Academic journal article Creative Nursing

Simulation Pedagogy with Nurse Practitioner Students: Impact of Receiving Immediate Individualized Faculty Feedback

Academic journal article Creative Nursing

Simulation Pedagogy with Nurse Practitioner Students: Impact of Receiving Immediate Individualized Faculty Feedback

Article excerpt

Family nurse practitioner (FNP) students must achieve basic competency in managing patients' primary care needs across the lifespan. Students in the FNP program have simulations integrated throughout their clinical theory courses to increase practice time with various patient cases. Students who received individualized faculty feedback immediately after self-evaluation of simulation performance showed statistically significantly increased knowledge (as evidenced by higher grades in course examinations and preceptor evaluations) than a control group of students who received feedback in a group class via a rubric grading guide 2-4 weeks after all students completed their individual simulations.

Keywords: graduate nursing education; immediate feedback; nurse practitioner students; simulation

Family nurse practitioner (FNP) students are required to have a minimum of 500 hours of precepted direct patient care experience before graduation; because FNPs care for multiple age groups, they are expected to "exceed this minimum requirement" (National Organization of Nurse Practitioner Faculties, 2012, p. 8), so many programs require 600 hours. These clinical experiences i nclude managing the care of complex patients, organizing time-restricted primary care appointments, and practicing effective communication (Handley & Dodge, 2013; Steinbrook, 2009). Because of decreased availability of clinical learning sites for nurse practitioner and medical students, educators need to create innovative clinical experiences (Association of American Medical Colleges, 2014). Our graduate nursing education program at Fairfield University integrated multiple case simulations with rubric evaluation measures throughout the program, offering a creative teaching-learning and evaluation strategy. Faculty evaluation was given in two distinct ways. The experimental group received their feedback on a one-toone basis immediately after each student's performance and self-evaluation. Faculty gave the control group feedback in a group class setting 2-4 weeks after all of the students had completed the simulations.


Evidence suggests that practice working with simulated patients will increase communication skills (Gaba, 2004) and advanced practice clinical skills (Rutherford-Hemming, 2012), and enhance the ability to identify differential diagnoses (Ferrario, 2003). Many registered nurses focus more on interventions than assessment (Fossum, Alexander, Goransson, Ehnfors, & Ehrenberg, 2011) and, in the nurse practitioner student role, have to relearn how to treat the patient using assessment data to determine differential diagnoses, management, and patient evaluation. Simulation offers one-to-one and group learning venues in which expert faculty can model advanced practice, demonstrate correct advanced primary care skill performance (Pittman, 2012), and teach the process of diagnostic reasoning simultaneously with the students' determination of the patient's differential diagnoses (Harjai & Tiwari, 2009; Pittman, 2012). Although there is a need to prepare nurse practitioners for primary care (U.S. Department of Labor, 2010), there are few studies that evaluate the impact of simulation on the education of advanced practice nurses (Pittman, 2012).

There were no studies addressing immediate, individualized faculty feedback with graduate nursing students post simulation, and few reliable measurements to evaluate simulation performance were identified (Adamson & Kardong-Edgren, 2012). Reinisch and Kwong (2014) evaluated nurse practitioner student readiness to begin clinical practicums with simulation and recommended the use of more time for immediate faculty feedback. They did not define immediate, nor did they state whether the feedback they studied was given individually or in a group.

One study discussed the advantage of giving immediate feedback with computer-based instruction by offering students an opportunity for test review after completion (Hattie & Timperley, 2007). …

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