Brooke Alleger and Dr. Debra Wing, College of Nursing
For students in the nursing program at Brigham Young University, lab time in the Nursing Learning Center in the basement of the Spencer W. Kimball Tower is a regular part of the classroom experience. In this lab, nursing skills such as assessments, starting IVs, inserting catheters and cleaning wounds are taught and practiced. Once basic skill sets are taught, students are challenged with real-life scenarios requiring them to think critically and practice a subset of learned skills on a mannequin during simulation labs.
The main mannequin students learn on is a high fidelity simulator (HFS) known as Sam. Sam is controlled via computer and has been programmed with a variety of simulations catered to the various levels of abilities students are at. The first simulations require basic assessments and medication administration. The last simulations bring high levels of intensity as scenarios present several life-threatening situations.
Throughout the time students participate in high fidelity simulations, they routinely provide feedback regarding how much they learned and whether they felt adequately prepared for the simulation. The goal is for students to communicate with staff members where they feel additional preparation is needed for real life situations in the clinical setting.
As a research assistant in the simulation labs, I became aware of the feedback several classes of students gave, and was surprised to learn students were seldom asked how simulation applied to actual clinical experience. I wanted to know if students came across similar situations in clinical as were presented in the lab, or if there existed other simulations students would like incorporated into the lab classroom. I turned to the literature in an effort to find how other nursing schools across the country incorporated HFS into the curriculum and how those students perceived simulation application in the clinical setting. Through my review of various articles I found very little research had been done in this area. I determined to conduct a study in the College of Nursing to discover what the student perception was of how HFS simulations applied to the clinical setting.
The ultimate goal of discovering this information was to provide staff members with more information from students about their experiences in order to best tailor the nursing curriculum with student needs.
The students that participated in this study were those in the Medical-Surgical semester in the College of Nursing. In this semester, students rotate through five HFS simulations and spend one day each week in the hospital for clinical rotations. Working with my mentor, Debra Wing, and a fellow research assistant, Emily Cottrell, a questionnaire form was created and administered to students as they completed all five scenarios. The data was analyzed and feedback from students compiled into a summary of what student experience was in both the simulation lab and the clinical setting.
It was my expectation that students would communicate an affinity for the simulation lab and provide examples of when having previous experience in the simulation lab was beneficial in the clinical setting. Overall, students responded with positive feedback regarding the helpfulness of practicing critical thinking and nursing skills in a controlled environment conducive to learning. Several students acknowledged they felt more prepared and confident in the clinical environment after participating in simulation. Surprising to me was the desire that more advanced scenarios be presented in the lab. The current simulation curriculum includes scenarios about heart attack, heart failure, internal bleeding, poor diabetic control and diverticulitis. Several feedback comments from students mentioned desires for additional scenarios – particularly kidney failure and respiratory challenges. These additional scenarios seemed more commonly encountered in the clinical setting than some of the scenarios currently in the curriculum.
One of the highlights of this research project was the opportunity to travel to Tampa, Florida in February 2012 for an international HPSN conference. Emily and I applied to present preliminary findings of our research during two break-out sessions and were granted the privilege of doing so. Several faculty members from other nursing schools across the country were very interested in the presentation and noted the importance of research in this area. Along with presenting preliminary findings, Emily and I demonstrated an example of how BYU simulation labs are conducted. This was also well received by the audience, particularly because BYU emphasizes peer involvement in the learning process, meaning that students further along in the nursing program mentor others in the lab setting. It was a great moment to understand the value BYU places on providing high quality education to those learning the art of nursing.
The benefit to this research has been an increased awareness of what studentsexperience in clinical compared to what is experience in the lab. Further research needs to be done with multiple semesters of students included. This would provide a better overall picture of the student experience. Subsequent follow-up questionnaires should be administered with any curriculum adjustment for future nursing students.
Overall the research has helped bolster BYU’s nursing program by providing a framework to improve the HFS simulations. The simulations can now be more similar to real-life clinical work. We hope that better training of BYU’s nurses can lead to better care for those they administer to.