First Advisor

Suit, Louise

Second Advisor

Berg, Barbara

Third Advisor

Gilbert, Marcia


Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice


Loretto Heights School of Nursing

Document Type

Thesis - Open Access

Number of Pages

147 pages


Abstract Nursing students may experience difficulty tmnsitioning from being competent in the campus lab environment to being capable in a clinical environment when the campus lab experience does not offer realistic challenges. Students have the knowledge of how to safely perform the skills but cannot demonstrate the skills, utilizing clinical reasoning, in the unstable and unpredictable hospital environment. Traditional campus lab instruction for medication administration includes small group practice that is task oriented in a stable and predictable environment. Progressive simulation challenges the student with utilization of multiple levels of simulation incorporating clinical reasoning .. The goal of this project was enabling the Associate Degree Nursing student to develop capability of medication administration in the unstable and unpredictable environment of the clinical setting This capstone project evaluated the cuniculum change of introducing progressive simulation involving an unstable and unpredictable environment in the campus lab. The students practiced administering parenteral medications with planned instructional methodology based on replicating a portion of a study done by Brydges, Carnahan, Rose, and Dubrowski (2010). According to Brydges et aI. (2010), progressive simulation is described as an environment where the student makes the decision of when to progress from one simulation station level to the next. The progressive simulation for this project was in the format of three stations with each station increasing in complexity that requires clinical reasoning during the medication administration process, utilizing mUltiple levels of simulation. A total of21 students completed the progressive simulation process. Self-efficacy surveys completed by participants prior to and follqwing the intervention revealed a statistically significant differenc:e with an increase in self-scoring (p= .00 I). In the clinical setting, 95.3% of the participants scored a passing score, successfully demonstrating capability in medication administration and clinical reasoning but the statistical analysis was not significant (p=O.5]). Faculty surveys did not reveal a statistically significant increase in satisfttction with the curriculum change (p=.060), but the evaluations included positive comments supporting maintaining the curriculum change.

Date of Award

Spring 2012

Location (Creation)

Denver, Colorado

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