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Strategy Submission

Patient Prioritization: A Neurology Simulation


Martha McMillan



Assitant Professor


Sarita James, PhD, RNCNE


Louisiana State University of Alexandria


Competency Categories:

Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration

Learner Level(s):

New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN

Learner Setting(s):

Skills or Simulation Laboratories

Strategy Type:

General Strategy

Learning Objectives:

1. Apply critical thinking and clinical judgment to identify priority nursing intervention in the care of patients with neurological diagnoses. (Patient-Centered Care) 2. Apply evidence based practice in the demonstration of a basic neurological assessment. (Evidenced Based Practice) 3. Demonstrate professional behaviors when prioritizing and managing safe care for a patient with a neurological diagnosis. (Patient-Centered Care, Safety) 4. Demonstrate effective use of technology and standardized practices that support safety and quality patient care. (Patient-Centered Care, Safety) 5. Uses effective verbal communication with team members to help patient achieve health care goals. (Teamwork and Collaboration)

Strategy Overview:

The Simulation activity provides an opportunity for nursing faculty to further develop student’s clinical reasoning, critical thinking, and professional behaviors in determining priorities in safe nursing practice. This active learning simulation activity can be used for the undergraduate or new graduate ASN, BSN, or RN-BSN nurse. The student is expected to apply clinical judgment and critical thinking in determining priorities in the safe nursing practice for the patient with a neurological diagnosis. The activity provides additional practice for the undergraduate or new graduate nurse to practice conducting a thorough neurological exam following an evidence-based checklist of the cranial nerves. Students are assigned to groups to rotate through 2 stations. The duration of the activity is based on the size of the group. One station involves receiving report on 2 patients with different neurological diagnoses. Each group receives report on 2 patients with different neurological diagnoses, requiring each student to use clinical judgment, critical thinking without collaborating to determine which patient requires nursing intervention first. Students determine the priority, provide the reason for their choice, including the reasons for choosing not to intervene for the other patient. The student documents this on a form and turns it into the faculty for debriefing. For the other station, students are assigned a partner to demonstrate a neurological exam of the cranial nerves, using neurological

Additional Materials:

For copies of any of the following please contact Martha McMillan at

Simulation Schedule with Objectives, Walking rounds with Kardex, orders, nurses notes, neurological assessment checklist, pre-simulation activity form, evaluation-debriefing form, priority form, and references.

Evaluation Description:

Evaluation of objectives was completed through the evaluation and debriefing of the experience. The evaluation document is attached. Students were able to identify and practice behaviors consistent with QSEN competencies. Furthermore, students were able to identify how patient care could be improved with further development of clinical judgment and critical thinking. This was evident by reviewing the feedback and how many students selected the hospice client over the client who was a full code.
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