Journal of Nursing Education

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Major Articles 

Collaborative Simulation Project to Teach Scope of Practice

Joyce Simones, EdD, RN; Joan Wilcox, MS, PMHCNS-BC; Kim Scott, MSN, RN; Darci Goeden, MSN, RN; Darlene Copley, MSN, RN; Renee Doetkott, BSN, RN; Margaret Kippley, MSN, RN

Abstract

Nursing faculty from three schools of nursing collaborated to develop a simulation project to enable nursing students to practice and apply principles related to delegation, supervision, scope of practice, leadership, and culturally competent care. A simulated five-bed hospital was created where students were assigned to teams to plan and care for these patients. After the simulation exercise, students participated in a debriefing session in which they reflected on their performance.

Abstract

Nursing faculty from three schools of nursing collaborated to develop a simulation project to enable nursing students to practice and apply principles related to delegation, supervision, scope of practice, leadership, and culturally competent care. A simulated five-bed hospital was created where students were assigned to teams to plan and care for these patients. After the simulation exercise, students participated in a debriefing session in which they reflected on their performance.

Dr. Simones is Professor, Ms. Wilcox and Ms. Copley are Associate Professors, and Ms. Scott is Clinical Lab Coordinator, St. Cloud State University, St. Cloud; Ms. Goeden is Associate Degree Nursing Faculty, Central Lakes College, Brainerd; and Ms. Doetkott is Practical Nursing Instructor, and Ms. Kippley is Nursing Faculty, St. Cloud Technical College, St. Cloud, Minnesota.

Funding for this project was provided by the Minnesota State Colleges and Universities (MnSCU) Legislative Initiative Grant.

Address correspondence to Joyce Simones, EdD, RN, Professor, St. Cloud State University, Department of Nursing Science, 720 Fourth Avenue South, St. Cloud, MN 56301; e-mail: jmsimones@stcloudstate.edu.

Received: June 06, 2008
Accepted: May 26, 2009
Posted Online: April 07, 2010

New graduate RNs and licensed practical nurses (LPNs) are expected to enter nursing practice prepared to work collaboratively in multidisciplinary health care settings. Delegation and supervision skills are essential abilities that graduate nurses must possess to work collaboratively with other nurses and other disciplines. The concepts of collaboration, delegation, supervision, and scope of practice are routinely presented in RN and LPN curricula at varying levels; however, the application of these essential nursing concepts presents a challenge in the authentic clinical setting during nursing students’ educational experience. In an effort to provide nursing students with the opportunity to work collaboratively as RNs and LPNs in a health care setting, nursing faculty from three schools of nursing in Minnesota partnered to create a simulation project to enable RN and LPN students to practice and apply principles related to delegation, supervision, scope of practice, leadership, and culturally competent care.

Literature Review

The literature reveals new graduate nurses display deficits in the areas of organizational and managerial skills (Mole & McLafferty, 2004). The competencies of delegation and supervision also are unfamiliar as well as knowledge related to scope of practice.

The scope and standards of nursing practice are developed and regulated through national, state, and local professional and regulatory organizations as well as by individual health care institutional policies and procedures. Much of the language within these documents is broad based to allow for some flexibility. However, this broad language is open to interpretation and often leads to confusion regarding licensing boundaries. Adding to the uncertainty is the fact that the boundaries of the scope of nursing practice are in constant flux because of advances in technology, time constraints secondary to reimbursement issues, the increasing use of assistive personnel as the result of health care worker shortages and cost constraints, and the need for health care workers in underserved areas.

Boards of nursing across the nation increasingly have been confronted with scope of practice as well as delegation and supervision issues and questions from all levels of nursing. For example, Spector (2005) described a study in which the National Council of State Boards of Nursing (NCSBN) assembled an expert panel that identified 163 tasks performed by LPNs. At least 25 of these tasks appear to be outside of the scope of practice in some jurisdictions, providing evidence that even experts in nursing practice are unclear about professional licensing boundaries. Davidson, Bloomberg, and Burnell (2007) reported a case study in which RNs were asked to perform procedural sedation, a task historically performed by physicians, demonstrating the blurring of RN practice boundaries. Hudspeth (2007) discussed whether the use of advanced practice nurses who had not graduated from an accredited adult or family psychiatric mental health nurse practitioner or clinical nurse specialist program in mental health settings were practicing within their scope. These examples provide substantiation of the current confusion related to practicing within one’s scope across all levels of nursing practice.

There is a lack of information regarding how nurse educators teach concepts related to scope of practice, delegation, and supervision. These concepts typically are threaded through nursing curricula when instructors discuss standards of nursing practice and state nurse practice acts in a traditional classroom setting; however, opportunity for application of these concepts usually is absent. Nurses in the clinical environment are faced with high patient acuity levels, shortened patient stays, and staffing shortages. These factors, combined with the fast pace of practice settings, too many students, and decreasing clinical sites, have contributed to a stressful clinical environment. As a result, it is not feasible for RN and LPN students to practice skills related to scope of practice, delegation, and supervision in an authentic clinical environment.

The introduction of affordable, portable, and multipurpose human patient simulators in the 1990s transformed health care education (Jeffries, 2007) and provided one solution to the issue of lack of opportunity for nursing students to practice necessary nursing skills in the clinical setting. Simulation is gaining popularity among nurse educators and is being used increasingly as a teaching-learning strategy and evaluation method in nursing education (Jeffries, 2007).

A review of the literature reveals the use of human patient simulators and live actors to create a simulated clinical environment in which students learn, practice, and perform nursing skills essential for competent nursing practice. Herm, Scott, and Copley (2007) described the creation of a simulated clinical environment using “SimMan,” a human patient simulator, to evaluate nursing students’ clinical competence, critical thinking, and decision making ability. Eaves and Flagg (2001) described a simulated medical unit developed by the U.S. Air Force to assist nurses practice the delivery of competent care in a war-time environment. Nine moderate-fidelity mannequins and two live actors were used to create the simulated medical unit in which nursing students were able to practice technical skills, sharpen critical thinking ability, and exercise delegation skills. Mole and McLafferty (2004) related their design of a simulated clinical setting in which teams of 10 to 12 nursing students cared for 5 patients on a surgical ward to practice organizational, managerial, and clinical skills.

However, there is little evidence or literature on the use of simulation to teach delegation and scope of practice concepts, particularly a simulation scenario using both RN and LPN students simultaneously to teach these concepts. Several other nursing programs throughout the state were contacted to identify how concepts related to delegation, supervision, and scope of practice were taught, and no models of simulation exercises to teach these concepts were found.

Background

It is essential that all professional and practical nurses have knowledge of their state’s nurse practice act, which provides the legal definition of the scope of practice for each level of nursing personnel. The practice of professional nursing includes the function of delegating nursing activities to other nursing personnel and to provide supervision, an essential component of the delegation process. The Minnesota Nurses Association (2005) has published delegation guidelines for professional nurses based on the Minnesota Nurse Practice Act (2005). Specifically, these delegation guidelines (Minnesota Nurses Association, 2005) state:

In a decision to delegate to another person, the Registered Nurse should consider the following: The assessment of the patient or client; the capabilities of the other workers; the complexity of the nursing task; and the ability of the RN to supervise the delegated activity and its outcome.

To provide both RN and LPN students with an opportunity to apply concepts related to delegation, supervision, and scope of practice, a regional collaborative simulation project was developed from grant funds awarded by Minnesota State Colleges and Universities. Nursing faculty from baccalaureate, associate degree RN, and LPN programs collaborated with health care clinical staff from the region to develop a simulation exercise to help prepare RN and LPN students for interdisciplinary culturally competent care within their defined scopes of practice. In Minnesota, all nursing students are required to complete 117 Minnesota Board of Nursing Abilities (MBNA) prior to graduation. The two MBNAs related to delegation and supervision were incorporated into the simulation project.

Support for the collaborative simulation project was provided by the Minnesota Board of Nursing prior to submitting the grant proposal. This support continued with ongoing collaboration and guidance by the Minnesota Board of Nursing throughout the implementation and evaluation phases of the project.

Grant Focus

The main foci for the grant were:

  • Scope of practice.
  • Leadership acquisition.
  • Delegation and supervision.
  • Cultural competency.

These concepts are included in nursing curricula at various levels in theory courses; however, there is limited opportunity for application of these principles, and even less opportunity for RN and LPN students to work together in a clinical setting during their nursing educational experience. These concepts were identified as the foci of the grant for the following reasons: there is a strong link between scope of practice and safe clinical practice, there is a blurring of accountability and definition of roles, there are different nursing care delivery models used at various clinical agencies, students cannot legally delegate in their clinical practice in their unlicensed role, and there is a lack of diverse populations in this region. Creating a simulation exercise integrating each of these concepts would enable students to have an opportunity to practice these important nursing skills in the simulated clinical setting prior to entering practice.

Grant Phases

The collaborative simulation project became a year-long project. There were four phases to this project:

  • Faculty development and resource allocation.
  • Simulation development.
  • Project implementation.
  • Evaluation of student learning outcomes.

Faculty Development and Resource Allocation

Two to three faculty members from each of the partnering colleges were designated to work on the collaborative simulation project. A total of eight faculty members from the partner schools received summer salary to create a simulated learning experience that would enable RN and LPN students to work together to provide care for a group of diverse patients to apply concepts related to scope of practice, delegation and supervision, and culturally competent care.

To achieve these outcomes, collaborating faculty determined that the setting for the simulation scenario should reflect a nonspecialized unit of a rural community hospital and integrate a team nursing model. This type of a health care setting was selected because caring for a group of patients with diverse ages and diagnoses is more likely and therefore believable.

Two directors from the Minnesota Board of Nursing reviewed the project and provided consultation. They attended a planning meeting with the simulation group to provide additional input and feedback on the project. Assistance and input from nurses in the community also was solicited.

To educate nursing faculty and facilitate collaboration between regional health care partners and the schools of nursing, a simulation workshop was held for professional development in the field of simulation in nursing. The invited conference presenter was Pam Jeffries, a nationally recognized expert in simulation and also a practicing nursing faculty who could identify with faculty concerns of incorporating simulation into practice.

The day-long conference was attended by more than 40 participants from the three partner schools and area industry partners such as nurse educators from local hospitals and long-term care facilities. Nurse educators attended at no cost and received continuing education credits. The industry nurses in attendance expressed great interest and support for the project and the desire to work on future projects. Evaluations of the conference were positive.

The day after the conference, Pam Jeffries met with the eight faculty members who had been designated to work on the collaborative simulation project to provide consultation and assistance in designing simulation experiences that are evidence-based and incorporate postsimulation guided reflective learning. She provided a template that was used for the development of the case studies and scenario progression timelines.

The project received valuable technological assistance from a student worker with expertise in information technology. In addition, the information technology support staff and nursing laboratory coordinators were available for assistance. Digital camcorders or ceiling mounted pan and tilt cameras were purchased for each partner school so the simulation exercises could be recorded for analysis of student performance and for review during debriefing.

Simulation Development

Development of this simulation scenario required the creation of online just-in-time learning modules, the development of individual patient scenarios within a larger simulation scenario, the development of an evaluation rubric, and the need to conduct several practice runs. This 4 to 6 month period was the most intense and time-consuming phase of the project.

The designated project faculty members from the partner schools met five times as a group and also conducted conference calls to plan and implement the project. A well-defined breakdown of workload was established. Each faculty member was assigned responsibilities and timelines for completion. To facilitate communication among the partners and share the information related to the project development, a shared Web site that could be accessed by the faculty members from each of the schools was developed for project management. All meeting minutes, case studies, scenario timelines, and evaluation forms were included on the Web site.

Just-in-Time Learning Modules. An important component of the developmental phase was the creation of just-in-time learning modules. The purpose of the learning modules was to ensure that all students, regardless of which school of nursing they were from, came to the simulation experience with a similar knowledge base related to the concepts to be applied during the simulation exercise. The learning modules consisted of online tutorials to prepare students for the simulation experience, including theory and application exercises on scope of practice, delegation and supervision principles, and cultural awareness. Faculty members from each partnering school developed content, discussion, and other learning activities related to scope of practice for RN and LPN roles in Minnesota. Links to the Minnesota Office of Minority and Multicultural Health related to health care disparities for American Indians, African Americans, Asian Americans, and Hispanics and Latinos were included on the Web site as resources for students and faculty.

Scenario Development. The simulation project required the creation of individual patient scenarios within a larger simulation scenario consisting of an acute care setting whereby RN and LPN students worked together as a team to care for multiple diverse patients. Five individual patient scenarios were developed, and each reflected a different racial and ethnic group to add diversity to the learning experience. The goal was to increase students’ cultural awareness and sensitivity, and then have them apply this knowledge in the clinical setting. The individual patient scenarios included: a 7-year-old Native American child (and parent) with asthma, a 62-year-old Hispanic woman with diabetes, a 70-year-old African American gay man with a cerebrovascular accident, a 32-year-old Somali postpartum mother and baby, and a 70-year-old Caucasian woman recovering from surgery.

To ensure accuracy and cultural sensitivity in each of the patient scenarios, experts were sought to provide input. The director of the American Indian Center provided useful information related to the Native American pediatric patient. A local hospital provided information regarding different racial and ethnic groups served in the area. A member of the gay and lesbian community provided input into one of the scenarios, and additional consultation was received from the Somali and Hispanic communities.

Props and supplies were incorporated to create an authentic hospital experience. These included a hospital documentation system, a medication administration system, a change of shift report, care plans for the five simulated patients, specific orders for the patients, and a mix of real actors and manikins. In addition, scripts were written for the actors who role-played the various patients to ensure consistency of the simulation experience for students.

Evaluation Rubric Development. After the individual patient scenarios were developed, faculty determined two separate evaluation rubrics were needed. One rubric was designed to reflect team performance related to scope of practice, delegation, supervision, teamwork, prioritization of care, and communication (Table 1).

Collaborative Simulation Grant Evaluation Rubrics

Table 1: Collaborative Simulation Grant Evaluation Rubrics

The second evaluation rubric was designed to reflect individual student performance in the caregiver role. Faculty identified critical behaviors students were to demonstrate for each of the five patients within the simulation scenario, and these elements were used to create the second evaluation rubric (Table 2). The critical behaviors identified were different depending on whether students caring for patients were RNs or LPNs. Critical behaviors within the individual patient scenarios related to identification of low blood sugar and implementation of appropriate nursing interventions, identification and treatment of a patient with respiratory distress, identification and treatment of a patient in pain, identification of fall risk and implementation of appropriate interventions for a patient attempting to get out of bed, and communication with a non-English-speaking patient. An example of a critical behavior specific to scope of practice could include the LPN reporting signs and symptoms of hypoglycemia to the supervising RN. The RN then would decide how to proceed within his or her scope of practice. Decisions would be made such as notifying the physician for follow-up assessment, medication administration, or delegating additional tasks to the LPN with clear instructions on what information to gather and the time frame in which to report back.

Sample Form to Evaluate Students’ Critical Behaviors Toward Patients

Table 2: Sample Form to Evaluate Students’ Critical Behaviors Toward Patients

Trial Run. Faculty conducted a simulation exercise trial run using nursing faculty who were not involved in the grant project and therefore had no knowledge of the scenario to identify any problems prior to going live. During the first trial run with volunteer faculty, it became evident that the individual patient scenarios were too complex for the time frame and student ability, and that timelines needed to be established so that all five patients would not exhibit symptoms simultaneously. Therefore, revisions were incorporated to make the individual patient scenarios more manageable.

Two directors from the Minnesota Board of Nursing observed the second trial run of the simulation scenario with members of the partner schools and LPN students who were about to graduate. Their feedback about the project and goals was positive.

A third trial run of the simulation scenario was performed with graduate RN and LPN students. The scenario went well and required only minor changes for smoother logistics, such as more authentic props.

Project Implementation

The RN and LPN students from the different sites were brought together for the simulated clinical experience. The nursing science laboratories were set up as patient care units, with the five patients being role-played by faculty and community members.

The scenario progression time line started at Station 1, the “report” room, where a nursing team of two RN and two LPN students prepared for patient care. The RN students determined how the team would be organized by making patient assignments, taking into consideration the role and abilities of each of the “nurses” on the team. The team was allowed 30 minutes to receive morning report on the five patients, make assignments, and complete patient care worksheets.

Station 2 was the simulated hospital unit, where RN and LPN students worked as a team to provide care for their five patients. Students were allowed 20 minutes at this station, after which time was called regardless of whether students had completed all of the indicators on the evaluation rubric.

The students then were directed to Station 3, which consisted of a 30-minute debriefing session with a faculty member guiding the team of RN and LPN students to reflect on their performance. According to Jeffries (2007), debriefing is a critical component of any simulation experience because it allows students to express feelings about their performance and to receive support and feedback from faculty and peers. This process of guided group reflection leads to new insights from which students learn. Table 3 provides a list of questions that were developed for the debriefing component of the simulation exercise to provide faculty direction and promote consistency of the debriefing experience.

Guided Reflection Questions for Simulation Debriefing

Table 3: Guided Reflection Questions for Simulation Debriefing

Evaluation of Student Learning Outcomes

Evaluation of student performance required the use of multiple faculty evaluators, as it was not feasible for a single person to effectively evaluate the individual performance of four to five students at different locations as well as the overall team performance simultaneously. Therefore, a faculty evaluator was placed at each patient station. These evaluators used the rubric that was developed to evaluate individual performance to record their observations (Table 2).

In addition to an evaluator at each patient station, one faculty member from the leadership course from each participating partner school observed the team dynamic throughout the entire process of the simulated experience, from the report room to the debriefing station. During report, the faculty evaluator documented discussion related to patient delegation and evaluated appropriate and inappropriate delegation of patient assignment. During the simulation “run time,” the faculty evaluator observed and documented student performance with regard to patient care decisions, delegation and supervision according to scope of practice, leadership skills, team work, and cultural competence using the team evaluation rubric (Table 1). The student team was directed to the debriefing station, where they completed a written evaluation of the simulation experience using the debriefing questionnaire (Table 3). While the students completed their written evaluation, the team evaluator conferred with evaluators from each patient station and received feedback related to individual student performance prior to joining the student team in the debriefing area. The feedback helped determine whether the delegation and supervision MBNAs were met. The faculty evaluator then facilitated the debriefing session, using the feedback provided by all of the evaluators.

Results

Student Satisfaction

Students’ perceptions strongly supported learning by this “hands on” method. Many reported that it felt different to think on their feet. Students noted they did not have the experience and comfort in working together as RNs and LPNs. Students also noted scope of practice decisions are not implemented readily or easily without further practice. Students enjoyed the opportunity to care for groups of patients and work collaboratively with one another. A typical educational strategy for students prior to this experience had been total care for one or more patients, without working in teams.

Student Performance

According to Jeffries (2007), simulation is used more often as a teaching strategy in nursing rather than as an evaluation method. In addition, simulation as an evaluation of student competence has not been rigorously tested for validity or reliability, although it is being used increasingly to measure progress toward programmatic goals (Jeffries, 2007). This collaborative simulation exercise was used both as a teaching strategy and as an evaluation strategy. It also provided an opportunity for students to apply concepts of delegation, supervision, scope of practice, and culturally competent care in a situation that closely resembled the authentic clinical setting.

The evaluation rubrics provided a means of documenting student performance to allow feedback to students about their performance as a team and as individuals during the debriefing session so learning could occur. Therefore, the elements on the evaluation rubrics of critical elements were graded as met or unmet.

Individual performance varied greatly among students. Some students performed all or many of the critical behaviors identified on the evaluation rubric for their assigned patients, whereas other students omitted the behaviors and interventions outlined on the rubric. Many students omitted basic nursing care functions, such as knocking or hand-washing, in light of directing their attention to the patient needs and perhaps some anxiety. These observations validated the need to continue to focus on and reinforce basic nursing principles. In contrast, when reviewing evaluations of team performance, it was discovered most team members performed their duties within their scope of practice, RNs were able to delegate appropriately, and team members were able to communicate effectively. These findings were consistent with students’ perceptions of their performance.

When asked to identify what they did well in the scenario, the RN students thought they were able to do a good job of delegating and prioritizing. They also believed they were good communicators. The LPN students stated they were efficient in completing the tasks assigned to them, and they worked cooperatively with the RN students. Considerations that influenced the delegation process for the RN students were primarily the capabilities and preferences of the staff with whom they were working. The LPN students believed they were not delegated enough tasks. When they had to make decisions about prioritization, RN students based their decisions on report and the acuity of the patients. The LPN students used airway, breathing, and circulation as a guideline, along with safety considerations. Focusing on collaboration, both RN and LPN students indicated they collaborated well to meet patient needs. Considering the cultural aspects of the scenario, the RN students expressed feeling culturally competent, but they found having a non-English-speaking patient difficult. The LPN students also identified the non-English-speaking patient as a major stumbling block to good patient care. Both RN and the LPN students felt they had sufficient knowledge and skills to manage the scenario. They also believed none of the assignments were outside their scope of practice.

When asked what they would do differently, RN students identified the need to perform more thorough assessments, and they suggested more time be allotted. The LPN students also expressed a need for more time. Both RN and LPN students believed they needed more practice to build confidence. All of the students reported the scenario was a positive experience, and they suggested having several scenario experiences in a semester. Based on student feedback and performance, it is evident this simulation exercise validated the benefit of more comprehensive threading of delegation and supervision and other leadership principles throughout students’ nursing education.

Barriers

Barriers were identified throughout the project. Scheduling the RN and LPN students and the nursing science laboratory time for two 8-hour days to conduct the simulation project was challenging. Recruiting adequate role-players and faculty to assist with evaluation of critical elements on the performance evaluation tool proved to be difficult. Contacts were made with the social work department to participate in the project, but this not possible at the time. Ongoing communication will continue to include the social work department in future student collaborative experiences. There was difficulty with grant reimbursement of different agency partners for purchases, faculty stipends, and work completed. Due to technology of the shared Web site, e-mail, and conference calls, the distance coordination was not a barrier as anticipated. The enthusiasm for the project resulted in full attendance at all scheduled meetings.

Modifications

Modifications involve refinement of the evaluation tool to allow more objective measurement of delegation, supervision, and leadership skills throughout the scenarios. It would be beneficial if each patient rubric would include delegation and supervision principles, collaborative team behaviors, and other leadership skills. It is not feasible for one evaluator to observe each of these components. The validity and reliability of the evaluation tool should be established. A similar simulation exercise could be used earlier in the curriculum and then repeated as a means of measuring progress toward the acquisition of knowledge related to delegation and supervision, scope of practice, teamwork, and culturally competent care. In addition, to use the simulation exercise as an evaluation method, each of the performance indicators on the evaluation rubrics could be pointed and weighed, and mean scores could be obtained for more quantitative data from which to evaluate student performance. Actual video clips could be used or group debriefing.

Future Plans

Plans call for the collaborative simulation project to be an ongoing component in the senior courses of each partner school. The collaborative faculty had the opportunity to present a PowerPoint® presentation of the simulation project to the board members of the Minnesota Board of Nursing using video clips of the simulations. The response to the project by members of the Board was overwhelmingly positive. The project findings were disseminated to a variety of technical and community college faculty at a regional conference. The digitally created simulation scenarios are available to faculty on the college Web site.

Future plans also include the development of additional scenarios with the same foci and key components but different patients so that scenarios can be rotated from year to year or implemented twice in each program’s curricula. Plans also include collaboration with allied health and social work disciplines to design new learning activities and simulation scenarios that promote greater emphasis on interdisciplinary learning.

Conclusion

The faculty from the three partnering schools worked effectively together in creating this project. There was excitement and creative energy with the team members, who all believed the simulation project was innovative and would positively impact student learning. The greatest benefit of the simulation project was the opportunity to collaborate with faculty from the partner schools to create the simulation learning outcomes, learning activities, case scenarios, and evaluation methods. This provided a forum for rich discussion about the issues related to the Minnesota Nurse Practice Act, the scope of practice for the RN and LPN role, an appreciation of the complex issues faced in practice, and the value of simulation in educating nurses for practice. In addition, there was an enhanced understanding and appreciation for the different nursing education programs and the importance of continuing to work together to provide joint clinical learning opportunities as part of educating future nurses. The project provided students with the opportunity to learn more about the scope of practice and how it is applied in nursing practice.

The simulation project was appreciated by the three partnering schools. It provided a unique opportunity to work in a collaborative manner on important issues in nursing education that will transfer into nursing practice in the region. The project faculty team has maintained ongoing enthusiasm and belief in the value of the project. The mock simulations and the implementation of the learning simulation along with the feedback from students and others have added to the strength of commitment to the importance of the project. Furthermore, as a result of the learning that occurred for both students and faculty, plans are in the works for future collaboration with involved faculty to create simulations that can be integrated earlier in students’ educational experiences.

References

  • Davidson, J.E., Bloomberg, D. & Burnell, L. (2007). Scope creep: When nursing practice moves beyond traditional boundaries: An evidence-based example using procedural sedation. Critical Care Nursing Quarterly, 30, 219–232.
  • Eaves, R.H. & Flagg, A.J. (2001). The U.S. Air Force pilot simulated medical unit: A teaching strategy with multiple applications. Journal of Nursing Education, 40, 110–115.
  • Herm, S.M., Scott, K.A. & Copley, D.M. (2007). “Sim”sational revelations. Clinical Simulation in Nursing, 3, e25–e30. doi:10.1016/j.ecns.2009.05.036 [CrossRef]
  • Hudspeth, R. (2007). Balancing need, preparation, and scope of practice: Issues impacting behavioral health services by advanced practice registered nurses. Nursing Administration Quarterly, 31, 264–265.
  • Jeffries, P.R. (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing.
  • Minnesota Nurse Practice Act. (2005). Retrieved from http://www.state.mn.us/portal/mn/jsp/content.do?id=-536882405&agency=NursingBoard
  • Minnesota Nurses Association. (2005). Delegation and supervision of nursing activities. Retrieved from http://nursesrev.advocateoffice.com/vertical/Sites/%7B41671038-B8D0-4277-90A9-50B10F730CBD%7D/uploads/%7B7E89E7DE-0551-46CC-A075-A1BB105CDF50%7D.PDF
  • Mole, L.J. & McLafferty, I.H. (2004). Evaluating a simulated ward exercise for third year student nurses. Nurse Education in Practice, 4, 91–99. doi:10.1016/S1471-5953(03)00031-3 [CrossRef]
  • Spector, N. (2005). Focus group on licensed practical nurse scope of practice at National Council of State Boards of Nursing. JONA’S Healthcare Law, Ethics, and Regulation, 7(1), 35–37. doi:10.1097/00128488-200501000-00008 [CrossRef]

Collaborative Simulation Grant Evaluation Rubrics

Overall scope of practice evaluation
  Student #1 (Charge RN) _____________________________________________________________
  Student #2 (RN) ___________________________________________________________________
  Student #3 (LPN) ___________________________________________________________________
  Student #4 (LPN) ___________________________________________________________________
  Student #5 (Recorder) ________________________________________________________________
  Faculty________________Date ________________________________
Critical elements
  Met_____Not met_____Practice within scope of practice for state of Minnesota
  Met_____Not met_____RNs effectively delegate and supervise health care team
  Met_____Not met_____Team work evident to provide quality patient care
  Met_____Not met_____Team demonstrates appropriate prioritization of patient care
  Met_____Not met_____Team demonstrates use of effective communication skills
  Met_____Not met_____Team demonstrates ability to obtain appropriate assessment data
  Met_____Not met_____Team demonstrates consistent clinical decision making based on assessment findings
Comments:

Sample Form to Evaluate Students’ Critical Behaviors Toward Patients

Registered Nurse
  Met_____Not met_____Knocks before entering; introduces self
  Met_____Not met_____Identify assigned patient by reading identification (ID) bracelet before initiating care
  Met_____Not met_____Provide for privacy
  Met_____Not met_____Wash hands before initiating direct contact with patient
  Met_____Not met_____Elevate head of bed
  Met_____Not met_____Assess oxygen saturation and other vital signs
  Met_____Not met_____Reapply oxygen
  Met_____Not met_____Assess lung sounds and respiratory effort
  Met_____Not met_____Reassess or delegate reassessment of oxygen saturation and vital signs 1 minute after oxygen reapplied
  Met_____Not met_____Call respiratory therapy (if appropriate)
  Met_____Not met_____Communicate with child and parents to decrease anxiety
  Met_____Not met_____Teach regarding patient condition, no smoking in hospital
  Met_____Not met_____Teach regarding asthma medications and therapeutic regimen
Licensed Practical Nurse
  Met_____Not met_____Knock before entering, introduces self
  Met_____Not met_____Identify assigned patient by reading ID bracelet before initiating care
  Met_____Not met_____Provide for privacy
  Met_____Not met_____Wash hands before initiating direct contact with patient
  Met_____Not met_____Elevate head of bed
  Met_____Not met_____Check oxygen saturation
  Met_____Not met_____Reapply oxygen
  Met_____Not met_____Report to RN
  Met_____Not met_____Complete delegated tasks and report back to RN

Guided Reflection Questions for Simulation Debriefing

What did you do well in this scenario?

Delegation focus:

What was your thought process leading to the delegation decisions?

Prioritization focus:

What data did you use to determine patient prioritization?

Collaboration focus:

What collaboration efforts were made in providing care throughout the scenario?

Cultural aspects focus:

How did the cultural diversity of the patient impact your decision making?

Did you have sufficient knowledge and skills to manage this scenario?

Were there any assignments that you were unprepared for or that you felt were outside your scope of practice?

If you answered yes to question 7, what would be your next step?

If you were able to do this again, what would you do differently?

Authors

Dr. Simones is Professor, Ms. Wilcox and Ms. Copley are Associate Professors, and Ms. Scott is Clinical Lab Coordinator, St. Cloud State University, St. Cloud; Ms. Goeden is Associate Degree Nursing Faculty, Central Lakes College, Brainerd; and Ms. Doetkott is Practical Nursing Instructor, and Ms. Kippley is Nursing Faculty, St. Cloud Technical College, St. Cloud, Minnesota.

Funding for this project was provided by the Minnesota State Colleges and Universities (MnSCU) Legislative Initiative Grant.

Address correspondence to Joyce Simones, EdD, RN, Professor, St. Cloud State University, Department of Nursing Science, 720 Fourth Avenue South, St. Cloud, MN 56301; e-mail: .jmsimones@stcloudstate.edu

10.3928/01484834-20091217-01

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