Integrating Evidence Into Clinical Practice Utilizing Simulation

Implementation of evidence-based interventions to improve individual and community health is a priority for nurses entering the workforce to provide patient care. In an effort to train nurses in evidence-based practice, the undergraduate curriculum of a large, private, urban college of nursing includes a research course entitled Integrating Evidence into Clinical Practice. The research course originally used lecture exclusively as a teaching strategy. Based on student course evaluations calling for more interactive teaching methods, simulation was selected as an additional teaching strategy for this class, as it is grounded in adult learning theory and provides student opportunities for active learning (Rutherford-Hemming, 2012). Nursing students participating in simulation reported higher levels of satisfaction and obtained higher scores on an Objective Structured Clinical Examination (OSCE) compared to their peers who participated in lecture (Stayt, Merriman, & Ricketts, 2015). Similar findings from a variety of clinical education programs have been reported in the simulation literature (Chang et al., 2017; Ramsingh et al., 2014; Maddry et al., 2014). The research course faculty collaborated with the simulation team to apply this evidence in education to the practice of teaching the research class. We hoped the simulation experience would provide a common experience for students to reflect on in discussion of evidence-based practice interventions to enhance safe fall prevention programs in the hospital setting, engaging in critique of evidence-based practice interventions that reduce inpatient falls, and analysis of study results and articles to determine effectiveness of evidence-based fall prevention.

Falls are a health concern worldwide because they affect the health of vulnerable populations, their caregivers, and the community as a whole (Tricco, 2017). Multiple evidence-based fall prevention interventions have been identified, and the right combination of interventions for each patient may depend on multiple factors. Fall prevention toolkits have been used to implement comprehensive fall prevention programs in multiple hospital settings (Ambutas, 2017). A simulation scenario incorporating the use of a fall prevention toolkit in the was created for students in the research class using INACSL Standards of Best Practice: SimulationSM (INACSL Standards Committee, 2016). Students reviewed evidence-based resources on fall prevention prior to simulation. On the day of simulation, a patient room was set up with multiple safety hazards for students to identify and correct. Students were divided into two groups. The first group had access to fall safety devices, such as skid-proof socks. The second group had access to a policy and protocol as well as fall safety devices and a fall prevention toolkit. Simulation debriefing included facilitated discussion, allowing students to compare the experience of the two groups and determine how the use of a fall prevention toolkit affected a nursing student’s ability to identify patient fall risk factors and safety issues in the environment. Discussion also included generation of further research questions using the PICOT (population, intervention, comparison, outcome, time) format. Students were encouraged to develop questions based on reflection of their simulation experience and application of the evidence-based resources they used to prepare for simulation.

More research is indicated to evaluate the effect of integrating simulation on fall prevention into a lecture-based undergraduate nursing class. A full evaluation of this intervention has not yet been implemented. If effective, this model is one that can be implemented in all undergraduate research courses to help students actively engage in changing behaviors to improve outcomes for patients overall in the healthcare setting.