Using Simulation to teach leadership
competencies in delivering safe patient care
Claudia Grobbel DNP RN
Michelle Costlow MSN RN, Jean Ann Dean MSN RN
Background
Using the Quality and Safety Education in Nursing QSEN)
competencies a leadership based clinical simulation has been
implemented to strengthen students knowledge and practice of
leadership strategies in delivering quality care in a junior level
baccalaureate nursing leadership course. The Agency on
Healthcare Research and Quality (AHRQ) and the Institute of
Medicine (IOM) evidence clearly documents that errors are directly
related to the issues in clinical practice of handoffs, interruptions,
improper or poor communication and delegation and lack of
teamwork. Communication, conflict, delegation and teamwork are
all topics in the undergraduate Care Management course.
Teaching these competencies require practice. The goal of this
assignment is for students to practice knowledge and strategies
learned in class as applied in clinical situations. This project was
designed using the simulation process of Page, Kowlowitz & Alden
(2010). The simulation represents a typical day on a nursing unit
with multiple patients, family, clinical staff and a variety of
communication methods.
Outcome measures
1. Pretest/posttest design on AHRQ information.
Theoretical Framework
Bandura’s Social Cognitive Theory
Bandura’s Social Cognitive Theory guided this study. Simulated
Teamwork and Collaboration: Function effectively within nursing
and inter-professional teams, fostering open communication,
mutual respect, and shared decision-making to achieve quality
patient care.
Safety: Minimizes risk of harm to patients and providers through
both system effectiveness and individual performance.
Such as: Two patient identifiers are necessary only when
administering medication. True or False.
Revealed no significant improvement. 88% to 95%.
practice provides a safe learning environment for students to practice
skills and consequently improve their self-efficacy.
2. Quality and Safety Self Inventory (QSSI).
18 statement self rated inventory developed around the QSEN
competencies (
Examples statement: “I feel I have the necessary knowledge to
practice patient centered care.”
Internal consistency evaluated for overall scale using
Cronbach’s alpha;  = .91.
Simulation Design
Learner Outcomes
Patient-centered Care: Recognize the patient or designee as the
source of control and full partner in providing compassionate and
coordinated care based on respect for patient’s preferences,
values, and needs.
Multiple choice test regarding safe practice.
NQSSI results
Pre-Work
• AHRQ & QSEN
readings
• Related to QSEN
competencies:
Patient Centered
Care; Teamwork &
Collaboration;
Safety
• pretest
Simulation
• Mock Unit: 3
patients at change
of shift report
• Shift to shift
report, delegation,
prioritization,
dealing with
interruptions, &
teamwork
De-Briefing
• Share
experiences;
relate to quality
and safety
research. Identify
areas of
improvement
• Comments:
“showed how
important
communication &
organizational
skills are”
Next Steps
• Pretest will be given prior to assignment given to determine
baseline knowledge. Earlier pretest was open book.
• Posttest immediately after debriefing.
• Set up a more structured report process. Include an HER.
• Allow more time, slow simulation down to give student
more time to process information, deal with interruptions
and delegate.
• Include standard safe practice evaluation to include hand
washing, patient identifiers, room assessment for safety.
• Use video recording to enhance debriefing.