P14 Simulated ‘transition’ ward for final year student nurses: developing leadership, management and professional nursing practice in a realistic clinical environment

Abstract

The transition from student to qualified nurse is stressful; impacting on performance and satisfaction in first job and higher rates of staff attrition. Whilst strategies to support this transition are thought to improve experience and retention, these tend to focus on orientation and support for newly qualified staff already in post (Edwards et al., 2015). At the University of Hertfordshire, a final year module is designed to support nurses in this phase prior to qualifying. The module runs alongside the final clinical placement, at the end of which, students are required to demonstrate that they can work autonomously, make appropriate decisions, and have the capacity to work in challenging environments. Important skills such as assertiveness, delegation, dealing with challenging situations are difficult to develop competence in. We sought to use simulation as a tool for students to explore and develop these skills during a complex simulated ward scenario. A scenario was undertaken in a clinical simulation centre; interactive manikins, simulated patients/actors were used to create a realistic ward environment for students to undertake shift leadership. The scenario had a timed progression of events, so that students were exposed to a range of conflicting priorities; acute patient deterioration, administration of blood transfusion, a confused aggressive patient and a staff confrontation. During structured de-briefing, students had the opportunity to reflect on their decisions, discuss comparable experiences and how they might respond in similar situations once qualified. Students found the simulation highly realistic and engaged in the communication opportunities. At the end of the final week placement, learning and application was evaluated using student feedback and comments from clinical assessors on the students’ capacity to work in challenging situations were also reviewed. Key learning points were an appreciation of the complexity of ward management and the importance of communication skills during challenging situations. Simulation based education often has clinical skills focus and commonly uses manikins to represent patients. Whilst manikins can realistically support clinical observations and procedures; personal interaction with manikins lacks realism and learners often struggle with this. We drew on 3-dimensional framework for fidelity, comprising the patient, clinical scenario and healthcare facilities (Kyaw Tun et al., 2015). Using a combination of modalities, we enhanced these elements to replicate the ‘real world’ of ward management. This supports the use of simulation based learning in the development of non-technical skills in preparation for transition to qualified practitioners. References Edwards D, Hawker C, Carrie, J, Rees C. A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies 2015;52(7):1254–68. Available at: https://doi.org/10.1016/j.ijnurstu.2015.03.007 Kyaw Tun J, Alinier G, Tang J, Kneebone RL. Redefining simulation fidelity for healthcare education. Simulation & Gaming 2015;46(2):159–74. Available at: https://doi.org/10.1177/1046878115576103