Simulation In Nursing Education

The Use of Simulation in Nursing Education

Simulation is something that looks, feels, or behaves like something else, usually used for the education or training of people (Merriam-Webster). Simulation has been used as an educational and training tool for hundreds of years by various fields and professions. Recent years have seen an increase in the number of nursing students and a decrease in clinical experience available. The field of nursing has always used some type of simulation in its curriculum and now its use is changing and on the rise. Now we have to ask ourselves: is simulation an acceptable substitute for clinical experience?

History of Simulation

In previous years simulation has primarily been used by the military, aviation, doctors

and astronauts (Hetzel, 2011). The United States military and NASA have utilized simulation for years as a way to train their personnel before sending them out into the field. The military uses computer simulation such as “war games”. Aviation programs and NASA use flight simulators. Doctors have used cadavers, role-playing, and simple manikins to practice their techniques and skills on. The field of nursing has also been using simulation to practice clinical and assessment skills for many years. Some early types of simulation included role-playing and simple manikins. As technology grows, becomes more affordable, and more readily available, its use by the nursing field also grows (Hetzel, 2011).
Types of Simulation
Today, any nursing program or hospital looking to expand their clinical education programs, to include some type of simulation, has a wide variety of options to choose from.
Simulation Definitions
Term Description
Clinical Scenario *The plan of an expected and potential course of events for a simulated clinical experience.
Debriefing *An activity that follows a simulation experience and that is led by a facilitator.
Facilitator *An individual who guides and supports participants toward understanding and achieving objectives.
Fidelity *Believability, or the degree to which a simulated experience approaches reality; as fidelity increases, realism increases.
High-Fidelity Simulations Simulations that utilize computerized manikins
Mid-Fidelity Simulations Simulations that utilize standardized patients, computer programs or video games
Low-Fidelity Simulations Simulations that use role play, non-computerized manikins or task- trainers
Task-Trainers Simulators that are used to practice a skill such as an IV arm that is used to practice IV insertions skills
In-situ simulation This refers to bringing the simulation (and simulator) to the site where the learner is practicing. This could occur in an ER trauma bay or surgical suite.
(Aebersold & Tschannen, 2013, Overview of Simulation).
Most programs already use some sort of low-fidelity simulation such as: role-playing, simple non-computerized manikins, and task trainers.

Role-playing simulation can either be between students or actors portraying patients. Low-fidelity manikins are simple foam or plastic forms without any computer programming. Task trainers are usually simple IV arms or foam pads that allow a student to practice giving injections, drawing blood, etc. There are also a number of mid and high fidelity manikins on the market today. Most are programmable or controlled by a computer. Laerdal is a medical devices company that makes a number of these mid and high fidelity manikins. They are most famous for creating Resuci-Anne, the CPR manikin used to teach CPR techniques. Their new manikins have heart, lung, and bowel sounds, generate ECG’s, have blood pressure, and some can even give birth and bleed out. The manikins are programmable and can be customized for different scenarios. They have a range of types of manikins including men, women, children, infants, and newborns. They include Adult SimMan, Simbaby, VitalSim, and Megacode Kelly to name a few. (https://www.samuelmerritt.edu/hssc/human-patient-simulators). The various manikins on the market range from a $300 to

$100,000.
In addition to using manikins and role-playing, simulation programs now have the option of using game or web-based simulation.

This is also referred to as e-simulation. Cant and Cooper (2014) write “e-simulation is an emerging technology that can be used to broaden the teaching strategies used in health science education” (p. 1435). The styles of web or game-based simulation available vary greatly. There are programs that focus on technical skills like IV insertion and sim or virtual environments that simulate patient care scenarios (Cant & Cooper, 2014). These types of programs encourage users to use critical thinking, problem solving, and decision making skills. The sim or virtual environment programs are referred to as Virtual Clinical Simulation or VCS. Some examples available are “The Neighborhood” and “Second Life”. The American Heart Association even uses e-simulation to teach cardiopulmonary resuscitation and advanced life support (Cant & Cooper, 2014). The cost of these types of programs also varies greatly from free to several thousand

dollars.
Effectiveness of Simulation
Clinical programs have seen an increase in the use of simulation not only because it is more affordable and readily accessible, but because it is desperately needed to bridge the gap in clinical experience.
Hayden, Smiley, and Gross (2014) write:
Concurrently, educational programs at the registered nurse (RN) and practical and vocational nurse (PN/VN) levels are struggling to obtain adequate clinical placements because there is more competition among nursing program and hospitals are eliminating or decreasing the number of students allowed in the clinical setting. (Lambton, 2008; Miller, 2014; Nehring, 2008). As programs face these challenges, it is understandable that there is interest in using simulation as a replacement for a portion of clinical-hour requirements. (pg.25)
As nursing programs across the country face shortages and limitations in their clinical settings; numerous research studies have been done to study whether simulation is an effective replacement for clinical experience. Simulation is shown to help build the learners confidence and to help them with their critical-thinking and decision-making skills. Most students that are surveyed in research studies report high satisfaction with various simulation programs. One study conducted by Khalaila (2013) reported that students’ anxiety levels decreased and self-confidence improved after using simulation (p.257). A study on the effectiveness of simulation concluded that “simulation education could improve learning outcomes…” (Shin, Park, & Kim, 2014, p. 181). Another study proved that students who participated in human patient simulation scored higher on a knowledge based test than those who did not (Shinnick, Woo, & Evangelista, 2012, p. 45).
Conclusion
In the book Game-Based Teaching and Simulation in Nursing and Health Care the author writes:
Educators can and should harness new methods of instruction that use technology to prepare nursing students and other health sciences students for those experiences that cannot be guaranteed during traditional didactic and clinical methods of education. As the role of the registered nurse continues to grow in terms of clinical complexity and professional and personal liability, it becomes more challenging but evermore important to prepare new graduates for the types of complex patients and environments they will encounter in actual practice. (Bauman, 2013, the Digital Shift).
In the coming years, as the need for nurses continues to grow and as clinical programs decrease or limit a student’s ability to obtain crucial clinical experience; the field of nursing will continue to see the use of simulation grow. Nursing programs are going to need to invest time and money in developing appropriate simulation programs for their students. While currently the usefulness of simulation is recognized as a supplementary educational tool; more research will be needed to show that simulation can be an essential and acceptable substitution for countless clinical skills and experience.