Clinical sites cannot, and do not, afford the same optimal learning opportunities to every nursing student. In order for students to have consistent experience with the variety of skills and clinical decisions that are expected in nurse graduates today, it is essential that nurse educators employ innovative learning strategies and resources (Benner, Sutphen, Leonard, & Day, 2010). The simulation lab on campus provides students with a safe environment in which to acquire and develop required nursing skills and practice decision-making. The use of simulation in nursing education is expected to increase because research supports its use as a learning pedagogy and viable option to replace traditional clinical hours (National Council of State Boards of Nursing (NCSBN), 2016; Nelson, 2016).
Benjamin Franklin said, "Tell me and I forget. Teach me and I remember. Involve me and I learn." This philosophy is consistent with active learning theory, which says that hands-on learning helps move students from lower to higher levels of thinking (Billings & Halstead, 2009). This theory, the need for additional exposure to clinical skills and situations, and the research that supports the use of simulation as a learning strategy provided the impetus for the development of the Nursing 2 Challenge (N2C). The purpose of the simulated clinical challenge experience was to provide a safe environment in which students could enhance skill competence and critical thinking utilizing a systematic, preplanned station rotation format in an enjoyable and nonthreatening manner.
LITERATURE REVIEW
There is an abundance of literature regarding the use of simulation in nursing education. Simulation can help to offset the challenges of limited access to clinical sites, variation in clinical experiences, and maintenance of patient safety. It is now recognized by professional organizations and boards of nursing as an acceptable alternative to some of the mandatory hours of student practice in the clinical environment (NCSBN, 2016; Nelson, 2016). It has been shown to improve clinical decision-making, medication safety, and response time to patient deterioration in some students (Campbell, 2013; Powell-Laney, Keen, & Hall, 2012).
The safe environment of a simulation laboratory offers a favorable place to stimulate learning utilizing various teaching stations. A rotating station format has been utilized successfully for skills learning and practice (Hacker, Hayes, Ullom, & Fluharty, 2014; Hogewood, Smith, Etheridge, & Britt, 2015). Ewertsson, Allvin, Holmstrom, and Blomberg (2015) concluded that students gained a feeling of proficiency and confidence for practice after spending time in the campus lab learning and practicing skills. Ideally, the skills learned will be transferred to the work place, but additional research is needed to support this theory.
CONTENT OF THE SIMULATION
During the N2C, students interacted with patient simulators of varying fidelities in order to complete an array of activities designed to stimulate critical thinking, utilize assessment techniques, and apply psychomotor skills. Students rotated in teams through the series of eight stations completing nursing actions or interventions that had been learned or practiced throughout the semester: Physical Assessment, Care Planning, Assessment of Enteral Medications, Administration of Parenteral Medications, Focused Respiratory Assessment and ABG Interpretation, Restraints and Patient Safety, Intake and Output Assessment and Calculation, and Mobility and Positioning.
At the Enteral Medication Administration Station, students were instructed to administer medication via a feeding tube placed in a low-fidelity patient simulator. Using clinical reasoning, students worked as a team to safely administer the medications prescribed. (See supplemental digital content 1 at http://links.lww.com/NEP/A64.) The team performed a focused assessment using student role-play with scripting to determine which medications to administer (See supplemental digital content 2 at http://links.lww.com/NEP/A65.) The students had access to resources (drug reference books, online nursing skills for feeding tube management) to assist them with their decision-making process and skill performance.
A second station required students to work in pairs. They performed a respiratory assessment on a moderate fidelity patient simulator, analyzed and interpreted arterial blood gas results, and developed and implemented a teaching plan appropriate to the identified nursing diagnosis.
Specific written directions were provided at each station. Some stations assigned a particular role or task to an individual student, whereas other stations permitted each team to decide how best to meet the objectives for that station.
The time allotted for each station was 30 minutes: 5 minutes for activity orientation, 20 minutes for the activity, and 5 minutes at the end to allow for students to move to the next station and for faculty to reset the activity.
A faculty member was assigned to each room to ensure safety and provide an overview of the activity. In addition, faculty observed each student group and provided feedback on communication, teamwork, organization, and completion of skills. Utilizing a skills checklist, a student observer at each station documented how well the team performed the required skills. (See supplemental digital content 3 at http://links.lww.com/NEP/A66.)
DISCUSSION
Student evaluation (n = 56) of this simulation experience was included in the standard end-of-semester course evaluation. The responses were overall positive with 64 percent of students finding the experience satisfying. The 27 percent who were not satisfied would have preferred that the N2C be offered earlier in the semester to allow for the application of skills in clinical. Nine percent of students did not respond. Faculty (n = 7) stated that the experience was a solid review of clinical objectives that provided students with opportunities to perform tasks and solve problems not encountered during the current semester.
CONCLUSION
Clinical assignments do not always meet all required course objectives, and many clinical sites restrict or limit tasks that students can perform. Simulation experiences can promote active learning, critical thinking, and improve psychomotor skills. A simulation day, highlighting course-required skills and concepts, gives students the opportunity to verbalize, demonstrate, and apply clinical skills. The students' use of clinical reasoning and decision-making, along with feedback from the students and faculty observers, fosters the development of critical thinking.
REFERENCES