Combining Simulation and Standardized Patients to Evaluate Critical Thinking Skills in Graduate Acute Care Nurse Practitioner Students

Thursday, September 20, 2012

Tonya Appleby, MSN, RN, CRNP
Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD
Lyn Stankiewicz Murphy, PhD, MBA, MS, RN
Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, Baltimore, MD

Learning Objective 1: The learner will be able to identify steps in creating case scenarios for simulation.

Learning Objective 2: The learner will be able to discover new ways to bring simulation into the classroom.

Introduction: Simulation labs have become a norm for many schools of nursing to teach skills in physical assessment, procedures and cognitive tasks such as rhythm identification and waveform analysis. Advances in technology have produced microprocessor enabled portable mannequins to provide real-world opportunities for students to exercise critical thinking skills as well as gain confidence in a safe environment. Methods: To evaluate our student’s critical thinking skills, faculty developed case scenarios based on a lecture topic. Objectives, key decisions, cues were developed. SimMan® 3G, a patient simulator, was brought into the classroom and students were given selected background information. A standardized family member and Registered Nurse (RN) were also present. In groups of 5, students worked together as a team, completing a history and physical, engaging with family member and the RN. Students also provided emergent stabilizing care when necessary, giving orders to the RN and updating the family member. Results: With minimal cueing and assistance, students were able to organize themselves with a lead acute care nurse practitioner (ACNP) student performing the history and physical and as a group; they developed a working diagnosis and differential diagnoses. They outlined a plan of care for the patient and interacted with the RN and family member. After the simulation ended, the group of students, faculty and the remaining students in class participated in a debriefing session. Discussion: With SimMan® 3G, faculty are able to evaluate ACNP students’ critical thinking skill in real time and students are able to experience the patient outcomes following their decision trajectory in a safe environment.