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Table 7 Struggling to make sense and coordinate

From: An activity theory perspective of how scenario-based simulations support learning: a descriptive analysis

Primary nurse “Ok, so I think that is kind of a reaction from the epidural [Education and Counseling], we just want to make sure we increase your fluids” [Goal]
“I’m going to hit the call button and get a second nurse in here.” [Goal]
Primary nurse Presses call button [Clinical Tool]
Support nurse “Hi, how's it going? What's going on?” [Situational Management]
Primary nurse “First, if you could get some extra pillows to turn her on her side, and then call the anesthesiologist back.” [Situational Management]
Support nurse Observes fetal tracing and maternal vital signs [Clinical Artifacts]
Support nurse “So, you just got an epidural?” [Diagnostic Question]
Patient “Yeah, there something wrong?”
Support nurse “So sometimes when we give an epidural we can have your blood pressure drop down a little bit, so were going to try and um, get that kind of…back up a little bit [Goal]. So were going to roll you over on your left side a little bit more.” [Education/Counseling]
Support nurse (to primary nurse) “Do you want to…uh…roll her over a bit more?” [Situational Management]
Primary nurse “…Uh, yeah…Okay.”
Support nurse (to primary nurse) “I'm just going to get another pillow so we can get her all the way over on her left.” [Situational Management]
Support nurse Exits and re-enters the room with an additional pillow [Clinical Tool]
  1. The two student participants portrayed in this scenario struggle to coordinate their care. Although the primary nurse appears to have some understanding of the clinical presentation, she struggles to describe the situation to the support nurse when she arrives. Faced with this, the support nurse makes a quick assessment of the situation by examining the fetal heart rate tracing and the maternal vital signs. She makes her understanding of the situation explicit when she describes the situation to the patient and then again when she recommends a plan to the primary nurse to roll the patient on her side