Background: The American Association of Colleges of Nursing endorsed prioritization, delegation, decision-making, communication, and leadership as essential skills for newly graduated nurses (Kirkman et al., 2018). Underpinning these skills are standards related to cultural competence which ensure graduate nurses’ preparedness to interact with staff and patients from diverse backgrounds (Ziemba et al., 2016). Yet, new graduates are often unprepared for professional practice (Cummings et al., 2018) due to infrequent opportunities to apply and develop these skills in real world settings (Kaplan & Ura, 2010). One strategy to develop these essential competencies is to participate in a simulation with international student collaboration (Kirkman et al., 2018). Simulation is an effective teaching modality for improving problem-solving, critical thinking, clinical judgment, and clinical competence (Lee & Oh, 2015). Participation in multiple-patient simulation improves prioritization, delegation, teamwork, and communication (Nowell, 2016) and increases confidence in perceived readiness to transition to professional practice (Kirkman et al., 2018). Additionally, simulation provides opportunities to engage with culturally diverse simulated patients and improve interdisciplinary teamwork (Armenia et al., 2018).
Methods: A cross-sectional pre-test/post-test survey design was used to determine if a multiple patient simulation improved pre-licensure nursing students’ attitudes and self-efficacy regarding prioritization and delegation of patient care activities and facilitated interdisciplinary teamwork and communication. Five BSN students visiting from the U. and 26 senior nursing students enrolled in a baccalaureate program in the southeastern US participated in the simulation and completed the survey. The simulation activity included listening to a report on four patients before determining clinical priorities and delegated tasks. Scripted, yet unexpected, challenges such as admissions were incorporated into the scenario. Each challenge required students to re-prioritize the plan of care and identify changes to the delegation plan. Debriefing facilitated exploration of differences and similarities in scope of practice, delegation parameters, and clinical reasoning. Data were analyzed using SPSS.
Findings: Participation in a multiple patient simulation with international nursing students resulted in statistically significant increases in comfort and confidence prioritizing care and delegating tasks (p < 0.012). The mean increase in survey scores was 0.39 with pre-test scores ranging from 3.03-4.29 and post-test scores ranging from 3.81-4.26 on a 1-5 Likert scale. Strengths and weaknesses of multiple-patient simulation in an international context were identified, including the ability to clearly and effectively communicate with members of a health care team and persons from diverse backgrounds.
Implications: High-patient acuity and shortened lengths of stay often preclude nursing students from practicing essential skills related to delegation and multi-patient management. Multiple-patient simulation can bridge the gap between academia and practice to improve self-confidence and enhance proficiency in senior nursing students’ ability to communicate, prioritize, and delegate.
Conclusions: Multiple-patient simulation is an innovative teaching/learning strategy that promotes development of leadership and clinical judgment skills. In addition, inclusion of international nursing students in multiple-patient scenarios increases awareness of diverse perspectives and the interdisciplinary collaboration skills needed by new graduate nurses in the medical-surgical setting. While utilized in an academic setting, it can be easily adapted for newly graduated or experienced medical-surgical nurses.