Navigating the Storm of Deteriorating Patients: Seven Scaffolds for Simulation Design

Recent trends in simulation use have necessitated a more considered approach in the use of this teaching/learning tool. The aim of this research is to discover ways to improve simulation as a teaching/learning platform. Action research was used to answer the question, “How can I improve pedagogical practices with undergraduate nurses in simulation?” This study was implemented at a University in Auckland, New Zealand between November 2012 and March 2014. A purposive sample was sought from second and third-year nursing students (n = 161) enrolled in the three-year undergraduate bachelor of nursing program. Methods included focus groups, questionnaires, debriefing sessions, pre- and post-tests, and Lasater clinical judgment rubric analysis. Seven instructional scaffolds emerged which maximized student learning and retention. These scaffolds: 1) helped move students from known into unknown knowledge; 2) provided situated coaching; 3) modeled expected performance; 4) gave opportunity for improvement; 5) reduced confusion; 6) taught effective communication; and 7) promoted new learning through debriefing. These strategies resulted in a simulation experience which improved clinical reasoning in undergraduate nursing students.