Incorporating Safety Challenges in Undergraduate Nursing Simulation Experiences

Purpose:

The purpose of this presentation is to demonstrate how safety challenges can be incorporated in simulation experiences.  The presentation will include simulation case development, implementation, and evaluation as well as important aspects for feedback and debriefing after the experiences.

Methods:

Undergraduate nursing students participate in several different simulation activities throughout the curriculum. These simulation experiences include Human Patient Simulator experiences, Standardized Patient Simulation experiences and Hybrid Simulation experiences. In the middle of the curriculum during a Simulation Day the nursing students participated in a Standardized Patient Simulation experience that included a variety of safety challenges. The safety challenges included the following: 1) incorrect name on patient identification band (first name incorrect but last name correct); 2) allergy band on patient with noted allergy to adhesive tape (student asked to do dressing change during the scenario and see if correct tape selected); and 3) prevention of patient fall (patient with dizziness in chair with bare feet who has to be assisted back to bed and note if the student puts the anti-slip stockings on the patient prior to assisting back to bed). A safety challenge was also included in the Hybrid Simulation experiences. These safety challenges included the following: 1) Patient with a DNR order, who was doing well and waiting for the discharge orders to go home, begins choking while eating lunch – what do the nursing student’s do? Do the students help the patient who is choking and clear the airway or do they do nothing because the patient is a DNR?; and 2) Teenage child, 17 year old, who initially came in unconscious after a car accident, lost a lot of blood during surgery, and now in the medical surgical unit, receiving a unit of blood. The parents come to see the child, the mother is a Catholic and the father is a Jehovah Witness. The father flips out when he sees the blood transfusion and demands the transfusion be stopped. The mother wants the transfusion continued because the daughter need the blood. The daughter who is now awake, was raised a Jehovah Witness but states she is ok with receiving the blood transfusion.  What does the nurse do?

Results:

During each of the standardized patient simulation experiences it was noted if the student identified the safety issue at the beginning of the scenario, the middle of the scenario, the end of the scenario or not at all.  Findings in regards to the incorrect first name on the patient identification band safety scenario demonstrated that the majority of the time when checking the identification band, if the first name was not correct, but the first name started with the same first initial as the correct name, the student did not identify the error.  The findings in regard to the patient with an allergy to adhesive tape safety scenario, when the student went to complete the dressing change the majority of students did not know the difference between adhesive tape and paper tape.  In the prevention of patient fall safety scenario, when assisting the patient from the chair to the bed approximately 50% of the students noticed the anti-slip booties on the counter in the patient room and placed the booties on the patient prior to assisting the patient back to bed. 

During each of the Hybrid Simulation experiences it was noted how the nursing student handled the safety situation. Findings in regard to the choking patient with a DNR order demonstrated more than 95% of the time that the nursing students did nothing because the patient had a DNR and let the patient choke until respiratory arrest and death! Even when a family member was included in the scenario at the bedside, the family member would ask the student, “Why are you just standing there?” “Why are you not helping my father?” The students would respond stating “He has a DNR so we cannot help him” or “He has a DNR – this is what he wanted”. The findings in regards to the patient with the blood transfusion were mixed. In some cases the students did not stop the transfusion and tried calling security to remove the arguing parents from the room.  In other cases the students stopped the transfusion and called the physician.

Conclusion:

During the feedback session with the standardized patient and in the debriefing session with the faculty the safety issue was presented to the students and discussed.  The safety scenarios were an eye-opening experience for the students and the feedback from the students was very positive.  The simulation scenarios also helped identify specific areas where additional education was needed in the curriculum. The incorporation of safety issues in standardized patient simulation experiences and hybrid simulation experiences can provide excellent learning situations for nursing students and can help to promote the importance of attention to specific details to ensure patient safety in a safe learning environment.