Simulator Use and Impact on Learning Domains In Nursing Education

Learning Domains In Nursing Education and Simulator Use and Impact

Simulation As A Teaching Learning Intervention,Impact of Simulator Use on Learning Domains,Affective Domain,Cognitive Domain,Psychomotor domain.

Simulation As A Teaching Learning Intervention

    As early as the late 1970s simulation was recognized as an effective training technique for critical skills such as those used in military maneuvers and flying. Over the last decade, simulation has been gaining accерtance as an invaluable educational tool for health care students because through the use of simulation students can be better prepared to provide competent and safe care for their patients.

    In the late 1970s, when many of today's nursing educators were students in skills laboratories, few students probably thought of the mannequin in the nursing lab's hospital bed as anything but an occupant. Likewise, their instructors probably saw the same mannequin as simply a physical object to be turned and manipulated as students practiced the art of making an occupied bed. 

    Not only has our conceptualization of the educational potential of simulation grown and matured in subsequent decades, but also the array of simulation modalities has multiplied. Partial-task trainers such as haptic IV start trainers and blood pressure arms assist students to achieve competence and confidence in the performance of a skill. 

    Computer assisted technology employs software that can challenge the user to apply knowledge and skills and to use critical thinking in real time (Seropian, 2003). Full bodied computerized and interactive human patient simulators are now affordable and prevalent in nursing learning resource centers and provide a physiologically accurate and realistic representation of a human patient.

    The importance of integrating simulation into nursing education is based on the fact that adequate clinical learning cannot be accomplished in the clinical arena alone (Carthew, 1998). Shortened hospital stays, increased patient loads, use of sophisticated technology on inpatient divisions, lack of appropriate professional nursing role models, and increased student enrollment all contribute to the problem of new graduates not being well prepared to handle the demands of the clinical care area. 

    Using simulation as a teaching tool promotes the acquisition of skills that can better prepare the novice nurse. Students can be exposed to a baseline set of experiences, from fundamental core skills to complex scenarios, and evaluated in the mastery of fundamental as well as advanced challenges that require students to apply knowledge and use critical thinking skills. 

    The simulation activities ideally include working as a member of the health care team. The instructor provides feedback and redirects the student in the controlled environment. No harm can come to the patient. For these reasons, simulations are already being used for competence testing for health professionals (Issenberg et al., 1999). 

    The literature contains examples of simulation being used in the teaching learning process for emerging care skills in health care programs, particularly in medical education. Gordon (2000) described a program at the University of Michigan where medical students were exposed to training scenarios designed to assist them to prepare for the care of acutely ill patients. 

    In Melbourne, Australia, high-fidelity human patient simulation was used to help students learn to care for patients experiencing a medical crisis, such as hemorrhagic shock (Flanagan, Nestal, & Joseph, 2004). Other sources describe computer-assisted simulation employed to assist students to acquire and retain advanced cardiac life support (ACLS) skills (Schwid, Rooke, Ross, & Silvarajan, 1999).

    In addition to preparing students for medical crises, simulation has been used as a strategy to prepare students for performing foundational skills and acquiring core knowledge. Carthew (1998) examined the role of the skills laboratory as a setting in which beginning students work on foundational skill attainment. She maintained that, with mastery of a full set of core psychomotor skills, students gain confidence and are more likely to perform efficiently in a current patient care encounter. 

    At Griffith University in Brisbane, Australia, clinical simulations are used to help beginning students develop problem solving and clinical decision making skills (Conrick, Dunne, & Skinner, 2004). 

    Recognizing the enormous interest in using simulation and simulation products in nursing learning resource centers, some of which are very expensive, the National League for Nursing (NLN) and the Laerdal Corporation, an international leader in medical educational and total training products, together sponsored a national multisite, multimethod study to develop and test models using simulation to promote student learning in nursing (NLN, Laerdal, 2003).

    Other primary purposes of the project include developing a cadre of nursing faculty who can use simulations that enhance student learning; and contributing to the refinement of the body of knowledge related to the use of simulation in nursing education (NLN, Laerdal, 2003).

Impact of Simulator Use on Learning Domains

    The skilled nursing professional must demonstrate competence across three domains: psychomotor, affective, and cognitive. Initially the use of simulation in clinical labs focused on the development of psychomotor skills to prepare beginning students for clinical experiences. 

    However, the advantages of simulation have more frequently been reported in affective and cognitive domains. Although the literature to date contains few quantitative evaluations of simulation, anecdotal and subjective examples are easily found. 

Affective Domain

    Students who have experienced simulation instruction want more opportunities to learn in this manner (Conrick et al., 2004; Gordon, 2000). Students required to participate in a simulation report feeling performance anxiety yet appreciate that this learning experience provides more safety to their current patients (Conrick et al., 2004). Consistently, students report greater confidence and self-efficacy in the protected environment (Mayne et al., 2004; Weiner, Gordon, & Gilman, 1993). 

Cognitive Domain

    Simulation as a teaching-learning intervention increases critical thinking skills and sound clinical judgment (Bruce, Bridges, & Holcomb, 2003). Additionally, studies report better acquisition of knowledge in general (Weiner et al., 1993). The literature often compares simulation experiences as an aid to knowledge retention to traditional instructional experiences alone (Schwid et al., 1999). 

    Working in complexly designed scenarios, students in one study appeared to demonstrate a sense of the value of professional teamwork and displayed an effort to provide holistic care (Mayne et al., 2004). Another study found that students studied more using simulation than they did with traditional textbook resources (Schwid et al., 1999). 

Psychomotor Domain

    From fundamental skill sets to complex and realistic scenarios, the use of simulation affords students the ability to practice in a protected and controlled environment as they progress through the nursing curriculum. Students can be exposed to a full set of skills, including practicing emergent medical crises under the supervision and with the guidance of a faculty member in a “do no harm” environment. 

    Motor skills and the use of highly technical equipment found in the acute and critical care settings can be practiced repeatedly without risk or inconvenience to patients through an assigned preceptor in their locations, yet the student can learn the content related to the skills through an online platform .

    From the educator's perspective, except for the use of the simplest task trainer, the architecture of a simulation experience is an enormous challenge. However, evidence suggests that students are helped to bridge the theory-practice gap, retain information better, and show more self confidence in beginning practice and desire to practice clinical skills. 

    Faculty who are experienced with using simulation evaluate it as an efficacious and efficient method for measuring students' critical thinking and psychomotor skills. More research is needed to identify what components make up an ideal simulated environment, including the faculty role, and to quantify the learner outcomes when using simulation and how it is best used or blended with distance education. Faculty need technical and pedagogical support within schools of nursing in designing and implementing simulations for students at all levels.