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Simulation in Nursing Practice: The Impact on Patient Care

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Michelle Aebersold, PhD, RN
Dana Tschannen, PhD, RN

Abstract

Simulation has a well-known history in the military, nuclear power, and aviation. It is also a recommended teaching and learning strategy supported by several landmark studies. Although in the past 20 years simulation has become more integrated into the education of nurses and physicians, it has not been as well integrated into the development of skills for practicing nurses. This article will provide an overview of simulation techniques and uses and review of selected simulation research. Despite recommendations for using simulation and growing integration of simulation into education, we still lack empirical evidence of its impact on patient outcomes. Our discussion provides a review of the current uses of simulation in the nursing practice environment with several exemplars and offers recommendations to develop a simulation program.

Citation: Aebersold, M., Tschannen, D., (May 31, 2013) "Simulation in Nursing Practice: The Impact on Patient Care" OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 6.

DOI: 10.3912/OJIN.Vol18No02Man06

Key words: Simulation, patient safety, staff education, nursing education, learning methods, practice, critical care, staff development, quality, training

The IOM report on nursing work environments recommends simulation as a method to support nurses in the ongoing acquisition of knowledge and skills.Simulation has a well-known history in the military, nuclear power, and aviation industries. The aviation industry uses flight simulators for pilot training and has developed Crew Resource Management for the training of non-technical skills for flight crews. The nuclear power industry trains for disasters, and the military has used war games and simulation very successfully in their training programs. Simulation in the area of medicine and nursing has become an important part of the education of students and practicing healthcare providers. Many institutions have made recommendations around the use of simulation in healthcare training. The Institute of Medicine’s report on nursing work environments recommends simulation as a method to support nurses in the ongoing acquisition of knowledge and skills (Page, 2004). In the Future of Nursing report (a Robert Wood Johnson Initiative), simulation is mentioned as a strategy to support interprofessional education (National Research Council, 2011). The Carnegie Foundation for the Advancement of Teaching report; Educating Nurses, highlights simulation as an effective strategy for the education of nursing students (Benner, Sutphen, Leonard, & Day, 2010).

Simulation...is not fully integrated into the development of skills for practicing nurses.Simulation has become more integrated into the education of nurses and physicians in the past 20 years, but is not fully integrated into the development of skills for practicing nurses. Despite recommendations for use of simulation, and growing integration of simulation into education, empirical evidence for the impact of simulation on patient outcomes is still underdeveloped. This article will provide an overview of simulation techniques and uses; review selected emerging research linking simulation to patient outcomes; discuss current uses of simulation by practicing nurses; and recommend strategies to develop a simulation program.

Overview of Simulation

“Simulation is a technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (Gaba, 2004, p. i2). As the science of simulation grows, there is ongoing work towards a common guiding taxonomy and set of practices; however, there is not currently one universally accepted framework or theory in use. One common framework used in nursing education is The Nursing Education Simulation Framework, developed by Jeffries (2007). Medicine and nursing have also used the Event Based Approach to Training (Rosen et al., 2008) to guide simulation development. The International Nursing Association for Clinical Simulation and Learning (INACSL) has developed a common set of definitions for use in simulation as well as a set of 7 Best Practice Standards (Kardong-Edgren et al., 2011).

...most simulations follow a similar design.Even though there is not a common simulation framework, most simulations follow a similar design.  There is usually some pre-work, or preparation learning, by the participant before the simulation. This is followed by the implementation of the simulation, which is subsequently followed by a debriefing session. Debriefings are generally conducted as a reflective learning experience in which participants review their performance in the simulation and the facilitator provides additional feedback. Commonly used terminology in simulation is highlighted in Table 1. Simulation techniques in nursing have also been well defined in an article by Galloway (2009) in which the various types of simulation techniques are described, such as role play and full mission simulation.

Table 1. Simulation Definitions

Term

Description

Clinical Scenario

*The plan of an expected and potential course of events for a simulated clinical experience.

Debriefing

*An activity that follows a simulation experience and that is led by a facilitator.

Facilitator

*An individual who guides and supports participants toward understanding and achieving objectives.

Fidelity

*Believability, or the degree to which a simulated experience approaches reality; as fidelity increases, realism increases.

High-Fidelity Simulations

Simulations that utilize computerized manikins

Mid-Fidelity Simulations

Simulations that utilize standardized patients, computer programs or video games

Low-Fidelity Simulations

Simulations that use role play, non-computerized manikins or task- trainers

Task-Trainers

Simulators that are used to practice a skill such as an IV arm that is used to practice IV insertions skills

In-situ simulation

This refers to bringing the simulation (and simulator) to the site where the learner is practicing. This could occur in an ER trauma bay or surgical suite.

*These definitions are directly from the INACSL Standards of Best Practice: Simulation (Kardong-Edgren et al., 2011, p. S4-S5) .

Review of Selected Simulation Research

This article is not an exhaustive review of the literature on simulation or the impact of simulation on patient outcomes, but rather considers selected publications to direct readers to emerging evidence and provide some context for the later discussion about simulation in nursing practice. There are several review articles the reader may want to consider. Cumin, Boyd, Webster, and Weller (2013) published a systematic review of simulation for multidisciplinary team training in operations rooms. Eighteen articles were reviewed and contained measures of both technical and non-technical skills. A critical review of simulation-based education (SBE) was conducted by McGaphie, Issenberg, Petrusa, and Scalese (2010) and contains recommendations for best practices in SBE. A systematic review of simulation exercises as a patient safety strategy was published by Schmidt, Goldhaber-Fiebert, Ho and McDonald (2013) and reported on 38 studies containing outcomes during care of real patients after simulation interventions. Orledge, Phillips, Murray, and Lerant (2012) reviewed recent studies on the impact of simulation on patient outcomes and skill retention in addition to other findings. Many review articles in nursing have focused primarily on nursing education (Harder, 2010; Lapkin, Levette-Jones, Bellchambers, & Fernandez, 2010; Shearer, 2013). There are some articles that have included nursing staff in hospital settings that have also measured patient outcomes. Those studies are reviewed in Table 2. The studies primarily involved team training for operating room teams or emergency response teams.

Table 2. Review of Simulation and Patient Outcomes

Outcomes

Study

Design
(e.g., descriptive non-experimental)

Sample Size

Major Findings

Patient Outcomes

Regular in situ simulation training of paediatric medical emergency team tp improve hospital response to deteriorating patients
(Theilen et al., 2012)

Prospective cohort study of all deteriorating in-patients requiring admission to a PICU for one year before and after implementing a pediatric medical emergency team (pMET) and concurrent team training which was comprised of in situ simulation. pMET team included physicians and nurses.

All unplanned admissions to the PICU were audited for one year. There were 56 admission pre pMET and 54 admissions post pMET.

Deteriorating patients were recognized more promptly post pMET (p<.0001), were transferred more often to high dependency care (p=.021) and more rapidly escalated to intensive care (p=.024).

Patient Outcomes

Teamwork:  crew resource management in a community hospital
(Shea-Lewis, 2009)

Pre/post design. All staff members in L & D (nurse and physician) were trained in Team Performance Plus (based on CRM). Includes didactic and simulation training.

Unknown. All current staff of L & D between April and May 2006.

Adverse Outcome Index (overall rate of deliveries with an adverse event) improved significantly after training. The Weighted Adverse Outcome Score (total weights of all adverse events divided by the total number of deliveries) improved significantly after training. The Severity Index did not change significantly.

Patient Outcomes

Safety Culture

Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital
(Riley et al., 2011)

Pre/post design. One hospital received TeamSTEPPS didactic only, one hospital received TeamSTEPPS didactic plus simulation and one hospital was designated as the control. All three were small-sized community hospitals.

36 participants in the didactic/sim (18 nurses). 60 participants in didactic only (30 nurses) and 38 in the control (17 nurses)

The Weighted Adverse Outcome Score significantly improved in the didactic/sim hospital (p=.05). There was not a significant change in the didactic only hospital. The AHRQ safety culture surveys generally high pre intervention and remained high post intervention. There was a significant improvement (p=.05) on teamwork for the didactic/sim hospital.

Patient Outcomes

Safety Culture

Outcomes from a labor and delivery team training program with simulation component
(Phipps et al., 2012)

Pre/post design. Staff were trained in CRM principles through MedTeams course. Training consisted of didactic and simulation components 

72% of the 256 L & D staff were trained in 2007. This included nurses and physicians.

There was a significant decrease in the Adverse Outcome Index post training. The safety culture was measured using AHRQ Hospital Survey on Patient Safety Culture. The overall perception of safety was high pre-training and remained high post training.

Patient Outcomes

Self-assessment

 

Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates
(Andreatta et al. 2011)

Longitudinal, mixed methods design. The clinicians who were responsible for pediatric resuscitations in a children’s hospital participated in mock codes over a 48 month period. This included physicians, pediatric intensive care unit nurses and acute care nurses.

228 junior and senior residents participated in mock codes over the 4 year period.

Six categories of key learning themes (clinical techniques, team factors, supplies/resources, management, diagnostic factors, and safety techniques) were identified. Residents rated themselves as being above average in their abilities to lead an actual code following the mock code event. Survival rates increased to approximately 50% (p=.000) and correlated with increased number of mock codes (r=.87).

Few studies measured the impact of nursing alone on patient outcomes. Buckley and Gordon (2010 ) studied the effectiveness of high-fidelity simulation on medical-surgical nurses’ ability to recognize and respond to clinical emergencies. This study was a self-report of the participants’ (38 registered nurses) ability to respond to emergencies after they received simulation training. Wolf (2008) reported on a simulation intervention to improve registered nurse’s triage ability in the emergency department. The six nurses who completed the simulation and didactic training showed improvement in their ability to accurately triage patients as measured through chart review of triage documentation. This brief review of the literature around simulation effectiveness demonstrates the extension of inquiry beyond the nursing education environment to consider how the use of simulation may impact patient outcomes. The next section will highlight some examples of how nurses are using simulation in the practice environment.

Use of Simulation in the Nursing Practice Environment

Simulation has been used in a variety of ways in the practice setting. At Massachusetts General Hospital in Boston, a simulation program was developed to target both nurses and the interdisciplinary team. They redesigned a classroom into a simulation room and purchased a Laerdal™ Sim Man. The program was so successful that they were able to obtain funding for a simulation center and capital funding for additional simulators, which included the addition of infant and birthing simulators. They currently have seven simulation programs, five of which are focused on nurses with varying levels of experience, including new graduates, and different types of work environments (e.g. critical care, acute care). Each program includes several scenarios, lecture/practice, and debriefing. The scenarios include respiratory arrest, asthma, post-partum hemorrhage, and acute changes in mental status (Nagle, McHale, Alexander, & French, 2009).

Some hospitals have included simulation as part of their critical care orientation. Georgetown University in Washington, DC, created a simulation program when it opened a new cardiac surgery unit and developed scenarios to focus on high-frequency, high-acuity situations (Vauen, 2004). In Canada, a Critical Care e-Learning program was developed that uses simulation as part of a three part approach, which also included on-line courses and a mentored clinical experience. Participants in this program completed 39 hours of high-fidelity simulation training. The simulations were developed using a scaffolding approach; this technique starts with learning stations, minor cases and then major cases. The major cases included cardiogenic shock, acute respiratory distress syndrome, abdominal aortic aneurysm, and septic shock. Simulation cases ran for 20 to 25 minutes followed by a 30 minute debriefing. The simulation training was offered through a partnership with nine universities and colleges and included both weekend and weeklong formats. Participants were evaluated using a pre/post knowledge test for each learning station. Feedback from participants consistently described the benefits such as increased confidence, engagement, and active learning (Goldsworthy, 2012).

Acute stroke care has become a priority in healthcare in many countries, including the United Kingdom. Providers in one London hospital used simulation with a goal to improve management of stroke patients in hyper-acute stroke units. A pilot stroke simulation study day was developed and included simulations on post-thrombolysis, raised intracranial pressure, seizures, and accelerated hypertension. The debriefing sessions focused in part on evaluating non-technical skills, such as teamwork, to see what improvements could be made. Pre and post questionnaires showed a self-reported improvement in leadership, communication skills, and confidence in managing hyper-acute stroke clinical situations in six of seven respondents (Roots, Thomas, Jaye, & Birns, 2011). In another project conducted with stroke unit nurses, high-fidelity simulation was incorporated into stroke unit education for registered nurses during their orientation to the acute stroke unit at a large tertiary care center. Nurses participated in three scenarios based on areas they felt were important to providing successful care for stroke unit patients. Overall evaluation by nursing staff after the simulation and debriefing was very positive; 100% of the participants ranked the effectiveness of the simulations as excellent (Aebersold, Kocan, Tschannen & Michaels, 2011).

Obstetrics is an area where much work in simulation has been done, most with a focus on teamwork skills in obstetric emergencies. Obstetrics is an area where much work in simulation has been done, most with a focus on teamwork skills in obstetric emergencies. For example, simulation has been used effectively in obstetrics to improve teamwork skills in the inter-professional team (Birch, et al., 2007; Fransen, et al., 2012). Several strategies using simulation education for practicing nurses have focused on infants and children. In the neonatal ICU, simulation has been used as a part of new graduate orientation, with scenarios focusing on the most common neonatal diagnoses: sepsis, seizures, respiratory distress syndrome, and codes. Participants play different roles in each scenario, thus allowing them to learn roles and responsibilities of all team members (Pilcher et al., 2012). Mobile in-situ simulation has been used to improve staff team performance in community settings and address breakdowns in communication that led to poor perinatal and neonatal outcomes (Pilcher et al., 2012). At Lucile Packard Children’s Hospital in Palo Alto, California, simulation is used as part of the annual training. The focus is on communication and, in particular, communication with families. Actual parents from the hospital advisory group participate in these scenarios (Pilcher et al., 2012).

Simulation has demonstrated benefits in nursing in preparation of newly graduated nurses for the practice environment. In a pilot study conducted at Ninewells Hospital in Scotland, in conjunction with the University of Dundee, a ward simulation program was developed with a focus on developing the capabilities of newly qualified nurses. The pilot study was small and included only four nurses who participated in eight ward simulation exercises, including debriefing every four weeks. The participants also kept a reflection and critical thinking journal. A focus group was conducted after the simulations were completed and the following themes were identified; increase in confidence, development of stress management skills, improved management of the acutely unwell patient, transfer of skills learned in the simulation to the clinical setting and development of communication skills and reflection skills (Stirling, Smith, & Hogg, 2012).

Simulation in virtual environments has also emerged. This work has primarily occurred in academic settings using Second Life™ (Linden Labs). Second Life is an open access virtual environment that has been used by nurse educators to develop competencies related to leadership and management skills (Aebersold & Tschannen, 2012). Virtual simulations can also focus on non-technical or interpersonal skills. In a small pilot study with nursing students that targeted non-technical skills, improvement was noted over a series of two virtual simulations conducted in Second Life™. Both communication and professional behavior skills showed significant improvement over the two virtual simulations that focused specifically on non-technical skills (Aebersold, Tschannen & Bathish, 2012). Further evaluation also showed that nursing students who participated in virtual scenarios were able to demonstrate significantly better performance in a subsequent high-fidelity mannequin-based simulation when compared to students who only received the usual education (Tschannen, Aebersold, McLaughlin, Bowen & Fairchild, 2012).

In the practice environment, Second Life™ has been used as an environment for deliberately practicing handoffs in an intensive care unit. In the practice environment, Second Life™ has been used as an environment for deliberately practicing handoffs in an intensive care unit. In this simulation, the handoff process of an intensive care unit patient was recreated in Second Life™. Staff nurses engaged in the virtual practice environment to improve patient care skills primarily in the area of communication, with particular emphasis on nurse to nurse handoffs. Within the simulation the nurses practiced key steps in handing over the care of an intensive care unit patient to another nurse. They have successfully recreated their unit, including admission and shift transfer documents, so nurses can practice using the documents as well as the verbal exchange that occurs during handoffs (Brown, Rasmussen, Baldwin, & Wyeth, 2012).

An additional focus of research in the simulation arena is patient deterioration and failure to rescue. FIRST2ACT is an education model with a simulation day incorporated into a course that focuses on improving nurses’ emergency management skills. On simulation day, participants complete a knowledge assessment questionnaire and then participate in two 7 to 8 minute high fidelity simulations or live actor simulations. Their performance is videotaped and scored and they participate in reflective debriefing that includes specific feedback from the expert who rated them. This program has been used with undergraduate nursing students, graduate nursing students, and registered nurses. To evaluate the effectiveness of the educational model, patient records were reviewed before and after the FIRST2ACT program. Researchers found that nurses were more likely to record observations at applicable intervals, record pain scores, and deliver/apply oxygen therapy correctly after this educational intervention (Buykx et al., 2012).

In another study, medical-surgical nurses participated in a simulation aimed at improving nurses’ performance in failure to rescue events. The nurses completed a knowledge assessment test and the Learning Transfer Tool (self-assessment of overall critical thinking skills) before the simulation, immediately after the simulation, and two weeks later. Results showed a significant increase in knowledge mean scores and critical thinking (pre and immediate post). However at the two week posttest, improvement was not sustained (Schubert, 2012).

In summary, this brief review of the recent literature on nursing simulation in the practice environment shows the variety of ways simulation is being integrated into the education of practicing nurses. However, it also demonstrates that most of the work has not been rigorously evaluated for its impact on patient care outcomes, which can be challenging to measure. A few studies have looked at the impact on patient outcomes but these have been primarily focused on evaluating performance in very specific areas such as code teams (Wayne et al. 2008). The next section will focus on how to get started using simulation in nursing, primarily focusing on the practice area.

Developing a Simulation Program

Developing a simulation program can be done as an institutional endeavor in which target areas for simulation are identified or it can be created on a unit or program level. This article will not focus on the acquisition and/or design of simulation space but rather on how to use simulation to support improving patient outcomes. Many resources available (see Table 3) to assist nurses to understand potential use of simulation.

Table 3. Simulation Resources

Organization

Description

Contact

International Nursing Association for Clinical Simulation and Learning (INACSL)

  • supports simulation in both the practice  and academic side
  • learning seminars
  • a journal focused on simulation in nursing
  • an annual conference each year

https://inacsl.org/

Simulation Innovation Research Center (SIRC) sponsored by the National League for Nursing (NLN)

  • resources and on-line courses
  • simulation center design information
  • designing and developing simulations
  • guidelines for simulation research

http://sirc.nln.org/

Society for Simulation in Healthcare (SSIH)

  • international
  • supports educators and researchers
  • a journal focused on simulation
  • conferences
  • simulation certification programs

http://ssih.org/

Peter M. Winter Institute for Simulation Education and Research (WISER)

  • classes
  • newsletters
  • information on simulation center design
  • conferences
  • symposium on nursing simulation

www.wiser.pitt.edu/

Drexel University

  • certificate in simulation
  • conferences
  • center for interdisciplinary clinical simulation and practice

www.drexel.edu/cnhp/about/CICSP/

The first step in developing a simulation is determining the overall purpose and goals of the training, as well as to consider the desired methodology or technique of simulation. Gaba (2004), one of the early pioneers of medical simulations, describes the diverse applications of simulation in healthcare and may be a useful resource in the initial step of simulation development. Dimensions to consider include (1) purpose and aims of the simulation activity; (2) unit of participation; (3) experience level of participants; (4) healthcare domain in which the simulation will be applied; (5) healthcare discipline of personnel who will participate; (6) type of knowledge, skills, attitudes, or behavior to be addressed; (7) age of the patient being simulated; (8) technology applicable or required; (9) site of simulation participation; (10) extent of direct participation; and (11) feedback method. Any particular application of simulation can be categorized as a point or range in each dimension. For example, dimension 1 (purpose and aims of the simulation activity) ranges from educational, training, and performance assessment to research (e.g., clinical, human factors) purposes. The first step in developing a simulation is determining the overall purpose and goals of the training, as well as to consider the desired methodology or technique of simulation.

Jeffries (2005) designed features of a well-developed simulation, including clearly written objectives; fidelity or realism that mimics real life situations; building a level of complexity; providing cues for participants as the simulation progresses; and debriefing during and after the simulation is finished. Jeffries framework is helpful in the actual design of a simulation and debriefing. Another method for overall simulation development that has been successful includes a five step process:  (1) key concept identification; (2) competency and standard mapping; (3) scenario building; (4) debriefing development; and (5) beta testing and refinement (as needed) of the scenario (Aebersold & Tschannen, 2012). In the first phase, key concepts are identified. Key concepts are subsequently mapped to clinical standards in Phase 2. This is an important step to ensure that the focus of the simulation is in alignment with current requirements and standards. Building of the scenario (Phase 3) includes brainstorming clinical scenarios that will stimulate the desired response/behavior. It is important to have clinical experts involved in this phase of the work to ensure realism and fidelity in the scenario.

Once the scenario has been developed, debriefing questions should be developed. The final phase, beta testing, involves running the scenario with a group of faculty, nursing staff, and/or students (depending on the topic) to ‘test’ the implementation of the scenario. Feedback should be requested from participants for all aspects of the scenario, including fidelity, implementation process, and overall experience. Participants should be asked to provide feedback about all aspects of the simulation (e.g., scenario, implementation process, fidelity). A variety of simulation development frameworks can be used in Phase 3 to design the actual simulation. Phase 4 (debriefing development) should utilize the appropriate method of debriefing based on the simulation scenario goals and objectives.

Exemplars of Simulation in the Practice Area

Even the brief review above provides multiple examples of simulation in a variety of practice settings using several different simulation techniques. A variety of simulation methodologies can be used for education and training of practicing nurses. This can include high and low fidelity mannequins, virtual environments, and unfolding video case simulations. This section will provide some exemplars from the authors’ own work in which a range of simulation techniques have addressed various areas, all with the goal of improving patient safety and outcomes.

Video Unfolding Case Simulations

A variety of simulation methodologies can be used for education and training of practicing nurses. This can include high and low fidelity mannequins, virtual environments, and unfolding video case simulations. In an effort to improve the overall effectiveness of the annual competency blitz at a large Midwestern health system, educators and faculty collaborated to develop an interactive delivery method. This included two 20 minute simulation videos based upon nurse sensitive quality indicators, including restraint alternatives; pressure ulcer prevention; fall and catheter-associated urinary tract infection (CAUTI) prevention; infection control; venous thromboembolism/deep vein thrombosis (VTEDVT) prophylaxis; and stroke recognition and intervention. Participants were placed into groups of 8 to 10 staff where the videos were reviewed and discussed. Throughout each video, there were opportunities to pause and ask debriefing questions related to content. For example, one of the videos showed a patient who was placed in restraints inappropriately. The discussion centered on how the use was inappropriate and possible alternatives to restraints.

Ambulatory Care

A multi-faceted educational approach aimed at improving nurse competencies in diabetes self-management was initiated with 21 ambulatory care nurses. Simulations were conducted in the virtual environment, Second Life™, to allow nurses an opportunity to practice empowerment-based skills in the context of Type 2 diabetes. The scenarios required the nurses to interact with three patients: one patient identified as ‘non-compliant;’ one patient who required education in medication management; and one patient who had extensive psychosocial needs that created barriers to effectively manage the diabetes. Each scenario required nurses to identify underlying issues for the patient, collaboratively create mutual goals, and consider next steps for the patient.

High-Fidelity Simulation

In an adult unit, simulation was used to support education aimed at improving the nurse’s ability to recognize and manage the deteriorating patient. Three unfolding scenarios were developed using high-fidelity simulation. The simulation scenarios focused on acute respiratory failure requiring intubation; atrial fibrillation requiring treatment; and mental status changes. These were areas of high volume on the unit and important for overall patient care. In an intensive care unit, several simulation scenarios were developed and implemented to support nurses who needed to learn a new procedure using complex technical equipment for very critically ill patients. The focus here was on troubleshooting alarms with the equipment and managing patient responses to therapy.

Conclusion

Simulation has demonstrated effectiveness as a method to train practicing nurses for new procedures, communication processes, and both skill based and non-skill based techniques. This can be done using a variety of methodologies, ranging from simple role-play to use of high-fidelity and virtual simulators. ...simulation provides a suitable methodology for deliberately performing skills necessary to be an effective practicing nurse. The above described exemplars provide an overview of the variety of ways simulation can be integrated into staff nurses’ training.

Simulation can provide an effective mechanism for improving competency in a given area. For example, if a manager reviews unit data and notes an increase in response time to codes (e.g. early identification of deteriorating patients is not occurring), simulation may provide an opportunity for the team to ‘practice’ assessment and subsequent treatment of the deteriorating patient. Similarly, unit leadership may note a reduction in collaboration occurring among the multi-disciplinary team. Simulation scenarios requiring communication among the team may assist in improving collaboration and subsequent patient care. Simulation could also be included in a new orientation program, requiring new orientees to participate in standardized simulations that depict issues most experienced by a given unit’s patient population.

Simulation can also be considered as an evaluation method. For example, new hires could be required to successfully complete a series of skill-based simulations (e.g. mastery of suctioning tracheostomies, assessing chest tubes, IV insertion) prior to completing orientation. Simulation could also be used to ensure annual competencies (as described in the unfolding case exemplar) or to remediate poor performing employees.

In addition to its usefulness in nursing education, simulation provides a suitable methodology for deliberately performing skills necessary to be an effective practicing nurse. Many of these simulations can be done without a costly, high fidelity mannequin. One must only consider the overall purpose of the simulation and be creative.

Authors

Michelle Aebersold, PhD, RN
E-mail: mabersol@umich.edu

Dr. Aebersold is a Clinical Assistant Professor at the University of Michigan, School of Nursing and Director of the Clinical Learning Center. She has an extensive background in simulation using both high-fidelity simulators and virtual reality simulation using Second Life. Her professional and academic career is focused on advancing the science of education through the development of innovative and effective educational techniques and technologies. Dr. Aebersold has conducted research using various types of learning pedagogies including simulation and virtual reality simulation and has developed evaluation tools for use in simulation to evaluate student performance.

Dana Tschannen, PhD, RN
E-mail: djvs@umich.edu

Dr. Tschannen is a Clinical Assistant Professor at the University of Michigan, School of Nursing. The aim of her research program is to improve nursing care delivery and patient outcomes through the utilization of technology and clinical information. This has included the development of numerous simulations for the virtual environment and high-fidelity simulator. Recently, Dr. Tschannen completed a funded study which involved the design of a virtual nursing unit using Second Life. The virtual environment has been used for didactic teaching as well as an environment for training related to quality, patient safety, teamwork, and communication.

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© 2013 OJIN: The Online Journal of Issues in Nursing
Article published May 31, 2013


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