Integrating Care Into Simulation

By Jean Ellen Zavertnik

Caring, the essence of the nursing profession, is an important concept to both the patient and the nurse. We know that caring impacts patient outcomes, patient satisfaction, and nurse satisfaction. Simulation generally focuses on practicing skills such as communication, safety, delegation, or teamwork. Simulations can, however, also provide an opportunity for the learner to “recognize the unique individual who is dynamically interconnected with others and the environment in a caring relationship” (Eggenberger & Keller, p. 42). Integrating the concept of caring into patient scenarios can help students and practitioners alike to contextualize the art and science of nursing care.  What steps can be taken to integrate caring and caring behaviors into a simulation program?

1. Educate instructors and students about caring and caring behaviors in simulation.

Example: We produced a video that describes caring and provides information about demonstrating caring behaviors in the simulated and clinical patient care settings.

2. Look for an existing scenario that lends itself to incorporating and promoting caring components.

Example: We utilized the NLN Judy and Karen Jones ACE.Z case in the fundamentals lab. The simulation focused on patient safety, communication, and caring about a patient with mild dementia and her family.

3. Provide prebriefing activities that prepare students on how they might demonstrate caring behaviors during the patient encounter.

Example: In the Judy Jones scenario, the students were required to watch a video that provided information about how to deal with a patient with dementia. Strategies included getting to know about the patient and engaging the patient in meaningful conversation about experiences. This is “knowing” about the patient – the patient’s background; social, spiritual, and psychological history; as well as medical information – all elements of caring.

4. Modify existing procedures to include aspects of caring.

Example: Our students practice the AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) method for introducing themselves and providing customer care to patients. We added a “C” for Caring.  After acknowledging the patient and introducing herself/himself, the student inquires, “As we plan our care together, please tell me what matters most to you in this moment.” This caring behavior demonstrates that the nurse is interested in knowing the patient rather than simply the patient’s illness.

5. Structure debriefing to include reflection on the caring aspects of the simulation.

Example: We have added a question on caring into our standardized debriefing tool: “What mattered most to the patient, family?” By asking this question, students can reflect on whether they included the patient and family in the care they provided and to what extent.

Other questions we use to facilitate reflection on caring include: “What did you do that was uniquely caring in this situation?” “How did you (or the nurse) uniquely express caring in this situation?” “What was important to know about this person?” 

6. Post Debriefing Reflection on Caring.

Example: Following the Judy Jones scenario, our students were asked to complete a brief reflective paper answering questions such as, “According to Mayeroff, a major component of caring is ‘knowing’ the patient. How did you (or could you) implement this into the Judy Jones geriatric scenario?”

Simulation often focuses on skill acquisition, clinical decision-making, and confidence. Technology and skill proficiency alone do not define nursing. The nurse requires authentic presence with the patient and family while demonstrating technological competence (Locsin, 2008). Integrating caring and caring behaviors into simulated patient experiences can be accomplished by intentional planning and implementation, using some of the steps outlined in this blog.


Blum, C., Hickman, C., Parcells, D., & Locsin, R. (2010). Teaching caring nursing to RN-BSN students using simulation technology. International Journal for Human Caring, 14(2), 41-50.

Coffman, S. (2016). Faculty experiences teaching caring in the simulation lab. International Journal for Human Caring, 20(4), 197-201.

Dunnington, R. M., & Farmer, S. R. (2015). Caring behaviors among student nurses interacting in scenario-based high fidelity human patient simulation. International Journal for Human Caring, 19(4), 44-49.

Eggenberger, T. L., & Keller, K. B. (2008). Grounding nursing simulations in caring: An innovative approach. International Journal for Human Caring, 12(2). 42-46.

Locsin, R. C. (2008). Caring scholar responses to: Grounding nursing simulations in caring: An innovative approach. International Journal for Human Caring, 12(2), 47-49.

Ward, G., Robinson, L., & Ware, L. (2017). The lived experience of nursing students participating in high-fidelity simulation at a school grounded in caring. International Journal for Human Caring, 21(4), 200-207.

Ware, S. M., & Schoenhofer, S. O. (2017). Perceptions of caring among baccalaureate nursing students during high-fidelity simulation. International Journal for Human Caring, 21(3), 120-133.

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