Embedding Sustainable Second-Order Problem-Solving Behaviour in Hospital Nurses via Simulation-Based Education

Area of Science:

• Healthcare quality improvement
• Nursing practice
• Patient safety research

Background:

• Second-order problem-solving is vital for addressing complex healthcare system failures.
• Nurses face barriers to sustainable problem-solving, including time pressure and normalization of deviance.
• Existing interventions often fail to bridge the gap between awareness and action.

Purpose of the Study:

• To identify strategies for fostering sustainable second-order problem-solving behaviors among hospital nurses.
• To evaluate the impact of an emotive audio narrative stimulus on nurse problem-solving.
• To examine barriers and enablers to problem-solving in a simulated clinical environment.

Main Methods:

• A mixed-methods observational study involving 80 hospital nurses.
• Random assignment to an emotive patient-safety audio narrative or control condition.
• Analysis of real-time behaviors during simulated tasks and semi-structured interviews for recommendations.

Main Results:

• Operational failures were widely detected (96.2%), but second-order problem-solving remained infrequent (21.9%).
• The emotive narrative increased emotional responses but not escalation or reporting behaviors.
• Barriers included normalization of deviance and time pressure; enablers were team debriefings, audit-feedback, and simulation training.

Conclusions:

• Emotional triggers enhance awareness but do not directly translate to action.
• Sustainable second-order problem-solving requires organizational strategies empowering nurses.
• Team reflection, audit feedback, and simulation training are key to strengthening system learning and improving flawed processes.