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Healthcare Journal of NEW ORLEANS INOV / DEC 2014 55
Karen C. Lyon, PhD APRN, ACNS, NEA
Executive Director, Louisiana State Board of Nursing
May 2013. Major findings included:
•No statistical differences between groups
on theATI RNComprehensive Predictor 2010
used to assess overall nursing knowledge;
•On a scale of 1 to 6, all students hadmean
scores above 5 in clinical competency, indi-
cating that they were all rated as clinically
competent by preceptors and instructors;
•There was no statistically significant dif-
ference in critical thinking between students
in the 3 groups;
•Therewas no statistically significant differ-
ence in readiness to practice between students
in the 3 groups;
•There were no statistically significant
differences between the 3 groups in ATI
Fundamentals of Nursing Assessment, ATI
Medical-Surgical Nursing Assessment, and
ATI Community HealthNursingAssessment;
•The 50%group had statistically significant
higher scores than the control group for ATI
AdvancedMedical-Surgical NursingAssess-
ment andATI Mental Health Nursing;
•The 50%group had statistically significant
higher scores than both groups for the ATI
Maternal-NewbornNursingAssessment and
theATI Nursing Care of ChildrenAssessment;
•The 50% group consistently reported
higher levels of feeling “prepared to practice”
compared with their study peers (descriptive
results only); and
•There were no statistically significant dif-
ferences between groups on any workplace
factors.3
The Texas Woman’s University (TWU)
study, of which
I was a co-prin-
cipal investigator,
has been accepted
and scheduled for publica-
tion in the Journal of ProfessionalNursing for
spring 2015.4 The study was patterned after
the integrated simulation approach utilized in
the space industry, using a 96-hour continu-
ous simulated hospital environment. Nurse
practitioner students served as patient actors
for eight-hour shifts and graduating seniors
provided care in eight-hour shifts to four
“standardized” patients each.
Themes that emerged from the debriefing
sessions and focus groups included that the
simulation provided a realistic approximation
to hospital practice and that the expectation
of actually “doing something” for the patients
in the simulationwas very different than just
observing in the hospital setting. Faculty ob-
servers noted that the soon-to-be-graduates
had trouble with their assignments, failed to
prioritize appropriately, and often seemed
overwhelmed by the requirements of care
for four (4) simulated patients.
Overall, students loved the experience and
felt that it was beneficial to have to think in-
dependently without faculty and/or precep-
tors making the decisions for them. One of
the greatest benefits that many of themnoted
was being able tomakemistakes in a safe en-
vironment and then having the opportunity
to debrief with a seasoned faculty member
to examine errors in their critical thinking
and decision making. The original study has
served as a model for clinical competency
testing with each subsequent graduating
class.
These studies providemounting evidence
that substituting high quality simula-
tion activities for traditional clinical
hours produces comparable, if not
superior, educational outcomes for
nursing students. Of course, not all
simulation is created equal, so it is
imperative that faculty members be
properly trained, subject matter ex-
perts conduct debriefing sessions after
the simulation, and resources are provided
that create a realistic environment, such as
the simulated hospital created in the TWU
study. It is important to realize that traditional,
agency-based clinical experiences often don’t
function as intended to provide the learning
experiences that faculty believe are impera-
tive for student learning outcomes. Hospital-
based practice is increasingly observational
because of safety, legal, and practical con-
cerns in our increasingly complex healthcare
environment. Simulation experiences bring
students and teachers together in a learning
activity where both teaching and learning are
facilitated in a creative environment that pro-
motes critical analysis and decision-making.
As we evaluate best practices for improving
teaching and learning in practice-based dis-
ciplines like nursing, simulation should help
to shape the future of nursing education. n
1. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010).
Educating nurses: A call for radical transformation. San
Francisco: Jossey Bass.
2. Institute of Medicine. (2010). The future of nursing:
Leading change advancing health. Washington, DC:
National Academies Press.
3. Hayden, JK, Smiley, RA, Alexander, M, Dardong-
Edgren, S, and Jeffries, PR. (2014). The NCSBN national
simulation study: A longitudinal, randomized, con-
trolled study replacing clinical hours with simulation
in prelicensure nursing education. Journal of Nursing
Regulation, 5(2), Supplement, July.
4. Ayers, C, Binder, B, Lyon, K, Montgomery, D, Jen-
nings, C, and Koci, A. (2015) The simulated hospital
environment: A qualitative study applying space in-
dustry techniques. Accepted for publication, Journal of
Professional Nursing , Spring 2015.