Use of Simulation to Teach Nurses Instead of Traditional Clinical Experience
Beverly Tennant
New York City College of Technology
Professional Nursing
NUR 4130, Section E748 (84527)
Professor Jose Hernandez
September 29, 2013
Today’s health care environment demands nurses who are prepare to deal with complex client issues and are well prepared to deliver safe competent care. Nursing education programs are faced with great pressure to produce competent nurses who are familiarized with technology and are clinically proficient to provide safe, high-quality healthcare. It is imperative for nursing educators to prepare students who feel competent and confident to enter a constantly changing, fast paced, work environment. Although nursing care has changed considerably over the past thirty years, methods to clinically train and prepare nurses have lagged behind. The traditional model of clinical nursing education where a faculty member oversees a group of eight to ten students on an acute unit for four hours provides little or no learning experience for the student, to build assessments skills, critical thinking, and work on collaborating with other healthcare professionals. Most nursing student has minimal opportunities during their clinical rotation to care for patients in a critical emergency situation such as a patient experiencing acute myocardial infarction. Many factors such as shortage of qualified nursing professors and increasingly scarce clinical sites for student to apply theoretical knowledge have encouraged many educators to seek alternative teaching methods to supplement traditional hands on clinical practice.
As technologies become more prevalent, the use of simulation has evolved as a reliable teaching tool, which allows students to practice nursing care and build skills outside of the healthcare setting (Huston, 2010). Human patient stimulators represent the latest state of the art simulation technology for education of healthcare providers at all levels and disciplines. The life-size mannequin allows provider to experience patient scenarios involving numerous pathologies and responses to a variety of treatments. The use of realistic and interactive patient scenarios provides excellent opportunity to educate and improve the healthcare provider’s skills, knowledge, and critical thinking abilities. The human patient simulation is currently been used in a variety of education settings, including nurse anesthetist programs, staff development programs, and medical schools (Marie Bremner, 2006). While simulation cannot replace human patient interaction, it does offer benefits to the student. There are several advantages to using high fidelity simulation for nursing education and development, such as patient safety is not threatened, multiple problems can occur at once, giving student wider exposure, learning is interactive, and includes immediate feedback, mistakes can be permitted and corrected, the experience builds confidence, and provides an excellent bridge to clinical practice. Several learners can also benefit from a session and learn from each other’s successes and mistakes, clinical time can be decreased. Review of research literatures clearly shows success in simulation to improve student’s acquisition and retention of knowledge and skills better and quicker than traditional education. Simulation is used in variety of setting, such as airline, maritime industries, emergency medicine, critical care nursing, and nursing anesthesia (Marie Bremner, 2006).
According to the article simulations as a teaching strategy for nursing education and orientation in cardiac surgery, simulation can be used to teach theory, assessment, technology, pharmacology, and skills. The article further points out that the emphasis in the use simulation is often on the application and integration of knowledge, skills, and critical thinking (Carol A. Rauen, 2004). According to the old Chinese proverb, “I hear, I forget; I see, I remember; I do, I understand,” (Carol A. Rauen, 2004). Simulation allows the student to function in an environment that is as close as possible to an actual clinical situation and provides them an opportunity to critically think, plan and evaluated how to solve these problems.
According to Ms. Huston, the use of simulation as a teaching strategy can contribute to patient safety and optimize outcomes of care, providing learners with opportunities to experience scenarios and intervene within a safe, supervised setting without posing risk to a patient (Huston, 2010). Some of the benefits of simulation are that the instructor can observe each step that students make and coach and correct any mistake without the consequences of patient harm. One study shows that students with preference for solitary learning and those with strong preference for social learning were satisfied with simulation enhanced learning experience. The article states that students with high scores on social learning benefits by comparing, listening, networking, and interacting with others. While the student with high scores on solitary learning, who prefers to work independently, can also observe the actions of others, use reflection, and complete self-paced projects. The use of simulation with scenarios provides students with different learning styles opportunities to internalize and apply new information in a safe and nonthreatening setting (Alfred, Rebecca A. Fountain and Danita, 2008). Another benefit to the use of simulation, the instructor can expose students to rare events such as situation like a code or shock and encouraged team participation and interdisciplinary collaboration. Students may also be allowed to experience the full consequences of their decisions, which can a have deep affect on the student. I cannot help but recall my first experience in giving an IM injection to a mannequin in the gluteal area during school lab, after watching a video. To my surprise when I gave the IM injection the needle bounced off the bone of the iliac crest and was bent. My classmates all teased me that I killed the patient and of course I was embarrassed, but my clinical instructor was able to teach me the correct way to give the IM. This corrective measure prevent me from jeopardizing patients safety in the clinical setting, it also help to boost my confidence when I had to give an injection in clinical setting. A major strength of simulation is that it integrates theory knowledge with clinical practice, thus requiring students to critically think about what to do or how to solve problems. Most nursing students have minimal opportunities to work in a critical care setting during their clinical practicum, yet it is important that they recognize signs of deterioration in patient status and are knowledgeable about appropriate assessments and interventions. Acquisition of these types of experiences is important, because of the need to intervene promptly to prevent adverse patient outcomes. Huston stated, that a major strength in the use of simulation is that it exposed students to a wider range of patient conditions and situations that they rarely encounter in the clinical setting, allowing them to identify pertinent changes in patients and intervening appropriately (Huston, 2010). In many instances using the simulator students were encouraged to work in teams, thus building competencies in communication and team building skills. The extensive debriefing following simulation use allows participants to discuss the case, analyze their actions or their failure to act, developed insights in communication lapses, reflect on their technical skills, and think on how to improve. Simulation is not only used in schools, or hospitals, but is also used in a range of high-risk environment for example aviation pilot training, navy, disaster and terrorism response, and also in war games and training exercises for military personnel (Errington, 2011). According to authors Colleen Dutile and Michelle Beauchesne, (Beauchesne, 2011)simulation experience can be effective preparation for novice nurses to develop competence early in the educational program prior to engaging in actual patient care. Most health care facilities are becoming more aware of the important role simulation play in staff development, resulting in increased patient safety and in the reduction of lawsuits. (Huston, 2010). Although there are positive sides to the use of simulation in nursing education, there are also disadvantages in using simulation.
The cost of a basic high fidelity simulator cost $30,000 to $40,000 and has an expected shelf life of around three years. In addition, the maintenance of simulation equipment, the need for supplies, staff training, and adequate lab space further increase the cost tremendously. Models that have sophisticated features may cost over $250,000. Additionally, the number of students who can work with the simulator at one time is limited and students require intensive faculty involvement, which is often more time consuming than regular traditional clinical supervision. Students may also feel put on the spot and experience anxiety, especially when they are been observed by peers and their instructor. Another barrier to the use of simulation is the shortage of qualified instructors who are well trained to work with simulators. Not to mention additional time it might take the instructor to plan these scenarios. Although, with new technology, there are simulators that bleed, cry and speak, they do not bring into play all the full range of human interaction in human encounters, such as facial expressions or psychological withdrawal. These challenges may become less important as the science of simulation technology evolves, but students need to interact with real patients to understand and experience the complexities of interpersonal communication (Jarzemsky, 2012).
Traditional methods of nursing education such as lectures, demonstration, practice of skills, and supervised clinical experiences in a hospital are giving way to diverse educational formats, educational aids and training interventions. The purpose of these new approaches are to stimulate critical thinking, to provide real world experiences without risk to patient or students, and to reduce student anxiety in new situations. The use of simulation provides a valuable tool for nurse educators who work with inexperience nursing students. This new technology affords beginning nursing students the opportunity to build comfort and confidence with newly acquired skills in a supportive environment. Simulation cannot replace the experiences that the nurse can gain with live patients, but it can prepare the new nurse to think critically about caring for their patients within a safe and controlled environment, lessening errors. According to Ms. Huston (Huston, 2010), although simulation is recognized as a complement to actual clinical practice, simulation should not replace it. “Simulation provides experience and skill that will enhance clinical practice,” (Huston, 2010, p. 56). Although this discussion will continue for years, it is not hard to see the increased benefits that could derive from nursing student using simulation in conjunction with clinical experience. The use of simulation is a great way to bridge the gap between theory and clinical practice.
References
Alfred, Rebecca A. Fountain and Danita. (2008). Student satisfaction with high_Fielity Simulation: Does It Correlate with Learing Styles. Nursing Education Research, 14-18.
Beauchesne, C. D. (2011). Virtual Clinical Eduation: Going the Full Distance in Nursing Education. Massachusetts: Bove College of Health Sciences.
Carol A. Rauen, R. (2004, June). Simulations as a Teaching Strategy for Nursing Education and Orientation in Cardiac Surgery. Critical Care Nurse, 24, 46-50.
Errington, R. (2011). The Edge of reality: challenges facing educators using simulation to supplement students’ lived experience . James Cook University Queenland , 1-13.
Huston, C. J. (2010). Professional Issues in Nursing: Challenges and Opprotunities. New York: Lippincott Williams and Wilkins.
Jarzemsky, P. (2012). Advancing the Science of Human Patient Simulation in Nursing Education. Wisconsin: university of Wisconsin-Madison School of Nursing.
Marie Bremner, K. A. (2006, August ). The Use of Human Patient Simulators: Best Practices with Novice Nursing Students. Nurse Educator, 170-174.
