Enhancing Nursing Education through Simulation

By Kellie Bryant, Director of Simulation Learning and Assistant Clinical Professor, New York University

Kellie Bryant, Director of Simulation Learning and Assistant Clinical Professor, New York University

Introduction

Simulation has played a significant role in the training of pilots and doctors however the integration of simulation into nursing education has become increasingly popular during the past decade. One of the major incentives for increasing the use of simulation is the alarming rate of patient deaths (440,000 deaths per year) attributed to medical errors. Based on this finding the Institute of Medicine has recommended use of simulation to enhance the education of healthcare providers and decrease medical errors. The use of simulation as a teaching strategy can promote patient safety by providing learners the opportunities to practice caring for simulated patients with various medical conditions within a safe learning environment. The popularity of simulation has caused a paradigm shift to increase use of simulation to educate and evaluate nursing students with the goal of graduating safe and competent future nurses. This article will provide an overview on the use of simulation in nursing education.

Overview of Simulation in Nursing Education

Simulation is the imitation of a real world process to achieve educational goals through experiential learning. Simulation can take many forms including role playing, virtual simulation, use of Human Patient Simulators (HPS) and Standardized Patients. HPS are full body manikins that have the ability to simulate human responses such as breathing, simulated heart sounds, secretion of bodily fluids, and can even speak. The HPS can be used to teach basic nursing skills such as obtaining a blood pressure with fresher to more complex simulation sessions as students advance in the program.

Many nursing programs are using simulation as a teaching strategy to enhance patient safety through critical thinking, problem solving, and enhancing psychomotor skills. Simulation has become an increasingly integral component of nursing programs with its use varying between less than 10 percent of clinical time to 50 percent of a student’s clinical experience. Although there is no established method of implementing a simulation, there are some basic components and principles of running an effective session. Most simulation sessions consist of three components, the first is the pre-simulation stage which serves to prepare the learner for the session by asking the learner questions about the scenario. This is followed by the actual simulation session which consists of the leaner caring for the “patient” experiencing a medical condition.

Simulation as an instructional strategy holds great promise for nursing education due to its potential to improve patient outcomes

The last stage is the debriefing stage which is a reflective discussion. With the learners that is facilitated by the instructor. The purpose of debriefing is to release emotions, analyze the learner’s actions and thought processes in order to improve their nursing practice.

Benefits of Simulation

Simulation as an instructional strategy holds great promise for nursing education due to its potential to improve patient outcomes. The use of simulation allows students to develop, practice, and apply knowledge and skills in the context of a simulated clinical scenario. Simulations can be customized to ensure students are exposed to clinical experiences that are difficult to obtain or encounter such as witnessing a live birth or caring for of a patient experiencing an allergic reaction. Research has shown that there are many advantages of using simulation in the field of nursing. The major advantage of use of simulation is that it provides a standardized learning experience without the risk of harming an actual patient. Students have the ability to make mistakes and turn them into learning opportunities. Simulation can be used to enhance communication skills to compensate for nursing student’s lack of opportunities to speak to other members of the health care in the clinical setting. Lastly the use of simulation has proven to increase students’ self-confidence and reduce anxiety during real patient care encounters.

The largest simulation study was conducted by The National Council of State Board of Nursing (2011) which involves comparing nursing students from 10 different schools with varies amounts of simulation. Students were divided into three groups which had various amounts simulation: a control group (10 percent or less of clinical time as simulation), 25 percent simulation group, and a group that had 50 percent simulation as clinical hours.

The results of the study found that students who had 50 percent simulation scored just as well as the other groups on the National nursing license examination. The study found no significant difference between the groups in critical thinking, clinical competency and overall readiness for practice as rated by managers at six weeks, three months and six months after working in a Registered Nursing (RN) position.

Challenges and Limitations

Although there are many advantages of using simulation in nursing education, there are also limitation and challenges. Since simulation is a relative new teaching modality, there are obstacles that schools need to overcome before implementing a simulation program. As with any profession, changing the way we educate students can be fought with challenge from educators who are comfortable with old teaching methods. The cost of the manikins, physical space, supplies, and faculty time can be exorbitant. The use of simulation is only as good as the faculty who use it. Educators new to simulation need to be trained to follow the principles of simulation education. Financial support is also needed from administration to compensate faculty for training, developing scenarios and running simulation sessions. Establishing consistency among instructors teaching simulations can be a major challenge. Unfamiliarity with the simulator and fear of the technology may evoke anxiety in students and faculty. Lastly the HPS are limited in their ability to simulate human interaction, physiological functions, and ability to express human emotions which can affect the realism of the simulation experience.

Conclusion

Simulation is an innovative teaching/learning method that allows students the opportunity to incorporate knowledge, psychomotor skills, evidence-based practice and critical thinking in caring for a simulated patient. More studies are needed to examine the best ways to effectively implement simulation as a teaching strategy. The ultimate goal is to determine if simulation translates into improved patient care and patient safety which would substantiate the cost of implementing a simulation program.

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