A meta-analysis revealed that simulation is an effective teaching modality for improving problem solving, critical thinking, clinical judgment, and clinical competence (Lee & Oh, 2015). Participation in multiple-patient simulation improves prioritization, delegation, teamwork, and communication (Blodgett et al., 2016; Chunta and Edwards, 2013; Nowell, 2016) and increases confidence in perceived readiness to transition to professional practice (Kirkman et al., 2018). Additionally, simulation provides opportunities to engage with culturally diverse simulated patients and improve interdisciplinary teamwork (Armenia et al., 2018; San, 2015).
Methods: A cross-sectional pretest-posttest survey design was used to determine if a multiple-patient simulation changed pre-licensure nursing students’ attitudes and self-efficacy regarding prioritization and delegation of patient care activities and facilitated interdisciplinary teamwork and communication. Five international BSN students visiting from the U.K. and 26 senior nursing students enrolled in the final semester of a baccalaureate program in the southeastern U.S. participated in the simulation and completed the survey. The simulation activity included listening to report on four patients before determining clinical priorities and delegated tasks. Scripted, yet unexpected, challenges such as admissions were incorporated into the scenario. Each challenge required students to re-prioritize the plan of care and identify changes to the delegation plan. Debriefing facilitated exploration of differences and similarities in scope of practice, delegation parameters, and clinical reasoning.
Results: Participation in a multiple-patient simulation with international nursing students resulted in statistically significant increases in comfort and confidence prioritizing care and delegating tasks (p < 0.012). The mean increase in survey scores was 0.39 with pretest scores ranging from 3.03-4.29 and posttest scores ranging from 3.81-4.26. Strengths and weaknesses of multiple-patient simulation in an international context were identified; including the ability to clearly and effectively communicate with members of a healthcare team and persons from diverse backgrounds.
Conclusion: High patient acuity and shortened lengths of stay often preclude nursing students from practicing essential skills in the clinical setting. Multiple-patient simulation can bridge the gap between academia and practice to improve self-confidence and develop competence in senior nursing students’ ability to communicate, prioritize, and delegate. The study revealed that multiple-patient simulation is an innovative teaching-learning strategy that promotes development of leadership and clinical judgment skills. In addition, inclusion of international nursing students in multiple-patient scenarios increases awareness of nursing practice in other countries.