Perceptions of Nursing Students on the Process and Outcomes of a Simulation Experience

N urse educators are increasingly challenged to find appropriate clinical placements. Nursing shortages lead to pressure to increase enrollments, hospitalized patients are more acutely ill, and few placements are available in specialty areas such as obstetrics and pediatrics. A theory-practice gap exists between what is taught in theory courses and what students actually encounter in clinical settings. Therefore, educators turn to high-fidelity patient simulation (HFPS) to enhance clinical learning; HFPS provides opportunities to enhance psychomotor and cognitive skills in a safe laboratory environment. However, widespread use of simulation in nursing is still developing, and the evidence base is limited. The perceptions of students with HFPS experience who then returned to the clinical setting can help inform the choices nurse educators make. A qualitative descriptive study involved 6 of 10 nursing students who had participated in a project that substituted 4 days of HFPS for hospital clinical time during 2 weeks of an 8-week, 16-day adult acute care placement. The project occurred during the fall term of year 3 in a 4-year baccalaureate program at a community college in Eastern Ontario. In the simulation laboratory, 2 groups of 5 participants simultaneously enacted scenarios. High-fidelity mannequins were programmed for each scenario, and learners were given report, supplies and equipment, medications, and documentation sheets. They played different roles—for example, nurses, family member, patient voice. They assessed the situation, administered medications and treatments, and dealt with unexpected events such as dropping blood pressure or pain. Scenarios were videotaped, and all students debriefed together with a nursing teacher with simulation experience. After ethics board approval, in the winter term, volunteer participants were interviewed using a semistructured interview schedule about their perceptions of the simulation experience and its influence on subsequent clinical learning. After data analysis, a focus group with 5 participants verified findings and responded to the model developed. Participants were 5 women and 1 man, ranging in age from 21 to 47 years. Five had previous postsecondary experience, 3 were immigrants, and 3 had previous simulation experience. Analysis of interview transcripts led to a model indicating 4 levels of process and outcomes of simulation. Four key process elements of simulation led to a positive simulation experience: clinical scenarios, realism, facilitation, and debriefing. Each of these elements had subcomponents contributing to positive experiences. The outcomes were enhanced knowledge development and skill acquisition that together contributed to the main theme of confidence (Figure 1).