Description: The face of nursing education is changing as evidenced by the lack of access to necessary clinical sites needed to develop nursing competencies, the higher acuity of patients in the clinical setting, the changing landscape of patient care delivery, and the influence of societal demands for safety and quality. There is a current lack of literature addressing the utilization of high-fidelity student-driven simulation to promote active involvement in realistic situations where students are encouraged to synthesize knowledge and problem solving relative to patient care. Nurse educators in a Southeastern baccalaureate nursing program developed an innovative approach to incorporating high-fidelity simulation in the first semester senior year of students taking a pediatric course that is experiential in nature. The activity actually “flips” the traditional instructor pre-scripted methods.
Each nursing student clinical group (10-12 students) is responsible for developing the scenario for one section of an unfolding case study (closed head injury, seizures, increased intracranial pressure, death and dying). The students and instructor discuss the intended outcomes prior to the development of the scenario and the group is further divided into five smaller groups which are sent to the computer lab. Each small group is responsible for their assigned component which includes research on the current diagnosis of the patient, identification of appropriate nursing diagnoses/rationales and interventions, policies and procedures to support the chosen interventions, necessary supplies, medication, safety and psychosocial issues, SBAR techniques, and development of the scenario with specific roles. The students are required to collaborate and integrate this information in the development of the scenario based on a simulation template developed by Jeffries (2007) that incorporates concepts of QSEN and NCLEX-RN Test Plan Categories.
After about two hours, the students return to the simulation lab and discuss their findings as a group so everyone has the same information and there is transparency of expectations and comprehension of the material. Half of the group takes on the assigned roles and then acts out the scenario they developed with a high-fidelity mannequin. Once the scenario is completed, they meet for critical reflective debriefing. Based on the debriefing, the students modify the scenario as needed and the second half of the group then acts out the revised scenario. Again, they come back together for critical reflective debriefing to discuss the outcomes and what this experience meant to them. In addition, students are required to write a brief essay with pre-determined prompts to further explore how this experience impacted them as a nursing student and how they feel this new knowledge will be incorporated in their professional practice.
