Patient Safety and Medical Errors in Nursing Education: Learning by Doing and Experiencing With Simulated Patients

One of the contemporary teaching methods that meets the requirements of today's nursing education system is simulation (Ünver et al., 2018; Özdemir, 2023). The type of simulation that has gained worldwide recognition is simulated patient application (Johnson et al., 2020). It is often emphasised that nursing students have no chance to make mistakes in clinical practice (Kuo et al., 2020). The dilemma created by this situation necessitates the use of teaching methods that do not carry risk, such as simulated patients, and provide learning experiences through doing and experiencing. Working with simulated patients allows students to experience real patient care in a safe environment (Yalcinturk, Ustun, 2023). Students can work individually or in groups in simulated patient education and see the normal or abnormal results of the intervention they apply (Ünver et al., 2018). In this context, simulated patient education supports students to be active throughout the process rather than passive listeners, to use their cognitive, affective, and psychomotor skills, and to relate the data they obtain from the simulated patient. In simulated patient education, a major advantage that increases the effectiveness of the training is that students experience situations that put patient safety at risk first-hand and, if they cannot prevent the risks, see the possible harm in advance (Sarmasoğlu et al., 2016; Uslu and Yavuz van Giersbergen, 2019). In this context, traditional teaching methods are insufficient in imparting knowledge, skills, and attitudes related to patient safety, whereas simulated patient education provides learning by doing and experiencing.

This research will be conducted in a randomised controlled experimental design with the aim of nursing students learning patient safety and medical errors through simulated patient education by doing and experiencing.

The population of the study will consist of students enrolled in the Fundamentals of Nursing course at Gazi University Faculty of Nursing in the 2025-2026 academic year. For the sample size, a power analysis was performed using the G*Power Version 3.1.9.7 programme on 269 students enrolled in the Fundamentals of Nursing course during the 2024-2025 academic year (type 1 error: 0.05, type 2 error: 0.20, and effect size = 0.80). The sample size was determined to be 52 people in total, with 26 people in each group. In order not to reduce the statistical power of the study, it was determined that 20% more students should be included in the sample, and the sample group should consist of 62 students. In this context, the distinction will be made with 31 students in the experimental group and 31 students in the control group.

The inclusion criteria for the study were: students who had enrolled in the Fundamentals of Nursing course for the first time, had no more than 20% attendance, and volunteered to participate in the study. The exclusion criteria for the study are students who have previously performed a nursing practice on a simulated patient. The dropout criteria are the student's unwillingness to continue the practices and failure to complete the data collection forms.

Students will be administered the Patient Safety Competency Self-Evaluation Scale (pre-test), the Medical Error Tendency Scale (pre-test), a knowledge test (pre-test) developed by the researchers, and a Descriptive Characteristics form. Students will be randomised into the experimental and control groups based on their knowlege test (pre-test) mean scores.

After all students in the experimental and control groups have completed the educator-centred theoretical and laboratory applications, the study will proceed to the application phase. First, those in the experimental group will participate in scenario applications (first and second scenarios) to gain experience with simulated patients. The first scenario covers applications related to the objectives of 'correct identification of patients' and 'ensuring medication safety'. The second scenario covers applications related to the objectives of 'reducing the risks associated with falls' and 'reducing the risk of healthcare-associated infections'. One week after the simulation, the experimental group will undergo psychomotor skill assessment related to patient safety on a simulated patient, and the control group will undergo psychomotor skill assessment on a low-fidelity manikin using control lists (first skill assessment). Subsequently, all students will undergo the Patient Safety Competency Self-Evaluation Scale (post-test), the Medical Error Tendency Scale (post-test), and a knowledge test (post test). Eight weeks later, psychomotor skill assessments (second skill assessment) using control lists, the Patient Safety Competency Self-Evaluation Scale (follow up-test), the Medical Error Tendency Scale (follow-up test), and the knowledge test (follow-up test) will be administered again using the same method.

The third and fourth scenarios will be used in the first psychomotor skill assessment exam that the experimental and control groups will take. The third scenario includes skills related to the objectives of 'verifying patient identity' and 'ensuring medication safety'. The fourth scenario includes skills related to the objectives of 'reducing the risk of healthcare-associated infections' and 'reducing the risks associated with falls'. The fifth and sixth scenarios will be used in the second psychomotor skills assessment exam for the experimental and control groups. The fifth scenario includes skills related to the objectives of 'verifying patient identity' and 'ensuring medication safety'. The sixth scenario includes skills related to the objectives of 'reducing the risk of healthcare-associated infections' and 'reducing the risks associated with falls'.