Nursing Education and Integration of Simulation In Course and Curriculum
How to Integrate Simulations into Courses and Curricular In Nursing Education
Simulations can be integrated into nursing courses, laboratory experiences, and clinical courses to promote more active and experiential learning at most schools of nursing (Katz et al., 2010). As more schools adopt clinical simulations in their courses and curricula and as actual clinical experiences are becoming more difficult to obtain, some faculty and their state boards of nursing are supplementing or substituting clinical time with simulations.
Trends of Simulation Use In Nursing Education
More recently, following the trend in electronic communications for teaching and students’ strong acceptance of online learning, more sophisticated technologies have enabled simulation approaches to transition from the classroom to a virtual platform.
Virtual simulation in online nursing education combines the pedagogy of face-to-face simulation with electronic multimedia options to produce activities that are both interactive and mediated by the learner.
Virtual simulation programs can be hosted online and accessed using a choice of navigable software using learning objectives that vary from highly focused technical skills training to broader, case based patient scenarios that require critical thinking and clinical decision making ( Cant & Caooper , 2014).
Some popular virtual simulation software products available for online nursing education include ArchieMD , CliniSpace , Second Life, TINA, Virtual Heroes, and Sim . Faculty have integrated simulations in a variety of courses. Thomas, Hodson Carlton, and Ryan (2010) used clinical simulations in a senior leadership course to better prepare and facilitate new graduates to clinical practice.
Clinical scenarios were developed that incorporated students, faculty, staff, and community volunteers who role played situations that students may encounter after graduation. Some of the issues embedded in the scenarios include staffing problems, physician interactions, patient and family communications, and crisis interventions.
Hamilton (2010) used clinical simulations during academic and clinical experiences to equip students with the skills necessary to productively cope with the stressors faced in difficult end-of-life situations. Using the End-of-Life Nursing Education Consortium materials, the educator found simulations to be an effective teaching strategy to identify anxiety levels prior to clinical experience and as a venue for exploring learning and coping styles.
Maternity simulators have been used to teach students about maternal and child health. Undergraduate faculty from a large Midwest nursing program implemented a 6-hour laboratory and virtual clinical experience for students in the maternal–newborn health rotation that incorporated various simulations (Bantz, Dancer, Hodson-Carlton, & Van Hove, 2007).
This experience consisted of eight stations, including assessment of the postpartum fundus, newborn assessment and care (with a SimBaby ), newborn nutrition, labor, and birth (with the Noelle birthing simulation manikin), fetal heart rate assessment and interpretation, Leopold’s maneuvers, and computerized charting.
According to Bantz et al. (2007), the majority of students who participated in this clinical laboratory experience indicated that they felt better prepared to provide nursing care to newborns and their mothers in the clinical site.
DeBourgh and Prion (2010) used a quasi experimental pretest and posttest study of 285 prelicensure students to teach students fall prevention and patient safety using clinical simulations with standardized patients.
The results of the teaching and research conducted concluded that the simulation learning experience provided students with knowledge and skill gains they could apply to clinical practice.
Thompson and Bonnel (2008) integrated the use of high fidelity simulation in an undergraduate pharmacology course to provide an applied learning experience where students could make connections between learned content and clinical application. An experience of safe medication administration has been added to both pharmacology course simulations and any simulation in which the “patient” is to receive medications.
Rosenzweig, Hravnak , and Magdic (2008) developed a patient communication simulation experience for the acute care nurse practitioner students at a major university to evaluate students’ perceived confidence and communication effectiveness before, immediately after completion, and 4 months after completion.
Results showed that the content and methods used for the simulation experience improved students’ confidence and perceived skill in communication in difficult acute care situations. As distance education course formats proliferate in nursing curricula, simulation has been recognized as a potentially rich learning strategy.
Nelson and Blenkin (2007) used online role-play simulation to provide students with the opportunity to learn professional and personal relationships in an online environment. The online learning platform provided students with a learning opportunity to deal with difficult behavior and to manage violence, abuse, and patients with dementia.
To initiate the learning activity, the authors built what was called a “kickstart” episode, in which students would have to react to a significant event, for example, a patient dying. Participating students logged in and played their assigned roles, which ranged from long-term care residents to facility staff members.
During the computer based event, students role playing as health care professionals could enter into an “interaction space ( ispace )” where a threaded discussion could occur about the patient’ s problem. Several resources were available to students within the online simulation environment, including instruction sheets and video clips to assist the students with the care of these selected patients.
Students immersed themselves in the online simulations and believed that the level of realism paralleled clinical nursing practice and offered a relevant student learning experience. Unfolding case simulations are gaining more attention in nursing programs. Durham and Sherwood (2008) used unfolding simulated cases to teach quality and safety concepts and how these concepts are integrated into nursing practice.
In addition, Batscha and Moloney (2005) used online unfolding case studies to facilitate nursing students to analyze, organize, and prioritize in novel situations. Finally, Azzarello and Wood (2006) suggest that unfolding cases can be used to evaluate students’ changing mental models because they offer a practical strategy for revealing flaws in students’ problem solving that would otherwise not be obvious.
Unfolding cases are not limited to the traditional simulation laboratory. Innovative use of unfolding cases has the potential to transform traditional teacher centered classrooms into interactive, engaging learning environments that support the flipped classroom (Educause Learning Initiative, 2012). The notion of the unfolding cases fits very well when teaching in the connected and “flipped” classroom (see Chapter 19).