Collegian 26 (2019) 392–398

Contents lists available at ScienceDirect

Collegian
journal homepage: www.elsevier.com/locate/coll

Simulation-based learning for patient safety: The development of the

Tag Team Patient Safety Simulation methodology for nursing
education
Stephen Guinea a,∗ , Patrea Andersen b , Kerry Reid-Searl c , Tracy Levett-Jones d ,
Trudy Dwyer c , Leeanne Heaton c , Tracy Flenady c , Judith Applegarth c , Phoebe Bickell c
a
Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade Fitzroy, Victoria 3065, Australia
b
Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast Sippy Downs Drive Sippy Downs, Queensland 4556, Australia
c
School of Nursing, Midwifery & Social Sciences, Central Queensland University, Building 18, Bruce Highway, Rockhampton, Queensland 4702, Australia
d
School of Nursing and Midwifery, University of Technology Sydney, Level 7, 235 Jones St, Ultimo, New South Wales 2007, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: Since the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was
Received 19 April 2018 published nearly two decades ago, patient safety has become an international healthcare priority. Uni-
Received in revised form 30 August 2018 versities are charged with the responsibility of preparing the future nursing workforce to practise in
Accepted 30 September 2018
accordance with relevant patient safety standards. Consequently, simulation-based learning is increas-
ingly used for developing the technical and non-technical skills graduates require to provide safe patient
Keywords:
care.
Simulation
Aim: Tag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing
Nursing education
Nursing student
students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe
Patient safety the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a
Tag team medication safety scenario.
Methods: Informed by the National Safety and Quality Health Service Standards and the Patient Safety
Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively
engage large numbers of nursing students in critical conversations around every day clinical encounters
which can compromise patient safety.
Conclusion: Tag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing
students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’
resilience and capacity to speak up for safe patient care.
© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Summary of relevance What is already known

Problem Simulation-based learning improves technical and non-
There are limited educational strategies currently available to technical skills but more attention to issues that impact on
prepare the future nursing workforce in the practical appli- patient safety is required.
cation of the National Safety and Quality Health Service What this paper adds
Standards. This paper contributes to the scholarship of simulation
by presenting an innovative and evidence-based simulation
approach that focuses specifically on empowering nursing stu-
dents to be safe practitioners and patient safety advocates.

1. Introduction

∗ Corresponding author at: Locked Bag 4115 Fitzroy MDC, Fitzroy, Victoria 3065, Clinical errors are reported as the third highest cause of death in
Australia. developed countries with reports showing that up to 80% of these
E-mail address: [email protected] (S. Guinea). errors are preventable (Makary & Daniel, 2016). Nurses comprise

https://doi.org/10.1016/j.colegn.2018.09.008
1322-7696/© 2018 Australian College of Nursing Ltd. Published by Elsevier Ltd.
 S. Guinea et al. / Collegian 26 (2019) 392–398 393

the largest group of the healthcare workforce (Australian Institute may risk patient safety, nursing students lacked the strategies
for Health and Welfare, 2016), and have a critical role in improv- and confidence to speak up and directly oppose poor practice.
ing the safety and quality of patient care (Vaismoradi et al., 2011). In their qualitative study exploring nursing students’ perspec-
Twigg and Attree (2014) emphasise that effective education has tives of nursing education to provide safe care, Vaismoradi et al.
an essential role in patient safety “through the development of (2011) found that nursing students did not feel knowledgeable or
knowledge, attitudes, values, skills, behaviours and practises. . .to experienced enough to promote patient safety, and desired educa-
promote and improve safe patient care” (p. 160). tional strategies to internalise the principles and values of patient
While nursing programs are charged with the responsibility for safety.
preparing graduates with the requisite knowledge and skills to
practise safely, addressing this goal has proven to be challenging 2.3. Simulation as an educational approach to teach patient
(Attree et al., 2008; Usher et al., 2017; Vaismoradi et al., 2011). safety
Additionally, few studies have focused on how the socio-cultural
aspects of practice influence students’ willingness to speak up Simulation has become a ubiquitous approach for equipping
about situations that may compromise safe patient care (Ginsburg, students and graduates with the necessary skills, knowledge and
Tregunno & Norton, 2013). Indeed, some studies have identified confidence to provide safe patient care (Niemeyer, 2018; Bland
that when faced with clinical situations that may undermine qual- & Tobbell, 2016). An umbrella systematic review by Cant and
ity care, nursing students often remain silent rather than intervene Cooper (2017) identified positive outcomes from simulation in rela-
(Bickhoff et al., 2017). tion to knowledge acquisition, psychomotor skills, self-efficacy,
In this paper we described a novel strategy titled Tag Team participant satisfaction, confidence and critical thinking skills.
Patient Safety Simulation (TTPSS) which was designed to address These finding are supported by the outcomes of an integrative
these issues. TTPSS extends Levett-Jones et al. (2015) previ- review which found that nursing students’ knowledge of and atti-
ous research about tag-team simulation approaches, and focuses tudes towards patient safety can be improved through simulation
specifically on facilitation of nursing students’ understanding and (Shearer, 2013). Recommendations from this review called for fur-
application of the principles and practice of safe patient care. ther studies utilising theoretical models of simulation to enhance
Importantly, TTPSS incorporates design elements and facilitation the quality of inquiry in this area. One such methodology is Tag
techniques that aim to build students’ resilience and enhance their Team Simulation (TTS) (Levett-Jones et al., 2015).
confidence to speak up and advocate for safe patient care.
2.4. Tag Team Simulation
2. Literature review
TTS was designed to address the challenges associated with
2.1. Patient safety standards of practice in Australia large student numbers and limited access to specialist simulation

In Australia, the Australian Commission on Safety and Quality in Table 1

Health Care (ACSQHC) introduced the National Safety and Quality Summary of the National Safety and Quality Health Service Standards (ACSQHC,
Health Service Standards (NSQHS) to drive the implementation of 2017).
safety and quality systems and improve the quality of healthcare NSQHSS Description
(ACSQHC, 2017; Twigg et al., 2013). The NSQHS Standards prioritise
Clinical governance Governance and systems required to maintain
key areas of safety and quality where it is known that patients expe- and improve the safety and quality of
rience higher levels of harm, and where there is solid evidence that healthcare
improved care could result in better patient outcomes (ACSQHC, Partnering with consumers Systems and strategies to advance a
2017) (Table 1). consumer-centred health system. By including
patients in shared decision making, ensuring
As the NSQHS Standards were designed primarily as a tool for
that patients are partners in their care, and
clinical governance and risk management (ACSQHC, 2017), Levett- that consumers are involved in the
Jones et al. (2017) sought to design a patient safety competency development and design of quality health care.
framework that was informed by the Standards and addressed the Preventing and controlling Systems and strategies to prevent infection, to
specific learning needs of nursing students. A three round modified healthcare-associated manage infections effectively when they occur,
infection and to limit the development of antimicrobial
Delphi study was undertaken with the aim of seeking consen-
resistance.
sus on the key patient safety competency statements, knowledge Medication safety Systems and strategies to ensure that clinicians
and skills essential to patient safety and relevant to undergraduate safely prescribe, dispense and administer
nursing programs. This resulted in the Patient Safety Competency appropriate medicines to informed patients,
and monitor use of the medicines.
Framework for Nursing Students. It includes nine competencies
Comprehensive care The integrated screening, assessment and risk
that align with the NSQHS Standards: 1. Person-centred care, 2. identification processes for developing an
Therapeutic communication, 3. Cultural competence, 4. Teamwork individualised care plan, to prevent and
and collaboration, 5. Clinical reasoning, 6. Evidence-based prac- minimise the risks of harm in identified areas.
tice, 7. Preventing, minimising and responding to adverse events, 8. Communicating for safety Systems and strategies for effective
communication between patients, carers and
Infection prevention and control, and 9. Medication safety (Levett-
families, multidisciplinary teams and
Jones et al., 2017). The framework was integral to the design and clinicians, and across the health service
implementation of TTPSS. organisation.
Blood management Systems and strategies for the safe,
2.2. Speaking up for patient safety appropriate, efficient and effective care of
patients’ own blood, as well as other supplies
of blood and blood products.
Research shows that during clinical placements nursing stu- Recognising and Systems, processes and workforce is setup to
dents frequently witness, yet often remain silent, about behaviours responding to acute ensure acute deterioration of a patient’s
that negatively impact quality patient care (Gunther, 2011; Rees deterioration physical, mental or cognitive condition is
et al., 2014). A key finding of a literature review conducted by recognised promptly and responded to
effectively.
Bickhoff et al. (2017) was that, despite recognising practice that
394 S. Guinea et al. / Collegian 26 (2019) 392–398

environments, which confront many Australian nursing programs 3. Tag Team Patient Safety Simulation methodology
(Bogossian et al., 2018). TTS is a flexible, interactive and inclu-
sive simulation approach which promotes the active engagement TTPSS was developed in accordance with accepted sim-
of both participants and observers. TTS is informed by the tenets ulation standards (Levett-Jones et al., 2015; International
of Forum Theatre (Boal, 2002), an approach designed to empower Nursing Association for Clinical Simulation and Learning [INACSL]
members of the cast and audience to discuss and co-construct the Standards Committee, 2016). Four TTPS simulations developed
performance, collectively making changes and becoming agents of focus on the NHSQS Standards (ACSQHC, 2017) of Medication
social change (Boal, 2002). TTS is structured as a play comprising a safety, Recognition and responding to acute deterioration, Com-
Prologue, Act1 1, Intermission, Act 2 and Debrief. Critical to TTS are prehensive care, Communicating for safety and Partnering with
the roles of Director, Protagonist, Cast and Audience members. consumers. In addition, the Standards Preventing and controlling
Evaluation of TTS identified that there was no significant dif- healthcare-associated infection and Communicating for patient
ference in levels of satisfaction between students who assumed safety are imbedded in every simulation. Each comprise a founda-
the role of observers and those who took a more active role in the tional and complex scenario and are informed by the Patient Safety
simulation (Levett-Jones et al., 2015). Competency Framework for Nursing Students (Levett-Jones et al.,
TTS was not designed specifically to teach patient safety. 2017) and NSQHS Standards. Like TTS (Levett-Jones et al., 2015),
Consequently, Tag Team Patient Safety Simulation (TTPSS) was TTPSS is presented as a theatrical ‘play’, comprising five parts; 1.
developed. This simulation approach extends upon the principles Setup and Briefing, 2. Act One, 3. Intermission, 4. Act Two, and 5.
of TTS but focuses on empowering students with the knowledge Debriefing (Fig. 1).
and skills required for safe practice.

Fig. 1. Summary of the TTPSS Process (Reid-Searl et al., 2018) as an extension of Tag Team Simulation (Levett-Jones et al., 2015).
 S. Guinea et al. / Collegian 26 (2019) 392–398 395

3.1. Tag Team Patient Safety Simulation fundamentals They also prompt students to consider how they will transfer their
learning from the simulation to their future practice.
TTPSS includes the roles of Director, the Protagonist, Audience
and Cast. The Director is the educator who conveys the patient 4. Tag Team Patient Safety Simulation – medication
story, promotes student learning, captures teachable moments, and administration example
facilitates the debrief. The Protagonist (often a patient) is the cen-
tral character in the play and has an authentic social and medical In the following section of the paper the TTPSS methodology
history that is relevant to the focus of the simulation scenario. The is illustrated with reference to a scenario about safe medication
Audience members are active observers who adopt the role of the- administration.
atre critics and provide feedback to the cast during intermission
and debrief. The Cast members are students who actively engage
4.1. Briefing
in the play by exchanging roles (tagging in and out of the unfolding
scenario). Tagging can be initiated by either the Director or Cast
At the commencement of the simulation, the Director intro-
members. Tagging supports students by managing performance
duces the TTPSS methodology to all students. An overview of the
anxiety during situations where students may feel overwhelmed
simulation is provided in the form of the Prologue (Fig. 4) which
or uncomfortable. Students can either ‘tag out’ or support another
includes the learning outcomes and the relevance of the simulation
learner by ‘tagging in’ and offering an alternative solution. Tag-
to patient safety.
ging is not reflective of level of performance, rather it is a strategy
The Director then allocates and explains the roles of Protagonist,
that allows learners to rehearse different ways of responding to
Cast and Audience members. The number of cast and audience can
everyday practice-based situations.
be adapted to suit the class size. For example, up to six cast mem-
bers may play the role of the student nurse. The number of audience
3.2. TTPSS facilitation techniques members can range from six to 60 students. Briefing cards are pro-
vided for each of the above roles (including the audience members)
Whilst the overall structure of TTPSS is similar to TTS, the key (see Fig. 5). The Director then distributes Cue Cards to the Audience.
difference is the use of the Patient Safety Competency Framework Act 1 begins with the Director providing a clinical handover,
for Nursing Students (Levett-Jones et al., 2017) which underpins the following which the Cast members take action and begin tagging
learning outcomes, scenario design and uses Cue Cards, Antagonist in and out. When tagging occurs, the new actor continues the role;
Cards and ‘What if. . .’ questions. however, they may influence the direction of the play through their
Cue Cards (Fig. 2) are distributed to the Audience members actions and reactions to the unfolding situation. The Director may
by the Director before the commencement of the play (scenario). use the Antagonist Cards to increase the complexity of the situation,
The Cue Cards allows each audience member to focus on a critical to engage learners’ critical thinking, and to promote their ability
patient safety issue related to the play by observing and providing to respond to a situation that may undermine patient safety. For
feedback about the performance during the Intermission and the example, in the Medication Safety simulation one of the Antagonist
Debrief. Cards reads: ‘As the Registered Nurse, you tell the student to leave the
Antagonist Cards (Fig. 3) are introduced to the actors (patient, medication at the bedside so that the patient can take it with their next
registered nurse or family member) during the play. The content meal.’
of Antagonist Cards is based on situations students commonly During the simulation the Audience members critically observe
report that undermine patient safety. Antagonist Cards increase the performance with a focus on the information provided on their
the complexity of the unfolding situation and require students to Cue Card. For example, in this simulation one of the Cue Card reads:
think critically, adapt to the unfolding situation and demonstrate ‘Observe and provide feedback about the student nurses’ adherence to
approaches to care which promote patient safety. The Antago- scope of practice and any actions taken to seek supervision for medi-
nist Cards illustrate professional and social challenges inherent in cation administration.’
contemporary clinical practice and are designed to help students At the conclusion of Act 1, Intermission is called. The Director
become more assertive and confident by learning how to manage reiterates the learning outcomes and seeks feedback from audience
difficult conversations in practice. members about what went well and what could be done differ-
‘What if. . .’ Questions are used by the Director during the debrief ently in relation to the specific Cue Cards. Key practice issues are
to ensure that the learning outcomes have been fully explored. summarised and strategies for improvement in Act 2 are identified.

Fig. 2. Example Cue Card. Fig. 3. Example Antagonist Card.

396 S. Guinea et al. / Collegian 26 (2019) 392–398

Fig. 4. Prologue for TTPSS Medication Safety.

Fig. 5. Example of briefing cards.

In Act 2, the play is repeated. The purpose of Act 2 is to pro- does not cover all learning outcomes, the Director may use ‘What
vide the opportunity for the Cast members to try out the strategies if. . .’ questions. For example: ‘What if the patient refuses medication
suggested by the audience during intermission. The Director may but the Registered Nurse says you must force the patient to take it or
again introduce Antagonist Cards however they may differ from hide it in their meal?’
those used in Act 1.
A structured Debrief follows Act 2. The Director uses Pendleton’s
Rules of Feedback (Pendleton et al., 1984) to facilitate an in-depth 5. Discussion
exploration of what unfolded during the play with a specific focus
on the perspectives of the patient, and the actions and reactions of Tag Team Patient Safety Simulation (TTPSS) is an innovative and
the Cast members. The discussion is informed by the Patient Safety pragmatic educational approach that aims to equip nursing stu-
Competency Framework for Nursing Students (Levett-Jones et al., dents with the knowledge and skills and needed to promote safe
2017) and the NSQHS Standards (ACSQHC, 2017). If the discussion patient care. Whilst the overall process of TTPSS reflects that of
 S. Guinea et al. / Collegian 26 (2019) 392–398 397

TTS, several design elements and facilitation techniques distinguish approach. These freely available resources provide educators with
between the two approaches: the templates required to develop individualised scenarios aimed
at addressing their specific learning objectives and outcomes.
1 Constructive alignment: Like in any simulation method, align-
ment between learning outcomes, the simulation, and the debrief 6. Conclusion
is essential (Biggs & Tang, 2011; INACSL Standards Committee,
2016; Levett-Jones & Guinea, 2017). The TTPSS approach utilises Nursing students require immersive and experiential learn-
this fundamental principle in innovative ways. For example, ing opportunities to develop the requisite skills and knowledge
the Patient Safety Competency Framework for Nursing Students to practice safety. This paper has provided an overview of the
(Levett-Jones et al., 2017) provides the basis for all learning out- TTPSS methodology. TTPSS is presented as an innovative simula-
comes, Cue Cards, Antagonist Cards, and ‘What if . . .’ questions, tion methodology that focuses on the National Safety and Quality
and in this way engage learners in an ongoing critical conversa- Health Service Standards (ACSQHC, 2017), fosters critical conversa-
tion about safe patient care. tions about patient safety and has the potential to enhance nursing
2 Active participation is a central principle for maintaining students’ resilience and confidence to advocate for safe patient care.
engagement of adult learners (Biggs, 1989; Knowles, 1970) and is One of the key advantages of TTPSS is its flexibility and potential
a central tenet of effective simulation (Motola et al., 2013). How- for use in different contexts and disciplines. Further information
ever, as the pragmatic constraints associated with large numbers about TTPSS as well as the toolkits, equipment lists, and simula-
of students, simulations are often conducted in large groups, with tion resources can be accessed at: https://www.cqu.edu.au/about-
few students participating in the scenario and most observing. us/structure/schools/nm/simulation/ttpss
Whilst some researchers report that observers typically learn The TTPSS website also provides templates and includes an
less than learners who have a ‘hands-on’ experience, and are instructional design framework to enable educators to design their
often less satisfied with the simulation experience (Levett-Jones own simulations using the TTPSS approach.
et al., 2015; Hober & Bonnel, 2014; Kettlewell et al., 2012), TTPSS
addresses this challenge by providing a key role for all audi- Disclosures
ence members through the use of Cue Cards. This approach is
supported by O’Regan et al. (2016) and Norman (2018) who The authors declare that they have no competing interests.
found that role clarity, the use of tools to provide focus for
observers, and inclusion of observers’ perspectives during the Ethical statement
post-simulation debrief can increase the achievement of learning
outcomes and satisfaction with the simulation experience. An Ethical Statement is not applicable for this manuscript.
3 A focus on resilience and moral courage: Resilience is an
essential attribute for navigating the complexity and challenges Conflict of interest
inherent in contemporary healthcare practice. A lack of ‘moral
courage’ often causes students to remain silent when they wit- None.
ness poor practice during clinical placements (Bickhoff et al.,
2017). The seminal work of Lave and Wenger (1991) highlight
Acknowledgements
the challenges associated with healthcare hierarchies and power
differentials and helps to explain why students may be reluc-
We acknowledge the Australian Government Department of
tant to ‘speak up’. The use of Antagonist Cards and ‘What if. . .’
Education and Training as the funding agency for this work. We are
questions in TTPSS promotes discussion about challenging clini-
also grateful to the academic and simulation staff at the universities
cal situations and allows for exploration of culturally appropriate
where the TTPSS methodology was trialled, and the reference group
behaviours and techniques that can be used to promote patient
and nurse educators who provided invaluable feedback. Finally, we
safety. This approach helps to empower students by building
acknowledge the significant contribution of the nursing students
resilience and the moral courage needed to confront practices
who volunteered to participate in this project and who provide the
that may threaten patient safety.
inspiration and motivation for our work.
4 Reflective learning, negotiation and shared understanding:
Shared learning through incorporation of each learners’ knowl-
References
edge and skills and active engagement in the learning milieu
through noticing, intervening and reflection-in-action, are essen- Attree, M., Cooke, H., & Wakefield, A. (2008). Patient safety in an English
tial to optimise learning from experience (Boud, 2010). TTPSS pre-registration nursing curriculum. Nurse Education in Practice, 8(4), 239–248.
provides opportunities for multiple learners to engage in and http://dx.doi.org/10.1016/j.nepr.2007.09.003
Australian Commission on Safety and Quality in Health Care (ACSQHC). (2017).
apply their skills and knowledge to the simulation. Intermission National safety and quality health service standards Retrieved from.(2nd ed.).
and the Debrief provides an opportunity for learners to return https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-
to the experience, receive feedback, and to attend to feelings standards/nsqhs-standards-second-edition/
Australian Institute for Health and Welfare. (2016). Australian hospital statistics
and emotions (Boud, 2010). Importantly, sharing experiences, 2014–15 Retrieved from. http://www.aihw.gov.au/publication-detail/
thoughts and feelings during these periods of reflection pro- ?id=60129556023
vide an opportunities for negotiation and practical application Bickhoff, L., Sinclair, P. M., & Levett-Jones, T. (2017). Moral courage in
undergraduate nursing students: A literature review. Collegian, 24(1), 71–83.
of patient safety standards and principles.
http://dx.doi.org/10.1016/j.colegn.2015.08.002
Biggs, J. B. (1989). Approaches to the enhancement of Tertiary teaching. Higher
One of the key advantages of TTPSS is its flexibility and poten- Education Research & Development, 8(1), 7–25. http://dx.doi.org/10.1080/
0729436890080102
tial for use in different contexts and disciplines. Anticipated
Biggs, J., & Tang, C. (2011). Teaching for quality learning at university (4th ed.).
future TTPSS developments include simulations about difficult Maidenhead, United Kingdom: McGraw-Hill / Society for Research into Higher
conversations and caring for a person with a mental illness, as Education & Open University Press.
well as interprofessional simulations. The TTPSS website pro- Bland, A. J., & Tobbell, J. (2016). Towards an understanding of the attributes of
simulation that enable learning in undergraduate nurse education: A grounded
vides templates and includes an instructional design framework to theory study. Nurse Education Today, 44, 8–13. http://dx.doi.org/10.1016/j.nedt.
enable educators to design their own simulations using the TTPSS 2016.05.011
398 S. Guinea et al. / Collegian 26 (2019) 392–398

Boal, A. (2002). Games for actors and non-actors. London, United Kingdom: Makary, M., & Daniel, M. (2016). Medical error: The third leading cause of death in
Routledge. the US. BMJ, 353, i2139. http://dx.doi.org/10.1136/bmj.i2139
Bogossian, F., Cooper, S., Kelly, M., Levett-Jones, T., McKenna, L., Slark, J., & Seaton, Motola, I., Devine, L. A., Chung, H. S., Sullivan, J. E., & Issenberg, B. (2013).
P. (2018). Best practice in clinical simulation education: Are we there yet? A Simulation in healthcare education: A best evidence practical guide. AMEE
cross-sectional survey of simulation in Australia and New Zealand Guide No. 82. Medical Teacher, 35(10), e1511–e1530. http://dx.doi.org/10.
pre-registration nursing education. Collegian, 25(3), 327–334. http://dx.doi. 3109/0142159X.2013.818632
org/10.1016/j.colegn.2017.09.003 Niemeyer, M. A. (2018). Effective patient safety education for novice RNs: A
Boud, D. (2010). Locating immersive experience in experiential learning. In N. systematic review. Journal of Nursing Education and Practice, 8(3), 103–115.
Jackson (Ed.), Learning to be professional through a higher education e-book. http://dx.doi.org/10.5430/jnep.v8n3p103
Retrieved from. http://learningtobeprofessional.pbworks.com/w/page/ Norman, J. (2018). Differences in learning outcomes in simulation: The observer
15914981/ role. Nurse Education in Practice, 28, 242–2477. http://dx.doi.org/10.1016/j.
Learning%20to%20be%20Professional%20through%20a%20Higher%20 nepr.2017.10.025
Education%20e-Book O’Regan, S., Molloy, E., Watterson, L., & Nestel, D. (2016). Observer roles that
Cant, R. P., & Cooper, S. J. (2017). Use of simulation-based learning in optimise learning in healthcare simulation education: A systematic review.
undergraduate nurse education: An umbrella systematic review. Nurse Advances in Simulation, 1(4) http://dx.doi.org/10.1186/s41077-015-0004-8
Education Today, 49, 63–71. http://dx.doi.org/10.1016/j.nedt.2016.11.015 Pendleton, D., Schofield, T., Tate, P., & Havelock, P. (1984). The new consultation:
Ginsburg, L. R., Tregunno, D., & Norton, P. G. (2013). Self-reported patient safety Developing doctor–patient communication. Oxford, United Kingdom: Oxford
competence among new graduates in medicine, nursing and pharmacy. BMJ University Press.
Quality & Safety, 22(2), 147–154. http://dx.doi.org/10.1136/bmjqs-2012- Rees, C. E., Monrouxe, L. V., & McDonald, L. A. (2014). ‘My mentor kicked a dying
001308 woman’s bed. . .’ Analysing UK nursing students’ ‘most memorable’
Gunther, M. P. (2011). Empathic anger in junior nursing students. The Journal of professionalism dilemmas. Journal of Advanced Nursing, 71(1), 169–180. http://
Nursing Education, 50(5), 242–247. http://dx.doi.org/10.3928/01484834- dx.doi.org/10.1111/ja.12457
20100930-01 Reid-Searl, K., Levett-Jones, T., Anderson, P., Guinea, S., Heaton, L., Dwyer, T.,
Hober, C., & Bonnel, W. (2014). Student perceptions of the observer role in Flenady, T., & Applegarth, J. (2018). Preparing undergraduate nurses for the
high-fidelity simulation. Clinical Simulation in Nursing, 10(10), 507–514. http:// workplace in the context of patient safety through innovative simulation. Final
dx.doi.org/10.1016/j.ecns.2014.07.008 report. A project completed on behalf of the Commonwealth Office of Learning
International Nursing Association for Clinical Simulation and Learning Standards and Teaching Department of Education.
Committee. (2016). Standards of best practice: SimulationSM . Simulation Shearer, J. E. (2013). High-fidelity simulation and safety: An integrative review. The
design. Clinical Simulation in Nursing, 12(Suppl), S5–S12. http://dx.doi.org/10. Journal of Nursing Education, 52(1), 39–45. http://dx.doi.org/10.3928/
1016/j.ecns.2016.09.005 01484834-20121121-01
Kettlewell, K., Southcott, C., Stevens, E., & McCrone, T. (2012). Engaging the Twigg, D., & Attree, M. (2014). Patient safety: Committing to learn and acting to
disengaged (NFER research programme: From education to employment) improve. Nurse Education Today, 34(2), 159–161. http://dx.doi.org/10.1016/j.
Retrieved from:. Slough, United Kingdom: NFER. https://www.nfer.ac.uk/ nedt.2013.11.002
publications/ETDE01/ETDE01.pdf Twigg, D. E., Duffield, C., & Evans, G. (2013). The critical role of nurses to the
Knowles, M. (1970). The modern practice of adult education: Androgogy versus successful implementation of the National Safety and Quality Health Service
pedagogy. New York, NY: The Association Press. Standards. Australian Health Review, 37(4), 541–546. http://dx.doi.org/10.1071/
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. AH12013
New York, NY: Cambridge University Press. Usher, K., Woods, C., Parmenter, G., Hutchinson, M., Mannix, J., Power, T., . . . &
Levett-Jones, T., & Guinea, S. (2017). The evolution of a mnemonic for quality Jackson, D. (2017). Self-reported confidence in patient safety knowledge
simulation practices. Clinical Simulation in Nursing, 13(11), 552–561. http://dx. among Australian undergraduate nursing students: A multi-site
doi.org/10.1016/j.ecns.2017.07.004 cross-sectional survey study. International Journal of Nursing Studies, 71, 89–96.
Levett-Jones, T., Andersen, P., Reid-Searl, K., Guinea, S., McAllister, M., Lapkin, S., & http://dx.doi.org/10.1016/j.ijnurstu.2017.03.006
Niddrie, M. (2015). Tag team simulation: An innovative approach for Vaismoradi, M., Salsali, M., & Marck, P. (2011). Patient safety: Nursing students’
promoting active engagement of participants and observers during group perspectives and the role of nursing education to provide safe care.
simulations. Nurse Education in Practice, 15(5), 345–352. http://dx.doi.org/10. International Nursing Review, 58(4), 434–442. http://dx.doi.org/10.1111/j.1466-
1016/j.nepr.2015.03.01416 7657.2011.00882.x
Levett-Jones, T., Dwyer, T., Reid-Searl, K., Heaton, L., Flenady, T., Applegarth, J.,
Guinea, S., & Andersen, P. (2017). Patient safety competency framework (PSCF)
for nursing students Sydney, NSW. Retrieved from. http://
patientsafetyfornursingstudents.org/