Clinical simulations that incorporate problem-based critical thinking strategies can help nursing students apply didactic content and facilitate safe performance of nursing skills (Zarifsanaiey, Amini, & Saadat, 2016). The prelicensure phase of an accelerated Master's in Nursing program is rapidly paced, and students often find difficulty conceptualizing the application of skills learned to actual patient care scenarios. Although eager to engage in clinical experiences, accelerated Master's in Nursing program students enter the nursing field with varied educational backgrounds. By integrating simulated patient experiences into laboratory classes each week, these second-degree learners can incorporate didactic knowledge and communication techniques into clinical skills performance.
During the spring semester of the 2017 Accelerated Master's in Nursing Pathway at the University of Alabama at Birmingham, faculty designed small-scale simulations, termed mini-sims, as part of a weekly foundational skills course. The primary objective for each mini-sim was to ensure that students could perform the physical assessment techniques taught in the current course module. As the semester progressed, the mini-sims grew in complexity and incorporated increasing requirements for critical thinking. Students were challenged to recognize abnormal findings and begin planning care interventions with the guidance of faculty serving as embedded participants. Depending on the experience planned, high- or low-fidelity patient simulators with moulage and props were stationed in the room to add to realism and prompt student responses.
One simulation focused on an adult patient who presented to the emergency department with active hematemesis. This complex scenario occurred later in the semester and required the learners to take a brief history, assess the patient, and provide basic nursing interventions. The students contacted a provider—another faculty member functioning as a nurse practitioner to report the patient's condition and receive new orders. These orders required skills such as initiation of intravenous access, blood specimen collection, and administration of intravenous crystalloids or blood products. The activities were set in a simulated hospital room located in the school's skills laboratory and lasted approximately 45 minutes, including debriefing time. Debriefing followed a Plus-Delta format and provided time to connect concepts from other courses including adult health, pathophysiology, and pharmacology.
Initial challenges to using the mini-sim teaching strategy in a foundational skills course included group size and student engagement. Smaller groups allowed more tailored formative feedback, permitting faculty to be able to gauge each student's learning more personally, as well as keep the student interested. Another challenge for faculty included adapting clinical content to the limitations of novice nursing learners who do not have significant clinical knowledge, abilities, or experience. Performance of skills without the understanding of why may make these experiences frustrating for learners and lead to decreased buy-in. Scheduling content delivery in alignment with other courses and prebrief strategies by faculty regarding the purpose of the experience and expectations for performance, may decrease this barrier and increase learner confidence (Chamberlain, 2017).
Hands-on experience in a simulated environment offers a safe place to make mistakes and provides a controlled opportunity for faculty coaching, which is not reliably available in all clinical settings. Students demonstrate increased engagement and report “feeling like a nurse” after these experiences. High-fidelity manikins provide a realistic, but controlled, experience, enabling cognitive linking of assessment findings with the simulated condition. Some students endorse feeling uncomfortable using manikins initially, but most report that simulation solidifies techniques learned through reading and didactic presentation. An early orientation to the laboratory environment, simulations, and the manikins themselves might help to negate the students' initial nervous responses.
In the experience at the University of Alabama at Birmingham School of Nursing, the use of mini-sims in a foundational nursing assessment course positively influences delivery of content and allows students to practice physical assessment skills in complex patient situations. Students report feeling more confident when providing care in clinical environments after these experiences. This teaching technique addresses Bachelor of Science in Nursing essentials for facilitating generalist nursing practice, communication, and collaboration to improve patient outcomes (American Association of Colleges of Nursing, 2008).
Dana Mitchell, DNP, ACNP-BC, CHFN
Tracie White, DNP, ACNP-BC, RNFA
School of Nursing
University of Alabama at Birmingham
- American Association of Colleges of Nursing. (2008). The essentials of baccalaureate nursing education for professional nursing practice. Retrieved from http://www.aacnnursing.org/Portals/42/Publications/BaccEssentials08.pdf
- Chamberlain, J. (2017). The impact of simulation prebriefing on perceptions of overall effectiveness, learning, and self-confidence in nursing students. Nursing Education Perspectives, 38, 119–125. doi:10.1097/01.NEP.0000000000000162 [CrossRef]
- Zarifsanaiey, N., Amini, M. & Saadat, F. (2016). A comparison of educational strategies for the acquisition of nursing student's performance and critical thinking: Simulation-based training vs. integrated training (simulation and critical thinking strategies). BMC Medical Education, 16, 294. https://doi.org/10.1186/s12909-016-0812-0 doi:10.1186/s12909-016-0812-0 [CrossRef]