Capstone activities using simulation with live ‘actors’ as patients


When did you first introduce the innovation?

Less than 12 months ago

Please describe the innovation you have developed

This innovation used simulation with a capstone style activity, which incorporated a number of case studies. The case studies were used to join together knowledge from 2 distinct but connected 3rd year modules (a practical skills module and a leadership and management module).

A full cohort of third year students were presented with case studies of patients in a ward situation. The ward was made up of a mixture of ‘live’ actors as patients/ relatives / doctors and medium/high technology manikins. The students had to arrive at a designated time (pre-arranged) in groups of 6-12 (further split into 2). One half of the group went into the simulation control room to observe the other went to manage the patients on the ward, then swapped. To get all students through the simulation took all day.

There were 7 patients on the ward mixing ‘live’ actors with simulation manikins. This session involved the students in:

  • Preparing/ planning for and working with others
  • Interpreting teaching materials presented as: medical notes, fluid balance charts, drug charts, observations charts
  • Undertaking observations and interpreting the results,
  • Making decisions about immediate interventions e.g. oxygen administration and checking its effect, managing risk, escalation of patients condition and communicating this to others, pain assessment and management using appropriate pain scales
  • Prioritising and calling for help, delegating, and in collaboration with others coming up with a plan of care.
  • Communicating with other health care professionals, relatives and patients
  • Working in the complex, unpredictable clinical environment dealing with difficult situations and the development of reflection-in-action skills.
  • Taking part in self and peer assessment, by observing from a control room one other group simulation.

This innovation combined a nursing ‘live’ simulated ward situation and a capstone style activity using student self and peer assessment (formative).

What prompted you to develop this innovation?

Assessment under its many guises is under scrutiny, with many proposals that higher education needs to create more opportunities for reform. The contemporary role of capstone assessment is to assist students with connecting areas of learning about nursing together. Through designing capstone is to provide students with activities that synthesise nursing knowledge, with the ability to apply this knowledge to real world scenarios and when relevant to provide appropriate decisions and solutions.

In your view, what is it about this innovation that makes it different/important?

This innovation is important as it can facilitate students to connect all areas of learning together and how knowledge and understanding of this can impact on one patient e.g. cultural, biological, pathophysiological, pharmacological, microbiological, skills development, managerial, ethical, emotional, professional, and research, and these are all in the curriculum. Yet, these knowledge types and learning about them are delivered in a disjointed way, mainly because nursing education is situated in a modular system, whereby, the nursing course and the consequent award is equal only to the sum of its modules and learning outcomes (or parts). Capstone can be used to further align simulation and self- and peer- assessment and so valuing what students learn outside of set modular learning outcomes, and moving towards acknowledging that nurse education is more than the sum of its parts (or modules and learning outcomes).

To what extent does your innovation make use of existing approaches, resources or technologies?

This innovation combined the use of high technological simulation manikins and ‘live’ actors as patients to facilitate student learning about real life situations they will encounter in clinical practice. These technologies and resources were used as a means to promote nursing students’ learning of work organization, people management skills, to enhance the acquisition of clinical skills in preparation for practice, and to enable students to recognize and respond to clinical emergencies. The implementation of simulation was about how nurse educators can make a module more compelling and engaging for both the lecturers and the students.

The combination of simulation and capstone style activities can contribute to transformative learning, which can serve to meet the need for more creative, and innovative forms of assessment e.g. self and peer assessment. In addition, function as a means to facilitate the development of reflection-in-action, the moment-to-moment decision-making required by future nurses, and the connecting and linking of different types of knowledge to help nurses better understand their own and others’ practice.

To what degree has this innovation led to changes in education or clinical practice?

The innovation has led to benefits for students showing:

  • Improvement in the student experience demonstrated in the NSS results for the university
  • How lecturers felt engaged in student learning as a focus rather than just teaching.
  • Value in what students can learn outside of set learning outcomes and giving credence to this
  • Employability, as student nurses are exposed to ‘real’ life practical situations that can enhance skill development and professional practice.

The innovation has led to benefits for staff by showing:

  • The confidence for less experienced staff to develop and produce new, innovative and creative learning and teaching strategies
  • Staff how to use evidence-based learning and teaching, and assessment practices to improve the student experience.

The innovation has shown potential benefits for the institution by putting it at the forefront of developing a variety of simulation strategies such as clinical scenarios, role play, high and low fidelity manikins, virtual environment, capstone, debriefing sessions and ‘live’ patients (actors).

What evidence do you have of the impact of the innovation?

The impact of the innovation given in the words of the students:

1. Reflection-in-action as a useful tool when caring for individual patients:

  • Being the first person at the scene of a deteriorating patient
  • Make you respond quicker to patients’ symptoms
  • Put you in the emergency to respond quick
  • It reminds me of the actual ward with real patients demanding for everything
  • Decision-making on the spot
  • I learned how to work under pressure

2. Develop skills of management and leadership:

  • The importance of working together as a team and communication
  • We learned the importance of good teamwork
  • Taught us about working collaboratively
  • Having to understand how MDT members work together
  • I delegated tasks to the staff nurse
  • It was an eye opener. Felt it was a true representation of the workload that could occur on the ward
  • It made my team and I think about prioritising
  • I found this very helpful and helped me to think about how I plan my care for more than one patient at a time while helping other staff on the ward
  • Co-ordinating the ward

3. Begin to build on previous knowledge for transformative learning:

  • Feedback from lecturer and patient (actor)
  • Relaxed and fun environment to learn
  • Acting out some issues that can arise on a read ward
  • More opportunities to practice this sort of ward based simulation exercise would enable us to develop skills and confidence
  • Made learning more interesting

4. Challenge themselves:

  • I learnt that I need to be confident when practicing my knowledge
  • I learned how effective it is to prioritise the needs of the patient and positive outcome it will have
  • Very nervous at the same time learned a lot from the experience to cope under pressure
  • I enjoyed it even though it was difficult
  • I felt more confident and comfortable and less nervous in dealing with acute patients
  • There was less interference from lecturers, which gave us the chance to use our skills independently
  • I did not enjoy being so disorganised, which put role play to good use

To what degree has the innovation been disseminated in your organisation or elsewhere?

The use of capstone was presented at a recent internal Higher Education Research Development (HERD) workshop proposing cross faculty simulation. This would involve other student groups studying at the university, e.g. social work, performing arts, law and policing. Cross-faculty simulation and capstone can be transferable into a number of health and non-health care professions.

Please provide details of any plans you have to disseminate the innovation in the future.

I am writing an article on simulation incorporating capstone and plan to send additional abstracts for consideration at related educational conferences e.g. Royal College of Nursing (RCN), Nurse Education in Practice (NEP).