NR 535 Week 6 Teaching Strategy Comparison Example

Teaching Strategy Comparison: One Objective, the Response to a Dislodged Chest Tube, Taught by a Full Simulation Scenario or by Repeated Short Practice on a Task Trainer, Judged Against Five Criteria Fixed Before the Verdict

Student Name

College of Nursing, Chamberlain University

NR 535: Theoretical Foundations and Instructional Strategies for the Nurse Educator

Instructor Name

Month Day, Year

Teaching Strategy Comparison: One Objective, the Response to a Dislodged Chest Tube, Taught by a Full Simulation Scenario or by Repeated Short Practice on a Task Trainer, Judged Against Five Criteria Fixed Before the Verdict

The Objective and the Choice

This comparison concerns a single objective from our residency's chest drainage session: each new graduate will show, hands on, what to do in the first seconds after the tubing comes apart from the drainage unit or the tube itself is pulled from the chest. The objective matters because both events are rare, frightening and time-critical. A nurse who has never practiced them is likely to hesitate. The session allows about 17 minutes for this objective, and there is no honest way to run both methods in that time. I must choose one, so the comparison holds the objective, the learners and the time constant and lets two methods compete.

Method A: a full simulation scenario. A high-fidelity simulator plays a postoperative patient. During a bed change, the tubing separates, and later the tube is pulled out. Four nurses manage the scenario while four observe, then they switch, with a structured debrief after each run.

Method B: repeated short practice on a task trainer. Each nurse practices the two responses at a task trainer, in turns lasting about one minute, with immediate correction by the educator, repeating until each nurse performs both correctly three times in a row. The event is described in one sentence and then happens on the trainer.

Criteria, Fixed in Advance

Before reviewing the evidence, I set five criteria and decided how much each should count.

1. Correct performance of the response steps at the end of the session (weighted most heavily, because this is the objective).

2. Hands-on repetitions per nurse, because rare emergency responses need to be practiced, not watched.

3. Realism of the cues that trigger the response, such as an alarm, the patient's distress and the sight of the tube, since recognizing the event is part of the response.

4. Educator time and equipment required, within what the skills lab has.

5. Fit with the learners' stage, since first-quarter new graduates may be overwhelmed by a complex scenario before the basic steps are secure.

Method A Against the Criteria

Simulation is strongest on realism. The simulator coughs, the monitor alarms and the tube visibly comes out, so the nurse must notice the event and act under pressure. In a large randomized study in prelicensure nursing programs, programs that swapped up to half their clinical placement hours for well-run simulation saw graduates perform about as well at the end (Hayden et al., 2014), which suggests simulation can teach clinical responses effectively when well designed and debriefed.

Simulation is weaker on repetitions. In 17 minutes, each nurse manages the scenario once and observes once. A nurse who hesitates or does the steps in the wrong order will be corrected in the debrief, but will not do them again that day. It also carries a heavier load. A whole scenario adds the patient's condition, the team and the environment to the steps themselves. For novices who have not yet learned the steps, those added elements compete for working memory (van Merriënboer & Sweller, 2010). And it needs the simulator, a programmed scenario and two facilitators.

Method B Against the Criteria

Repeated short practice is strongest on repetitions and on correct performance. In 17 minutes with two trainers, each nurse can perform each response six to eight times, with correction after every attempt. This is close to deliberate practice as Ericsson (2004) described it: focused work on a well-defined task, with immediate feedback and repetition until performance is reliable. It fits the learners' stage, because it isolates the steps before adding the complexity of a patient.

It is weaker on realism. The trigger is announced rather than discovered, and there is no alarm or distressed patient. A nurse may perform the steps perfectly at the trainer and still freeze when the real event happens unexpectedly. It needs less equipment and one educator. There is a further weakness worth naming: repeated practice of a fixed sequence may produce nurses who perform the steps quickly but do not think about the patient in front of them, for example forgetting to assess breathing after covering the insertion site. The repetitions must therefore include a spoken assessment step, not only the mechanical response.

The Verdict

Scored against the criteria in the order of their weight, Method B wins on the first, second and fifth criteria and Method A wins on the third. On the fourth, Method B needs less. Because correct performance of the steps is the objective and carries the most weight, and because these learners are at an early stage, I choose Method B for this objective in this session.

The verdict is limited, and I want to say exactly how. Method A's advantage in realism is real, and a nurse who has never had to recognize the event under pressure is not fully prepared. The verdict does not say simulation is inferior. It says that for novices learning a rare emergency response for the first time, securing the steps comes before practicing them in a realistic scene.

What Would Change the Verdict

Three conditions would reverse the choice. If the learners had already practiced the steps, the next session should use Method A, because realism would then be the missing piece. If the session had 40 minutes instead of 17, a combination would be possible: short repeated practice first, then a simulation scenario to test the steps under pressure. If bedside checks two weeks after the session showed that nurses could perform the steps at the trainer but did not recognize a real disconnection, the lack of realistic cues would be the limiting factor, and Method A should be added.

The residency's second-quarter session on complex chest drainage problems already includes a simulation scenario. I will ensure that it contains a disconnection and a dislodgement, so that the nurses who learned the steps by repetition in the first quarter meet the event again, unannounced, in a realistic scene. The two methods then work in sequence rather than competing. That is perhaps the most useful conclusion of the comparison. Framing the choice as one method against another was necessary for a single 17-minute block, but across the residency year the question is not which method is better. It is which method should come first for a given objective, and what evidence from the bedside should prompt the switch to the next one.

References

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10, Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2, Suppl.), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4

van Merriënboer, J. J. G., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44(1), 85-93. https://doi.org/10.1111/j.1365-2923.2009.03498.x