Integrating Increasingly Complex Simulation into a Junior Level II Course in a BSN Program to Provide Students with an Active Learning Strategy to Reinforce Learning

Problem: Simulation has been used for years in other fields, whereas nursing has only just begun their quest to utilize high fidelity simulation in the last ten years. Nurse educators have been challenged by the IOM to change the way nurses are taught in order to improve the quality of care provided and patient safety.  The literature supports using simulation in nursing education and identifies it as a safe way for students to practice skills and build self-confidence in the management of complex patients without risk of harm to a patient.  The use of simulation is slowly being integrated into many nursing programs. Saint Xavier University had not yet integrated simulation into the junior II level Care of Adults nursing course. Therefore, this was an opportunity to offer students high fidelity simulation experiences to reinforce learning.

Approach: Progressively complex simulation scenarios were defined as scenarios that built upon the previous one in both skill performance and patient complexity. The scenarios were developed between spring of 2014 through fall 2014. The first scenarios were piloted in spring of 2014 with a group of senior level students in leiu of clinical time. These scenarios were then modified and integrated into a junior II level Nursing Care of Adults course in the fall of 2014. The project objective was to provide students with an opportunity to participate in simulations throughout their program. The goal was to  promote self-satisfaction in learning, skills acquisition and reinforce learning

Intervention: Three progressively complex simulation experiences were developed and integrated into the junior II level Nursing Care of Adults course in a BSN program. The accelerated BSN students were able to participate in all three simulation scenarios which occurred on three seperate days after their exams. The traditional BSN students participated in two of the simulation experiences on one day in leiu of clinical time.The scenarios included pre-sim, simulation, debriefing, and two surveys for evaluation of the experience. The surveys used were obtained fromthe Natinal League for Nurses and used with their permission. The project utilized a convenience sample of 12 accelerated and 71 traditional BSN students totaling 83.

Finding: Data was collected from observation, debriefing, and surveys which were collected after each simulation.  Observation revealed that some students were nervous while others forgot what to do when put into a life-like situation. Debriefing supported these observations. The data gathered from the surveys supported continuing the use of simulation in the junior level course as well as expanding the current project to allow for both accelerated and traditional students to participate in all three simulation experiences. A barrier to implementing the simulation experiences was the amount of time required to circulate 83 students through the simulations.  Of the surveys completed correctly, the majority agreed or strongly agreed with most items on both surveys in support of simulation as being a beneficial educational practice that promotes self-confidence and satisfaction in learning. Students expressed they would like more simulations.

Implications and Relevance to Nursing: Feedback from this project was positive. The clinical instructors who were invited to participate in the debriefing sessions found the experiences to be beneficial to the students as well as to them.It allowed the clinical faculty to see how their students were doing clinically. Students do not always get to practice skills or gain the confidence needed during a traditional clinical setting. Simulation offers nurse educators an alternative educational pedagogy to meet the needs of today’s nursing students.