Monday, 29 July 2019: 12:00 AM
Simulation as a learning strategy for undergraduate nursing students to help them learn critical thinking skills in a safe and controlled environment is becoming more common in nursing curricula. As a result, student simulation experiences related to clinical areas show potential for a positive impact on patient safety (Schaefer et al., 2011). However, many programs do not utilize simulation in their Nursing Leadership and Management courses (Smith, 2013). Critical decision-making, effective communication and delegation skills are vital for nurses to safely manage their patients’ care. The purpose of this evidence-based project was to introduce two senior Leadership and Management classes of nursing students from a faith based university (N= 113) to a patient scenario using low fidelity simulation with role modeling. The simulation presented a scenario in which a patient was decompensating while another patient was becoming unruly and the physician on call was less than attentive. Prior to attending the simulation students were assigned readings on delegation, prioritization, and conflict management to prepare them for the simulation scenario. Students were also asked to complete a “Ticket to Entry.” The ticket consisted of questions related to TeamSTEPPS Communication Techniques: CUS, SBAR, HUDDLE, and Check Back (AHRQ, nd) to encourage the use of effective communication, collaboration, delegation, prioritization, and conflict resolution skills during the simulation (Castledine, 2002; Huber, 2014). Student and clinical faculty volunteers were briefed on the scenario prior to the simulation and volunteer student actors were briefed on their roles. Once the simulation was completed the students met in their respective clinical groups and debriefed on the following topic areas: 1) What went well in the scenario 2) What did not go well in the scenario and 3) What actions could have been taken, if any, to improve safe patient outcomes in this scenario. All student clinical groups shared their thoughts when they rejoined the other clinical groups for the entire class debriefing session. The simulation scenario was then repeated using information disclosed during the debriefing. The second simulation was much improved from the first simulation. Students with simulation roles used QSEN communication techniques and debriefing suggestions relating to delegation, prioritization, and conflict resolution during the repeated simulation. Evaluation of the effectiveness of student learning with the simulation consisted of a pre test-post test (15-question questionnaire) and subjective narratives responses from the students and clinical instructors who assisted with the simulation. The TeamSTEPPS curriculum was used for the pre test-post test questionnaire. Pre test-post test student scores from the two Leadership and Management classes were compared using t-test analysis. Pre-test score for group 1 was 13.03 and group 2 score was 13.39 (p= .610). Post-test score for group 1 was 13.02 and group 2 score was 13.43 (p= .136). Although there was no statistical significance between the two Leadership and Management groups for pre-test or post-test, the results indicate that despite having two different classroom instructors student learning was consistent between the two classes. Interestingly, further analysis of the t-test highlighted two test questions that many students (in both groups) missed on the pre-test and post-test. These questions pertained to dealing with issues of blame and error reporting and speaking up despite the hierarchy of a director of nursing. Several possible explanations were identified for student incorrect responses. One is that novice nurses may struggle with confronting those who are in charge and the second was that students who attend a faith based university may have been influenced regarding challenging authority. As situations dealing with errors and reluctance in overriding authority could negatively impact patient safety, clinical instructors and educators need pay close attention to these situations in the clinical environment and further evaluation is needed into the reason why students are reluctant to respond appropriately in these situations. Lastly, the subjective evaluation of the simulation class supported that all participants believed the simulation to be beneficial and important in student understanding of clinical situations. The simulation provided students a safe environment to practice their responses without negative impact to patients. These results provided awareness into how students from a faith based university as well as soon to be new nurses would perform in certain situations. The use of simulation in a nursing Leadership and Management course should be considered in future nursing curriculum to evaluate student understanding of leadership and enhance patient safety.