Teaching the Nursing Process through the Use of Simulation in the Lecture Hall

The nursing process is a difficult concept for undergraduate students at any level to grasp. Yet, nursing faculty members expect students to apply this problem solving strategy as they individualize care for their assigned patients. According to Novak (2013) and Kirkman (2013), stimulation may be a more effective method to transfer knowledge than reading a textbook or listening to a lecture. Not all students have experienced a hospital setting prior to the beginning of nursing school which can lead to increased anxiety and fear about the first “real” patient encounter in a clinical assignment. Traditionally, a computerized slide presentation has been used to convey the steps of the nursing process in the classroom. Lack of a clear understanding of the concept became evident as faculty reviewed the students’ written care plans during clinical rotations. Thus, a new strategy was conceptualized by faculty to improve students’ understanding and application of the nursing process. Given the literature support for varying the methods used for instruction of a large student body (Foronda & Bauman, 2014), the faculty incorporated simulation into the classroom to teach the interrelated topics of clinical reasoning and the components of the nursing process as key factors for comprehensive nursing care.

The nursing process, otherwise known as ADPIE (Assessment, Diagnosis, Planning, Intervention, and Evaluation), was taught to junior students in the didactic setting by using simulation techniques with a standardized patient in the lecture hall. After a brief lecture using a computerized slide presentation highlighting the elements of the nursing process, the simulation strategy is introduced to the students sitting in the classroom. A standardized patient is brought into the classroom via stretcher with full moulage in place. A faculty member approaches the patient and models a real life encounter as would be performed by a registered nurse. The faculty introduces herself to the patient and performs a five minute clinical assessment to gather data which is verbalized to the students as it is identified. The standardized patient interacts with the faculty by answering questions about his current medical status. Students are expected to take notes throughout the demonstration identifying any abnormal data which can be used later to construct a patient-specific plan and nursing care interventions (steps of the nursing process). In front of the students, interventions are incorporated into the scenario such mobilizing the patient to a chair, using of an incentive spirometer, and administering medications. The patient data obtained is the foundation with which students build a concept map. The standardized patient is used to accomplish learning objectives for junior level students. This strategy acts as a bridge between the conceptual understanding of the nursing process and the reality of a hospitalized patient. The real time interactions portrayed between the faculty “nurse” and the “patient” allows the students to observe a comfortable way to approach and interact with a hospitalized patient during their future initial encounter. By observing this teaching strategy, the students become actively engaged in the activity, thus reducing their anxiety and uncertainty experienced when approaching patients for the first time. Students report that the use of simulation in the lecture hall provides a method to envision their role as student nurses in the clinical setting. This innovative teaching approach changes the classroom environment to a setting characterized by active and experiential learning.