If you remember practicing your subcutaneous injection technique on an orange, you’re no stranger to the practice of simulation in nursing education. Today, simulation is more mainstream than ever, driven by trends like a shortage of nurse educators and patient confidentiality concerns at hospital-based clinical training sites.
Simulation has also gone high-tech, making it an effective tool not only for new nursing graduates, but for more experienced nurses who want to learn or improve advanced skills. It is mentioned specifically by the IOM’s Future of Nursing report as a strategy for training higher numbers of nurses to meet the needs of an aging patient population.
As an education strategy, simulation typically involves three parts: preparation work (usually done as self-study or a classroom lecture), then the simulation, then a debriefing session. The debriefing is usually a type of reflective learning exercise in which students review their own performance and consider how nursing theory is actually applied to nursing practice, then receive feedback from an instructor.
A large body of research shows that simulation is incredibly effective as a teaching methodology and can contribute both to better patient outcomes and a culture of safety among nursing staff. Various studies have demonstrated that nurses participating in simulation activities improve skills in areas like recognizing a deteriorating patient, triaging emergency patients more accurately, managing stroke patients, working collaboratively in an obstetrics setting, and more.
The future of nursing education may be in the area known as high-fidelity simulation: the use of computerized mannequins that exhibit a wide range of patient conditions. In contrast, low-fidelity simulation includes our example of practicing injections on an orange, as well as role playing, static mannequins, part task trainers (like a model “arm” designed for practicing IV insertion), and even virtual reality settings that allow students, via computer screen, to develop non-technical or interpersonal skills – like briefing colleagues during patient handoffs or teaching diabetes self-management strategies to a patient.
Hi-fidelity simulation labs can be quite sophisticated. They might include a mock hospital room, exam room, critical care room, operating theater, birthing suite, or even a senior citizen’s apartment, for home health training purposes. Computerized mannequin “patients” can range in age from neonate to adult, and can be assigned names and medical histories, along with anatomically correct features like a pulse, specific pupil responses, a voice, and even spurting blood. They respond to the “care” provided by students and to “medications” in a physiologically correct manner, for example with blood pressure changes or convulsions. Real medical equipment like IV pumps and crash carts add to the reality of the simulation lab. Often, instructors can remain hidden behind one-way mirrors in order to evaluate student performance without being physically present at the “bedside.” These high-fidelity simulation labs are an effective way for nurses to practice the skills needed to manage complex, high-acuity patients; drill for emergency preparedness; or practice teamwork and collaboration with other providers.
With more innovation in nursing education comes a higher level of knowledge and competence in nursing practice. There’s currently a need for nurse educators who can bring transformational leadership to the field, through an understanding of simulation and other new curriculum models. Developing a simulation program – for nursing school or for an institution that has specific training and improvement goals.
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