Table 4 Key elements of multiple patients scenario

Participant orientation

Orientation to simulator

Participants were familiar with simulator after having completed 12 group simulations in the previous two semesters

Orientation to environment

Educator provided 5-min scripted orientation to environment including review of operating phone system, patient monitor, Pyxis medication dispense system, and medication refrigerator for insulin. Participants had 10 min to review electronic health record independently.

Simulator type

Make and model

Three Gaumard interactive patient simulators similar to Hal® S3201

Functionality

Pulse sites, heart sounds, ECG rhythms, lung sounds, chest rise, wireless streaming audio, eye blinking, touchscreen vital signs monitor, bowel sounds

Simulation environment

Location

Simulation center with one double patient room and one single patient room used by each participant, central control room, and separate medication room

Equipment

Electronic health record, medication room with supplies for participants to choose from, Pyxis medication dispense system, simulation phone system, AV system with cameras capturing all spaces for raters to view via live stream

External stimuli

In the large simulation center, one participant completed scenario at a time using two patient rooms and a medication room. Participants interacted with an embedded participant in the role of nursing assistant. Participants gathered their own supplies from the medication room as needed.

Simulation scenario

Event description

Scripted orientation, prebrief, scenario progression, and triggers. One patient experienced chest pain at 30-min mark. Scripts available in appendix.

Learning objectives

1. Prioritize which patient to see first

2. Individualize safety checks and focused assessments

3. Communicate therapeutically

4. Administer medications safely

Educator provided orientation to objectives during scripted orientation to environment. Participants reported which patient they wanted to see first in order to help educator know how scenario would begin.

Group vs. individual practice

Individual practice. There were no observers. Each participant completed two scenarios

Use of adjuncts

Moulage for wounds and dressings. Alaris IV pumps running during scenario. Participants administered medications for IV and subcutaneous routes. Headwall allowed for O₂ titration.

Operator characteristics

Two nurses with 2 years’ experience as simulation technician operated the simulator and provided scripted cues

Pilot testing

> 200 individual participants in previous teaching and research over 5+ years

Standardized patients

Two female embedded participants who work routinely in simulation center served as nursing assistant to whom participants could delegate care; one with clinical experience as medication aide; training by PI; scripted cues and vital signs provided; wore ear bud walkie-talkie for cue to notify participant of chest pain at 35-min mark

Simulation exposure

Duration

45 minute scenario representing the beginning of shift in acute care setting

Timing

No just-in-time training or educational intervention before scenario

Frequency

Two multiple patients scenarios completed approximately four weeks apart

Clinical variations

All participants provided care for the same patients. Patients had diagnoses of respiratory distress, cardiac disease, and diabetes complications. Research team mapped complexity of patients for scenario 1 and scenario 2 to ensure equivalence.

Assessment

Rater observer measurement of behavior performance using Creighton Simulation Evaluation Instrument™. Standards established through two rater training videos and discussion to establish consensus on behavioral descriptors. Eight educators served as raters.

Range of difficulty

Simulation patients had low acuity similar to acute medical-surgical hospitalized patient. Difficulty in scenario presented mostly on time management and priority setting with care of three patients simultaneously

Nonsimulation interventions and adjuncts

Participants reviewed simulation preparation materials related to performing safety checks and focused physical assessments, prioritizing patient care, communication to providers using SBAR framework over the telephone, delegating to unlicensed assistive personnel, administering medications safely, and using a nurse brain tool to organize care. Preparation materials were available on learning management system in several formats (expert modeling videos, voice over PowerPoint, and reading materials) for participants to choose from according to learning style preference. Simulation preparation occurred before participants reported to the simulation center.

Integration

Participants previously completed two group simulation courses involving 12 class days and 36 patients over the course of two academic semesters. This simulation activity represents the capstone simulation experience in a five semester prelicensure nursing curriculum. Participants completed this simulation immediately before their capstone clinical experience (internship)

Feedback

Source

Educator

Duration

45 min

Facilitator presence

One educator face-to-face

Facilitator characteristics

Nurse educators with 3–30 years’ experience teaching in clinical and simulation settings. PI provided open-ended prompts and trained educators on stating behavioral observations guided by the Creighton Simulation Evaluation Instrument™ (CSEI) using Advocacy/Inquiry approach

Content

After simulation 1, attention to focused assessment and safety domains from Creighton Simulation Evaluation Instrument™

After simulation 2, attention to communication and priority setting domains

Structure

Reactions, Gather, Analyze, Summary format

Timing

Debriefing immediately after simulation and after participants completed NASA TLX

Video

After debriefing, participants watched their 45 minute simulation video and wrote a reflection about integrating suggested behaviors into their performance

Scripting

Scripted open-ended prompts available in appendix.