Techniques and educational advantages of simulation for nursing students
Director of Simulation Kelly Foltz-Ramos observes students in a simulation from the control room. Her observations help guide the post-simulation debriefing with students, a vital component of nursing simulation.
Director of Simulation Kelly Foltz-Ramos discusses common questions about simulation in nursing education.
NYS recently passed legislation that permits nursing programs to provide up to one third of student clinical work in a high-tech simulation environment. How might this impact nursing programs, education and the workforce?
This legislation will positively impact nursing programs, education and the workforce. The bill's goal is to increase the flow of nurses into the workforce to help with the nursing shortage. It has been difficult for nursing schools to increase enrollment because of a lack of clinical sites for training. Allowing up to 30% of the clinical training to be replaced by simulation will provide students with more consistent and standardized training experiences.
High-tech simulations can better prepare students for real-world health care settings by helping to develop critical thinking skills, decision-making abilities and clinical judgment. Not only can this increase the flow of new graduate nurses, but it can also contribute to better-prepared graduates entering the nursing workforce who have increased confidence and readiness to provide safe and effective patient care.
What are the benefits of using nursing simulations in nursing education?
Safe environment: Simulations provide a safe and controlled environment for nursing students to practice their skills without risk to actual patients or themselves. The simulation lab is a safe place to make mistakes, learn from them and refine techniques without compromising patient safety.
Realistic patient scenarios: Simulations can recreate a wide range of realistic patient scenarios, allowing students to experience and manage various health care situations they may encounter in their future careers, including exposure to common scenarios and rare or complex scenarios, which will help them handle challenging situations with confidence.
Active learning and engagement: Simulations promote active learning by actively involving students in patient care scenarios. They must assess the situation, make decisions and implement appropriate interventions. This hands-on engagement enhances learning and retention compared to passive learning methods.
Bridging theory and practice: Simulations allow students to apply theoretical knowledge acquired in the classroom to practical, real-life situations. This integration of theory and practice helps students understand the relevance and application of their knowledge, preparing them for the complexities of clinical practice.
Interprofessional collaboration: Simulations can involve interdisciplinary teams, allowing nursing students to collaborate with other healthcare professionals, such as physicians, pharmacists and physical therapists. This interprofessional collaboration enhances communication, teamwork and understanding of each profession's role in patient care.
Immediate feedback and reflection: Simulations offer immediate feedback to students, allowing them to assess their performance and identify areas for improvement. Facilitators provide constructive feedback and guide students toward best practices through debriefing. This feedback loop promotes reflective practice, fostering continuous learning and growth.
How do you ensure that nursing simulations are realistic and relevant to real-life clinical situations?
Keeping up to date with the current clinical setting is essential to ensure that nursing simulations are realistic and relevant to real-life clinical situations. Having a simulation space that looks like the environment we are portraying and has the same equipment is important. We reevaluate each scenario continuously to ensure the simulation accurately reflects clinical practice and aligns with current evidence-based practices.
We are also often updating our processes to improve fidelity. For example, we are more apt to use standardized patients/actors using hybrid simulation technology than a full-body high-technology simulator. The simulator used to be a preferred method, but standardized patients can provide more realistic patient interactions, communication challenges and emotional responses. Training standardized patients to accurately represent patients' physical and emotional characteristics enhances the simulation's authenticity. Using hybrid technology like a SimShirt (shirt with embedded electrodes allowing changes in heart sounds, lung sounds and bowel sounds) or MamaNatalie (wearable birthing simulator) further adds to the realism of the scenario.
How do you assess student performance during nursing simulations?
Performance assessment can vary in simulation depending on the purpose. Generally, we have performance checklists for each scenario developed from the learning objectives. Each checklist is essentially a list of expected actions, including assessment techniques, medication administration and patient safety practices for the scenario. Facilitators can use the checklist to help guide debriefing with good judgment, using pluses and minuses from the checklist to provide an advocacy paired with inquiry style of reflection.
After each simulation, students complete a program evaluation which includes questions about their self-confidence and satisfaction with learning. Additionally, we regularly lead research studies to improve the state of simulation. Our assessments have included critical thinking and clinical judgment skills, emotion, cognitive load, knowledge gain and change in attitudes toward teamwork.
What are some common challenges that students face during nursing simulations, and how do you address them?
Time management can be challenging during simulations, as students must complete tasks within a limited timeframe. We mimic the timing in real-life clinical situations to address this. In debriefing, we give guidance on effective time management strategies, such as setting priorities and making quick decisions when necessary.
Performance anxiety: Students often experience anxiety during simulation, which can affect their performance. We promote a supportive and non-judgmental learning environment. Immediately before each simulation, students receive pre-briefing, where they are reminded of the safe environment and get oriented to the room and the patient to reduce anxiety, reduce cognitive load and provide the best environment for learning.
Effective communication is crucial in nursing. Nurses must communicate effectively with other health care providers, patients and family members. In simulation, students often recognize that they do not know what to say in different situations. In debriefing, we will often role-play difficult conversations, giving students some scripting to use in the future. We also discuss therapeutic communication techniques, active listening and conflict-resolution tools.
Being a nurse requires constant reevaluation of priorities. As a student nurse, juggling all the competing priorities of a deteriorating patient or a complex medical situation is often difficult. When we debrief following the scenario, this is a time to reflect on the different things happening, how they are all connected, and how that impacts the care needed. You can see lightbulbs going off during this process as students gain a deeper understanding and self-confidence.
Published January 8, 2024
