Simulation in Nursing Education
This chapter focuses on a novel approach to the already established practice of incorporating simulation in healthcare provider education programs. The researchers recognize the value of simulation as well as some of the drawbacks, most notably cost, personnel, and equipment breakdown. The use of 3D technology addresses these issues while providing a valid learning experience and may well be a viable option in the future of healthcare provider education.
Future health care professionals need to be proficient critical thinkers quickly able to collaborate and respond to emerging situations. The purpose of this research is to design 3D learning environments and 3D cases to explore the affordances and constraints of using 3D technology to establish multidisciplinary collaborations and engage underrepresented groups anytime anywhere.
Nursing educators believe that it is not until the student applies theory to a given patient situation thereby linking the theory with practice that true understanding materializes. This is one of the reasons that clinical experiencies have been an essential component in nursing education programs. With the enormous increase in nursing education programs, both public and private for-profit, there has been an unprecedented competition for a declining number of available clinical experiences in many urban areas. The decline in available clinical experiences is partly attributed to the recent downsizing and closing of hospitals resulting from both economic downturn and efforts to decrease hospital length of stay and managed care programs.
Simulation, as a teaching tool, is found to meet the broad goals within the context of any program: think critically, communicate effectively, and intervene therapeutically. Users can take on a new role, learn by doing and reflection, take risks, and engage in meaningful knowledge construction through proactive interaction with peers in the process. Unquestionably, the use of simulated patient scenarios is a core component in current nursing education programs. It provides students with opportunities to be involved in patient care experiences they may otherwise not be exposed to in actual clinical settings; to critically analyze patient data and intervene while learning from one's errors; and to learn in a low-stress environment. One factor that has contributed to the frequent use of simulation has gained popularity is that there is increased competition for a declining number of actual clinical site experiences. In addition, some patient situations are not appropriate for students. One example would be a patient whose condition is deteriorating and requires expert clinical care for stabilization. The use of these simulated patient scenarios can allow students to experience a situation such as cardiac arrest in a safe non-threatening atmosphere. Anxiety is decreased since no harm will come to a live patient. Often students report that their anxiety is a negative factor in learning. Students can make errors and learn from them without putting actual patients at risk.
The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a not-for-profit organization responsible for the accreditation of more than 19,000 health care organizations and programs in the United States and very concerned with the quality of health care services as well as education programs for all healthcare employees. Joint Commission accreditation is essential for third party reimbursement for health care institutions.
The Joint Commission has identified certain patient situations as “low volume, high risk.” This means that they occur less frequently and pose a greater risk than normal. As can be expected, hospitals are not willing to allow students to be involved in the care of these patients for medical and legal reasons. Examples include patients who have experienced major trauma with multiple, severe injuries; patients who are in shock; as well as mothers delivering babies. Often women go into labor during times when students are not in the hospital setting. Without birthing simulators, students often do not have the opportunity to assist and problem solve in childbirth. Only so much can be gleaned from watching videos and paper case studies.
These “low volume, high risk” patient situations lend themselves well to simulation and permit faculty to insert opportunities for students to problem solve in a calmer atmosphere. The use of simulation has been endorsed by The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Medicine both of whom advocate integrating simulation into nursing education both at the primary level as well as for continuing professional education, Durham and Alden (2008). The AHRQ publication, Patient Safety and Quality: An Evidence-Based Handbook for Nurses (2008) has detailed the benefits of simulation on reducing potential errors and improving patient safety.
The National League for Nursing not only endorses the incorporation of simulation in nursing education programs; they have established the Simulation Innovation Resource Center (SIRC)—an online e-learning site where nursing faculty can learn how to develop and integrate simulation into their curriculum, and engage in dialogue with experts and peers (www.qsen.org). Multiple sample learning tools are available for faculty use on their website.