NUR 649E Simulations
The era of advanced technology has finally integrated its way into nursing programs across national and international shores. Nurse educators have found that simulations offered a unique way to bridge the gap between clinical experience for nursing student when finding adequate clinical sites poses as a challenge (Jefferies, Swoboda, & Akintade, 2016). Simulations portray real-world events in the form of activities or events. Simulations can be further categorized regarding low, medium, or high fidelity (the degree of realism associated with the simulation). Low fidelity includes methods such as role-playing or case studies to instruct nursing students about patient situations and what Eyikara & Baykara (2017) describes as a partial task trainer or static manikin. Examples include inserting an indwelling urinary catheter or performing central line dressing changes on a manikin using aseptic technique. Medium fidelity involves a two-dimensional active learning experience where nursing students are presented with situations that involves the recollection of learned concepts and apply these concepts to scenarios to problem solve. For example, nursing students being able to assess adventitious breath sounds on a manikin without being able to visualize the rise and fall of the chest. High fidelity simulations are highly sought after in the nursing school setting. It is considered the most realistic of simulations. High fidelity simulations involve the usage of full-body patient simulators, eSimulations (virtual reality), or standardized patients (i.e., stand-in actor or nursing faculty).
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Significance of Simulations
With the shortage of adequate clinical sites for undergraduate nursing program, many states have approved the use of simulations to replace nearly 50% of traditional clinical hours (Fey & Kardong-Edgren, 2017). Simulations are proven to enhance nursing students’ knowledge bases and skills. According to Eyikara & Baykara (2017), simulations bridge a link between theory and clinical application by presenting patient scenarios that closely mimic what could happen at the actual patient bedside. A well-constructed simulation (especially that of a high-fidelity caliber) has resulted in the improvement of nursing student levels of confidence and learner self-satisfaction as documented in numerous of research manuscripts. The overwhelming positive results associated with learner’s outcomes, simulations, and undergraduate nursing students has prompted researches to expand research into studying how to apply quality simulations to match the learner needs of graduate nursing students (Fey & Kardong-Edgren, 2017). Graduate level nursing clinical sites are also a challenge for even the most prestigious universities. If you combine this with the expansion of distance-learning nursing program you can see how simulations can prove to be beneficial to nurse educators, nursing students, and most importantly patients whose quality of care is partially dependent on the knowledge, skill, and expertise of the nurse clinician (regardless of the scope of practice).
Attributes to Simulations (Li, 2007)
Low and medium fidelity is considered User-friendly
Low fidelity simulations are considered suitable for 1st-year undergraduate nursing students
Low Cost (Low and Medium Fidelity)
Limited physical interaction (Low Fidelity)
Limited application of learning theories (Low Fidelity)
Allow for nursing students to work at their own pace
High Fidelity simulations are not cost-efficient; estimated cost $100,000.00
Limited access (high fidelity)
High Fidelity simulations are considered suitable for thirdand 4th-year undergraduate nursing students
Nursing students experience with simulations is dependent on faculty expertise
Advantages and Disadvantages of Simulations as an Educational Tool
Simulations often require nursing students to work together in small groups which is a form of cooperative learning. Cooperative learning encourages active and reflective learning while cultivate a sense of comradery and teamwork amongst nursing students which is necessary for the development of interpersonal skills and communication (Phillips, 2016). Procedural knowledge is cultivated in nursing students by the use of simulations (especially those of low-fidelity methods). Simulations such as manikins used for nursing students to practice their intravenous insertion skills is an example of acquisition of procedural knowledge. Lastly, simulation all incorporates active learning by demonstration (Phillips, 2016). Video-taping simulations allow for reflective learning and evaluation of skill by performance feedback. Retention of performed skill increases when nursing students can dissect their performance with constructive feedback from peer, self, and nurse educators to understand the complexities problem-solving and critical thinking. In a qualitative study by Au, Lo, Cheong, Wang, & Van (2016) revealed that nursing faculty viewed simulations (with bias to high-fidelity simulations) as a unique tool to achieve learning outcomes while instilling the importance patient safety. Nursing students view simulations of high-fidelity tier as a bonafide learning experience. Qualitative data included nursing students expressing the desire to have high-fidelity simulations as a prerequisite before entering the clinical setting.
The experience nursing students receive during simulations unfortunately dependent on the expertise of the nursing faculty facilitating the learning activity. Nursing students feeling as if one person is not putting as much effort as the other could lead to a breakdown in communication, rise in stress levels, and the possibility group conflict leading to the non-retention of nursing concepts and applications. These barriers to learning can develop if the facilitator is ineffectively monitoring the simulation. Faculty not accounting for the difference in skill procurement amongst nursing students can lead to feelings of anxiety and inadequacy in students participating. High fidelity simulations are costly which can result in a limited equipment usage and practice time to preserve on the cost of restocking supplies and possible maintenance work related to high fidelity manikins and other advanced technology. Au et al. (2016) reported nursing students expressing feelings of anxiety and lack of communication between students and faculty during simulations. Since these simulations are represented as real-world situations, these negative experiences could cause students to correlate any poor performance during simulations with their ability to successfully transition into the role of the clinical nurse at the bedside (Au et al., 2016).
National League for Nurses: Nurse Educator Competencies
The National League for Nursing (NLN) developed eight competencies to offer guidance, framework, and role development in nurse educators. In this blog, I will highlight two of the eight competencies that is relatable to nurse educators implementing simulations in the classroom to meet the learner needs of nursing students. The first competency is nurse educators as facilitators of learning. The use of simulations requires nurse educators to possess content mastery regarding the content being taught to students (Halstead, 2007). Simulations require the nurse educator to understand the flow of patient care including the correct course of action to take when things go astray. The nurse educator must possess clinical competency, content mastery, and be adaptable of various teaching styles to meet the learner needs of a diverse nursing student audience (Halstead, 2007).
The successful facilitation of simulations by nurse educators build confidence within the novice and experienced educator. A nurse educator competency presented by the NLN encourages nurse educators to aim for continuous quality improvement when teaching tomorrows nurses (Halstead, 2007). Faculty feeling inadequate in regards to technology is an identified barrier to the incorporation of simulation in the classroom. Nursing faculty, as well as nursing administration, should invest in the continuous enrichment of faculty. The investment in faculty will increase job satisfaction, reduce role strain, and increase faculty productivity (Halstead, 2007). Nurse educators must commit to being lifelong learners to ensure that tomorrow’s nurses enter the workforce prepared to withstand the ever-changing flow of healthcare and patient care.
Au, M. L., Lo, M. S., Cheong, W., Wang, S. C., & Van, I. K. (2016). Nursing students’perception of high-fidelity simulation activity instead of clinical placement: A qualitative study. Nurse Education Today, 3916-21.
Eyikara, E., & Baykara, Z. G. (2017). The importance of simulation in nursing education. World
Journal On Educational Technology: Current Issues, 9(1), 2-7.
Fey, M. K., & Kardong-Edgren, S. (2017). State of research on simulation in nursing education
programs. Journal Of Professional Nursing, 33(6), 397-398. doi:10.1016/j.profnurs.2017.10.009
Halstead, J. (2007). Nurse Educator Competencies: Creating an Evidence-Based Practice for
Nurse Educators . New York: National League for Nursing.
Jeffries, P., Swoboda, S., & Akintade, B. (2016). Teaching and learning using simulations. In D. Billings, J. Halstead, & 5th (Ed.), Teaching in Nursing: A Guide for Faculty (pp. 304-323). St. Louis, Missouri: Elsevier.
Li, S. (2007). The role of simulation in nursing education: A regulatory perspective. Retrieved from National Council of State Boards of Nursing: https://www.ncsbn.org/Suling2.pdf
Phillips, J. (2016). Strategies to Promote Student Engagement and Active Learning. In D. Billings, J. Halstead, & 5th (Ed.), Teaching in Nursing (pp. 245-263). St. Louis, Missouri: Elsevier.
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