Embedding Simulation-Based Learning in a Capstone Undergraduate Nursing Subject to Develop Clinical Reasoning Skills

Reflective learning and clinical reasoning skills are highly valued and even deemed essential in healthcare professions where constantly changing situations require effective and efficient reasoning and decision-making processes (Parker & Myrick, 2009).  Research suggests the capacity of simulation-based learning (SBL) as a technique to stimulate the development of metacognitive processes such as clinical reasoning is dependent upon a purposeful and structured approach to curriculum design (Dreifuerst, 2010; Hoffman, 2007; Kuiper, Heinrich, Matthias, Graham, & Bell-Kotwall, 2008; Lapkin, Levett-Jones, Bellchambers, & Fernandez, 2010).

In October 2014, the Australian Catholic University School of Nursing, Midwifery and Paramedicine re-designed a final semester Bachelor of Nursing capstone subject from a blended mode of lecture-and online delivery to a simulation-based mode of delivery, with a focus on developing clinical reasoning skills.  The ensuing simulation program took a unique approach of incorporating two existing resources designed to develop clinical reasoning skills in undergraduate nursing students; written scenarios based upon an eight-step clinical reasoning framework (Levett-Jones, 2013); and the validated six-step Debriefing for Meaningful Learning^© (Dreifuerst, 2010) debriefing framework.

The success of this re-design was dependent upon specialised knowledge and skill in both the facilitation of the simulation program and the Debriefing for Meaningful Learning^© framework.  This presented as a significant challenge as the subject was to be conducted simultaneously on five campuses across the eastern seaboard of Australia, involved over 1500 undergraduate nursing students, and in excess of 30 academic staff both continuing and casual; many of whom had limited prior experience of SBL.

This presentation will present: the design principles underpinning this innovative curriculum re-design; an overview of the simulation program; and the strategy employed to support academic and technical staff in delivering this subject.  Finally, preliminary data will be presented regarding student and staff satisfaction with this re-design.

References:

Dreifuerst, K. T. (2010). Debriefing for meaningful learning: fostering development of clinical reasoning through simulation. Doctor of Philosophy, Indiana University.  

Hoffman, M. H. G. (2007). Learning from people, things and signs. Studies in Philosophy and Education, 26(3), 185-204. doi: 10.1007/s11217-007-9027-5

Kuiper, R., Heinrich, C., Matthias, A., Graham, M. J., & Bell-Kotwall, L. (2008). Debriefing with the OPT model of clinical reasoning during high fidelity patient simulation. International Journal of Nursing Education Scholarship, 5(1), 16. Retrieved from http://www.bepress.com/ijnes/vol5/iss1/art17

Lapkin, S., Levett-Jones, T., Bellchambers, H., & Fernandez, R. (2010). Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing, 6(6), e207-e222. doi: 10.1016/j.ecns.2010.05.005

Levett-Jones, T. (Ed.). (2013). Clinical reasoning : learning to think like a nurse. Frenchs Forest, NSW: Pearson.

Parker, B., & Myrick, F. (2009). A critical examination of high-fidelity human patient simulation within the context of nursing pedagogy. Nurse Education Today, 29(3), 322-329. doi: 10.1016/j.nedt.2008.10.012