Simulators Us for Nursing Education and Benefits for Learning
What are Simulators
Simulation is an active learning strategy that uses devices or techniques to develop an environment that closely represents a clinical setting, as well as provides educators safe, hands-on approaches to teaching and assessing psycho-motor, communication, and critical-thinking skills (Blevins, 2014). Simulation is “a dynamic process involving the creation of a hypothetical opportunity that incorporates an authentic representation of reality, facilitates active student engagement, and integrates the complexities of practical and theoretical learning with opportunity for repetition, feedback, evaluation, and reflection” (Bland, Topping, & Wood, 2011, p. 668)
Types of Variety of Simulators
A variety of simulator types can be used from the very simple to very high tech. Simulator types include part task simulators that focus on a specific part of the body (eg. mannequins used in cardiopulmonary resuscitation training) simulated patients who are trained to act like patients; screen-based computer simulators that use web or computer assisted programs and integrated simulators that are capable of producing physiological responses (eg, full sized adult. pediatric or obstetrical simulators: Durham & Alden, 2008)Jeffries” (2005) simulation in the nursing education framework has been widely used in nursing education.
The model has six specific areas that must be addressed when designing simulation objectives. planning, fidelity, complexity, cues, and debriefing Objectives describe what the students should know or be able to do at the end of the simulation. Planning activities address each objective and identify needed information related to role expectations, mental and physical co-morbid conditions, timelines, expected outcomes, props, and equipment.
Fidelity or realism focuses on the need for the experience to reflect clinical reality. Cues are provided by the faculty who act as facilitators and provide learner support and debriefing, Debriefing allows students an opportunity to engage in reflective learning and to link theory, research, and practice into effective interventions in complex situations (Jeffries, 2005).
Beneficial Aspects of Simulator Use In Nursing Education
T he beneficial outcomes of including simulation throughout an undergraduate nursing program are reduced levels of anxiety in students, increased knowledge retention, and development of psycho-motor, communication, and critical-thinking skills within a safe environment (Stroup, 2014), Kelly , Hager, and Gallagher (2014) asked 102 nursing students to rank 11 components of simulation in terms of making a contribution to enhancing clinical judgment. Facilitated debriefing, post simulation reflection, and guidance by the educator were ranked as most beneficial.
Reviewing the audio-taped simulation and patient case notes was ranked as least beneficial. Jeffries et al. (2011) implemented a simulation-based cardiovascular assessment program in four universities using a full-sized adult mannequin. Thirty six advanced practice nursing students participated and reported significant improvements in their self-confidence to perform cardiovascular assessment, and were extremely satisfied with the simulation methods as an effective teaching strategy.
Sixty second year associate degree nursing students participated in an obstetrical simulation experience and audio taped their reflections of the experience Qualitative analysis revealed three themes: the nonthreatening environment, enhancement of learning, and feeling more prepared to practice (Partin, Payne, & Slemmons, 2011). Three hundred third-year nursing students reported high-fidelity simulation using three different scenarios to be enjoyable, challenging, and matched well with course content (Wotton, Davis, Button, & Kelton, 2010).
Students also found debriefing to be important for clarification and providing a rationale for practice. Students did, however, report having short episodes of feeling confused when the simulated patient's clinical condition changed. Kaplan and Ura (2010) developed a simulation based learning experience to increase senior nursing students' confidence, as well as their ability to safely and effectively prioritize, delegate. and implement care. Ninety seven students rated that they agreed or strongly agreed that the simulation experience was well organized, realistic, and increased their understanding of prioritization and delegation Over three quarters of the participants also reported having more confidence in their leadership abilities.
Brewer (2011) conducted an integrated review of the literature and summarized that students and faculty view simulation positively, yet most of the studies are qualitative with the need for more quantitative research.The use of simulation has been found to be an effective, interactive teaching strategy. Nursing students have reported simulation experiences provide safe, informative opportunities to practice communication and technical skills. Outcomes of simulation experiences that have been reported include increased self confidence levels, enhanced leadership skills, and feeling more prepared for real-time clinical experiences
Outcomes of Simulators Use for Nursing Education
The need to provide undergraduate nursing students with clinical experiences that will foster competencies in acute and chronic illness management, clinical reasoning, assessment, diagnosis, and intervention is paramount. Challenges of finding clinical placements for students have made it difficult for nursing educators to provide necessary experiences. One solution to address clinical placement shortage is the use of simulation.
According to Bland, Topping, and Tobbell (2014), nursing educators should also be aware of the limitations of using simulation in terms of authenticity. Although high-fidelity simulators are designed to be realistic with heart rates, breathing sounds, moaning, and crying, some students may still find these experiences lacking authenticity. Further research is needed to better understand the relationships between fidelity, authenticity, and learning to improve the effectiveness of simulation in nursing education.
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