Learning from Mistakes in a Simulated Leadership Laboratory, Part II

Tuesday, 31 July 2012: 2:10 PM

Mary Anne Schultz, PhD, MBA, MSN, RN
School of Nursing, CSULA, Los Angeles, CA

Learning Objective 1: Describe the scenario for Care of Multiple Patients

Learning Objective 2: Discuss how to add fidelity to the scenario in order to more fully evaluate student outcomes

            Human patient simulation (HPS) in nursing education has become an accepted and expected form of pedagogy. Research on the use of human patient simulation to evaluate student performance, however, is still at an early stage. The vast majority of these sources report the unit of analysis as the nurse-patient dyad (one nurse/one patient) situated in an infrequently occurring, high-risk, or costly event such as a code blue, and the literature reveals little evidence on the efficacy of the use of simulation for the care of multiple patients. The teaching innovation, discussed herein, involving a simulation, used a leadership scenario multiple times that illustrated a routine day in an acute-care hospital unit.

            The aim of the project, which was the focus of this study, is to provide a high-fidelity simulation of the competing demands on a nurse’s time and attention while caring for multiple patients. Working as a team, using principles of prioritization, delegation, scope of practice, and communication, senior baccalaureate nursing students assumed the various roles of interdisciplinary team members as they moved through staged sequences of changing patient and unit conditions. This was followed by debriefing session that prompted the students to identify their errors in judgment, including sending the wrong patient to the operating room, failing to rescue a patient, and failing to delegate critical tasks to other nursing team members. Upon repeated use of the scenario, frequent errors were repeated, sometimes after debriefing and repeating the same scenario. These included: frank privacy violations, a failure to appropriately discharge a patient against medical advice and a failure to appropriately return a patient to bed who had fallen.