Debate #2: The Use of Simulation
A. OPENING ARGUMENT
The nursing profession has evolved throughout the years but one thing remains the same: the use of simulation. Simulation, in some form, has always been used as a teaching tool to enhance the skills of novice nurses and competent healthcare professionals. For many of us, our clinical experience started with the use of mannequins to practice position changes, wound dressings, head-to-toe assessments, and inserting various tubes, (Huston, 2014, p. 48). These early forms of simulation were only capable of specific tasks and limited in their degree of realism. However, with todays technological advances high-fidelity simulators have fundamentally changed the way nursing students and health care professionals are taught. These devices have the capacity to provide nursing students with realistic patient scenarios (e.g. speaking or responding through operator voices, displaying vital signs and physiologic parameters, responding to nursing interventions) and allow time for teachable moments.
Additionally, some hospitals are refusing nursing students the opportunity to perform clinical procedures due to accreditation oversight, (Huston, 2014, p. 48). For this reason, simulation should be seen as an invaluable learning tool in substitution of traditional clinical experience. Some argue that traditional clinical experience is the only way that novice nurses gain expertise in the nursing profession. We, however, firmly disagree. Simulation has and will continue to educate the nurses of today and future generations. This innovative learning tool “meets the demand for more nurses in the face of limited resources and complexity of care,” (Jarzemsky 2012, p. 355). My teammates and I have pinpointed some of the many reasons why simulation should be utilized as an alternative to traditional clinical experience. Our arguments will focus on the exposure simulation provides, the satisfaction of patient safety, flexibility of care, and instilling confidence in nursing students.
First, we believe the exposure simulation provides is a great learning opportunity for nursing students. In the clinical setting, nursing students are limited in the type of patients they can care for- most times they are only given stable patients. However, with simulation they can experience rare and/or critical situations that can be practiced repeatedly. This will enhance their competency and nursing performance should they be faced with a similar situation in a real health care setting. Simulation also ensures that all nursing students are exposed to the same learning experiences, “providing more uniformity in student experience,” (Huston, 2014, p. 52).
Second, patient safety is a guarantee with simulation. In the United States, there has been an increase in the morbidity and mortality rates of hospitalized patients. This brings into question the competency of health care professionals, namely nurses. It is our obligation to provide safe, effective care to patients and one way this can be accomplished is through using simulation to educate future nurses. Nursing students can hone their clinical nursing skills in a safe environment that allows for mistakes and professional growth. They are reassured that their actions will not pose a threat to human life and risk potential nursing licensure.
Third, simulation encourages flexibility of care. In a traditional clinical setting, nursing students are required to spend a certain amount of time in a healthcare facility as determined by state regulations. However, simulation is convenient in the sense that it is always accessible and can be utilized as needed.
Lastly, simulation helps to instill self-confidence in nursing students. Practicing clinical skills, effective communication, building teamwork rapport, delegating duties, and building leadership skills are integral roles that are taught in a simulation laboratory. These experiences help ease anxiety and prepare future nurses to competently care for live patients. When nursing students feel confident, it translates into their care and promotes better patient outcomes.
Our role here today is to show forth the many benefits simulation will provide to the nursing profession. For the nursing profession to ensure competent, quality care it has to change with the times. Our patients expect us to care for them competently and safely. We strongly believe that simulation technology will transform nursing practice by making sure we remain faithful to their trust.
B. SUPPORTING ARUGUMENT
The use of simulation in nursing education
Safety
Patient safety is a concept that is central to clinical education. The major advantage of using simulation as an instructional strategy in nursing education is that it provides opportunity for active and interactive learning without risk to an actual patient. Simulation mirrors the clinical setting and mimics patients responses in a controlled setting, students can make mistakes without fear and without the risk of harming patients.
Use of simulation can prevent medication errors. A recent analysis of 1,305 medication errors by nursing students showed that the most common medication errors made was not giving the medication and giving the wrong dose. Students make these errors because they are inexperienced or they get distracted. In national safety goals for 2007 of the Joint Commission, improving the safety of medication use is listed as the third goal. (“National patient safety goals,” 2007) Medication administration is an important aspect of nursing practice and nursing education. To safely administer medication, students need to be able to assess and manage side effects. Simulation provides students with a realistic approach to medication administration in a safe setting where there is no risk of harm to an actual patient. They also have the time to understand the rationales for medication use, this way they are able to see how medications fit into the treatment of different conditions. They can identify appropriate drugs, determine safe dosages, calculate dosages, properly identify the patient, observe for side effects and evaluate effectiveness of medication.
Simulation provides an alternative to the traditional teacher- centered approach to nursing education with emphasis on the learning needs of the students. A simulated learning experience with the patient simulator allows the instructors to expose students to situations that they may never see in their clinical experiences. Students can learn to think critically as they apply knowledge they learn in the classroom and assess, plan, implement, and evaluate care that they give. Students are placed on different units in the clinical setting. There is a lack of consistency in learning opportunities for students. The use of patient simulators enables instructors to provide structured simulation lab experiences instead of trying to find these rare patient care opportunities in the hospitals.
The majority of unexpected events that happen in the hospital or other healthcare settings are due to miscommunication. The Joint Commission found that in healthcare settings miscommunication is the cause of 70 percent of unexpected events that lead to death or serious physical or psychological injury. (“National patient safety goals,” 2007) Effective communication is fundamental to quality patient care. According to the Joint Commission, patient safety is improved when communication is clear, accurate, complete, and timely. (“National patient safety goals,” 2007) Good communication is needed to enhance the quality of care and promote patient safety. In simulation scenarios, we can teach students to effectively use SBAR, a standardized communication method, and allow them to practice this technique. SBAR could be added to each simulation. This will help students refine their communication techniques and therefore increase patient safety.
The institute of medicine urges organizations to develop strategies to improve teamwork, thereby increasing the quality of care for the patient. Nursing education programs train students as individuals but they are also required to work in teams within organizational systems. Nurses must interact on a regular basis with other personnel such as the physician. Working together and sharing information can help enhance patient safety. Research has shown that the risk for serious events is reduced when team training has been implemented. The importance of teamwork is emphasized in a simulation setting. Students are able to work in small groups as team members. The students can be assigned different roles such as primary nurse, secondary nurse, or medication nurse. Simulation allows the student to learn how to delegate tasks appropriately. Students learn to assess the patient and the situation, and identify important information that needs to be communicated with the doctor. Ostergaard and associates say that simulation is the preferred educational strategy to teach teamwork skills such as leadership, communication, and cooperation. (Durham & Alden, 2008)
Flexibility
The simulation lab increases educational opportunities for students and provides flexibility in learning approaches for faculty. In real clinical practice, the clinical instructor has to watch over many students and patients. In simulation, the instructor can watch everything that the student does. Instructors are able to observe a complete set of actions. They can question a student’s line of thinking and provide guidance. Simulation allows for more teachable moments. There is more opportunity to correct mistakes that students may make. The instructor can let students make mistakes so that they can learn. In a real clinical situation if a student makes a mistake, the patient can die as a result of his/her actions.
Simulation provides us with many possible scenarios. Students can be exposed to many conditions or events that they might never see in a clinical situation. Instructors can ensure that all the students are exposed to specific critical learning experiences. Each student can have the same experiences and have the same opportunity to learn how to think critically. Students can practice dealing with critical events that don’t occur frequently such as cardiac arrest and dealing with a code.
With simulation the instructor has more control over what is going on. Instructor can set the level of difficulty based on the students’ level. Many different scenarios can be developed to provide for the development of critical thinking and clinical decision making and it can be used for competency evaluation. Using simulation can encourage students to push limits of their abilities so that they can better learn what to do in a real clinical situation. It also allows for repetitive teaching of skills and concepts in many clinical situations.
Simulation can be used across the nursing curriculum. For example, it can be used to teach fundamental assessment skills by demonstrating abnormal physical findings. In medical surgical nursing it can be used to teach students about drug and IV fluid administration. Instructors can also alter the complexity of the content.
Exposure
Along with patient safety and flexibility, exposure is another point that we would like to discuss when it comes to simulation. Simulation allows nursing students and health care providers to experience cases they may never get to encounter because they are confined to a specific unit or because the clinical portion or nursing school limits you in what you are allowed to do and what kind of patients you’re allowed to have.
With the exposure that simulation can give you it helps prepare students for any difficult or high risk scenarios they may encounter in their careers. Let’s take the high risk professions such as the military, pilots, and people who work with the nuclear power production for example. How do you think they are able to perform adequately and in a timely manner in times of emergencies? The answer is simulation! Simulation has enabled them to get the exposure they need to react in those situations. According to an article written by Susan Galloway, “Modern simulation was developed to meet the training and risk management needs of complex and high risk industries and organizations such as aviation, nuclear power production, and the military.” Despite their associated hazards, these industries have experienced remarkably low failure rates. Now with that being said, how can we not see that simulation is very beneficial in the nursing industry, which I may add can have complex and high risk cases as well.
Another point that I would like to make as far as simulation exposing nursing students to what they may not get a chance to experience in their careers is the debriefing portion of simulation. Wouldn’t you like to know and discuss the actions you’ve taken, the possible mistakes you’ve made, and what you could have done better without actually being reprimanded about it or worst get fired? Simulation allows for debriefing at the end and everyone who participated in the simulation can get evaluated on how they did, how the felt about the experience, and the reasoning behind what they did. According to an article by Pamela G Sanford (2010), “debriefing is one of the more important components of the experience. Reflection during debriefing allows the student to critically think through the lived experience.”
Lastly, as mentioned previously in the introduction all nursing students can have exposure to specific critical learning experiences (Huston, 2014). Simulation allows for clinical professors to point out errors to students and make corrections, oppose to clinical which there is only one clinical professor and ten nursing student spread out in different patients rooms. This kind of exposure greatly benefits nursing students.
Confidence
Another point that my team and I would like to discuss is the effect simulation has on nursing students and staff’s confidence levels. There have been a number of studies conducted to show that simulation builds one’s confidence and self efficacy levels. In a study that was written by Joy Washburn, Deborah Bambini, and Ronald Perkins, students who participated in a postpartum simulation showed a higher level of confidence verses the students who didn’t participate. They also displayed higher levels of self efficacy.
In another report written by Lilly Mathew (2011) it was stated that “students have rated the simulation learning experiences as overwhelmingly positive based on the rankings and comments. For example, students reported that they enjoyed and had effective learning from a code scenario.” Codes happen frequently in hospitals and it wouldn’t hurt if simulations helped better prepare us for dealing with one. I would probably freak out for my first code, but if I participated in simulation that prepared me for it, I feel that I would be ready. Wouldn’t you guys? Another study found that students showed an ability to think deeper about the clinical situation they encountered during the simulation experience (Cato, Lasater, Peeples, 2009).
Confidence is a component that is needed in the health care industry especially in nurses. A patient doesn’t want to see a person who lacks confidence in charge of their health. That would just make the patient feel uncomfortable and place fear in them because they would be scared of their outcome. I’d be asking for a new nurse, and I would probably tell that nurse to get out of my room. If simulation can increase confidence as it’s been shown to do by studies and scholarly written articles, my team is 100% for its use in nursing education.
References
2007 National patient safety goals. (2007). Retrieved from https://www.premierinc.com/safety/topics/pressure-ulcer/pressure-ulcer-downloads/07_ltc_npsgs.pdf
Bambini, D., Perkins, R., Washburn, J., (2009). Outcomes of Clinical Simulation for Novice Nursing Students: Communication, Confidence, Clinical Judgment. Nursing Education Persepctives 30(2)
Cato, M. L., Lasater, K., & Peeples, A. I. (2009). Nursing students self-assessment of their simulation experience. Nursing Education Perspectives, 30(2), 105-108.
Durham, C. F., & Alden, K. R. (2008). Chapter 51 Enhancing patient safety in nursing education through patient simulation. In H. RG (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2628/#_ch51_s14_
Galloway, S., (2009) “Simulation Techniques to Bridge the Gap between Novice and Competent Healthcare Professionals” Online Journal of Issues in Nursing, 14(2), manuscript 3.
Huston, C. (2014). Professional issues in nursing challenges & opportunities (3rd ed.).
Philadelphia: Lippincott Williams & Wilkins.
Jarzemsky, P. (2012). Advancing the Science of Human Patient Simulation in Nursing Education. Nurs Clin N Am, 47, 355-364.
Mathew, L. (2011). Teaching childbirth preparation using birthing simulators: transferring practice from nursing education to parent education. International Journal of Childbirth Education 26.4 (2011): 32+. Health Reference Center Academic.
Sanford, P., (2010) “Simulation in Nursing Education: A Review of the Research The Qualitative Report 15(4)
