What Would the Patient Say? Satisfaction with Nursing Care during a Simulation Experience

Clinical practice hours in a simulation environment with manikins that replicate physiologic responses are becoming an integral part of nursing education.  Simulation experiences are popular because they provide a safe learning environment for students.  In the process of learning how to deliver nursing care students can perform a variety of technical, communication and inter-professional skills.  The simulation ends when the students and faculty leave the simulation room and the manikin is reset and readied for the next group of student.   However in the real world of nursing practice, patient are not reset and their perception of and satisfaction with the care received is part of important benchmarks used by the organization and external agencies to assess the quality of care.

As part of the clinical experience in a maternal-newborn clinical practice course nursing students engage in a simulation of a woman in labor with a prolonged deceleration of the fetal heart rate and a birth followed by a post-partum hemorrhage.  To provide variety to the experience the use of the Mama Natalie obstetrical simulator and the Noelle obstetrical simulator are alternated.  Mama Natalie is a portable obstetrical simulator that is worn by an actor who controls the birth of the infant and the release of blood for the post-partum hemorrhage.  Noelle is full-body manikin and the birthing event and bleeding is controlled by a computer program.  An actor is used to supply Noelle’s voice.

As part of the evaluation of the simulation experience and the quality of nursing care, the actor was asked to document their perception of three aspects of nursing care during the simulation.   Three items related to nursing care were adapted from the HCAHPS Survey:

• During this hospital stay, how often did nurses treat you with courtesy and respect?
• During this hospital stay, how often did nurses listen carefully to you?
• During this hospital stay, how often did nurses explain things in a way you could understand?

These item was rated on a 4-point scale (1=never, 4=always) similar to the HCAHPS survey tool.  In addition the actor was asked to provide a statement describing or providing an example to support their rating of these items and was asked if as the patient they felt safe with the care being provided.

 A total of 16 simulation sessions were conducted:  8 with the actor wearing the Mama Natalie simulator and 8 with the actor as the voice of the Noelle simulator.  The lowest rated item was did the nurses explain things in a way you could understand.  The actors indicated that the nurses did not explain to the “patient” what was happening until the patient asked.  The actor (who knew the scenario included a complication) indicated that the nurses often provided false reassurance “everything will be alright” or “the heart rate is a little low but it is OK”.  These scores were lower in the scenarios with the Noelle simulator than with the Mam Natalie simulator.  Similarly the scores for feeling respected and treated with courtesy were lower with the Noelle simulator.  The actors identified that in most of the scenario the nurses initially addressed the patient by name and introduced themselves, but the use of names and actions indicating respect for the patient, such as keeping the perineum exposed even if nothing was being done or watching the monitor or computer screen while the patient was making a request became more frequent as the scenario proceeded. The actors also scored the item related to the nurse listening carefully to the patient lower when the Noelle manikin was used as the patient. The responses to feeling safe demonstrated wide variation but the scores were lower when the actor was wearing the Mama Natalie Simulator than with the Noelle simulator.  In part this may be explained that the actor is in the room and the blood pressure and other non-invasive assessments are actually performed on the actor’s body with the Mama Natalie Simulator, whereas with the Noelle simulator the actor is in the control room and assessments are performed on the manikin with the data provided from an external source.  As one actor shared, when the nurse couldn’t get the oxygen to work I became anxious –even though I could breathe just fine!

Nursing is more than the performance of technical skills.  In the nursing practice environment attention to addressing patient centered care and promoting patient satisfaction is important.  In the simulation environment we need to consider how to develop these skills concurrent with leaning the technical aspects of nursing care.  This presentation will share the qualitative comments from the actors as well as observations of the simulation coordinator and strategies for the future.