Evaluating the Impact of Scenario-Based High-Fidelity Patient Simulation on Academic Metrics of Student Success
Sportsman, Susan, Schumacker, Randall E., Hamilton, Patti, Nursing Education Perspectives
Despite the ongoing nursing shortage, nurse educators are responsible for preparing students to practice in highly complex health care systems. As nurse educators explore new learning strategies to support an increase in student admissions, they must also evaluate the impact of these strategies on the quality of the educational experience. The study reported here evaluated the impact of scenario-based, high-fidelity patient simulation used to increase student admissions in an associate degree and baccalaureate nursing program in north-central Texas upon students' sense of their own clinical competence, graduating grade point average (GPA), and performance on standardized exit examinations. These are measures commonly used by nurse educators as metrics of success.
Key Words High-Fidelity Patient Simulation--Academic Metrics Nursing Students--Clinical Educators
JOINING FORCES, a school of nursing in a liberal arts university in north-central Texas, a nearby community college nursing program, and a 359-bed regional medical center obtained a Texas Higher Education Coordinating Board (THECB) grant in 2004 for the purpose of developing a Regional Simulation Center (RSC). The primary goal was to increase by 39 percent the total number of students admitted to both entry-level nursing programs. To enable faculty to pursue other activities, including teaching additional students, scenario-based practice with high-fidelity manikins took the place of traditional, hospital-based clinical education with actual patients. Responsibilities for competency education and validation were delegated to four clinically strong, baccalaureate-prepared, laboratory mentors (Sportsman et al., 2009).
When the RSC was established, the Texas Board of Nursing (TBON) had no regulations regarding the substitution of clinical simulation for traditional clinical experience. However, it did require that nurse faculty hold a master's degree or higher. Because this project used BSN-prepared laboratory mentors in the simulation center, the project director requested and received a waiver to that rule. Based on the evaluation of the three-year project, reported annually, the TBON in 2008 made the decision to remain silent on limitations to the number of hours Texas students can participate in simulation as part of their clinical experience.
This article reports on the evaluation for the grant as reported to the TBON. The purpose was to determine if participation in scenario-based, high-fidelity patient simulation in the RSC for a portion of the clinical experience traditionally supervised by faculty would influence student outcomes. The research questions for this descriptive, longitudinal study focused on several areas: students' sense of their own clinical competence; anxiety regarding school performance; attitudes about and interest in learning opportunities; motivation to learn; concentration during learning activities; and satisfaction with the clinical learning environment. Finally, the study evaluated the impact on seniors' graduating grade point average (GPA) and scores on a standardized exit examination.
Literature Review A report by del Bueno (2005) suggested that only 35 percent of new graduates meet entry expectations for clinical judgment when evaluated by the Problem Based Development System (PBDS), which uses video simulation to assess nurses' competence. According to del Bueno, a major cause of this failure is the emphasis in nursing programs on teaching greater amounts of content, rather than the application of knowledge. Assuming del Bueno's findings are correct, providing greater opportunity to apply clinical knowledge through the use of high-fidelity patient simulators (HFPS) may lead to greater competence among new graduates as reflected in traditional academic markers.
Multiple benefits of patient simulation have been identified in the literature, including: a) the ability to administer care to high-acuity, low-frequency cases, using actual clinical equipment without the potential to harm patients; b) skill development in procedures that require eye-hand coordination and ambidextrous maneuvers; c) the enhancement of confidence; and d) improved decision-making, teamwork, and communication in times of crisis (Jha, Duncan, & Bates, 2001; Medley & Home, 2005; Patow, 2005). …