workforce
Photo: Sydney Nursing School
Within that basis, we embedded the
course on Kolb’s theory of experiential
learning, meaning that you learn a lot from
actually experiencing an event. And the
closest we can get for our students in
experiencing an event is to use simulation.
So our course is heavily embedded in
clinical simulation, using human bodies, so
casualty actors, and also using mannequins
that we have in our laboratories at
the school.
As part of the program, we have
three key modules. The first is called
Stabilisation. This is where the students will
learn how to care for and treat a patient in
an out-of-hospital setting. We embed that
because a lot of mass casualty incidents
will involve a main component in the
pre-hospital setting, before the casualty is
moved into the hospital. So we’re starting
off there with a more simple concept.
Then we move on to another module
called Transportation. That’s where we
teach the students how to package
patients safely to be transported from
the pre-hospital setting into the hospital,
and also transportation within hospital –
patients may go for a scan or investigation,
and you may have to leave a clinical
area to go to another one – and also
between hospitals.
Although the modules we develop are
quite heavily focused on the pre-hospital
setting, we acknowledge within the course
that not many of the nurses will actually
work in the pre-hospital setting once they
qualify. More often than not, they’ll work
in the hospital setting. But there’s lots of
learning that can be translated into that.
The final module is Mass Casualty. This is
where things become a lot more complex
for the students. We present them with
different dynamic scenarios in tutorials,
lectures and laboratory sessions. We
culminate the course into a one-day mass
casualty incident, which is a simulated
incident where we present the students,
who are working in groups, with a scenario
like a fire in a hospital, or a party where the
roof of the hall has collapsed. The students
will work with each other in groups and
also with a medical student who comes
over from Sydney Medical School, and they
work together to care for the casualties.
The scenarios run for around
40 minutes. There is a prelim phase to it
and then a debrief phase afterwards. The
students are facilitated by faculty members
and community partners. So, we have
members of New South Wales Ambulance,
for instance, that come in and work with
us for the day. We have members from
New South Wales Air Ambulance. We
have some medical practitioners, often
from Bankstown emergency department.
And all of these people have experience
in managing complex casualty situations,
and they have real-world experience from
their day-to-day job of managing multiple
casualty incidents as well. So they facilitate
the students through the scenario, offering
some prompting and some feedback, once
the scenario’s ongoing.
Then once the scenario finishes, the
students have a debrief with those faculty
members along the lines of ‘What do you
think went well? What do you think you
would do differently next time’, and all of
those key learning points are brought out.
The students tell us that they get a lot
out of that. There’s a lot of evidence that
says most of the learning from simulations
occurs through the debrief. So we try to
focus on the debrief as a major tool within
that activity.
And how did students find the live mass
casualty simulation? What impact did
it have on how prepared they felt for a
mass casualty event?
The unit title is First-Line Interventions,
and that’s the unit that encompasses
these three key modules. The mass
casualty is the final module of that.
The whole unit runs right at the end of the
Bachelor of Nursing (Advanced Studies)
program, which means the students are
just brinking on graduating from their
course, and then the following year
they’ll be working in the hospital setting.
So it’s quite a pivotal time for them.
They’re trying to hone their skills, to build
their confidence.
So as part of our paper, we asked
the students to complete a satisfaction
survey, which is a validated tool that we’ve
used that we talk about in the paper.
And we also got them to do a unit of
study evaluation.
The feedback was very positive from the
students. The students tell us they were
highly satisfied with the simulation, that
there was learning that they took from the
simulation that they believe they would
be able to apply to their future practice.
And that was very important to us,
because as we know, these mass casualty
incidents are rare and we acknowledge
that fully, and wanted to make sure that
there were elements to the course that
were transferable to many situations
that the students may potentially find
themselves in.
As I said, this triaging of casualties is very
important, even when you’re working in a
ward environment. A registered nurse will
always need to prioritise the care they give
to their patients. Albeit, you wouldn’t be
using a triage tool that you do in a mass
casualty incident, but the actual principle
of the matter is the same.
Very similarly, one of the big focuses of
the course is assessment. And this is an
airway breathing circulation assessment,
a full primary assessment followed by
a secondary assessment. And these
are skills the students will use virtually
every day in their careers as registered
nurses. So they’re really important skills
to hone.
And what the students tell us from their
satisfaction surveys is that there were skills
that they learned that are transferable.
Further to that, they also believe that
the way the course was taught enabled
them to apply what they’d learned within
the theoretical parts of the first-line
intervention. Bridging that theory with
a practical activity was very effective at
enabling the students to consolidate
what they’d learned. Which, again, is very
positive feedback for us, and important
feedback that we constantly seek from our
students at Sydney Nursing School, so that
we can constantly improve the way that
we’re teaching and delivering programs
of education. ■
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