Implementation and Evaluation of Home Health Simulation to Improve Pre-licensure
Bachelor of Science Nursing Students’ Learning:
An Action Research Study
Kathryn Kollowa Ed.D MSN RN
Platt College
Aurora, Colorado
Abstract
This action-based research study used a descriptive triangulation process, which included quantitative and qualitative methods to analyze nursing students’ perceptions of learning using home health simulation in a community health course for
a BSN nursing program. The simulation included a home health simulation with a high-fidelity mannequin. The study was performed at a private, proprietary 36-month baccalaureate (pre-licensure) nursing program. The research study was
introduced to students in the community health course during the Spring and Summer quarters of 2013. The data collection in this study includes measurements from pre- and post-survey questionnaires, observations during the simulation
process, and focus group interviews related to the home health simulation experience and the home health nursing role. The instruments focused on the Quality Safety and Education in Nursing (QSEN) competencies of patient-centered care,
safety, teamwork/collaboration, and quality improvement. The Mann Whitney U test was completed on the June and August cohorts to identify any statistically significant differences between the groups’ experience. Thematic coding was analyzed
from the focus group interviews to identity patterns in student learning in the home health nursing role and setting. The conclusion is that the implementation of home health simulation can enhance student learning and better prepare them for
the required competencies of a graduate nurse.
By 2030, the population in America over age 65 is expected to
increase from 31 to 71.5 million representing 19.6% of the
population (Centers for Disease Control and Prevention [CDC],
2003). This equates to nearly one out of every five people being
an older adult, and this segment of the population will have
doubled since the year 2000. With the changing demographics,
an expected shift of health care delivery will result in the need
for increased home healthcare. A significant issue will be
ensuring that nurses are properly trained to provide high quality
home health care for individuals age 65 and older. Pre-licensure
Baccalaureate Nursing programs need to incorporate quality
community health learning experiences that include
opportunities for the unique area of home health care delivery.
Action-based research study
--Descriptive triangulation process
Quantitative methods
Pre and post survey
Observation (field notes on group simulations)
Qualitative method
Focus group interviews (Grounded Theory approach)
Data Analysis
Context:
Setting was a small, private, proprietary college with a 36 mo
BSN pre-licensure nursing program in a Midwestern state
Accredited by the Commission on Collegiate Nursing Education
(CCNE)
Senior year students enrolled in community health course
Practical application learning: clinical setting
Alternative learning: Home health simulation
Results
Methods
Introduction
Quantitative
Pre and post surveys
11 questions/Likert scale 1-5
Analysis
Measures of central tendency
Nonparametric
Mann-Whitney U test due to small sample size
Software used (SPSS 22)
p< 0.05/95% CI
Quantitative
Observation tool
11 questions/Likert scale 1-5
Observation Questionnaire
Frequency (%) of Likert scale ratings for each
simulation group within each cohort
Focused group interviews
12 open-ended guided reflection questions facilitated by
Researcher digitally recorded & transcribed verbatim
Qualitative
Focus group interviews
Axial Thematic Coding
Dedoose software
Codes & themes analyzed until saturation
1 c. What are the results when
comparing two cohort of students who
are participating in the home health
simulation that show improved student
perceptions of learning as a whole?
Comparing June and August cohorts
with:
Pre/Post online survey results:
see 1 a. statistical analysis results
Observation tool results:
Comparison of observed cohort
simulation performance
1 a. What statistically significant differences
are there with nursing students’ perceptions
of learning after completing a home health
care simulation?
 Pre and post survey results:
June Cohort:
 Competency (p=0.008)
 Teamwork
 Education (p=0.009)
 Value of Home Health Simulation
(p=0.005)
 August Cohort:
 No statistical significance (p=0.04) noted
1 b. What patterns of responses will be
identified with the focus groups related to
their perceptions of the home health learning
experience?
 Focused group interview results:
 June & August cohorts
 3 themes
 Theme 1: Awareness of the value of learning
through the home health
simulation experience
 Theme 2: Knowledge deficit of the home

health nursing role
 Theme 3: Home health care is in an
unfamiliar setting
STRENGTHS
(Likert scale 2 or above)
June and August Cohorts
•
•
Patient care 100%
Communication
Education
Patient centered care
Teamwork: 100%
Professionalism
WEAKNESSES
(Likert scale 3 or below)
Organizational skills
June 80% and
August 50%
Final Results
1. What is the impact of the BSN student perceptions
of learning with the use of home health simulation?
Enhanced learning
Recognized the value
Recognized lack of knowledge
Identified challenges unique to care in home health
setting.
Recognized their own limited critical thinking &
decision-making skills in this unfamiliar home
health nursing role
Student perceptions of learning:
Valued high fidelity home health simulation
experience
“Prepares you”
Recommendations: System change. The outcomes
reveal overall positive results of the students’
perceptions of learning in home health simulation.
Conclusion
The students’ perception of the home health learning
experience justifies a recommendation of a system-wide
change for this nursing program, with implementation of
home health simulation in the course curriculum of
community health. This improvement process may help
students be better prepared to meet their nursing
competencies of QSEN for quality and safe patient care as
graduate nurses.