International Journal of Healthcare Simulation

Background:

When developing our new undergraduate nursing curriculum, we wanted to ensure that it was simulation based; however, we were unable to find frameworks or direction of how to integrate this. Despite a wealth of evidence to support the use of simulation as an effective modality, there is no current literature that describes a system of integrating simulation in a standardized manner. Ferguson ^[1] concluded that there is a gap in how a simulation strategy becomes effectively implemented and embedded within a curriculum. Before we started to make changes, we first wanted to gain an understanding of how students found the existing delivery of clinical skills and simulation and understand what was working and where improvement could be made.

Aim:

The aim of this research was to have both qualitative and quantitative data to support the hypothesis that a framework is needed to integrate skills and simulation with a healthcare education curriculum.

Simulation activity outline:

For this study, there was no new addition of simulation; the aim was to look at what was in existence and gather student experience data.

Method:

This study took a mixed methodology collecting both qualitative and quantitative data through a questionnaire. The questionnaire was designed to ascertain the student’s existing level of experience in skills and simulation, their opinion as to how effective the current method of delivery was. Opinion was also sought on thoughts in relation to changing the delivery of skills and simulation. All first- and second-year pre-registration nursing students were invited to take part. Ethical approval was sought and granted by the university ethics panel.

Results:

Three main themes were generated and will be discussed. Communication: many students described their lack of confidence in communicating with senior staff and other members of the multi-disciplinary team (MDT). This was, they felt, linked with a lack of experience and a lack of exposure to working with more senior staff. Confidence within their role: Students felt that simulation did improve their confidence but that there should be much more of it within their curriculum. They discussed the fact that it was a much more powerful resource than ‘sitting in a lecture theatre’. Feeling stressed and intimidated: Students reported that although the high-fidelity simulation sessions and scenarios could prepare them for ‘real-life’ emergency situations they did find them rather stressful and intimidating.

Implications for practice:

The results of this initial study demonstrated that students wanted more simulation and that their confidence and competence would be improved from more simulated practice. From the responses given, it was evident that the current delivery of clinical skills and simulation preparation was not effective and student satisfaction was poor. In response to these findings, we have developed a five-stage approach to create a scaffolding of learning bringing simulation into the curriculum from the very start allowing for a gradual cognitive load. The authors expect to find an improvement in the student perceptions of both their competence and confidence in relation to clinical practice.