Development of an Ambulatory Care Nursing Simulation Toolkit

Purpose: The purpose of this project was to develop and assess a simulation toolkit for teaching key ambulatory care nursing competencies to pre-licensure nursing students.

Background: As health care needs in the community grow in complexity, there is an increased need for nurses to deliver high quality care in ambulatory care settings. Yet, nursing students are not adequately trained for this specialty role. As part of an academic-practice partnership (APP) between a major university school of nursing and a regional health care organization, an ambulatory care (AC) simulation toolkit was designed to enhance clinical reasoning and skills unique to ambulatory care settings.

Methods: The APP curriculum team developed simulations addressing: 1) annual wellness visits (AWV), 2) EHR inbox management, 3) telephone triage, 4) chronic illness self-management, and 5) psychological first aid. Clinical content experts reviewed all simulations, which were then revised accordingly. Simulations were implemented with BSN students in Autumn 2020 via video conferencing due to COVID-19. Students completed online evaluations on which they rated their attainment of the learning objectives and responded to items from the simulation evaluation tool-modified (SET-M). On the SET-M, respondents rate the effectiveness of prebriefing, the scenario, and debriefing. All items were rated “strongly agree,” “somewhat agree,” or “do not agree.” The study procedures were approved by an institutional review board.

Results: A total of 79 students completed the AWV, EHR inbox management, and telephone triage simulations to date, of which 44-53% completing the evaluations. Over 90% of the students responded “strongly agree” or “somewhat agree” on their ability to meet the 5 learning objectives for each of the simulations. “Strongly agree” was endorsed by ≥75% of students on all except 3 objectives: understanding top-of-scope RN practice in the AWV simulation (68%), and ability to document care in the EHR inbox (57%) and telephone triage (69%) simulations. On the SET-M, students responded “strongly agree” to the items in each domain. Pre-briefing (2 items): AWV, 68-76%; EHR inbox, 77-80%; telephone triage, 83-95%. Scenario (11 items): AWV, 38-76%; EHR inbox, 51-83%; telephone triage, 60-91%. Debriefing: AWV, 84-92%; EHR inbox, 88-91%; telephone triage, 95-100%.

Conclusions and implications: Results indicate that overall, the AC simulation toolkit was designed in such a way that the learning objectives were met, except for three objectives addressing top-of-scope RN practice and documentation. Future work will focus on strengthening the simulations to meet these objectives. The SET-M responses supported the effectiveness of the prebriefing for the EHR inbox and telephone triage simulations, and debriefing of all 3 simulations. The prebriefing of the AWV will be revised, and the scenarios of all 3 simulations will be revised according to the specific SET-M items that were rated poorly, which differed between the scenarios. Future research will explore the translation of the competencies addressed in these simulations to in-person clinical settings. The AC simulation toolkit demonstrates promise in filling a crucial gap in addressing the nation’s health by providing practical RN training that is specific to ambulatory care.