Patient safety in the 'Room of Horrors' simulation: a multi-method study of student, novice, and experienced nurses

Abstract

Background: Patient safety is a critical concern in healthcare, with unsafe care causing significant harm. Nurses play a vital role in promoting safety and must be equipped with the skills to identify and manage safety hazards. The Room of Horrors (ROH) simulation was developed to enhance these skills by presenting learners with a simulated patient scenario containing safety hazards. This study aimed to evaluate the effectiveness of the simulation by (1) comparing hazard recognition performance across different groups; (2) assessing changes in self-perceived patient safety competency and confidence; (3) exploring participants' simulation experiences; and (4) examining perceived benefits for clinical practice.

Methods: A multi-method design was employed, incorporating a quasi-experimental three-group pre-test, post-test, and two-week follow-up structure, and a qualitative analysis of participants' experiences and perceptions. The study involved participants from one nursing college and five hospitals in Korea. The sample (N = 90) comprised three groups: nursing students (n = 30), novice nurses (n = 30), and experienced nurses (n = 30). Participants underwent a 20-minute pre-briefing, 10-minute simulation, 10-minute self-reflection, and 40-minute debriefing session. Data were collected through structured surveys on patient safety competency, confidence, and open-ended questions about participants' experiences and perceptions. Two-week follow-up surveys evaluated perceived clinical relevance. Quantitative data were analyzed using descriptive statistics and regression analysis; qualitative data were analyzed through content analysis.

Results: Experienced nurses identified significantly more hazards, including those requiring two-step logical reasoning, than nursing students and novice nurses. Both novice and experienced nurses showed improvements in safety competency and confidence. Participant feedback was overwhelmingly positive, particularly highlighting the value of debriefing. The two-week follow-up indicated that almost all participants had applied the knowledge gained through the simulation in their clinical practice.

Conclusions: The ROH simulation enhances self-reported patient safety competency and confidence, especially among experienced nurses, supporting its integration into nursing education and continuing professional development. Findings also suggest the importance of tailoring scenario complexity and debriefing strategies to learner readiness and highlight the potential value of integrating ROH simulations into experience-sensitive safety training programs. Further research is warranted to investigate its long-term impact on clinical practice.

Trial registration: Not applicable.