Leadership Behaviors Development Using Multiple Human Patient Simulators
Margaret Kroposki, PhD, RN; Debbie Lyles, PhD, RN; Ann Stuck, MSN, RN
University of Phoenix and Greenville Technical College
Abstract
Nurses are expected to possess leadership skills and employers
demand new graduates demonstrate leadership skills such as
professional behaviors, critical thinking, conflict management,
prioritization, delegation, and excellent communication skills.
However, few senior nursing students express confidence in their own
leadership skills. Simulation can be a confidence building approach to
develop leadership skills.
To determine if a simulation activity can develop students’
leadership skills, small groups of students responded to multiple
simulated patients. Following a change-of-shift report, four students,
functioning as nurses, and a fifth student, acting as charge nurse,
cared for four human patient simulators that represented typical
acute care patients requiring simultaneous care. The patient care
scenarios were designed with a change in patient status or a need for
the student to make a decision during the scenario.
Students evaluated the activity by writing a narrative of their
leadership experience. Faculty members assessed students’
demonstration of quality improvement guidelines, agency policies,
risk management principles, ethical principles, legal guidelines,
prioritization, delegation, and communication. The faculty
determined that the activity was effective in developing leadership
behaviors based on feedback from students and faculty who
participated in the activity. .
Using simulators to develop leadership skills with a group of peers
and evaluated by faculty may benefit nursing students to prepare for
clinical decision-making. Assessment of student performance during
carefully crafted scenarios may identify the necessary knowledge,
skills, and attitudes for professional behaviors, prioritizing,
delegating, and excellent communication skills required by nurses in
today’s healthcare environment.
Preparation
Course leaders selected scenarios and prepared a sequence of
activities to include the care of four typical medical, obstetric, and
pediatric patients. Two of the four required a phone call to the MD.
Three of the four experienced a sudden change of condition that
required nursing intervention. One of the four developed a life
threatening change requiring new orders from the MD.
The course leader oriented and assigned faculty to four simultaneous
scenarios, two charge nurse (faculty) and one outgoing night shift
nurse (faculty). The four scenario faculty played the roles of patient,
monitor, and physician. Faculty and students used cell phones to
assist with communication.
Implementing the Scenario
Student’s Perceptions
Night shift nurse (faculty) gave a short report to student staff nurses.
The report was realistic in that not all information was reported.
Student staff nurses were expected to request pertinent information.
Students brought their own stethoscope, pen, paper, penlight, and
cell phone to use to call for lab results or the physician if necessary.
Debriefing included a short individual evaluation, a group discussion,
and a written narrative response to the statement: “Reflect on how
the simulation experience helped you understand or apply concepts
of leadership and management such as conflict management,
delegation, communication, prioritization, quality improvement, and
risk management.”
In Students’ (n=67) Own Words
Student staff nurses entered the patient area and began assessment
of assigned patient. All patients were stable for about 10 minutes.
Students could consult a bedside chart that included an order sheet,
any standard protocols for that patient’s condition, and the phone
number of attending physician who was played by the faculty
monitoring the scenario. The student charge nurse made rounds and
responded to student staff nurse concerns.
Objectives
At the conclusion of this presentation, the participant will
1. State how nurse educators can teach leadership skills
leadership skills in a simulation lab using multiple
simulators.
2. State how nursing students perceive their experience
with multiple simulators enhanced their confidence in
the development of leadership skills such as
professional behaviors, prioritizing, delegation, and
communication.
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Faculty charge nurse gave the student charge nurse a separate
report. The student changer nurse assigned other students as staff
members to the four different simulated patients.
Faculty monitored the scenario, changed the patient’s condition,
used a microphone to verbalize for the patient, played part of MD
when called by nurse, and gave orders to respond to patient’s change
of condition. Technology included one-way window, video and audio
capture, and real time audio to allow student to interact with
patient. A lab manager solved technical issues.
“I think that the simulation allowed me to help improve my
communication skills with other staff.” (21)
“I feel it allows you to know when to delegate tasks and when to
actually take action yourself.” (17)
“It allowed all of us to come together as a team and prioritize the
situation that was happening.” (10)
“The fast paced environment and multiple simulations also cause one
to focus on conflict management skills.” (4)
“Safety is and should always be a priority but seems to have been put
on the back burner during our scenario.” (1)
I appreciate the realism which brought to my attention where to
focus my attention for improvement (QI). (1)
References
Cooper, S., Kinsman,L., McConnell-Henry T., Endacott, R. & Schools, J. (2010).
Managing the deteriorating patient in a simulated environment: Nursing
students' knowledge, skill and situation awareness. Journal of Clinical
Nursing, 19, 2309-2318.
Kaddoura, M. A. (2010). New graduate nurses’ perceptions of the effects of
clinical simulation on their critical thinking, learning, and confidence. The
Journal of Continuing Education in Nursing, 41(11), 506-516.
Kaplan, B., & Ura, D. (2010). Use of multiple patient simulators to enhance
prioritizing and delegating skills for senior nursing students. Journal of
Nursing Education, 49(7), 371-377.
Radovich, P., Palaganas, J., Kiemeney, J., Strother, B., Bruneau, B., &
Hamilton, L. (2011). Enhancing leadership orientation through simulation.
Critical Care Nurse, 31 (5), 58-63.
Schaefer, J. J., Vanderbilt,A., Cason, C.L., Bauman, E.B., Glavin, R.J., Lee,
F.W., & Navedo, D.D. (2011). Instructional design and pedagogy science in
healthcare simulation. Simulation in Healthcare, Supplement 6 (7), s30-38.
Contact
Margaret Kroposki, PhD, RN
University of Phoenix Online
mkro18@email.phoenix.edu
mkroposki@att.net