Education In Nursing and Simulations as a Teaching Learning Strategy, Assessment & Evaluation and for Inter Professional
Simulations as a Teaching Learning Strategy In Clinical Learning Environment In Nursing Education
Nurse educators have used low-fidelity simulation such as manikins, role play, and case studies as a teaching learning strategy for decades. The introduction of high- fidelity simulation (in the form of affordable, portable, and versatile human patient simulators) in the late 1990s transformed health care education and is now one of the foundational strategies in the preparation of health care professionals not only for teaching, but also for assessment and evaluation, developing inter professional team skills, and for clinical substitution and making up for missed experiences.
Simulations used for assessment and Evaluation of Learning In Nursing Education
Given the widespread use of simulations, there is also the potential for using simulations for assessment and evaluation of student learning. Using simulation for assessment and evaluation of learning should be integrated into the larger process of planning, implementing, assessing, and evaluating learning.
Faculty should identify the purpose of the assessment or evaluation early in the process to ensure the evaluation is relevant and evaluates the learning outcomes for which it is intended (Adamson, 2014).
Although more traditional forms of assessment continue to be employed for example, pretesting and post testing using multiple-choice tests simulation based assessments are increasingly being used in the evaluation process, both in a formative manner, as part of an educational activity or training , or in a summative manner, as part of a graduation or certification process.
When simulations are being used for assessment or evaluation, the activities fall into two broad categories “ low-stakes” and “high-stakes” situations depending on the significance of the evaluation (Boulet & Swanson, 2004). Low-stakes assessments are situations in which the simulation is used by the learner and faculty to mark progress toward personal, course, or program learning goals.
High-stakes assessments include licensing and certification examinations, credentialing processes, and employment decisions (Jeffries, Hovancsek, & Clochesy , 2005). Simulation technologies used for assessment range from case studies and standardized patients (eg, OSCEs) to haptic task trainers and high-fidelity human simulators.
As with any type of assessment, faculty must consider the issues of validity and reliability. For assessments in low-stakes or learning situations, construct and concurrent validity should be addressed. Construct validity is the degree to which an assessment instrument measures the dimensions of knowledge or skill development intended.
Concurrent validity is determined by evaluating the relationship between how individuals perform on the new assessment (in this case a simulation) and the traditional (standard) assessment instrument.
An assessment with high concurrent validity, for example, is one in which the learner’s simulator assessment score is comparable to his or her score when performing the same examination on a standardized patient scored by using a checklist.
Predictive validity is required for simulations used in assessments in which licensing, certification, or employment are at stake. Determining predictive validity in high-stakes assessment is a complex process. Predictive validity is the extent to which performance on a particular simulation predicts future performance, such as clinical decision making or psychomotor skills.
Evaluating predictive validity requires that, in addition to current performance, the clinical skill or decision making of specific individuals be tracked over time. There has been little research and evidence-based information specifically focused on quantifying the effect of simulation-based assessment activities on student or practitioner learning.
Simulations are also used to assess and evaluate students’ clinical skill competencies and clinical decision-making capabilities. Using standardized patients to assess the clinical skills of medical students and residents has become widespread (Chambers, Boulet, & Gary, 2000).
OSCEs are clinical examinations that vary in format but mostly include a set period for the student to assess and interact with a standardized patient, an actor or actress hired to portray a certain type of patient with a specific diagnosis and clinical symptoms. Wilson, Shepherd, and Pitzner (2005) used the low-fidelity human patient simulator to acquire and then assess nurses’ health assessment knowledge and skills.
The use of the low-fidelity manikins proved to be an effective tool to assess health assessment skills. Miller, Leadingham, and Vance (2010) used the human patient simulator to meet learning objectives across core nursing courses.
When using simulations as an assessment mechanism, the nurse educator should also consider the improvement in the use of standardized patients, the sophistication of computer-based evaluation techniques, the use of newer physiologic electromechanical manikins, and the fidelity of immersive haptic devices.
Because of these advances, nurse educators are now better able to assess learning, promote a better educational effort, improve academic courses and programs, and ultimately prepare students to provide quality, competent and safe patient care.
Simulations Used in Inter Professional Education In Nursing
Conventionally, nursing and other health care education as a whole is delivered on a uni professional basis, eliminating the reality of everyday inter professional collaborative clinical practice. IPE is bridging that gap (Alinier, Harwood, & Harwood, 2014).
IPE can be defined as two or more professions that work together and learn from and about one another in an effort to improve collaborative practices and the overall quality of patient care (Newton, Bainbridge, & Ball, 2014).In Canada, IPE to improve inter professional collaborative practice has been documented for more than 50 years, but in terms of research, it has gained popularity in the last 15 years.
Currently, most health education programs are beginning to embed IPE into their curricula, thus increasing attention to continuing professional development. There are many advantages of IPE, including breaking down both real and perceived barriers between different clinical aspects, enhancing inter professional cohesiveness and awareness, and providing an opportunity to develop mutual respect among members of an interdisciplinary team.
Within an inter professional team, an important element of providing safe and effective patient care is knowledge and understanding of other professionals’ roles and skills (MacDonald et al., 2010). A study by Alinier et al. (2014) investigated the knowledge and perceptions of immersive clinical simulation in undergraduate health care IPE.
The study showed that students acquired knowledge, became familiar with other professions, and developed a better appreciation of inter professional learning even with limited inter professional simulation experiences. During the debriefings, discussions highlighted the importance and value of inter professional training by students, especially when well contextualized and facilitated through exposure to realistic scenarios.
Even though it is widely agreed that collaborative practice among health care professionals improves quality of care and patient outcomes, evidence-based and innovative suggestions as to how this should be accomplished are lacking.
Current literature is limited in providing strategies that foster inter professional collaborative learning in an easily adoptable and implementable way. Additional research is needed in IPE to quantify its effects on theoretical and clinical practice applications and the ability for nursing students and the integration of novice nurses into clinical practice.