Abstract:

This paper will discuss building confidence in professional and managerial decision making by combining simulation with an Enquiry Based Learning (EBL) approach. Effective clinical reasoning in health care depends on the development of both cognitive and metacognitive skills. In clinical practice nurses are required to make numerous decisions in order to deliver safe and effective care. Pre-registration nurse education aims to facilitate the development of clinical and decision making skills to ensure students are competent to fulfil the role of a registered nurse.

Many of the psychomotor skills required for nursing practice are traditionally taught in simulated clinical areas. Simulation acts as a representation of ‘real life’ experience in a safe environment. It provides an opportunity to identify and reflect upon mistakes encouraged by a facilitator who adopts a different approach to the traditional didactic role of the lecturer. Debate and discussion is encouraged so building on the learner’s knowledge and skills via exploration of their own and shared experiences.

The challenge of providing an opportunity to develop the metacognitive skills required for synthesis, clinical decision making, application of policy to practice and transferability has been met using a combination of simulation and EBL. The aims of EBL are congruent with many of the aims of higher education, such as promotion of self-directed learning and problem solving. EBL promotes active learning, fosters intrinsic motivation, and provides an opportunity to work within a small group offering peer support and feedback.

Groups of final year, pre-registration nursing students were offered the opportunity to manage a simulated hospital unit and were presented with a series of audio triggers. The eleven audio triggers are delivered at ten minute intervals and have been devised to cover a range of management, delegation and prioritisation issues. Students are required to produce an evidence based response to each trigger. This involves organisation of the team to ensure that one member is available to receive the trigger information and subsequent decision making, delegation and research skills. The team are further required to factor in food breaks, agree a group response based on the available evidence and organise feedback for the whole team. This enables students to practice managerial skills and provides discrete management opportunities separate from the more obvious issues presented by the audio triggers. Timing of the audio triggers further promotes multi-tasking and decision making under pressure.

Feedback and debrief takes place following release of all triggers and each group is tasked with feeding back the decisions they have made. During this time the facilitator promotes whole group debate and encourages students to compare and subsequently reflect upon the clinical decisions they have proposed.

Evaluative data is available from a number of sessions. In summary comments suggest that the relevance and realism of the exercise has been of particular value alongside development of time management and team working skills. Evaluations further suggest that whole group debrief provided a good opportunity to consider decision making from several perspectives and was felt to consolidate the learning experience. In conclusion, this exercise has been received positively as an opportunity to build confidence in professional and managerial decision making.

Keywords:

Clinical decision making, Problem solving, Enquiry Based Learning, Simulation.