External validation of an instructional design model for high fidelity simulation: model application in a hospital setting

The purpose of this study was to investigate the use of the design characteristics component of the Jeffries/National League for Nursing Framework for Designing, Implementing, and Evaluating Simulations when developing a simulation-based approach to teaching structured communication to new graduate nurses. The setting for the study was a medium sized tertiary care hospital located in the southwestern United States. Participants in the study were an instructional designer (who also served as the researcher), two graduate nursing education specialists, one unit based educator, and 27 new graduate nurses and registered nurses who had been in practice for less than six months. Design and development research was employed to examine the processes used to design the simulation, implementation of the simulation by faculty, and course evaluation data from both students and faculty. Data collected from the designer, faculty and student participants were analyzed for evidence on how the design characteristics informed the design and implementation of the course, student achievement of course goals, as well as student and faculty evaluation of the course. These data were used to identify the strengths and weaknesses of the model in this context as well as suggestions for strengthening the model. Findings revealed that the model generally functioned well in this context. Particular strengths of the model were its emphasis on problem-solving and recommendations for attending to fidelity of clinical scenarios. Weaknesses of the model were inadequate guidance for designing student preparation, student support, and debriefing. Additionally, the model does not address the role of observers or others who are not assigned the role of primary nurse during simulations. Recommendations for strengthening the model include addressing these weaknesses by incorporating existing evidence in the instructional design of experiential learning and by scaffolding students during problem-solving. The results of the study also suggested interrelationships among the design characteristics that were not previously described; further exploration of this finding may strengthen the model. Faculty and instructional designers creating clinical simulations in this context would benefit from using the Jeffries/National League for Nursing Model, adding external resources to supplement in areas where the model does not currently provide adequate guidance.