Nursing Simulations

No amount of formal preparation can adequately account for the experience of direct responsibility for the life of another human being when their heart stops. How can one get ready for such an experience? What steps can be taken to ensure effective performances that, by all means necessary, act to save the lives of individuals? For many, nursing simulations provide a reasonable solution to ensure that nursing students obtain adequate training for code blue situations and other important medical procedures. Nevertheless, such technological extensions bring their own emotional amputations to nursing procedures with a striking disconnect from real-world scenarios. Is the use of a dummy truly a useful tool for teaching in nursing or does it impede upon real student learning? In examining the viewpoints of nursing professionals, the actual value of simulation use in the medical setting will receive full consideration from both supportive and contrarian viewpoints.

One of the most direct summaries explaining the tenets of both viewpoints comes from Lynda Lampert. Lampert (2011) acknowledges that technological advancements will play a key role in "high-fidelity" simulations that place nursing students in a near-reality situation: "simulation . . . gives the learner the chance to be evaluated by an educator and then critiqued on her performance" (p. 1). In a situation where a student could reproduce multiple code blue situations in a single afternoon, they would have a chance to repeatedly make mistakes and advance their understanding of emergency medical procedures without affecting real world patients (Lampert, 2011, p. 1). Such an insulated learning environment could provide for rapid and meaningful learning advancements.

Lambert quickly points out the complications that can arise with an overly dependent focus simulation alone. No matter the procedural advantages proffered through mannequin simulations, they are not real and carry a hefty price tag that requires technological training for effective implementation (Lambert, 2011, p. 1). Without the stress of a real-world situation, it may remain difficult for students to truly comprehend the magnitude of emergency procedures.

Jeffries describes a situational reality where educators grapple with a need for beneficial training. In this educational setting, curriculum designers must choose how much nursing student clinical experience can be required and how much can be supplemented with simulation measures (Jeffries, 2012, p. 10). Such a balance threatens to undermine standards of excellence where only real-world training experiences are perceived as valid for a real-world profession (Jeffries, 2012, p. 10). However, the reality of giving students access to proper medical training environments presents a complicated scenario. Jeffries (2012) reports that "barriers such as lack of quality [to] clinical sites and lack of qualified faculty are fostering the widespread adoption of alternatives," where . . . simulators are increasingly used in a supplementary effort to compensate for this lack of access (p. 11). Even when working in clinical situations, studies show that students spend 12% of their time disengaged from care activities or were simply waiting for someone (Jeffries, 2012, p. 12). In consideration of such limitations and inefficiencies, educators are motivated to use simulators to compensate for a lack of real-world access to training procedures.

In addition, studies show that simulations compare favorably to real world training. Jeffries (2012) cites reports that "time spent in simulation enhanced clinical performance as students in simulation achieved higher scores more quickly than those without simulations" (p. 21). With evidence that simulations can augment the nursing practice, these tools appear positioned to grow in implementation as technology advances.

In the conflict between simulation and clinical immersion, the advantage seems to favor simulation experiences. Hicks, Coke, and Li (2009) highlight a myriad of advantages where educators can engage in team training scenarios where students have the opportunity to benefit from colleague decisions and reflective learning where teachers record simulations and review procedures with students after the fact (p. 2). As students learn operational procedures devoid of the emotion of their first true code blue moment, they stand to develop an internal rubric for ensuring that they precisely follow directives (Hicks et al., 2009, p. 2). This guided training will prepare students with an academic understanding of their profession that will blossom into on-site efficiency upon completion of their education.

Nevertheless, simulations present fine barriers to learning that stop short of simplistic answers. Johannsson and Wertenberger (1996) describe simulation results where students often succeed at defining simple and medium level problem yet still struggle with advanced issues—ultimately, their proficiencies excel in the realm of diagnosing the problem and fall short of providing meaningful solutions to the given issues (p. 325). As this addresses the development of critical thinking skills, it remains clear that there are no easy answers; performance based development systems should be used as a tool and means to an end rather than viewed as a perfect solution to bridge the gap between educational experience and nursing reality (Johannsson et al., 1996, p. 327). By using simulations to supplement progress, students can achieve meaningful learning advancements.

In considering the integration of simulations in the nursing education experience, multiple facets deserve consideration. Cost, emotional relevance, procedural repetition, practicality and the opportunity to learn from colleagues all play a role in their use. Although simulations should not be viewed as the authoritative solution to nurse training, their practicality will become increasingly difficult to ignore as technology delivers more realistic simulations and on-site training continues to suffer from limited availability. It appears this tool is here to stay.

References

Hicks, F. D., Coke, L., & Li, S. (2009). The effect of high-fidelity simulation on nursing students' knowledge and performance: A pilot study. National Council of State Boards of Nursing, 40, 1-35.

Jeffries, P. R. (2012, May 25). Clinical versus simulation: Outcomes, the evidence, and current research. John Hopkins University School of Nursing. Retrieved from http://www.wiser. pitt.edu/sites/wiser/ns12/pdfs/Clinical%20versus%20simulation_Jeffries.pdf

Johannsson, S. L., & Wertenberger, D. H. (1996). Using simulation to test critical thinking skills of nursing students. Nurse Education Today, 16, 323-327.

Lampert, L. (2011, March 30). Pros & cons of clinical simulation in nursing. eHow. Retrieved from http://www.ehow.com/info_8138546_pros-cons-clinical-simulation-nursing.html