Do simulation roles really affect clinical decision-making accuracy in an acute care scenario?
Kristen Zulkosky, PhD, RN, CNE, PA College of Health Sciences [PCHS]; Krista White, PhD, RN, CCRN-K, CNE, Georgetown University; Amanda Price, PhD, psychology –PA College of Health Sciences [PCHS]; Jean Pretz, PhD, psychology –Elizabethtown College
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- International Nursing Association for Clinical Simulation and Learning (INACSL)
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The purpose of this study was to assess the accuracy of on clinical decision making (CDM) among various roles in an acute-care simulation scenario in pre-licensure nursing students. This study utilized a mixed factorial design with decision point (shortness of breath [SOB] and rhythm change [atrial fibrillation, AFib]) and decision phase (cue acquisition, diagnosis, and action) as within-subjects factors and simulation role (observer, family, auxiliary nurse, and primary nurse) as a between-subjects factor. We assessed decision-making accuracy among fourth-semester Associate in Science in Nursing (ASN) students who were randomly assigned roles in a simulation scenario.
Examination of CDM Accuracy across stopping points and simulation role indicated that students’ role had an impact on decision making performance. During the AFib situation, mean levels of cue acquisition accuracy differed across role: observers (67%), medication and education nurses (50%), primary nurse (46%), and family members (41%). The significant role effect (p = 0.03) in the AFib situation indicated observers were statistically more accurate with cue acquisition than family members. Overall CDM accuracy in the AFib stopping point, though not statistically significant (p = 0.07), revealed observers were most accurate in the CDM process while family members were the least accurate.
We found the simulation experience for observers to be beneficial to the CDM process, contradicting common beliefs held by nurse educators and students who view active roles in simulation as most valuable. It is worthwhile for students to rotate roles because active and passive roles each hold value.
INACSL Conference 2017: Nursing Simulation, Marriott Wardman Hotel, Washington, DC, USA
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