Use of Scenario Based Clinical Example in Nursing
Clinical Scenarios Definition
The term scenario is derived from
the Latin word scenario, indicating a place for building a stage; “scaena” is the
term for the stage itself. A scenario is a collage of events or series of
actions that unfold during a performance. Clinical scenarios in nursing address
relevant events that occur in the actual execution of health care. During the
last decade, a theoretical model and guidelines have emerged to steer the
advancement of inter active student learning scenarios in nursing education and
clinical practice.
Clinical Scenario In Nursing Education
Clinical scenario applications have
been used by the aeronautic, automotive, military, and other industries to
develop the best defensive tactics for the prevention of error and promotion of
safety. Scenarios are a component of the broader category of simulation
education that incorporates low- and high-fidelity manikins, skill and task
trainers, virtual reality trainers, and computer-based simulators. The scenario
requires a model or laboratory that represents the real-world clinical process.
Simulation characterizes the operation of the model or activities that mimic
the clinical reality (Jefferies, 2005).
A scenario is the enacted performance
creating opportunity for a high level of realistic interactivity for students
to learn and develop confidence. A specification of the details of the
enactment and the order of the activities is required. Written materials are
prepared for the faculty and a separate script is designed for the student. An
important aspect of the clinical scenarios is the debriefing segment, which
includes reflection on the experience, the student’s performance, and what was
learned (Schneider Sarver, Senczakowicz, & Slovensky, 2010).
Application of Scenario Based Evidence In Nursing Education
Scenarios have been written to
address essential domains of nursing practice including technical and
functional training, problem solving decision making, and team based
competencies (Schneider Sarver et al, 2010). They are increasingly used in
nursing education throughout the United States and internationally. Both
prelicensure and advanced clinical skills require active listening, effective
communication, knowledge, and competence appropriate to the individual’s
education and experience. The scenario must match the specific level of the
undergraduate student while advancing in various degrees of complexity.
Both
simple vignettes and complex scenarios were rated by students as beneficial in
helping them to set priorities, develop critical thinking, acquire assessment
skills, and gain an awareness of the nurse’s role (Guhde, 2011). Scenarios used
in graduate programs, particularly the post-scenario reflection, have been
identified as an effective teaching method for graduate faculty and a positive
learning experience for graduate students (Einion, 2013; Velok & Smedley,
2014).
Simulation scenarios have been
incorporated into the employment setting for licensed providers to learn new
techniques and maintain and strengthen skills that are necessary for events
that rarely occur. Clinical scenarios are a mechanism for integrating individual
skills into complex operational capabilities. Clinical scenarios are designed
to develop and enhance team interaction, giving students the opportunity to
improve communication, decision making, and team discipline (Liaw et al.,
2014). Although simulation scenarios can be traced back to several decades,
current designs are more realistic and congruent with the complexity nurses
encounter in the workplace.
Clinical scenarios provide students with a means to
safely understand the potential for failure while gathering the necessary data
to make critical decisions in real-time replication. Jefferies (2005)
identified six critical areas as essential components for clinical scenarios:
objectives, planning, fidelity, complexity. cues, and debriefing Continued efforts
in simulation scenario education produced theoretical frameworks for generating
scenarios (Jeffries & Rogers, 2009). Sixteen studies from the United States
and the United Kingdom have used frameworks in undergraduate and graduate
curricula to design and evaluate respective simulation scenarios.
Students
reported that participation in clinical scenarios provided more opportunity for
problem solving and that the experience positively affected critical thinking.
Analysis of the student outcomes demonstrated improvement in patient safety
competencies, higher levels of student satisfaction with the learning method,
and increased confidence regarding clinical skills (LaFond & Van Hulle
Vincent, 2013)Waxman (2010) introduced an
evidence-based practice (EBP) template for constructing clinical scenarios as a
means to promote effective learning.
The template was derived from EBP data to
advance clinical reasoning skills. Key elements of the template include
techniques to measure learning and validation criteria for written scenarios.
Data from the Simulated Professional Learning Environment (SIMPLE) provided
further evidence of the value of clinical scenarios for baccalaureate students.
The students believed that they were better prepared for transitioning to the
workplace as a result of the clinical scenario experience (Liaw et al., 2014).
The health care environment is continually changing, thus challenging educators
to provide a safe platform for learning while preparing graduates to apply
clinical reasoning skills in the actual setting Clinical scenarios prepare the
learner to quickly organize data derived from multiple sources, process the
data, and identify priority needs. Evaluation, reflection, and feedback provide
the learner with the opportunity to safely advance in proficiency.
Outcomes In Nursing Education
Multisite trials with large sample
sizes have been called for to thoroughly evaluate the effect of simulation
scenarios on prelicensure students (Shinnick, Woo, & Mentes, 2011),
Jeffries et al. (2011) reported on the effectiveness of a highly complex
simulation based cardiovascular assessment curriculum for advanced practice
nurses (APN). There was participation from four university-based nursing
programs distributed across the United States, with a small number of participants
from each institution.
Logistic challenges, human resources, and cost have
posed obstacles to conducting more multi site complex trials and
well-constructed clinical scenarios have emerged primarily in the medical
surgical practice areas. Future effort should include the development of
maternal infant and child scenarios that address childbearing and parenting
Substantial validation of the effectiveness and cost-effective improvement of
student learning and patient outcomes will provide valuable information for
broadening the use of clinical scenarios in nursing education.