Patient Safety and Use of Simulators for Nursing Education
Simulator Use and Patient Safety
Simulation is the technique of imitating real experiences with guided experiences that replicate significant aspects of the real world in a fully interactive manner (Gaba &e DeAnda, 1987). It is performed primarily for the purpose of study or training, Simulation has roots in aviation like the aviation industry, simulation in health care is aimed at safety of the consumer, or, more specifically, the patient.
Useful Structured Use of Simulation In Nursing Education
Nursing has generated many useful structures and standards for the implementation of simulation toward patient safety. In an annual message, the president of the International Nursing Association for Clinical Simulation and Learning (INACSL) recently affirmed that patient safety is the primary focus of health care simulation (Durham, 2014) INACSL has been a leader in the promotion and dissemination of evidence based practice standards for clinical simulation methodologies, research, and education. INACSL updated the standards for best practice in simulation, which consist of terminology, professional integrity of participants, participant objectives, facilitation, facilitator, the debriefing process, and participant assessment and evaluation (Clinical Simulation in Nursing, 2013).
Through collaborative work with the National League for Nursing, Jeffries created the Jeffries' simulation model (Jeffries, 2005). The model was developed from the theoretical and empirical literature related to simulation and identifies essential aspects of simulation design that bolster student outcomes. The factors of model include teacher factors, student factors, educational practices, design of specific simulation experiences, and student outcomes (Jeffries, 2005).
During the same time period, a group of nursing researchers developed a comprehensive approach to ensure patient safety competencies were being addressed in nursing education. The six competencies of quality and safety education for nurses (QSEN) are patient-centered care, teamwork and collaboration, evidence based practice, quality improvement, safety, and informatics (Cronenwett et al. 2007). It has been stipulated that these competencies cannot be mastered through a didactic approach (Cronemwett et al. 2007), simulation is essential to the integration of patient safety competencies in nursing education and their sustainment in nursing practice.
Nursing literature specific to simulation and patient safety includes the evaluation of patient safety competencies (Henneman et al., 2010), improvement of patient safety behaviors (Gantt & Webb Corbett, 2010), and improvement in medication administration performance (Harris, Pittiglio , Newton, & Moore, 2014; Sears, Goldsworthy & Goodman, 2010) Henneman et al. (2010) examined the types of errors that occurred or were recognized and corrected in a simulated clinical environment. The authors reported that all students committed an error and thus concluded that greater emphasis is needed on effective educational interventions to teach patient safety (Henneman et al., 2010).
These findings endorse simulation as an effective method to evaluate patient safety competencies.Looking to influence patient safety behaviors in student nurses, Gantt and Webb Corbett (2010) reported improved patient safety behaviors with simulation as an educational intervention. The authors found that simulation provides an opportunity to teach patient safety with well-defined standards for performance of many QSEN competencies. These findings support the use of simulation to incorporate QSEN competencies.
Simulation methods should be re-conceptualized by nursing faculty as not only teaching tools for clinical situations, but as tools that can be used by greater numbers of students at various levels of nursing to integrate patient safety competencies (Harris et al. 2014).Nursing research has also focused on medication safety using simulation as an educational intervention (Harris et al. 2014; Sears et al., 2010). Harris, Pittiglio, Newton, and Moore (2014) examined the effects of simulation on safe medication preparation in junior-level nursing students and reported significantly higher performance in students who experienced simulation.
Sears, Goldsworthy, and Goodman (2010) used a quasi-experimental design to examine whether the use of simulation could help reduce medication administration errors and reported study results that demonstrate a positive effect of simulation on the reduction of medication administration errors. Although samples in both studies were small, findings suggest that simulation education may contribute to a reduction in medication errors involving student nurses. Both studies contribute to knowledge in the area of simulation in nursing education and patient safety specific to medication administration, replication and expansion in this area are recommended (Harris et al. 2014: Sears et al., 2010).
It is noteworthy that most research in the area of simulation and patient safety has been performed in adult patient simulation with lit the focus on the pediatric population Zhang, Thompson, & Miller, 2011). Simulations may be of particular interest to pediatric patient safety because of children's size and the nature of physiological reserves, as well as the added stress to health care providers that parents at the bedside can bring (Gaba, 2007, Harris, 2011), Simulation intervention in pediatric nursing education has shown significant increases in student clinical scores and anedotal reports of increased confidence in the clinical setting (Harris, 2011).
Effectiveness of Simulation Use In Nursing Education
Simulation in nursing education has shown to be useful in evaluating patient safety competencies and improving those competencies, specifically in the area of medication administration safety. From an integrative review of patient safety and simulation in nursing education, Berndt (2014) reported simulation to be more effective than traditional didactic methods. Furthermore, it was concluded that existing evidence supports the efficacy of simulation in teaching patient safety competencies. Future research needs to include more rigorous design with larger samples from multiple sites.
Simulation helps reduce medical errors and encourages patient safety. Although the up-front costs of establishing simulation centers may be high, the long term cost will be recovered from the consequent decrease in medical errors and subsequent increase in patient safety (Abraham, Wade, O'Connell, Desharnais, & Jacoby, 2011). The key drivers to further simulation efforts to improve patient safety include public interest, liability insurers, professional organizations, accrediting bodies, and government regulatory organizations (Gaba, 2007).
Effects on Health System and Learning
In many health systems currently, emphasis is placed on basic science education, individual knowledge and skill, and an apprenticeship model of training. Simulation needs to play a principal role in the education, training, and clinical care sustainability of health care providers. Simulation provides both structure and standardization of basic education, training, and continued education of practitioners to achieve excellence in patient safety.
A transformation of the entire education, training, and continued education of health care providers is called for in the literature (Gaba, 2007, Zhang et al. 2011) Simulation will be an important bottom-up tool for creating and maintaining a culture of safety and for fostering changes in work procedures and communication systems (Gaba, 2007).
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