Using Role Play in Simulation to Teach Complex Client Concepts

Purpose: The transition to clinical practice gap contributes to difficulties newly graduated nurses experience during the first year on the job. Nurse leaders and educators have developed strategies to improve newly graduated nurses’ transition to clinical setting through nurse residencies and other innovative approaches. It is also essential to address this problem in the educational setting prior to graduation. Newly graduated nurses (N=31,000) consistently ranked emergency (ER) code responses, management of chest tubes, and ventilator care in the top five of skills they felt most uncomfortable performing (Goode et al., 2013). Surveys of chief nursing officers nationwide revealed that most newly graduated nurses were not proficient in psychomotor/technical skills performance and had difficulty responding appropriately to emergencies, essential nursing skills (Krugman et al., 2006; Smith & Crawford, 2002). Preparing senior nursing students for their role as future providers is essential to help bridge the education to practice gap. Simulation is an excellent tool for improving nursing students’ knowledge, technical skills, and level of comfort in caring for clients requiring special equipment or emergent interventions. The benefits of simulation as an educational strategy are supported in the literature (Cooper, 2017; Everett -Thomas, et al., 2014); little research has been published on the use of simulation to teach complex clinical skills and challenging clinical concepts to senior nursing students. Most studies have been conducted in post graduate registered nurses or medical students (Abe, Kawahara, Yamashina, & Tsuboi, 2013; Alluri, R. K., Tsing, P., Lee, E., & Napolitano, J., 2016). The purpose of this presentation is to describe an active learning strategy in which faculty use role modeling to teach senior nursing students how to provide care to clients with complex clinical problems.

Methods: Prior to participating in the three simulations students were segregated into teams of six or seven members. Each team provided care to a multi-trauma client, a intensive care client, and a client experiencing cardiac arrest. Student outcomes were evaluated after each scenario with the Student Satisfaction and Self-Confidence in Learning survey (NLN, 2005). The three simulations integrate skills and equipment routinely used in the critical care and emergency department settings. The scenarios were developed from the recommendations of the Society of Critical Care Medicine (SCCM) (Dellinger et al., 2012), the Association of Critical Care Nurses (ACCN) (Bell, 2015), Emergency Nurse Association (Moore, K. 2012), the American College of Gastroenterology (ACG) (Greenberg et al., 2016), and the American Heart Association (AHA) (Morrison, et al., 2013).

Results: Student outcomes were evaluated after each scenario with the Student Satisfaction and Self-Confidence in Learning survey (NLN, 2005). Students (N=311) reported increased confidence in critical thinking ability (91%), decision-making skills (87%), assessment skills (88%), and ability to recognize and respond to significant changes in clinical condition (>90%). Students also reported increased knowledge of the conditions presented in the scenarios (90%). Overall students felt more comfortable with providing care to clients in the critical care setting (>86%).

Conclusion: Students reported increased confidence and comfort with providing care to clients with complex clinical problems. Students also reported less anxiety and felt more prepared for clinical rotations in critical care clinical settings and other complex clinical settings. Additionally, students reported high levels of satisfaction with role modeling and simulation as an instructional strategy. The results of this study can be used by nurse educators to improve instruction of students and training of nurses in complex clinical settings.