Student Perceptions of the Observer Role Play Experiences in the Implementation of a High Fidelity Patient Simulation in Bachelor's Degree Nursing Programs

Abstract

Research has shown that high fidelity patient simulation (HFPS) experiences can improve critical thinking, increase students' self-confidence, improve psychomotor skills, advance communication skills, and increase awareness of patient safety and care issues (Harder, 2010; Henneman, et al., 2007; Jeffries & Rizzolo, 2006; Kiat et al., 2007). HFPS commonly employs role play to foster affective, cognitive, psychomotor, and formative domains of learning (Lowenstein, 2011). Role play reportedly interconnects experiences, theoretical underpinnings, and learning outcomes within HFPS (Bastable, 2008; Cannon-Diehl, 2009). Additionally HFPS may have relevance for helping students develop clinical judgment (Lasater, 2007a, 2007b; Tanner, 2005, 2008). As HFPS use continues to augment student clinical practicum preparation, analyzing what the student learns or is able to draw upon from the various roles experienced as part of simulation is important. While attention to broad roles in HFPS (primary, secondary, family and Observer roles) was found in the literature, no specific study of the Observer role was found. It may be that strategies to enhance the Observer role (such as engaging in a guided observation activity of the HFPS) are beneficial. Further research is needed to evaluate specific processes and outcomes that student Observers use in HFPS role play. Particularly, since this role can be used to extend student numbers in HFPS, it is important to understand how to optimize the processes for engaging the Observer as well as outcomes of this role. The purpose of this study was to examine the perceptions of nursing students who role play in HFPS, with particular attention to the Observer role. Using a descriptive, exploratory approach, role play factors and Observer role enhancement were described including the Observer's perception/experience of completing the guided observation activity in the Observer role. Additionally role play practice experiences were compared among the primary, secondary, and Observer roles. Data was collected from a convenience sample of senior Baccalaureate degree nursing students at two university colleges in the Midwestern United States that actively use HFPS. As part of normally scheduled formative course simulation experiences, all students were randomly assigned to participate in simulation role play as the primary nurse, secondary nurse, or Observers and asked to participate in this research study. During the HFPS main activity all consenting students in the Observer role were asked to engage in the simulation by completing a guided observation activity. After HFPS debriefing, all consenting students were asked to complete three simple surveys/data collection tools, called the Hober Student Demographic Questionnaire, the Hober Written Survey, and the Educational Practices in Simulation Scale (Student Version - SPSS-S). All consenting Observer students participated in an interview using the Hober Qualitative Interview Prompts and were then asked to complete the three simple surveys. Twenty-three interviews were conducted and a total of fifty students completed the on-line survey questionnaires. Qualitative data was analyzed using a naturalistic inquiry, iterative process to find patterns and themes. Three themes emerged: Conceptualizing the learning experience, Capturing the big picture, and Connecting with the team. The first theme captures the participants' ability to minimize stress and learn by analyzing the simulation performances of peers. The three categories within this theme were: (a) Minimizing the Stress for Applied Learning; (b) Collecting Data and Thoughts; and (c) Contemplating/ Calculating. The second theme was distinctive in that it encompasses the participants' comprehensive grasp of the simulation experience from their unique point of view. The three categories within this theme were: (a) Increasing Confidence in Thinking; (b) Gaining a Difference Point of View; and (c) Concluding/ Confirming. And in the third theme, Observers stressed that they needed to once again communicate with the simulation team. The two categories within this theme were: (a) Communicating; and (b) Consulting. Using a descriptive, exploratory approach, five research questions were answered. Focus was given to Observer role experiences and strategies for enhancing the Observer role. Observers reported that they gained learning opportunities and perceived the Observer role in HFPS to be "important". Observers described a difference in `seeing and doing' simulations, recognized the importance of effective nursing care, and the benefits of safe working environment. The Hober Guided Observer Activity was described to be an engaging activity for the Observer in simulation. Observers shared that their experiences would likely assist him/her in future clinical practicums and that clinical judgment (noticing, interpreting, responding, and reflecting) was utilized in the Observer role. Data compared the Observer and Nonobserver groups on perceptions of simulation best practices and its importance using the EPSS-S tool, finding that most perceptions between the groups were similar in this study. Descriptions of the Observer and Nonobserver (primary and secondary nurses) responses to the on-line Hober Written Survey provided supplemental data.