Developing Nurse Leaders Through Human Patient Simulation

Background:

Human patient simulation (HPS) is an educational strategy that provides students with exposure to realistic clinical situations using life-like examples, thereby increasing clinical reasoning skills (Lapkin, Levett-Jones, Bellchambers, & Fernandez, 2010). It allows learners to enhance existing knowledge and to practice psychomotor and critical thinking skills in a safe environment while improving teamwork, confidence, and communication (Figueroa, Sepanski, Goldberg, & Shah, 2013); these capabilities contribute to the leadership skills needed by nurses.

Leadership abilities are essential for all baccalaureate nursing graduates and “emphasize ethical and critical decision-making, initiating and maintaining working relationships, and mutually respectful communication and collaboration within inter-professional teams” (American Association of Colleges of Nursing, 2008). Additionally, the American Association of Critical Care Nurses (2016) maintains that a healthy work environment includes ‘authentic leadership’ as one of six standards needed for professional practice. Last, the Institute of Medicine (2011) further emphasizes the need for nurse graduates with leadership competencies to deliver high quality care. However, practice environments rarely include leadership development opportunities for nursing students. 

Nursing education programs provide few opportunities for students to experience the role of expert and develop leadership skills in a clinical setting. HPS facilitation experiences may provide opportunities for students to progress into the role of a professional nurse leader, a skill deemed to be vital to the profession of nursing. This study implemented senior nursing students as HPS facilitators for their junior and sophomore peer participants in the HPS experience. HPS facilitation is characterized by guiding participants through a HPS clinical scenario and leading a debriefing discussion and reflection of events. This creates a leadership development opportunity for senior nursing students in a peer-assisted learning environment (with faculty supervision).

Evidence suggests that peer-assisted learning, characterized by learning guided and facilitated by peers, increases self-confidence and communication skills (Awasthi & Yadav, 2015), which may contribute to leadership abilities. HPS provides an ideal opportunity for a peer-assisted learning environment, allowing all levels of learners to safely participate and/or facilitate. HPS also provides an opportunity for senior learners to practice and reflect on their leadership skills, their strengths and their weaknesses. Sophomore and junior participants also benefit from peer-assisted learning as they build relationships and respect with novice and experienced students, modeling a desirable, collaborative, supportive work environment.

Method:

This study examines the effects of Human Patient Simulation (HPS) on leadership skills in a peer-assisted learning environment. We developed and implemented a unique learning opportunity for senior nursing students to function as experts in a peer-assisted, small-group HPS experience.

Four small-group HPS experiences were developed and integrated into four existing nursing specialty courses: OB, pediatrics, gerontology, and psychiatric nursing. Each HPS experience included one to two sophomore and one to two junior nursing student participants, one senior student facilitator, and one faculty supervisor. The senior student facilitated the HPS and led junior and sophomore debriefing

To investigate the effects of HPS facilitation on leadership, senior students (n=75) completed a  self-assessment of leadership (Authentic Leadership Questionnaire). Junior and sophomore students completed a peer-assessment of leadership for their senior facilitator following each HPS experience. Qualitative data regarding leadership was gathered following the intervention with four student focus groups including sophomore, junior and senior students.

Impact:

This research will fill a gap in the literature as an evaluation of HPS as a pedagogical approach for leadership development and peer-assisted learning. Additionally, the study contributes by increasing the understanding of elements which may have an impact on the leadership skills of senior level nursing students. Ultimately, the study’s results will assist nursing faculty in the development of curricula to best meet their students’ leadership needs.