The effectiveness of simulation in preparing student nurses to competently measure blood pressure in the real-world environment

This research report outlines the key findings of a collaborative pilot study between the School of Nursing, UCOL, New Zealand, and the Department of Nursing and Health Studies, University of Huddersfield, [UH] England, which sought to evaluate the effectiveness of simulation in the teaching of clinical skills to Year One nursing students. The clinical skill of blood pressure measurement was selected as the focus for the research project.

Comparisons were made between the teaching and learning approaches utilised by the two institutions in teaching blood pressure measurement; students were surveyed as to the effectiveness of the simulation sessions before and after their first clinical placement; and the clinical preceptors/mentors working with those students on that placement were surveyed about their evaluation of student preparation and performance.

Dr Marian Bland (left) discusses the project with research colleague and Nursing Laboratory coordinator Susie Le Page.

The findings highlight the complexities of teaching blood pressure measurement. Both institutions used remarkably similar teaching approaches and resources, including the number of hours students spend in the clinical skills laboratory. The key difference was related to the timing of summative assessment of clinical skills competency – with UCOL conducting assessments prior to the student’s first clinical placement, compared with UH, who conducted their summative assessment after the student’s first clinical placement.

Students in both institutions reported feeling some degree of confidence and competence in blood pressure measurement following the simulation sessions, although confidence levels were slightly higher at UCOL. UCOL students reported practicing blood pressure measurement more often than their UH counterparts, although this may be due in part to the timing of the summative assessments. By the conclusion of their clinical placement, 99% of UCOL students and 100% of those at UH rated themselves as having a good understanding of the relationship between the theory and practice of blood pressure measurement, and felt confident in applying that theory to practice.

The nurses who worked alongside the students on their first clinical practice as mentors/preceptors considered that the majority of students (80% UCOL, 70% UH) were competent in blood pressure measurement. Surprisingly, considering the number of students they rated as being not yet competent, 75% of the UCOL and 96% of the UH mentors/preceptors considered the simulation sessions prepared the students effectively.

This research has demonstrated that simulation plays an important role in preparing students to competently measure blood pressure in real-world environments. It does raise questions however as to what should be expected of first year student nurses in relation to this skill, what degree of competency is realistic and achievable. It also raises questions about the timing of summative clinical skills assessment, and whether this should be conducted before or after students have completed their first clinical placement.

The use of simulation is becoming more widespread in undergraduate nursing education. It is important to not only answer the questions raised by this research, but also consider the implications of including simulated practice hours in the total of accumulated clinical hours each student must accumulate prior to the completion of their programme. Further consideration should also be given to identifying teaching and learning strategies that could be adopted to help overcome the anxiety students experience in relation to performing blood pressure measurement.