The purpose of this project is to evaluate if students’ self-efficacy related to chain-of-command is enhanced after educational sessions and student-driven, high-fidelity simulation. Historically, students demonstrate relatively high levels of anxiety and little confidence in regard to communication with healthcare providers.
Since the Institute of Medicine (2000) identified human error as a contributing factor in the deaths or permanent injury of potentially 98,000 patients each year, public concern and professional responsibility have grown tremendously. The National Patient Safety Foundation (2015) recognizes nursing education as having a significant impact upon both individuals and systems to promote a culture of patient safety. Accordingly, Quality and Safety Education for Nurses (QSEN) competencies now guide nursing curricula to better prepare graduates to deliver safe, high quality patient care (Dolansky & Moore, 2013). Globally, 6.6 million children die before the age of five and 289,000 preventable maternal deaths have occurred (Kuruvilla et al., 2014) Variables related to these deaths include deficient medical services and communication with health care providers.
In the clinical setting, nursing students are often perceived as inexperienced learners with limited authority and novice communication skills. Following graduation, new graduates enter the workforce unprepared to confidently advocate for healthy patient outcomes. To address this practice gap, student-driven simulation has been identified as a means to introduce the application of chain-of-command protocols. Students are provided a written scenario with basic information such as patient’s diagnosis, written orders and vital signs. When a threat to patient safety arises, such as repetitive late decelerations, students are then faced with the dilemma regarding interventions to promote maternal-fetal health. The students may feel the healthcare provider’s presence is required at the bedside for further assessment, but are met with resistance. Students must utilize chain-of-command to secure the healthcare provider’s presence at the bedside so that the immediate plan of care can be addressed. Babenko-Mould (2010) asserts that nursing schools must provide such opportunities so that students will develop empowerment and confidence.
Methods: The convenience sample, composed of 48 junior nursing students, was randomly divided into four simulation groups, and then further divided into active or observational status. Active participants planned interventions and participated in high fidelity obstetrical simulations related to patient safety and chain-of-command initiation. Active and observational students participated in a combined debriefing session. A pretest posttest design utilizing the General Self-Efficacy Scale was utilized to measure chain-of-command self-efficacy in relation to both active and observational roles.
Results: Study results indicate active and observational roles increased and are equivocal regarding chain-of-command self-efficacy in high fidelity, student-driven obstetrical simulation. This finding is consistent with Bandura's (1986) concept that doing a task, as well as observing a task, can enhance one's self-efficacy related to accomplishing the same task.
Conclusion: Student feedback supports the use of obstetrical student-driven simulation as a means to apply chain-of-command protocols, increase student confidence, and potentially promote healthy maternal-fetal outcomes. Nursing educators, specifically simulation specialists, may alter current practices which require each student to actively participate within a specific simulation scenario.