aspects of simulation as a teaching strategy

aspects of simulation as a teaching strategy

Simulation is more than just technology; people tend to think it to be in the nursing industry. In nursing practice, simulation is a teaching method or strategy that enables students, both graduates and undergraduates, to learn and practice in a proper environment. This teaching strategy aims at improving communication, the safety of patients and the ability of students to perform in advance nursing setups. Besides, simulation in nursing increases with regulations, standards and guidelines that help particular programs to get the best patient outcomes. This paper outlines the following aspects of simulation as a teaching strategy: theory, literature, efficacy, merits, demerits, variables and evaluation.

There are learning theories that support or need simulation in nursing as a teaching method. It is necessary to develop a proper understanding of these theories because they help students with little knowledge about simulation to appreciate its success in teaching. An adult learning theory called the Andragogy theory by Malcolm Knowles can adopt clinical simulations (Radhakrishnan, Balachandran, Venkatesaperumal & D’Souza, 2013). Furthermore, the approach incorporates the method of transformative learning to its effect on a better understanding of simulations in nursing education. The Andragogy theory brings together six pillars; motivation, self-direction, need for knowledge, orientation to learning, experience and willingness (Gore & Thomson, 2016). These pillars are the reasons adults choose to learn differently from young people.

The experiences of adults are a factor that influences their decisions about whether something is worth learning or not. Therefore, active learning only takes place when instructors customize their contents to fit or add to the knowledge of their learners (Gore et al., 2013). Also, instructors should reduce clashes of information and concepts while integrating the new learning strategy into the experiences of the learners to stimulate their thoughts. The need to make such learning sessions experiential and interactive makes simulation an appropriate teaching strategy. This theory borrows mainly from the concept of transformative learning, which can also use simulation-teaching methods in nursing education.

Transformative learning, on the other hand, has ten phases; disorientation, self-examination, assessment of assumptions, recognition of sharing of transformation and discontent, exploring new roles, planning for action, acquiring knowledge to implement the plans, trying the new functions, developing self-confidence in the new roles, and integration into the new life (Radhakrishnan et al., 2013). This theory is a version of the andragogy with complex phases. The phases of transformative learning theory usually occur in a simulation process. For instance, learners of code simulation miss changes in cardiac rhythms because of their total focus on chest compressions. Simulations enable learners to point out their weaknesses and respond to them appropriately (Gore et al., 2013). Transformative and androgyny learning theories can apply simulation-teaching methods and achieve similar results.

There is a lot of information on scholarly articles about simulations and theories, especially on its significance as a teaching strategy in nursing education. The simulation aims to offer learners with an environment that supports natural performance and give insights into the workplace complexities (Radhakrishnan et al., 2013). Besides, clinical simulations enable students to transfer their laboratory experiences to clinical settings (Wagner, Bear & Sander, 2009). The leaners can relate their past experiences to their current in the clinics during simulations to respond to their weaknesses, which transforms their future behaviours, skills and competence as nurses.

Jeffries (2009) identifies the outcomes of simulations as self-confidence, improving critical thinking, the satisfaction of the learner, skill improvement and learning. As a teaching strategy, simulation in nursing helps in the transitioning of novice nurses into the workforce. This shows the applicability of simulations in transformational learning since students get the experience that prepares them for the job industry or nursing practice (Wagner et al., 2013). Simulations give students the expertise to complex patient situations in the health system. For the above reasons and benefits, there has been an increase in simulations in nursing education, according to the National Council of State Boards of Nursing and Simulations (NCSBN) standards.

The NCSBN study on pre-licensure nursing programs concluded that 50% of clinical experiences are replaceable with simulations (Alexander, Durham, Hooper, Jeffries, Goldman, Kesten, 2015). The study incorporated the INACSL Standards of Best Practice: Simulation in conjunction with other high-quality simulations, methods of debriefing in educational/learning theories and simulation faculties. The NCSBN requires instructors to design simulations with clear objectives and adhere to set standards by INACSL (Alexander et al., 2015). Besides, NCSBN release guidelines that help nursing boards evaluate readiness for simulations in pre-licensure programs and establishment of simulation programs. These guidelines are in line with the demands of transformative and andragogy learning, which apply simulations. The organization also recommends simulation as a practical nursing teaching strategy.

Wagner et al. (2009) describe various significances of simulations in nursing education. The enhancement of learning is the leading importance as nurses augment their clinical experience time by simulations. Besides, students become more autonomous and confident in their capabilities and skills (Alexander et al., 2015). These simulations support transformative learning since students get to ink their experiences to their current situations, which influences their future nursing behaviour.

Harder (2010) outlines three types of simulations that are applicable in health sciences in this case patient education, low-fidelity, mid-fidelity and high-fidelity simulations. Patient teaching is a crucial part of nursing practice. Low-fidelity simulations use trainers or manual methods of simulations, while high fidelity uses highly computerized human patient simulators. Mid-fidelity simulations use standardized simulated patients (Harder, 2010). These simulations are valuable learning strategies useful in developing patient education skills, which translates to improving clinical practice (Doolen, Mariani, Atz, Horsley, O’Rourke, McAfee & Cross, 2016).  Simulation learning can link the theories and training, which gives meaning to the experiences of students. This plays a significant role in the transitioning process of students in the job market.

Sabei & Lasater (2016) analyses the significance of debriefing in nursing simulations and its importance in enhancing the nursing student’s skills in clinical judgement. This analysis defines debriefing in simulations as a process through which nursing students appraise their psychomotor, affective and cognitive performances in the context of clinical judgement (Sabei et al., 2016). Doolen et al. (2016) affirm that learners get an active role in the process that enables both students and instructors to participate in a conducive environment that enhances transformative learning.

Shepherd CK et al. (2010), in an investigation to assess the applicability of simulation as a teaching strategy in nursing education, made several deductions. The continuous use of automated equipment in simulations might influence the future of the industry negatively. Automation is likely to de-skill nurses in the industry if simulations continue to take that path (Shepherd et al., 2010). The study revealed that students are incapable of determining vital signs manually. This did not improve six months after the study. However, simulations are significant in improving students learning is in several ways (Gore et al., 2013). This study used role-paly and manikin simulation methods, which gave the same outcomes on student’s capabilities.

Simulations can give desirable results on learning if used effectively as teaching strategies. The efficacy can be viewed in terms of two aspects; one as a learning strategy and two as acquisition and retention of skills and knowledge (Silva Araújo, da Paixão Duarte & da Silva Magro, 2018). High fidelity simulations use human patient simulators to mimic symptoms that allow changes in the responses to interventions. The efficacy of simulations in education is the measure of value-added to the skills and competence of students learning using it (Silva Araújo et al., 2018). HFS stimulates the clinical situation by improving knowledge, skills and clinical expertise. It is also essential in enhancing the initiatives and interests of students, the ability to apply knowledge, practice, theory, and teamwork (Harder, 2010). To use simulations effectively in nursing teaching, instructors must be willing to invest in the projects, comply with set standards and guidelines, and develop theoretical foundations and clinical experiences.

Simulation learning has several effects, which are exploitable for the best results in nursing education. Simulations should give the opportunity of experiencing different cases or situations that real-life clinical practice does not offer. Also, the learning experience should be authentic and reproducible for useful simulations (Alexander et al., 2015). This reveals to learners the significance of meaningful education. Dynamism in the interactions of peers is also another way of effectively using simulations as a teaching method in nursing education (Silva Araújo et al., 2018). Learning as a group also enhances the efficacy of strategy in students, as they are more likely to link their clinical experiences to theory and practice more efficiently. This interaction can increase by the projection of videos and bringing together different actors. This is likely to stimulate dynamic discussions among learners and, consequently, enhance the acquisition of knowledge and experiences.

Simulation strategies also need to harmonize theory and practice for efficient delivery. Educators need to develop theoretical content in simulations that are applicable in practice.  These learning and teaching approaches should facilitate the acquisition of knowledge (Alexander et al., 2015). Additionally, the software of virtual patients can also improve the effectiveness of simulations in teaching nurses. They stimulate learning backed by theories. Simulations accelerate the process of learning if it is integrated appropriately into the student’s curriculum (Gore et al., 2013). The combination of prior knowledge with learning experiences stimulates the development of competencies by reflection and mapping of concepts. Therefore, educators have to integrate curriculums accurately into simulations for effective teaching.

In terms of acquisition of skills, the communication methods influence the efficiency of simulation in teaching. HFS is useful in mitigating challenges that arise during the learning process; to complement other teaching strategies.  A proper organization of resources such as those of laboratories can also enhance the efficiency of acquiring simulation learning knowledge (Silva Araújo et al., 2018). In such setups, students are likely to share their experiences amongst themselves, which enhances autonomy and self-confidence, giving the learning more meaning (Alexander et al., 2015). Besides, nurse educators should use or explore effective methods of transferring skills and knowledge from simulations to real scenarios and vice versa.  Educators may also enhance the participation of learners during simulations. This improves the roles of students in the retention of knowledge. Thus, the combination of simulations, skills, prior experience and traditional teaching strategies promotes active learning.

Simulations have several advantages as a teaching method in nursing education. Simulation teaching can achieve more than traditional strategies if it is implemented effectively (Harder, 2010). Students can get the clinical education outcomes that are required for the better under simulation strategies than traditional teaching (Shepherd et al., 2010). Learners also get the opportunity to learn more than what they can in the clinical practice setting. Besides, simulations increase the confidence of learners in their areas of work.

Students also get skills and competencies by simulation strategies that alternative teaching methods cannot give efficiently. HFS is applicable in clinical reasoning in students, its value in nursing education in equipping learners with different skills (Shepherd et al., 2010). Simulations are also useful in sharpening the expertise of clinical judgement in learners. Debriefing enables students to refine their psychomotor and cognitive performances in the context of clinical judgement (Sabei et al., 2016). Simulations also train learners on safe practice and patient education skills, which are crucial elements of nursing. The most significant advantage of simulation in nursing is the development of skills and competencies than alternative methods.

The limitations of simulations in nursing education link to several factors. The costs of investing in simulations are expensive, especially HFS. Nursing educators also have to meet the requirements and guidelines set by the NCSBN, which sometimes are too high. The need for accreditation and certification by NCSBN might be a challenge for some educators who might want to use simulations to educate their learners (Alexander et al., 2015). Therefore, simulations require teachers to have clear clinical thinking and experiences on top of a deep theoretical background. Besides, it is a challenge for educators to devise means of linking simulations to real-life nursing practice scenarios (Silva Araújo et al., 2018). This affects the efficiency of the simulation, both as a learning strategy and as retention of knowledge.

The variables that influence the selection of a particular teaching strategy are the efficiency of approach in learning and its efficacy in the acquisition and retention of acquired knowledge and skills.  These variables can also be viewed from two perspectives; educators and learners. The available teaching strategies or alternatives to simulations influence its choice because of the advantages it has over them. The ability of nursing institutions to develop simulation laboratories is a crucial variable that affects the selection of the strategy (Alexander et al., 2015). This should take into account the costs and expertise required to develop simulation systems. Also, the ability to link theory and practice using simulations is a crucial consideration in the choice of this strategy. The adaptability of simulations in the curriculum is another variable that influences the choice of this strategy (Gore et al., 2013). On the other hand, students need to have exposure to simulations to prevent overexcitement, which may affect the efficiency of delivery. The ability of students to work as a team is a significant variable in choosing simulation learning in nursing education.

The evaluation of the outcomes of simulation as a learning strategy can be done in two ways; summative and formative evaluations. Summative evaluations are useful in determining the competency level of the students learning using the simulations (Sando, Coggins, Meakim, Franklin, Gloe, Boese & Borum, 2013). It is essential to design and implement these types of evaluations properly, especially where they involve high stake decisions. Formative evaluations are assessments on the performances of students, which points out their weaknesses and strengths (Sando et al., 2013). The feedback helps to improve the learners because they note the areas they need to work on more. Simulation evaluations are critical in the learning of nursing students.

In conclusion, simulations are useful strategies for teaching nursing students. The efficacy of this method increases if nurse educators combine it with other approaches. However, nursing educators need to overcome the challenges that simulators come with. Besides, educators should adapt learning theories that best fit their students for the effectiveness of their simulative teaching.

References

Radhakrishnan, J., Balachandran, S., Venkatesaperumal, R., & D’Souza, M. S. (2013). Simulation: A teaching strategy in nursing education for safe practice. International Journal of Nursing Education, 5(1), 251-255.

Jeffries, P. R. (2009). Dreams for the future for clinical simulation: Nursing Education Perspectives, 30(2), 71-72.

Gore, T., & Thomson, W. (2016). Use of simulation in undergraduate and graduate education. AACN Advanced Critical Care, 27(1), 86-95.

Wagner, D., Bear, M., & Sander, J. (2009). Turning simulation into reality: Increasing student competence and confidence. Journal of Nursing Education, 48(8), 465-467.

Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49(1), 23-28.

Sabei, S. D. A., & Lasater, K. (2016). Simulation debriefing for clinical judgment development: A concept analysis. Nurse Education Today, 45, 42-47.

Doolen, J., Mariani, B., Atz, T., Horsley, T. L., O’Rourke, J., McAfee, K., & Cross, C. L. (2016). High-fidelity simulation in undergraduate nursing education: A review of simulation reviews. Clinical Simulation in Nursing, 12(7), 290-302.

Sando, C. R., Coggins, R. M., Meakim, C., Franklin, A. E., Gloe, D., Boese, T., … & Borum, J. C. (2013). Standards of best practice: Simulation standard VII: Participant assessment and evaluation. Clinical Simulation in Nursing, 9(6), S30-S32.

Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kesten, K. S. (2015). NCSBN simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), 39-42.

Shepherd, C. K., McCunnis, M., Brown, L., & Hair, M. (2010). Investigating the use of simulation as a teaching strategy. Nursing Standard, 24(35).

Silva Araújo, P. R., da Paixão Duarte, T. T., & da Silva Magro, M. C. (2018). EFFECT OF SIMULATION FOR SIGNIFICANT LEARNING. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 12(12).