Care of Veterans: Use of Patient Simulation to Address Healthcare Needs of Veterans

Jemica M. Carter, PhD, RN, Faculty VA Nursing Academy, MSN Virginia Nelson, MSN Marge Freundl, MSN Lorraine Wadlington, PhD Maureen Anthony, and PhD Shirley Escamilla

DESCRIPTION: To describe the use of high fidelity patient simulation to introduce undergraduate nursing students to concepts related to culturally competent care of the Veteran population as a part of a state collaborative Veterans Affairs (VA) Nursing Academy. The American Nurses Association (2008) supports collaborative efforts to advance Veteran health care services, research and nurse-led innovations to improve Veteran care. Students may not be prepared to address Veterans’ complex, multifaceted healthcare needs within the VA and the private sector.

Methods: A case study involving a hospitalized male Vietnam Veteran was developed for high fidelity simulation.  An interdisciplinary VA clinical expert panel participated in the development and validation of the scenario. A checklist was developed reflecting key behaviors, skills, and safety considerations in the scenario, based on the Quality and Safety Education in Nursing (QSEN) competencies. The simulation lab at University of Detroit Mercy (funded by HRSA grant) was used to conduct the simulation. An evaluation tool adapted from the Simulation Design Scale (Jeffries, 2005) was used for pilot testing. Clinical expertise and student feedback were used to make modifications to the scenario and checklist. The simulation debriefing provided an opportunity for students to share preconceptions about veterans and anxieties related to clinical assignment at the VA.

Results: Students rated the simulation as highly authentic (high fidelity) and agreed that the simulation increased awareness of veteran care. Students were neutral about the preparation resources provided. Based on the Jeffries Simulation Model (2005), student learning outcomes were achieved. High fidelity simulations offer opportunities to increase students' decision-making abilities and self-confidence in providing quality veteran-centered care.

Implications: The increasingly complex healthcare needs of veterans warrant knowledge and clinical decision-making skills that focus on providing quality patient care, patient safety, and implementation of evidence-based practice guidelines and interventions. High-fidelity simulation can help nursing students learn and practice standardized scenarios without causing harm to a patient and ultimately enhance their level of confidence. Several researchers (e.g., Rhodes & Curran, 2005) have found that simulation has potential advantages (e.g., strengthen clinical decision-making skills, freedom to learn without fear of harming a patient and/or making mistakes) when compared to traditional methods of clinical experience.

Future activities:

Modifications to challenge students at different levels including mental health considerations of veterans.

Impact:  Evidence of positive learning outcomes was apparent. Students reported and faculty observed enhanced critical thinking and clinical judgment skills regarding veteran care. Clinical and university collaboration on the development and use of simulation scenarios can help nursing students acquire skills, knowledge, and sensitivity to the needs of veterans.