Abstract:

Background: Comprehensive assessment skills in nursing are necessary to gather information about the patient’s physiological, psychological, sociological and spiritual status. An ongoing concern with nursing education is how to improve students' assessment skills using appropriate strategies as well as knowledge application. High-fidelity simulation provides a pedagogical link between education and practice, and provides nursing students with the opportunity to analyze and synthesize patient data in order to review clinical decisions in a safe environment. Objective: The purpose of this study was to explore how high-fidelity simulation based learning contributed to comprehensive assessment skills of nursing students. Method: A quasi experimental study with one group repeated-measures design was conducted in 85 baccalaureate nursing students at one nursing school in Macao. Students voluntarily participated in 36-hour simulation and interacted with five simulated scenarios. Each scenario was designed using a human patient simulator (the SimMan, Laerdal Sales Office, New York, USA) which mimics real-life patients through a palpable pulse, a voice, a realistic upper airway, variable heart and lung sounds along with chest movement for simulation of breathing. The researchers developed the comprehensive assessment evaluation rubric (the CAER) for two qualified tutors to assess students’ comprehensive assessment skills in each simulation session through observation. The inter-rater reliability of the CAER in each session ranged from 0.801 to 0.818. Results: Mean score of students’ assessment skills increased from the first session (mean 0.80, S.D. 0.15) to the last session (mean 1.33, S.D. 0.35). It meant that high-fidelity simulation experience has potential to support the development of comprehensive assessment skills in nursing students. Regarding students’ written comments, most of students perceived that simulation enhanced knowledge application, assessment skills, collaboration and communication. However 71.8% students considered it was difficult to emulate the lived experience using the SimMan because of the slow response to inquiries without any facial expression. Conclusions: The designed scenarios facilitated student interaction with the computer-controlled human patient simulator. Students improved their abilities to manage contingency and emergency. The debriefing experience offered a unique way for students to critically analyze their own performance. Students engaged in introspective learning to self-correct. The fidelity of the psycho-social and emotional responds to situations should be enhanced in scenario design. Forthright feedback from the facilitator was needed to enhance the realism of the scenario with physical props and psychosocial interactions.
Acknowledgment: the research program code RP/ESS-01/2012

Keywords:

High-fidelity simulation, Comprehensive assessment skill, Observation, Nursing, Baccalaureate student.