Nursing programs are purposed to offer ready-to-apply experiences in critical care. It was for this reason that simulation was introduced in clinical education some 111 years ago. Simulation in clinical studies is the creation of almost real scenarios that facilitate the application of acquired skills in real life. That said, nursing simulations not only take the form of human bodies, body parts, or alike figures. A lot can be achieved in behavioral, standardized patients, and role-playing simulations too.
Even while the main goal is hands-on experience, simulation-based learning (SBL) is focused on specific objectives, such as training specialized care for nurses who have specified specialties like maternity, equipping critical care skills and resource management during emergency care, team building among students and healthcare staff, and for assessment purposes.
Pre-briefing Before Simulation
Simulation is a learning experience, and has to be prepared for just like any other study session. Pre-briefing is a concept mapping session whereby the trainer interacts with the students and gives information as to the kind of simulation that will be unfolded, the purpose of that simulation, learning objectives, instructions to the simulation exercise, and what is required of the students. Pre-briefing serves the following objectives:
- Attending to the psychological safety of learners. Research has shown that creating a safe environment from the beginning of the simulation exercises reduces the learner’s insecurity with risk-taking and commission of mistakes, and averts any defensive behaviors upon such mistakes. Research has also shown that simulations make students very apprehensive and may breed anxiety that is unsafe for the experience. Pre-briefing should avail a safe space to address these and other psychological insecurities.
- The International Nursing Association for Clinical Simulation and Learning (INACSL) details standards for quality simulation exercises, and provide that pre-briefing sessions should provide learners with information on the method of evaluation, location of equipment, roles played by each participant, communication practices, the timing, and limitations off the simulation experiences.
- Pre-briefing facilitates the communication of the session’s learning objectives. Simulation as a learning technique should be guided by objectives that are specific, measurable, attainable, realistic, and time-bound. Examples of learning objectives could be practicing patient-centered healthcare, successful maternal deliveries, and fostering safety during resuscitations.
Types of Simulations in Nursing
There are many forms simulations can take, while more are being invented each day during these sessions. However, all forms of simulations are grouped into either low, medium, or high fidelity. Fidelity is an important concept in simulations, with the word itself meaning the level of reality achieved by a simulation exercise. High-fidelity simulations employ the most sophisticated technologies to portray a humanly reaction from learners’ stimuli, while the lowest level of fidelity simulations may take the form of theoretical case studies.
1. Case Study Simulation
Learners are provided with information on a real case scenario. A set of tasks are derived from these scenarios and the learners’ responses are evaluated. Case studies are low-fidelity simulations and only provide learners with theoretical knowledge with no physical experiences. This model, however, is significantly popular among nursing schools as it is less-costly, safe to the learner, and absolutely not exhaustive.
2. Role Play Simulation
Students are provided with real case scenarios, and required to act out in response of those scenarios. The objectives of role play are to equip learners with clinical judgement to offer care solutions in different scenarios. Role play is also used to foster teamwork at the work place, as well as providing patient-centered care. During role play simulations, learners can be provided with challenges like language barrier, patient paranoia, as well as leadership gaps. Role play are the best fit for interpersonal interactions between colleagues and dealing with issues such as work place bullying can be learnt.
3. Standardized Patients
These are professional actors invited to act-out patient roles for real scenarios for the purpose of learning. Standardized patients (SP’s) are specialists, and are rigorously trained to serve the learning objectives of simulations involving them. Standardized patients, otherwise called simulated patients, are required to deliver real patient performances. They should look sickly when required to, have paranoia concerns, and present other clinical challenges. In SP simulations, nurses are required to conduct life-like interviews, check vitals, and conduct lab tests as would be in a real situation. SPs offer the most human-like performances during simulations, eliminating the risks that would be posed during interactions with real patients.
High-fidelity mannequins are the height of simulation technology. They employ high-tech features that simulate real-patient scenarios, and result in reactions to any stimuli administered, as would be with a real-life patient. High-fidelity mannequins absorb the risks that would be in a real scenario, as the mannequins deteriorate in health, and even die when exposed to required conditions. High-fidelity mannequins are computerized, and may be controlled even as the simulation exercise is on. Low-fidelity mannequins, on the other hand, include static models and partial tasks. Static models are commonly used to train resuscitations and other non-invasive procedures, while partial tasks are body parts that are used to demonstrate functions like IV pump mechanisms, and making injections.
5. Virtual Reality Simulation
A very new technology, virtual reality in its latest versions provide life-like simulations that are not only thrilling to experience, but are also very indulging. Virtual reality use computer modeling to present a life-like sensory environment, controlled by the learner’s movements of a part or the whole body. The sensory environment is not only visual but also audio and touch. This technology is still gaining momentum in healthcare education, but will have many modifications in due course.
Some other simulations include E-learning, where electronic models are displayed on monitors, phones, and tablets to demonstrate particular scenarios.
Debriefing After Simulation
At this stage, learners and the trainer gather to discuss the outcomes of the simulation exercise. Debriefing is an opportunity for learners to express their psychological status as a result of the simulation exercise. The session also allows the trainer to give remarks on the performances of each learner, share the success of the simulation’s objectives, and make recommendations to the conduct of learners in the future. That way, the SBL learning process is successfully complete.