Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Joseph F. Burkard, DNSc, CRNA, Chairperson; Sharon Boothe-Kepple, PhD, FNP-C, PHN; Carmen N. Spalding, PhD, RN, CHSE-A


healthcare simulation, simulationist, simulation-based learning event, simulation-based education, iteration, frequency


Title:Strategies for the improvement of healthcare through simulation

Background: Medical errors continue to plague the healthcare industry. The annual rates of morbidity are approximately 2.69 million (AHRQ, 2019), while mortality rates exceed 400,000 per annum (Makary & Daniel, 2016). There may be no panacea to combat these egregious rates. However, simulation of patient care events may better prepare healthcare professionals to prevent medical errors as it has been proven to be an effective learning strategy (Kirkham, 2018), enhancing skills while gaining experiential knowledge, without risk to actual patients.

Purpose: The purpose of this qualitative study was to gain a better understanding of factors that impede or foster the frequent utilization of simulation as a modality to rehearse patient care activities for healthcare professionals, and to better identify processes that could reduce medical errors across the continuum. Aim 1: Describe the demographics of the study population: Current profession, area of specialty, time in profession, time in current role, education level, age of the participant, gender of the participant, and operational setting. Aim 2: Explore and identify barriers to the frequent practice of healthcare simulation. Aim 3: Identify processes that can lead to the reduction of errors in the healthcare industry.

Methods: This was a hermeneutic phenomenological qualitative study that also used descriptive statistics to gain a better understanding of the subjects and their responses to the solicited survey.

Findings: The barriers of time, space, access, and cost continue to pose impediments to iterative rehearsal. These factors were compounded by the paucity of qualified facilitators & support personnel in this modality; all exacerbated by the pandemic. A need for diversity in SBLE to reflect patient population was also identified. According to the participants, the value of simulation is realized through relevant and iterative SBLE. To enhance confidence and competence, participants overwhelmingly indicated the need for monthly rehearsal of patient care events. Leadership buy-in was identified as key to program success.

Implications: By employing regular practice of simulated patient care events, positive patient outcomes can be realized, as the healthcare provider’s clinical acumen is exercised and further developed.

Keywords: healthcare simulation, simulation-based education (SBE), simulation-based learning events (SBLE), iteration, simulationist

Document Type

Dissertation: Open Access