Unfolding Stroke Simulation: Promoting Nursing Clinical Judgment in Emergent and Routine Care Situations

Background/Introduction: Faculty teaching in a prelicensure baccalaureate program constructed a two part, unfolding stroke simulation involving emergent and routine nursing care. Simulation activities foster the development of clinical judgment, which is emphasized in the Next Generation NCLEX examination.

Purpose: The simulation activity cultivated the development of critical thinking and clinical judgment in students providing care to a client during the acute and rehabilitative phases of stroke treatment. Holistic and family-centered nursing care was highlighted.

Methods or Processes/Procedures: Faculty developed an unfolding, two part simulation encompassing the nursing care of a client experiencing a stroke upon presentation to the Emergency Department (ED) and subsequently on the stroke unit, utilizing actors as standardized patients. During part one in the ED, students applied the nursing process to recognize stroke signs/symptoms and prioritize interventions. Part two transpired on the stroke unit, where students exercised clinical judgment during medication administration while caring for the same client with impulsivity and dysphagia. Students were further challenged to provide supportive family-centered care in both scenarios. Groups of two students participated in the first scenario while two others watched on video and then switched roles for the second scenario. A faculty-led debriefing was conducted after each part with all students.

Results: Student feedback after attending the simulation was overwhelmingly positive. Students appreciated the comprehensive, unfolding nature of the scenarios and commented that this enhanced their confidence and understanding of the continuum of stroke care. Students expressed that the debriefing sessions were constructive and facilitated their learning.

Limitations: The various actors representing the standardized patients led to inconsistent portrayal of stroke signs/symptoms and client/family anxiety.

Conclusions/Implications for Practice: Emergent and non-emergent unfolding simulations promote the development of critical thinking and clinical judgment in nursing students. Implementation of unfolding simulation scenarios throughout undergraduate curricula can facilitate student understanding of the essential nursing skills required in both acute and routine situations.

Tara Burnham
MS, RN, CCRN
Clinical Assistant Professor
University of Vermont

Biography

Tara Burnham is a Clinical Assistant Professor of Nursing at the University of Vermont (UVM) and Staff Nurse in the medical intensive care unit at the University of Vermont Medical Center in Burlington, VT. Professor Burnham is an experienced RN, with a BSN from UVM in 1994 and an MSN from Northeastern University in 2001, who teaches adult health and critical care nursing to baccalaureate students. She believes that clinical reasoning and critical thinking are essential skills for novice nurses and is interested in developing innovative active learning strategies to prepare students for practice in a changing healthcare system.

Phone: (802) 656-3781
Email: tara.burnham@med.uvm.edu

Co-Author(s)
Brandon Brown, MSN, RN-BC, CNL