Simulation in Nursing: The impact on students by Jacqui Gladwin

Having just completed two days of simulated practice for our students I wondered about the impact the scenario had on the students involved. As a programme lead I regularly feel under pressure to review the amount of time spent by staff teaching within the curriculum. There are so many demands on staff time to do other things that the pressure to reduce teaching hours is immense. However the use of simulation within health curricula is increasing and we have a team of staff who have invested a lot of time being trained to use high fidelity equipment in order to support student learning in a safe environment. We have a specialist simulation tutor who has a strategic role across two departments increasing the capability of staff and the programmes to enhance simulation within the curriculum. As an A&E nurse I am used to working in emergency situations and having to think on my feet. The scenario I have introduced the second year students to is that of a young man involved in a road traffic collision with a drunk driver. The students work through the scenario starting with a lecture addressing the pathophysiology of trauma and then the systematic team approach utilised in assessing the patient from his arrival in A&E. There are many theoretical aspects of care embedded within this scenario such as teamwork, communication and leadership and the use of high fidelity simulation is designed to provide an opportunity for students to work in groups of up to seven as a team practicing a systematic A-E assessment of a critically injured patient. As you will see in the following picture.
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From a staff perspective this level of simulation is resource intensive as it requires two staff to be in the room with the students a member of staff to act out additional roles such as the relative a technician to operate the meti man and then two staff to run the additional elements of the scenario which focus on IV administration, blood transfusion and calculating emergency drugs. The students are prepared before the scenario by me and the intended outcomes of the session are explained. Students are often very anxious at this stage as they don’t know what role they will be playing within the team although they have watched a video in class explaining the roles of a trauma team and outlining the primary and secondary survey.

The scenario starts with the students preparing to receive the patient and being allocated roles which is done at random. This can mean that students are allocated a role they really didn’t want or equally one they feel they will thrive in. They then have to work as a team to assess the patient and make appropriate interventions based on the information they gain from the meti man. They have to support the wife of the patient who arrives in the middle of the scenario and is obviously very upset having been informed by the police that her husband has been in a serious accident.

The scenario finishes with the patient demonstrating signs of raised intra cranial pressure and being transferred to CT so the student have to consider the moving and handling implications of transferring a critically ill patient.

Once the scenario finishes myself and the other facilitator debrief the students and ask them how they felt they worked together. This part is always really interesting because although every group has worked through the scenario and successfully treated the patient and maintained his safety recognising his sudden deterioration many of them feel disappointed with their own performance and feel that everyone else has performed much better than they have.

The formal debrief is followed up by an online forum where the students can post feedback regarding their experiences once they have had time to reflect on them. The feedback ranges from very personal accounts of how being in the role they were allocated felt to critical reviews of how students felt the group performed together. Many of the posts were very powerful and I will be sharing them with you soon.

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