Enhancement of Learning In Distant Nursing Education By Use of Simulation
Simulation As An Enhancement To Clinical Practice
Already noted were dynamics of the clinical area: increased staff workload, increased patient acuity, highly technical environment, shortened patient stays, and demands of increased nursing enrollments that limit the clinical facility's ability to be an ideal learning environment. Although research showing the effects of simulation on clinical performance is not well established, studies have shown positive effects on students' confidence as well as on student learning.
A study of the impact of an interactive videodisc simulation on the confidence and knowledge of junior maternity students revealed the positive impact of the preparatory simulation preceding clinical experience over student clinical experience alone (Weiner et al., 1993). At Bell College of Health Studies in Dumfries, Australia, the challenge of greatly increased numbers of nursing students needing foundational experiences was met by providing a skills week (Mayne et al., 2004).
In the context of case studies, the students made careful decisions and practiced skills while learning about teamwork. A study by medical educators at the University of Texas at Galveston described the preparation of students in cardiopulmonary physical examination skills. The educators, driven by the belief that “bedside teaching is becoming a lost art,” turned to a simulation program for instruction, practice, and assessment (Karnath, Thorton, & Frye, 2002).
The international threat of terrorism has expanded nursing roles related to disaster nursing. Fortunately, this clinical training venue rarely exists and therefore simulation is employed to train health care professionals. Two programs the Joint Trauma Training Center and United States Air Force Nursing Wars kills Simulation Laboratory use simulation as a teaching modality to ensure that nurses are prepared to respond to international medical disasters.
Learning outcomes testing critical decision making and trauma skills show that both programs are successful in nurses preparing to provide care to critically injured military personnel and civilians (Bruce et al., 2003). The tendency to enter advanced practice roles early in one's career means that the student does not bring a wealth of professional experience learned from years of practice to the graduate study setting.
Simulation experiences representing situational realities of practice can be used effectively to develop skills previously learned from practice experience.Miller, Wilber, Dedhiya, Talashek, and Mrtek (2004) used simulated patients (SPs) to assess the interpersonal skills of nurse practitioner students. They found the experience to be profitable for these students, who benefited from the immediate and candid feedback offered by the SPs.
In a distance education setting, the encounters with the SPs can be videotaped and linked to the content in order for the learner to assess the interpersonal skills of the caregivers in the vignette. The videotaped activity can also provide a mentoring model emphasizing good interpersonal skills for the learner.
In general, the factor that determines whether an individual has no skill, some skill, or complete mastery of a skill is the amount of deliberate practice that that person has completed (Issenberg et al., 1999). One problem in health care education has been that the situational practice usually involved a real patient. This problem creates the need for new methods of instruction, knowledge acquisition, and assessment of students.
Advances in simulation technology as well as advances in pedagogical knowledge concerning how to use simulations present new tools and new methods for overcoming this challenge.
Unlike patients, simulators do not become embarrassed, stressed, or injured; have predictable behavior; are available at any time to fit resume needs; can be programmed to simulate selected findings, conditions, situations, and complications; allow standardized experience for all trainees; can be used repeatedly with fidelity and reproducibility; and can be used to train individuals and teams for procedures and difficult management situations (Issenberg et al., 1999).
Simulation As An Assessment Method In Distant Education
Simulations are increasingly being used in assessment of health professionals (Schuwirth & Vander Vleuten, 2003). Ever since the use of simulation in preparing health care professionals began in anesthesia, there is considerable information in the anesthesia literature about the use of simulation in performance assessment (Byrne & Greaves, 2001). The use of simulation in assessment falls into two broad categories: low stakes and high stakes situations (Boulet & Swanson, 2004).
These assessments may use a range of simulation technologies, from case studies and standardized patients to haptic task trainers and high fidelity human simulators. Low stakes assessments are situations where the simulation is used by the learner or faculty to mark progress toward personal, course, or program learning goals.
High stakes assessments include licensing and certification examinations, credentialing processes, and employment decisions. As with any type of assessment, issues of validity and reliability must be considered (Boulet et al., 2003; Clauser, Kane, & Swanson, 2002).
For low stakes assessments, construct and concurrent validity should be addressed. Construct validity is the degree to which an assessment instrument measures the dimensions of knowledge or skill development intended. Concurrent validity is determined by evaluating the relationship between how individuals perform on the new assessment (in this case a simulation) and the traditional (standard) assessment instrument.
An example of how this concurrent validity can be evaluated is following a learning exercise, a pelvic exam for example, students would be asked to perform the exam on a simulator (eg, METT's Exam Sim) and on a standardized patient (Pugh & Youngblood, 2003). An assessment with high concurrent validity is one in which the learner's simulator assessment score is comparable to the score achieved when performing the same exam on a standardized patient, using an accepted scoring checklist.
Predictive validity is required for simulations used in high stakes assessments. Determining predictive validity is a complex process that takes a significant amount of time and can be quite expensive. Predictive validity is the extent to which performance on a particular simulation predicts a future performance, such as decision making or psychomotor skillfulness in a real-world clinical situation.
Evaluating predictive validity requires that in addition to performance on the simulation, clinical skill or decision making of specific individuals be tracked over time. Assessment of the clinical performance over time is required so that a calculation can be made of the degree of certainty that one can have about the ability of the performance on a simulation to predict future performance. Evaluating the reliability of assessments conducted using simulation can be difficult. In order to determine the reliability, or reproducibility,
Simulations As Blended Teaching Learning Model With Distance Education
The impact of the World Wide Web on nursing education has been significant. Many researchers (Chaffin & Maddux, 2004; Lindeman, 2000) believe this is an era of rapid change for nursing education, with technology being the change agent. This shifting paradigm, teaching and learning via the Internet, coupled with the increased use of simulations and simulated learning, has great implications for nursing education.
Nursing education is no longer limited to the domain of the university, college, or hospital classroom. Education can be accessed in many cases through the Internet using asynchronous communication, e-mail, listservs, newsgroups, and conferencing (Carlton & Miller, 1999). Just a decade ago, there was a lot of uncertainty with learning on the Internet; However, today nontraditional innovation in nursing is ever present.
New modes of instructional methods using technology have arrived, such as the use of personal data assistants (PDAs) to retrieve and store information and resources (Thomas, Coppola, & Feldman, 2001); the use of the Internet for students to obtain a clinical practicum and instruction (Baier & Mueggenburg, 2001; Billings & Jeffries, 2004).
Health assessments being performed worldwide using the Internet (Scherubel, 2001); instruction on suturing wounds using virtual reality (Parvati et al., 2002); certification renewal in special procedures using simulators in an online environment (Thacker, 2004); and remediation for struggling students using the online environment and a patient simulator (Haskvitz & Koop, 2004).
Nursing educators value simulated teaching and learning. Clinical and community instruction have been a core part of educating nursing students for many years. Nurse educators have employed numerous inter active, experiential, simulated processes in the classroom such as role play, using case scenarios (Lee & Lamp, 2003; Tomey, 2003), simulations reenacting realistic scenarios (Morton, 1999), gaming (Foster & Hardy, 1997), and other interactive activities.
Nursing educators have also incorporated various modes of media and technology into the educational process such as PowerPoint presentations, videos, webcasting, and the use of electronic portfolios. The interactive teaching-learning strategy in this section combines these two educational traditions simulated learning with the technological. Selected examples of the blended use of simulated learning (eg, use of simulations) and technological learning (ie, use of distance education) will be described, as well as nursing implications of this educational strategy.
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