Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study

Abstract

Background: Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings.

Objective: To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies.

Design: Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis.

Setting: Simulation laboratories in one university nursing school in Australia.

Participants: 21 final year nursing students in seven teams.

Methods: Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies.

Results: Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness.

Conclusions: Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

Keywords: Communication; Contextual determinants; Culture; Grounded theory; Nursing student; Patient deterioration; Simulation; Team.