Patient safety in the ‘Room of Horrors’ simulation: a multi-method study of student, novice, and experienced nurses
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".