Nursing Education and Guidelines for Implementation of Simulation Use In Clinical Learning Environment
Implementing Simulations In Clinical Environment In Nursing Education
Once the simulation is designed, faculty members are ready to implement it into the nursing course.
Guidelines Implementing Simulations In Clinical Environment
The following guidelines may be useful to educators implementing simulations into their nursing courses:
1. Make sure specific objectives match the implementation phase of the simulation. When faculty design a simulation, the objectives and nature of the simulation should be clearly defined for the students and facilitator.
Furthermore, if the simulation is designed, for example, around the care of an insulin-dependent patient, then the scenario should be created using problems typically encountered and the problem-solving skills needed for that patient’ s care. The simulation should focus on the objectives and not on potential co-morbidities or extraneous issues.
2. Set a time limit for the simulation and the debriefing encounter and then adhere to it. Too often instructors observe that in simulations students are immersed for a specific time limit but are not able to accomplish all of the assessments and interventions the instructor had desired.
At times instructors may let the scenario proceed beyond the specific time frame; However, if the simulation is scheduled for 20 minutes, the encounter needs to be 20 minutes. If students do not achieve the objectives desired, the reflective observation time can be spent on their experiences and the meaning they make of them.
3. Implement an appropriate orientation of students to the simulation labs where they will be interacting with the simulators. This is an important step to help eliminate the anxiety and fear of the unknown associated with initial exposure to simulation as a whole.
It is also important to engage in a confidentiality agreement with the students that makes debriefing a safe environment for students and faculty, and lastly, implement a fiction contract where students are expected to treat the simulation environment as they would a true clinical encounter.
4. In undergraduate nursing programs, it is advisable to make assignments so students know their specific roles during the simulation. Unless developing or testing team leadership skills, students need roles (eg, nurse, observer, family member) assigned before encountering the simulation to bring organization to the experience.
If roles are not assigned, students waste time trying to decide what role to play. In advanced practice nursing programs, role delineation may be handled by the students. It is conceivable that advanced practice nurses can come together to determine specific roles and responsibilities. This may also be a good topic to investigate during post simulation debriefing.
5. Avoid interrupting the simulated encounter when students are trying to problem-solve on their own. In simulation, the learners function as professionals, not as students, so they are asked to step beyond their comfort zone and interact in the scenario without anyone directing them how to act.
Facilitators should observe a simulation remotely, either behind a one-way mirror or via closed-circuit television, so students cannot see facial expressions, hear comments, or see nonverbal gestures. It is best for faculty to discuss the points of concern, prioritization, and problem-solving issues during the debriefing immediately after the simulation event.
If this is not done in the immediacy of the simulation, the behaviors can be forgotten or confused with other scenarios.
6. Involve a limited number of learners in the simulation experience in addition to one or two observers or recorders of the encounter. Typically, two to six students are each assigned a role in the simulation experience. The roles within the simulation need to be identified before and recognized during the simulation.
For example, students can wear name tags or labels and appropriate clothing for particular roles or have certain props available to help delineate the roles. When an educator has more students than are needed to participate in the simulation, these students can be assigned an observer role.
7. Ensure that the simulation is appropriate for the learners’ skill levels and cognitive ability. Although a prominent design feature when developing simulations is fidelity, simulations need to be realistic to the degree that matches the learning level of the student group.
Early on in exposure to the simulation environment, students benefit from scenarios that are comparable to their didactic learning. Low- or medium-fidelity manikin and standardized patients with basic care needs offer opportunities to focus on basic skill and knowledge acquisition.
Failure and anxiety in the simulation scenario can occur when the simulation objectives include skills or competencies students have not learned (eg, IV management prior to IV curriculum or altered cardiac or lung sounds prior to cardiac or lung modules).
As exposure to the simulated environment increases, learners benefit from a higher level of complexity and a mix of fidelity, including challenges found in a complex environment such as simulated emergent events that involve critical thinking, active interaction, teamwork, and collaboration with the health care team to achieve a common goal.
Simulations assist students at the application level of learning to practice their decision making, problem solving, and team member skills in a nonthreatening environment. The environment needs to be sufficiently realistic to allow for suspension of disbelief so that the transition of knowledge from theory to practice can be stimulated. In simulation there is no “pretend.”
All necessary equipment should be available and standards and protocols should be followed to mimic the clinical setting. If a patient is to take a medication, the proper steps for administration should be used.
8. When planning to incorporate simulations into the course or curriculum, ensure that faculty development is included in the planning. Faculty need to know how to conduct a simulation and a debriefing session to achieve the desired outcomes with the teaching–learning strategy. Faculty need to be prepared to design and conduct simulations in the educational setting before they are actually placed in the learning laboratory or clinical practicum with students in a simulation situation. All faculty members using this type of strategy in their classroom or clinical instruction need to be aware of and clear about the purpose of the simulation activity. At the end of the simulation, a clear summary and highlights need to be included by all instructors, particularly if there are several educators using the same simulation in a course. Discussion about simulations and how to implement them and clarity on learning outcomes for the simulation are needed and must be agreed on by faculty before implementation of the simulation. Clear delineation of the objectives of the scenario and the debriefing model should be followed by all facilitators. A predesigned concept map for each scenario can help guide facilitators for consistent debriefing.