for the development of a nursing integrated simulation experience that more fully addresses the issues related to preparation for safe, effective nursing practice. Space flight uses a progressive model from task-training through a fully integrated mission simulation. Nursing simulations currently focus on task-training without the progression to full integration.

Nursing employer feedback identified that new graduates do not have the expected critical thinking, decision-making, and organizational skills required for entry-level practice. The researchers used that feedback to develop the outcomes which guided the development of the project. Faculty emphasized students demonstrating those skills actually needed in an entry-level nursing position without faculty or preceptor intervention.           

The simulated hospital environment began with development of a doctoral nursing elective resulting in creation of the 96-hour continuous simulation script. Due to the complexity of the script, expertise and strategies from the space industry were used.

The researchers designed experiences to include human factors-based interactions and all clinical activities that generally occur on a medical-surgical unit. Undergraduate students were assigned to a normal entry-level patient load; graduate nurse practitioner students were assigned the role of provider. Since nursing is relational, standardized patients were graduate nursing students. High fidelity simulators were only used for critical incidents such as codes. An electronic health record was also incorporated into the experience.

While medical, nursing schools and hospitals are touting the development of virtual and simulated hospitals, evidence of the development of true simulated hospital environments does not exist. The outcomes of this effort were remarkable.

The researchers believe that true hospital-based shifts and experiences provided in a high fidelity hospital environment will result in a transformational view of nursing education.