Is Simulation The Future Is Simulation The Future Of Nursing Educatio ✓ Solved

Is Simulation the Future Is Simulation the Future of Nursing Education?of Nursing Education? Nigel Wynne National Teaching Fellow Senior Academic Learning & TeachingSenior Academic Learning & Teaching Birmingham City University Disclosure Project Lead for the Virtual Case Creator O li Si l ti k t d Online Simulation workstream – made available to HEI and Health Care Organisations Under LicenseOrganisations Under License No Personal Financial GainNo Personal Financial Gain Birmingham Cityg y • Acquired University status in 1992 status in 1992 • Approx. 25000 stds • 8 Faculties8 Faculties • New £150m City Centre Campus F lt f H lthFaculty of Health • Approx 7000 students• Approx. 7000 students • Nursing (4 branches), SLT, Radiography, Social Work, ODP’s, Midwifery • Centre for Defence • Centre for Defence Medicine • 3000 pre-registration nursing stds • 300 staff BCU Simulation • 2004 Online simulation BCU Simulation Milestones platform (VCC) • January 2005 CETL Status • May 2005 International ay 005 e a o a Council of Nurses conf.

Taiwan • March 2006 Pitt visit • Sept 2006 NMC Pilot • June 2006 QAA rating • April 2007 Installation of • April 2007 Installation of VERT BCU Simulation BCU Simulation Milestones • January 2007 Laerdel HQ • Nov 2007 Laerdel Int. ConferenceConference • Jan 08 2nd Pitt Visit • March 08 Scoping Exercise • BU and WU Med • BU and WU Med Schools • July 08 3rd Pitt Visit: formalise collaborative formalise collaborative projects The Pendulum That Swung Too Far?Too Far? • 20th century -Practice Based Learning E l 1990’ P2K • Early 1990’s – P2K and HE • Peach Report 1999 –Peach Report 1999 Damming Critique P ti M k P f tPractice Makes Perfect Practice Makes PermanentPractice Makes Permanent Only well supervised practice with constructive feedback that makesconstructive feedback that makes good practice permanent (Nichol, 2006) Project 2000 and Higher Education IntegrationIntegration • The development of the “knowledgeable h h d h l f The development of the knowledgeable doer†• Focus upon academic disciplines Research showed that upon qualification nurses had less developed clinical skills setsocus upo acade c d sc p es • Development of critical thinking skills • Heavily criticised sets.

Heavily criticised “I must be the only knowledgeable doer Phillips et al (1994), While et al (1995), Luker et al (1996), Macleod Clarke et al (1996), Runciman et al (1998), Carlisle et al (1999).I must be the only knowledgeable doer who doesn’t know what they are doing†et al (1999). Defining Simulationg Simulation is a technique - not a technology – to amplify experiences that evoke or replicate amplify experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. Gabba (2004) C ll d d i k f h li Controlled and risk free encounters that replicate real life scenarios allowing students to learn rehearse and apply skills before transferring these pp y g to clinical practice.

Morgan(2006) Nurse/Simulation Publications Nursing&Simulation Publications 140 CINAHL Plus Literature Search Literature Search Frequ Over 4 fold increase in Simulation/Nursing P bli ti f Year Nov Publication cf 2000 The Power of High Fidelity Simulation NMC Pilot Background • Nursing and Midwifery Council • regulator for 682,000 nurses and midwives in UK • Commissioned Simulation and Practice • Commissioned Simulation and Practice Based Learning Project in 2006 • 13 pilot sites selected to capture a wide ange of app oaches to sim lation range of approaches to simulation focussed learning within pre-reg. nursing only NMC Pilot • Aimed to identify what is required to ensure that simulation can develop skills as safely as practice experience • Potential Outcome: Changes in the proportion of time learners need to p p spend in practice during their course NMC Pilot • Study population approx.

1000 learners Sept – Dec 06 • On average 6 days of clinical practice g y p replaced by simulation based learning.g • Most learners participated in 6 simulation scenarios.simulation scenarios. OutcomeOutcome Th i ifi h i UK • The most significant change in UK nurse education in the past 15 years • Up to 300 hours of the 2300 hours • Up to 300 hours of the 2300 hours practice component to provide clinical training within a simulated practice learning environment in support of providing direct care in the practice setting (NMC Circular 36/2007)setting. (NMC Circular 36/2007) What is the key challenge facing the field of simulation in health the field of simulation in health care? 50% 1 Promoting patient safety 24% 22% 1.

Promoting patient safety 2. Improving the fidelity of simulation scenarios 3 Maximising the y 5% 3. Maximising the educational value of simulation 4 Obtaining further ro mo tin g p ati en t s af ety mp ro vin g t he fid eli ty .. Ma xim isi ng th e e du ca ... Ob tai nin g f ur th er in v.. .4.

Obtaining further investment in simulation learning P ro Im M a O b Effective Education Design and Curriculum Integration: Priceless?Curriculum Integration: Si E i t £40 000 Sim Staff: £1000 Priceless? Sim Equipment £40,000 Sim Facilities £500,000 Where do we go from here?g One SolutionOne Solution By Applying and Aligning Different Simulation Modalities within a Curriculum F d F kFocussed Framework Maximising Learning by Constructive Alignment of Biggs (1999) Co st uct e g e t o Multiple-Modality Simulation (CAMMS) ASSESSMENT INTERVENTION AND EVALUATION FOR ACUTE ADULT NURSING Virtual Case Creator LTI PART TASK TRAINING / SKILLS/LO’s Slide 65 PLENARY TRADITIONAL TEACHING SIMULATIONS & VIDEO MOODLE CLINICAL PRACTICE SUMMATIVE ASSESSMENT Full Context Simulation S iScenario F ilit t t i th l f th•Facilitators act in the role of the students’ ‘mentor’ in practice.

E t d t t k•Encourages students to seek help and ask questions when unsureunsure. •Develops students confidence to question and challengeto question and challenge practice Streaming Live Videog •Peer observation •Facilitated plenary and debrief Modes of debriefModes of debrief • Private debrief by facilitator immediately post scenario post scenario • Debrief by peers outside of simulation suite • Self-guided reflection of video performanceof video performance This This or This Scoping Skills and Simulation: MethodsMethods • Desktop survey of • Desktop survey of over 50 organisations • National Online Survey • Curriculum mapping exercise exercise • Expert Panel • Vision Statements and Recommendations Scoping Skills and Simulation: RecommendationsRecommendations L d hi• Leadership • Multi and Inter professional learning opportunities • Educational Framework • Regional Staff Dev.

Academy • Regional Advisory Board • Focus on Evaluation • Hub and Spoke Approach Hub and Spoke Approach to Centre Organisation So Is Simulation the Future of Nurse Education?of Nurse Education? • For us, rarely has emphasis on one field of , y p educational innovation, led to such a transformative effect. • More situated learning on campus • More effective module design • Increased student progression • Increased external fundingg • Increased R&D opportunities We’re still unsure about We’re still unsure about the impact that simulation will have on the wider sector but whatever sector but whatever happens in the future we k h ld know that we would never go back to the past.e e go bac to t e past References • Gabba, D.M. (2004) Journal of Quality and Safety in Health Care, 13 (suppl), i2-i10 • Lave, J & Wenger, E (1991) Situated Learning.

Legitimate peripheral participation. Cambridge University Press, Cambridge • McCallum, J. (2006) The debate in favour of using simulation education in pre-registration adult nursing, Nurse Education Today, 27, p e eg st at o adu t u s g, u se ducat o oday, , 8 5 83 • Morgan, R. (2006) Using clinical skills laboratories to promote theory practice integration during first practice placement – An Irish perspective. Journal of Clinical Nursing, 15, 2, 155 – 165 • Nichol M (2006) Simulation in Interprofessional Education Why Bother? • Nichol, M (2006) Simulation in Interprofessional Education. Why Bother? accessed 2/11/2008 • Peach Report UKCC Commission for Nursing and Midwifery and education Fitness for practice.

London: UKCC, 1999. SHA (West Mids) (2008) Scoping the Future of Clinical Skills and Simulation. Strategic Health Authority (West Mids) (Not yet published) Contact Details Nigel Wynne Senior Academic L&T Birmingham City University [email protected] Acknowledgments and ThanksThanks Professor Stuart Brand – Head of Learning & Teaching Birmingham City University Teaching, Birmingham City University, [email protected] Luke Millard – Learning and Teaching Project g g j Manager, Birmingham City University, [email protected] Matthew Aldridge Senior Lecturer Birmingham Matthew Aldridge – Senior Lecturer, Birmingham City University, [email protected] Lindsay Yardley - Lecturer, Birmingham City y y , g y University, [email protected] Part Task Trainers NG Tube and Tracheostomy Care Airway Management Wound CareIV Training PICU Scenario Learning objects can be linked to support decision making and to scaffold learning ll i li i l kill t b f h d dallowing clinical skills to be refreshed and further developed.

Online Simulation: Teacher Online Simulation: Teacher and PC Supported Scaffolding Communication ScenarioCommunication Scenario Cracks in Posture perhaps indicating wall perhaps indicating socio economic low self esteem, lethargy. P h economic status, lack of support, motivation Withering plant indicating Perhaps some indication of alcohol dependency/ low motivation p y failing to cope The use of video allows the learner to interview this client and the decision making exercise allows them to further assess and initiate care. Advanced Patient SimulatorsAdvanced Patient Simulators APS Scenarios build upon VCC, Learning Object and Part Task Trainer learningg Sailing into the Futureg " The great thing in this world is not so …The great thing in this world is not so much where we stand, as in what direction we are moving…we must sail g sometimes with the wind and sometimes against it, but we must sail, and not drift, nor lie at anchor." Oliver Wendell Holmes Who are our students? • id 168id=168 Part Task Trainers NG Tube and Tracheostomy Care Airway Management Wound CareIV TrainingIV Training Learning Objects Urinalysis Oxygen Administrationy yg Blood Transfusion Early Warning Scoring Systems Practice Learning Theory Lave & Wenger Vygotsy Brown et al Schon Rejected the dualisticRejected the dualistic construction of knowledge promoted “knowing†as an Dewey Argyris promoted knowing as an active and practice immersed process Practice Learning Theory VygotsyLave & Wenger Brown et al Schon Zone of ProximalZone of Proximal Development Dewey Argyris Scaffolding (Bruner) Practice Learning Theory Lave & Wenger Vygotsy Brown et al Schon Legitimate PeripheralLegitimate Peripheral Participation Dewey Argyris Practice Learning Theory SchonLave & Wenger Vygotsy Brown et al The swampy lowland of messy practice problems that can’t be solved by application of facts andsolved by application of facts and formal theories Dewey Biggs Practice Learning Theory Brown et al SchonLave & Wenger Vygotsy Situated Cognition Dewey Biggs Practice Learning Theory SchonLave & Wenger Vygotsy Brown et al Constructive Alignment Dewey Biggs Patient Safetyy •To Err Is Human •An Organisation with a Memory•An Organisation with a Memory •Astonishing human and economic cost of human error •Increase in multi site studies that explore in-practice behavioural outcomesbehavioural outcomes •Potential for Simulation to facilitate these studies

Paper for above instructions

Is Simulation the Future of Nursing Education?

Nursing education has undergone substantial transformation in recent years, emphasizing technological integration and innovative teaching strategies to enhance student learning and patient safety. Among these advancements, simulation-based learning has gained prominence as a potent educational tool. This essay will critically evaluate whether simulation represents the future of nursing education, drawing on existing literature and practical insights for a comprehensive understanding.

Understanding Simulation in Nursing Education

Simulation is defined as a technique designed to replicate real-world experiences in a controlled environment, allowing students to engage in hands-on practice without patient risk (Gabba, 2004). It encompasses various modalities, from high-fidelity simulation with advanced patient simulators to virtual case scenarios. The inception of simulation in nursing education can be traced back to the early 2000s when it began to be regarded as a fundamental component in the bridging of theoretical knowledge and practical application (McCallum, 2006).

Historical Context: The Shift Toward Simulation

Historically, nursing education emphasized extensive practical experience in clinical settings; however, criticisms arose regarding the adequacy of traditional training models. The Peach Report published in 1999 encapsulated concerns that graduates were often ill-prepared to meet the complexities of patient care (Peach, 1999). Subsequently, initiatives like the Nursing and Midwifery Council (NMC) in the UK began to advocate for simulation as a means of augmenting practical learning (NMC, Circular 36/2007). By integrating simulation into the curriculum, nursing schools aimed to ensure that students could practice clinical skills safely and confidently before entering real-world healthcare settings.

The Benefits of Simulation-Based Learning

1. Enhanced Skill Acquisition: Simulation provides an environment that encourages repetition and practice, leading to skill mastery. It allows learners to practice on advanced medical manikins or in virtual environments that mimic real-life scenarios, enhancing their technical skills in a safe space (Morgan, 2006).
2. Improved Decision-Making and Critical Thinking: Through simulated scenarios that mimic clinical situations, nursing students can develop critical thinking skills and learn to make swift decisions under pressure (Nichol, 2006). This experience is invaluable in preparing them for the fast-paced nature of healthcare environments.
3. Safe Learning Environment: Simulation allows for "failure" in a controlled environment without the risk of causing harm to real patients. Students can make mistakes and learn from them without the ethical implications of jeopardizing patient safety (Gabba, 2004).
4. Personalized Learning: Simulation-based education can be tailored to meet the diverse needs of learners, catering to their unique learning styles and pacing, thereby enhancing overall educational outcomes (Morgan, 2006).

Challenges and Considerations

Despite its evident benefits, the integration of simulation in nursing education does present challenges. One such significant challenge includes the need for substantial investment in physical equipment and technology to create high-fidelity simulation environments, which may not be feasible for all institutions (Lave & Wenger, 1991).
Moreover, while simulation offers valuable experiential learning, it cannot wholly replace clinical placements. The Nursing and Midwifery Council's guidelines indicate a requisite balance between simulated learning and direct patient care experience (NMC, Circular 36/2007). Thus, educators need to consider how to complement simulation with practical experiences effectively.

The Future of Nursing Education and Simulation

The future of nursing education appears to be leaning towards an integration model that harmonizes simulation and traditional clinical placements. The National Council of State Boards of Nursing (NCSBN) has acknowledged simulation as a valid means of assessing competencies, leading to changes in regulations that incorporate simulation into licensure examination frameworks (NCSBN, 2017).
The advent of technology and blended learning approaches facilitates more sophisticated simulation experiences. For instance, online simulations and virtual reality simulations offer new modalities for nursing practice (Broussard, 2021). These models can enhance accessibility to education, especially in regions with limited access to clinical placements.

Conclusion

In conclusion, simulation represents a significant advancement in nursing education, with the potential to enhance skill acquisition, boost critical thinking, and create a safe learning environment. While challenges regarding investment and the need for clinical experience persist, the consensus among educators and regulators indicates that simulation will play a foundational role in future nursing curricula. Adapting educational frameworks to incorporate simulation alongside traditional learning will likely prepare nurses to meet the demands of modern healthcare environments effectively.

References

1. Broussard, L. (2021). The Role of Virtual Reality in Nursing Education: A Review. Nurse Education Today, 97, 104697.
2. Gabba, D. M. (2004). A Proposal for the Use of Clinical Simulation in Nursing Education. Journal of Quality and Safety in Health Care, 13 (suppl), i2-i10.
3. Lave, J., & Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge University Press.
4. McCallum, J. (2006). The Debate in Favour of Using Simulation Education in Pre-Registration Adult Nursing. Nurse Education Today, 27, 83-90.
5. Morgan, R. (2006). Using Clinical Skills Laboratories to Promote Theory-Practice Integration During First Practice Placement – An Irish Perspective. Journal of Clinical Nursing, 15(2), 155-165.
6. NCSBN. (2017). A Study of the Use of Simulation in Nursing Education. National Council of State Boards of Nursing.
7. NMC (2007). Circular 36/2007: Guidance on the Role of Simulation in Nursing and Midwifery Education. Nursing and Midwifery Council.
8. Nichol, M. (2006). Simulation in Interprofessional Education: Why Bother? Nurse Education Today, 27(3), 271-276.
9. Peach Report. (1999). Fitness for Practice. London: UKCC.
10. Runciman, P., et al. (1998). The Safety of Surgical Procedures: A Study of the Adverse Effects of Surgery. Quality in Health Care, 7(4), 328-335.