Simulation in Education

Nurses in an academic setting are often referred to as being in “an ivory tower” — meaning a place or situation in which people make and discuss theories about problems without having any direct experience with those problems. Fortunately, the educators and students at most U.S. nursing schools can’t be accused of this, since they offer students real-world experiences during the course of their education via the opportunity to simulate patient care situations in simulation labs.

Simulate to Educate
Simulation exercises are widely used in other industries, such as aviation, nuclear power and the military. The aviation industry uses flight simulators to train pilots, the nuclear power industry simulates disasters to train personnel on how to respond, and the military stages simulated “war games” to train new soldiers.

Most simulations follow a similar design. Students usually perform some type of textbook-based learning and coursework prior to the simulation (“preparation learning”). After this, the student is ready to participate in the simulation. Following that is a period of reflection, in which the student, the educator and, in some cases, the student’s peers, collaboratively review the student’s performance during the simulated exercise. The educator can provide a targeted critique and additional feedback about what the student did right and what the student needs to improve.

A Natural for Online Schools
In the nursing arena, nursing simulation laboratories can provide “hands-on, life-like patient care experiences, focusing on applied skills and knowledge in a safe environment while offering real-time performance feedback from faculty members and peers,” stated Betty Nelson, PhD, RN, academic dean for University of Phoenix College of Health Professions School of Nursing.

“These virtual environments offer a safe learning space that allows for repeated practice, so students can really develop their skills,” added Tona Leiker, PhD, APRN-CNS, CNE, associate dean of nursing curriculum and assessment and associate professor of nursing at American Sentinel University. Here, a 3D “virtual community” is home for the students’ community health assessments. In this interactive world, nursing students interact in the virtual world to develop their community health assessment skills. “The students may collaborate to solve common community health problems and enhance their knowledge of health policy development,” Leiker commented.

Soon, American Sentinel students will have the opportunity to improve their informatics knowledge through both front-end and back-end user skill development. “We want to teach our students to ask the type of pressing questions that can now be answered using big data analytics,” Leiker explained.

Nursing Simulation Labs at the University of Phoenix also use many different technologies to bring patient care scenarios to life. Some are very simple anatomical models, called “task trainers,” which replicate only a select anatomical portion of the human body and are designed to teach basic psychomotor skills and procedures, such as a mannequin used to teach cardiopulmonary resuscitation.

In addition, the school also offers complex mannequins that mimic many of a person’s basic human functions. High-fidelity adult and infant mannequins, plus a birthing simulator, also exist.

“It’s critical to offer nursing students access to complex practice scenarios,” said Nelson. “Students need to practice a variety of clinical procedures, such as giving injections, putting in a catheter, starting an IV, taking vital signs, conducting physical assessments, and responding to changes in a patient’s condition, such as when a patient is suffering a heart attack or undergoing childbirth.”

Of course, Nelson added, these simulators, which offer dozens of different patient care scenarios, “give the students the opportunity to build their confidence and skills in real-life nursing situations without presenting any risk to live patients”-an ideal situation that eliminates much of the stress of practicing.

Brick & Mortars Do It, Too
The Betty Irene Moore School of Nursing at University of California, Davis (UC Davis) is home to a Center for Virtual Care (CVC), which is comprised of a trauma bay, operating room, inpatient unit, six-bay simulation area, standardized patient exam rooms, and “debriefing” room.

“This is the hub of our technology resources,” reported Amy A. Nichols, EdD, RN, associate clinical professor at UC Davis. “At the center, with the amazing support of the CVC team, we can mimic a single intensive care unit, or replicate the flow of patients through the medical center-from the field to transport through emergency treatment and surgery to the intensive care unit.”

Simulation exercises “assist our students with critical-thinking skills and improve their clinical decision-making abilities,” Nichols remarked. “It allows our students to use some of the equipment nurses commonly use, such as IV pumps, central monitoring equipment and heart rate monitors. They also get to practice things like IV drug delivery, catheterization, suturing, and airway management-all in a safe, learner-centered environment.

“One of the most important aspects of simulation,” Nichols continued, “is the ability to practice team training and create a virtual interdisciplinary training environment to work on critical issues like communication and patient decision-making.”

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The CVC also has several portable mannequins, which allow nurses to train off site with paramedics in the field. In addition, students earning a master’s degree get to work with live “patients” (that is, trained actors who have been given scripted scenarios and are rehearsed in how to behave like patients). “This affords our students a ‘real-time, real-life’ interaction with a patient, which really prepares them for their future practice,” Nichols said.

UC Davis will soon be expanding its simulation exercises in a new nursing school building. It will feature an eight-bed inpatient hospital ward, a 15-room primary care clinic, a task and anatomy skills lab, and a one-bedroom apartment so students can practice providing direct care to patients outside the hospital or clinic setting.

Observing & Critiquing
In the new building at UC Davis, professors will be able to watch through one-way glass as students go through patient care simulations, which will be videotaped for follow-up discussion.

The debriefing rooms on the other side of the simulation areas provide an environment to review recordings with each student and discuss their bedside decision-making capabilities immediately afterward.

“Ultimately, it is the faculty members’ ability to analyze and evaluate a student nurse’s progress during these simulation exercises and provide feedback that leads to improved student learning outcomes,” Nelson said.

Anne Collins is a staff writer. Contact: [email protected].

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