Distance Education In Nursing and Use of Clinical Simulations
Overview of Simulations In Nursing Education
An important challenge of nursing educators is to develop efficient and effective methods to teach decision making, critical thinking, and problem solving skills to an increasingly diverse population of students. In the past, educators believed it was enough to provide students with a variety of clinical experiences in which learners could apply the classroom content to become a competent nurse.
Today, however, experienced nurses, staff development educators, and managers agree that many students and new graduates lack the critical thinking skills needed to work in increasingly complex clinical environments. To meet the diverse needs of students and graduates working in these complex environments, clinical simulations are being designed and implemented in nursing courses and programs.
Providing simulations in nursing education is a relatively efficient method of teaching content and critical thinking skills safely and in collaboration with the instructor without fear of causing harm to actual patients (Weis & Guyton Simmons, 1998). This can be particularly helpful in distance education, where students are not physically present with the teacher to practice clinical techniques. This practice can be “simulated” through CD ROMs, the Internet, or by use of a preceptor model.
Using a preceptor model, an assigned responsible person can be accountable for teaching and evaluating the learners' skills in a physical environment while the student learns content in a distance learning platform (Billings et al., in press). In this chapter, advantages and challenges of using simulations, general concepts of using simulations, and how simulations are being used in distance education today will be described.
Additional sections will discuss simulations used as:
(a) a teaching-learning intervention
(b) an enhancement to clinical practice
(c) an assessment method
(d) a blended teaching learning model when combined with distance education. Implications for the nursing educator related to these multiple uses will be discussed.
Incorporating simulations into the educational environment provides many advantages, but implementing simulation strategies can also challenge the educator. Despite the challenges, however, this innovative, interactive educational strategy is being used increasingly in many different arenas of health care and other disciplines.
General Concepts of Simulations
Types of simulations
Simulations are defined as events or situations made to resemble clinical practice as closely as possible (Seropian, 2003). Various types of simulations are being incorporated into the teaching-learning environment today. Full scale patient simulations using high fidelity, sophisticated patient simulators provide a high level of interactivity and realism to the learner.
Less sophisticated, but still educationally useful, other simulations involve the use of computer based simulations in which the participant relies on a two dimensional focused experience to solve problem, perform a skill, or make decisions during the clinical scenario. Studies have shown the two dimensional experience has merit in terms of positive learning outcomes and skill acquisition (Jeffries, Woolf, & Linde, 2003).
Part task training devices, such as IV arms and haptic (forced feedback) IV trainers are used in simulations for psychomotor skills with the learner able to practice a skill repeatedly before performing it on a real patient. The part task trainers typically ensure a satisfactory rate of achievement of objectives and benefit to the participant.
Studies have shown that these task trainers do instruct the participants on the psychomotor skill and that the skill set is transferred to the real patient environment (Engum & Jeffries, 2003; Hovancsek, Horn, Jamison, & Narsavage, 2004). Programs or courses in which the task trainers are used include clinical laboratory courses and modules during which specific skill sets and goals need to be obtained.
From a distance learning environment, the course content can be learned from the Web-based course, with the actual skill being assigned to be performed in the laboratory on a task trainer with a preceptor facilitating the experience. Two dimensional CD ROMs can also provide interactive practice with skills if simulators are not available.
The Instructor's Role In Use of Simulator
Teachers are essential to the success of using interactive learning experiences such as simulations. Teachers can facilitate learning by providing learner support in the form of cueing (providing hints and a direction) during the simulation experience and conducting a reflection guided time following the simulation experience. Guided reflection is structured to provide feedback to students about their decision making but is also a time for learners to reflect on their experience, emotions, and clinical competence.
Reflection time can vary, but because of its importance it should be given at least the same amount of time as the simulation itself (ie, 20 minute simulation, 20 minute guided reflection).Although the literature does not define the teacher's role very specifically in this context, it is known that the instructor is an integral part of any simulation. Weis and Guyton-Simmons (1998) during computer based simulated experiences discussed how students solved problems better when a faculty member was present.
Depending on whether the simulation is being conducted for learning or evaluation purposes, the teacher's role during the process will vary. However, unlike the traditional classroom, the instruction is no longer teacher-centered, but student-centered, with the teacher playing the role of a facilitator in the students' learning process. Teacher facilitation in distance learning can take place in numerous ways such as posting in discussion forums, through list serves, live chat rooms, or just simple e-mails sent to the individual students.
Educators must be prepared and feel comfortable with the simulations they are designing and implementing. Immersing educators into a simulation can allow the teachers to experience feelings similar to those of students, enabling them to understand students' anxiety and discomfort related to the simulation experience. To assume the role of the teacher in simulations, educators may require assistance in relation to design and activities, use of the technology, and setting up of the simulation and equipment.
Learner's Role for Use of Simulator
Learners need to have specific information about the roles they are to play, particularly if the students are to work in groups. In simulations, learners usually play specific roles within the activity, with the roles varying from case to case. The literature suggests anywhere from 2 to 6 participants in a simulation. Learners can rotate through assigned roles in addition to talking about the various roles during the guided reflection time.
Cioffi (2001) discussed two learner roles (response-based and process-based) when simulations are implemented in clinical practice. In the response-based role, the learner is not an active participant and has no control over the data presented. An example of this type of presentation would be assigning a student an observer role. These learners would not be active participants during the simulation, but could provide responses during the guided reflection on their perceptions of how the scenario unfolded.
In the process based method, the learners are active participants in the simulation, such as through patient role-plays or being assigned active roles in the simulated activities. In distance education settings, roles can be assigned for a particular debate, for example, an ethical, legal topic that is seen in nursing today. Students can be assigned roles to take part in this online debate and post accordingly in the discussion forum.
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