NURS 767 Week 4 Written Assignment 4 Example

Teaching in the Simulation Lab: Designing, Prebriefing and Debriefing a Postpartum Hemorrhage Scenario for Junior BSN Students

Purpose of a Second Simulation

The first postpartum hemorrhage simulation, run in Week 3, was deliberately simple: one patient, a clear boggy fundus and heavy bleeding that began as students entered the room. Students learned to recognize uterine atony and begin fundal massage, but the debriefing showed a pattern. Several students said they would not have noticed the bleeding if the manikin had not been visibly soaked, and almost none mentioned vital signs. In real practice, hemorrhage often develops more quietly, with a slowly rising heart rate and a patient who says she feels "a little off" before the bleeding is obvious. The second simulation, in Week 5, is designed to teach that quieter presentation. Oermann et al. (2018) describe simulation as a way to give students experience with clinical situations they may never encounter in placements, and a slowly developing hemorrhage is a good example.

Design

Watts et al. (2021) set out the standard for simulation design, which begins with a needs assessment and measurable objectives and then builds a scenario, a fidelity level and an evaluation plan around them. The objectives for this scenario are that students will recognize early cues of hemorrhage in vital sign trends and the patient's report before visible bleeding is heavy, perform the first actions for uterine atony in the correct order, calculate cumulative quantitative blood loss during the scenario and communicate the patient's status to the provider using SBAR.

The patient is a 31-year-old woman, three hours after a vaginal birth following a 22-hour induced labor with oxytocin, which places her at higher risk of atony. She is on a high-fidelity manikin with a moulage of lochia that the operator can increase. A standardized patient voice, played by a faculty member, allows her to speak.

The key teaching moment is state 1, where cues are present but quiet. If students skip vital signs, the scenario moves on after five minutes, and the debriefing will return to what they missed.

Prebriefing and Psychological Safety

McDermott et al. (2021) describe prebriefing as the preparation and briefing that let learners take part safely and meet the objectives: orienting them to the environment, equipment and manikin, clarifying roles and expectations and establishing a psychologically safe setting. In this prebriefing, students will see the room and manikin, practice weighing a pad on the lab scale, learn which part each will play, with one student leading care, a second assisting, a third keeping the timeline and a fourth acting as the patient's husband, and hear the ground rules: the scenario is meant to be challenging, mistakes are expected and nothing said in the debriefing will affect their grade.

Stress deserves attention. Obstetric emergencies are frightening, and simulation can produce real physiological stress. Akalin et al. (2026) monitored nursing students' stress during high-fidelity simulation with an electronic wristband and tested a brief debriefing intervention in a randomized design, concluding that tailored debriefing may improve well-being and satisfaction with learning. The lesson for this scenario is that stress is useful up to a point and must be acknowledged afterward. The debriefing will open by asking students how they feel, and the facilitator will watch for students who freeze or become distressed during the scenario.

Facilitation During the Scenario

I will be the facilitator, with my preceptor operating the manikin. The plan is to stay out of the scenario unless safety in the learning sense requires it. If students have not taken vital signs by minute five, the patient will say, "My heart is racing," a scripted cue rather than a rescue. If students are frozen for more than a minute in state 2, the second nurse role will be prompted to call the charge nurse, played by the preceptor. These lifelines keep the scenario moving toward the objectives without taking the decisions away from students.

Debriefing

Decker et al. (2021) set the standard for debriefing as a planned, structured conversation led by a trained facilitator, based on a theoretical framework, that promotes reflection and helps learners transfer what they learned to practice. This debriefing will use three phases. In the reactions phase, students say how the scenario felt. In the analysis phase, the facilitator guides them through what happened, using the recorder's timeline: when the heart rate began to rise, when it was noticed, when the fundus was checked and how the blood loss total grew. Questions include what the patient's statement that she felt off might have meant, what the heart rate trend told them before the bleeding was obvious and what made it hard to act sooner. To close, every student commits aloud to a single change in how they will assess postpartum patients on the unit next week.

The debriefing will take thirty minutes, twice the length of the scenario. The analysis phase is where the quiet cues from state 1 will be made explicit, which is the main purpose of this simulation.

Evidence for the Approach

Simulation of obstetric emergencies has support across settings. Fernández Idiago et al. (2026) found that a high-fidelity obstetric emergency program for 82 third-year nursing students improved knowledge of complex obstetric situations and students' sense of safety in managing emergencies, and students described the debriefing as central to their learning. Faustine et al. (2025) used simulation-based education to teach the prevention and management of postpartum hemorrhage to 55 student nurse-midwives in Tanzania and found significant improvements in knowledge and skills afterward. Neither study had a control group, so the evidence shows improvement after simulation rather than proof that simulation outperforms other methods, but it is consistent across very different programs.

Evaluating the Simulation

The simulation will be evaluated in three ways. The recorder's timeline will show how long each group took to notice the quiet cues and to begin fundal massage, and those times can be compared across groups. Students will complete a brief evaluation of the scenario and debriefing. And my preceptor will observe my debriefing and give written feedback on whether I talked too much, asked open questions and drew out the quiet cues. The scenario gives students an experience; the debriefing decides whether that experience becomes learning.

Running the Scenario for Several Groups

The course has 32 students, and the lab can hold one scenario at a time. Running the scenario for groups of four means eight runs of fifteen minutes, each followed by a thirty-minute debriefing, which is more than a day of facilitation. The plan therefore uses two rooms on the simulation day: the scenario runs in the high-fidelity room while the previous group debriefs in the conference room next door with my preceptor or me, alternating. Students who are waiting complete a short skills station on weighing pads and calculating blood loss, which reinforces the second objective without giving away the scenario. Because later groups could learn the scenario from earlier ones, students sign the usual confidentiality agreement, and the operator varies two details between runs, the patient's first statement and the timing of the heart rate rise, so that the core cues stay the same while a memorized script fails. The extra planning is worth it: every student meets the quiet presentation of hemorrhage before the clinical days, not only those in the first groups.

What the Clinical Days Must Add

Simulation cannot teach everything. Students will not learn on the manikin how a real fundus feels under the hand or how a real patient sounds when she says something is wrong. On the clinical days, I will ask students to describe the fundus and the patient's account at every postpartum assessment, so that the habits practiced in simulation meet real variation.

References

Akalin, A., Demedts, D., D'haenens, F., Fobelets, M., Vermeulen, J., & Tricas-Sauras, S. (2026). Monitoring nursing students' stress levels during high-fidelity simulation using an electronic wristband device. Nursing Education Perspectives. Advance online publication. https://doi.org/10.1097/01.NEP.0000000000001595

Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare Simulation Standards of Best Practice: The debriefing process. Clinical Simulation in Nursing, 58, 27-32. https://doi.org/10.1016/j.ecns.2021.08.011

Faustine, R., Tjoflåt, I., Risa, E. C. F., Rogathi, J., & Mahande, M. J. (2025). Improving Tanzanian student nurse-midwives' knowledge, skills and attitude in postpartum hemorrhage prevention through simulation-based education: A pre-post quasi experimental study. BMC Pregnancy and Childbirth, 25(1), 471. https://doi.org/10.1186/s12884-025-07590-4

Fernández Idiago, M., Velarde-García, J. F., Arrogante, O., Zaragoza-García, I., Álvarez-Embarba, B., Fernández-Alonso, V., & López-Pedraza, L. (2026). Preparing nursing students for obstetric emergencies: Effects of high-fidelity simulation on knowledge, confidence and learning. Nursing Reports, 16(4), 137. https://doi.org/10.3390/nursrep16040137

McDermott, D. S., Ludlow, J., Horsley, E., & Meakim, C. (2021). Healthcare Simulation Standards of Best Practice: Prebriefing: Preparation and briefing. Clinical Simulation in Nursing, 58, 9-13. https://doi.org/10.1016/j.ecns.2021.08.008

Oermann, M. H., De Gagne, J. C., & Phillips, B. C. (Eds.). (2018). Teaching in nursing and role of the educator: The complete guide to best practice in teaching, evaluation, and curriculum development (2nd ed.). Springer Publishing Company.

Watts, P. I., McDermott, D. S., Alinier, G., Charnetski, M., Ludlow, J., Horsley, E., Meakim, C., & Nawathe, P. A. (2021). Healthcare Simulation Standards of Best Practice: Simulation design. Clinical Simulation in Nursing, 58, 14-21. https://doi.org/10.1016/j.ecns.2021.08.009