Navigating the Storm of Deteriorating Patients: Seven Scaffolds for Simulation Design

Abstract

Recent trends in simulation use have necessitated a more considered approach in the use of this teaching/learning tool. The aim of this research is to discover ways to improve simulation as a teaching/learning platform. Action research was used to answer the question, “How can I improve pedagogical practices with undergraduate nurses in simulation?” This study was implemented at a University in Auckland, New Zealand between November 2012 and March 2014. A purposive sample was sought from second and third-year nursing students (n = 161) enrolled in the three-year undergraduate bachelor of nursing program. Methods included focus groups, questionnaires, debriefing sessions, pre- and post-tests, and Lasater clinical judgment rubric analysis. Seven instructional scaffolds emerged which maximized student learning and retention. These scaffolds: 1) helped move students from known into unknown knowledge; 2) provided situated coaching; 3) modeled expected performance; 4) gave opportunity for improvement; 5) reduced confusion; 6) taught effective communication; and 7) promoted new learning through debriefing. These strategies resulted in a simulation experience which improved clinical reasoning in undergraduate nursing students

Are They Watching: Pedagogical Influence of Role Modeling on Student Competence, Confidence, and Clinical Reasoning

“…Simulation has been used as a teaching strategy in nursing education for decades [6] [14] [15]. Combining role modeling with simulation presents a unique opportunity to develop student knowledge, skills, and attitudes [16].…”

“…Role modeling occurs when a behavior or skill is demonstrated and then duplicated by an observer [16]. It can act as an educational scaffold to move students progressively toward deeper understanding and greater independence in the learning process [6]. John Dewey, one of the earliest thinkers informing constructivism, explains that genuine education comes through experience, but that not all experiences are educative [18].…”

“…We did not think they were really watching. However, students reported that they changed their practice based on what they observed as we role modeled caring for a deteriorating patient [6].…”

Dose–Response Relationship between High-Fidelity Simulation and Intensive Care Nursing Students’ Learning Outcomes: An Italian Multimethod Study

“…At the early stage of the study, students had negative feelings, such as anxiety, fear, and embarrassment, which are recognized as potentially detrimental to learning [ 41 ]. However, multiple exposures to simulations and tailored support given during sessions [ 42 ] allowed participants to quickly absorb their initial emotions and focus on the learning outcomes by appreciating the support given by the faculty. In addition, repeated simulations allowed students to make mistakes without consequences and progressively improve their orientation during the simulation activities.…”