Nurse educators' perception using simulation in teaching:Change in Technology - Dissertation Example

?Nurse Educators' Perception using Simulation in Teaching: Change in Technology Introduction Simulation is a teaching methodology in nursing which involves students taking an active role. The students are immersed into a realistic clinical situation where they are required to integrate core concepts and knowledge learnt in a theoretical class. During the process the students apply critical thinking and decision making skills used in nursing. The nursing process involves assessment, diagnosis, planning and implementation of the nursing care. Simulation as a mode of education in nursing has been present from the era of the Second-World-War. This was experienced in the form of role playing and CPR manikins. It is important to note that the High-fidelity and Low-fidelity simulation has come into use quite recently due to the advancement in technology. The simulations come in the form of high technology simulations and computers. The new technology has helped nursing to incorporate new ways in teaching nursing students critical thinking and reflection based on practice. There is no doubt that simulation has had a great impact in the teaching methodology of nursing students. This in return makes it of great importance to understand the perception of nurse educators on simulation training after they themselves undergo such training. Statement of the problem There is evidence that clinical simulation has enhanced nursing education. With studies at Capstone showing that there was increase in scores due to high levels of comfort with simulation and confidence of students. It is important to realize that the nurse educators’ perception of simulation in teaching may affect their level of productivity in a positive or a negative way. This in return will affect the level of competence of the student nurses since they will lack the comfort and confidence from the simulation training which is the very purpose of simulation training in the very first place. Simulation seeks to improve patient safety by reducing errors, increase quality of patient care and enhance team work, Billings & Halstead (2005). As a result it is important to evaluate the nurse educators’ perception of simulation training which and its effects on the eminence of teaching and the value of nursing care received by the patient. Since simulation training is new and comes as change to old bedside nursing training, most of the nurse educators maybe slow to wholly embrace the change (simulation training) due to technological advancement thus affecting their attitude. The study seeks to find out the Nurse Educators' Perception using Simulation in Teaching: Change in Technology Background and significance of the problem Adoption of assimilation training in nursing is due to the fact that it provides superior outcomes compared to other forms of applied methodologies. This is due to the fact the simulated experience provides a platform to identify the students’ strengths and weaknesses. Besides, simulation training is carried out in a controlled environment which is vital in increasing the students’ confidence and comfort in executing quality patient care. This in return ensures the patients’ safety. Consequently, many schools of nursing have adopted simulation training as an efficient and safer method of bringing clinically related experience into the schools. This has lead to the adoption of simulation in teaching various subjects and with students of different abilities. Simulation training is seen by many as the solution to the deficiencies in nursing care caused by lack of proper nursing training and the new challenges in nursing care. Nursing training has focused on biomedical science paradigm in training for a long time Billings & Halstead (2005). However, simulation training will supply new perspectives and skills based on its focus on experiential paradigm which provides psychomotor nursing skills. Assimilation training comes with the realization that nursing care plays an imperative role in humanizing patient wellbeing. The training helps reduce patient injuries, unplanned admission of patients in the intensive care units. This is due to the skills the nurses’ gain in recognizing changes in the patient to allow for prompt interventions and accurate reporting. With this observation, there is no doubt that assimilation training comes with an improved skills capability to the nurses and hence improved nursing care to the patients. In order to reap the benefits from simulation training, it is crucial to understand the perceptions of nurse educators. Whether negative or positive, their attitudes towards simulation training directly affect the training of nurses. Eventually, this will trickle down to interfere with the quality of patients’ nursing care. For instance, according to Billings & Halstead (2005), perception of the nurse educators towards simulation training affects the collaboration and team work of the bed side nurses. This is because the simulation training offers nurses a controlled environment where they learn how to coordinate and work as a team. This skill can not be gained effectively if the nurse educators have a negative perception. The perception of the nurse educators on the simulation training and technology change can be due to a number of reasons. They include; the confidence and comfort levels after the initial training of the simulation methodology which they themselves will be required to facilitate when they teach the new nurses. The stress levels of the nurse educators can also come in as a factor affecting the nurse educators’ perception of the simulation training methodology. Negative environment can fuel negative perceptions that will tend to augment the level of strain on the nurse educators. Similarly, their perception on simulation training can also be influenced by the how well they understand the concepts of reinforcement and extinction which are vital in the simulation training. Educators who manage to internalize these concepts are likely to develop a more positive response towards simulation training compared to those who do not. Benner argues that communication skills during the teaching process also affects the educators perceptions (1984) adding that it is vital for both the instructors and the scholars to acquire communique skills to improve the quality of the learning process. Another important factor effecting the perception of the nurse educators in simulation teaching is the level of skills gained while they were being trained. Simulation training educators who excelled during the training and can therefore facilitate training with ease, develop positive attitude towards the simulation training. Students of such trainers report increased understanding of course material as a result of participating in clinical simulation scenarios. The simulation experience provides the student with an opportunity to be involved in patient care experiences which they may not be involved in actual clinical settings. These experiences may either be high or low frequencies which they would otherwise not experience. Giving the students an opportunity to critically analyze their actions and reflect their clinical reasoning and decision making process. The simulation approaches allow for rotation of students to attain educational goals and evaluate teaching methods. Simulation training also helps in improving nursing education and advance the field of nursing as a whole. It is always a time of fear and uncertainty among nursing student in the process of transiting from classroom to clinical part, Morton (1995). Hence, it is vital for nurse educators to assist nursing students from theoretical class work to real world where nursing is practiced. The perception of educators on the assimilation teaching has a tremendous effect on this smooth transition. There are very many nursing teaching schools but the study will take a scope of 15 nursing schools within the surrounding of the university because they are easily accessible. Review of the Literature Simulation has achieved great success as an educational tool and a lot of literature has been written about it. Studies have been conducted on various issues affecting simulation as an education tool in the nursing teaching. This includes literatures comparing the simulation methodology with old methods of pedagogy. Studies have also been carried out on simulation and its effect on acquisition and knowledge retention hence reducing shortcomings in skills practice and reducing the time required in instructional training. However, very modest study has been carried out to evaluate the perception of nurse educators on simulation as a teaching method. Much more needs to be done in the field of simulation training for nurses. Rogers et al (2010) carried out a study on students’ rotation in critical care. Students were evaluated on an examination, a skill station test and interactive simulation with high fidelity simulator. His study found out that that among the three evaluations. The students performed best in the written exams. This was due to the fact that application of theories was not easy to demonstrate in clinical simulation. They acknowledged being influenced by the perception of the educators. Another study by Gordon et al (1999) surveyed both students and educators on simulation as a teaching tool. The author found out that there were constructive and unconstructive effects of simulators. Positive outcomes of simulators were highly increased by positive perceptions of the educators rather than negative perceptions. This was confirmed by the studies by Majors Flagg and Eaves of the US Air Force. Their study consisted of a 10-bed simulation with actors, full-body simulators, and other specialized mannequins (2001). The study looked at how the nurses would perform under stress. The findings showed that the educators did not practice important nursing procedures under stress. Problem solving, delegation and critical thinking recorded lower under stress. Similarly, the influence of the perception of the nurse educators showed decline under stress (Comer, 2005). New technological advances have led to the demand for nurses’ educators to be more sophisticated. The need to conform to the technological changes in simulation and the practice of critical care serve as a stressor or a motivator. A study by Morton (1995) was done to determine undergraduate nursing students’ perceptions regarding learning outcomes developed during simulation experience. The nursing simulation experience comprises application of critical thinking and nursing skills. The study which involved students from four different semesters reported their perception of simulation experience in regard to learning experience, (Comer, 2005). The students rated increased nursing skills, understanding classroom learning, increased critical thinking and ability to facilitate team work. Students perceived that the development of these skills was made more easily with the perception of nurse educators who trained them. 162 respondents representing all the classes in the nursing program were selected for the study. The outcome of the study showed an overall increase in students ranking in critical thinking and nursing skills. Students showed that they had increased ability in analyzing situations and apply knowledge as a result of simulation training. They also mentioned the positive attitude by their educators as also having an impact. The students were able solidify the skills gained through practice in simulation training. The continued support by their educators ensures there was continued growth in confidence and comfort in use of skilled gained. A study by A Best Evidence Medical Education (BEME) carried out a review 109 journal articles also support the results found, Comer, (2005). Research questions The study seeks to find out the Nurse Educators' Perception using Simulation in Teaching: Change in Technology. The following questions will be used as tools construct an instrument for data collection. 1. What are the perceptions of nurse educators on use of simulation in teaching? 2. What are the issues that manipulate the insights of nurse educators on use of simulation in teaching? 3. How does the Nurse Educators' Perception using Simulation in Teaching affect the quality of training nursing students? The study will employ focus group discussion which will help to validate the general assumption and hence help in constructing the questions. The focus discussion will help ensure that the questionnaire will only contain instruments that are relevant to the population under study to eliminate ambiguity in the questionnaire. The focus group will consist of 10 people each coming from the intended study location as are representatives of that population. Data will be collected using the instruments designed (questionnaire). The study will be cross-sectional. Methodology The study will involve use of expert/experienced nurse educators but are now novice in the classroom and are being introduced to simulation for the first time due to change in technology. They now have to incorporate simulation in teaching and using it to train their student to be able to perform in the clinical area and to develop critical thinking and perform safely in patient care. The lessons will make use of a cross-sectional plan since the study will be carried in different nursing schools. Data collection Subjects will include nursing educators and their students. Across 10 nursing schools and consent will be sort before giving out the questionnaires. The questionnaire will be given after simulation training. Instruments The questionnaire will contain demographics and questions (short questions for quantitative data and long questions for qualitative data) Quantitative Quantitative data will be collected from general post-training surveys which will be created. The questionnaire will be in form of licker scale. Strongly agree (5) to strongly disagree (1) Qualitative A focus faction discussion will be put in place. Close ended questions will be avoided in this session in order to encourage the respondents to give additional subjective information/ answers for the qualitative data. An example of the question is ‘What influences your perception of simulation training when teaching nursing session?’ Data Analysis Quantitative data will be sorted out and scored. The scored data plus demographic data will be entered into SPSS for the analysis. The outcomes will be offered in terms of graphs, charts and tables. The qualitative data on the other hand will be coded then entered into SPSS where it will be analyzed and will be represented in terms of graphs, charts and tables. Importance of study and expected results The study expects to find that indeed nursing educators have varying perception of simulation teaching in the nursing practice. This in return affects the delivery of their training because the attitude towards assimilation conscious or unconscious has a direct affect to the quality of delivery. The study will enable nurse educators to appreciate the fact that their perceptions on the simulation training have an effect on their delivery of training. This has a direct effect to the new nurse trained by these nurses. The impact can either be positive or negative which greatly influences the quality of nursing care given to patient. In the end the primary objective of nursing care is jeopardized. References Billings, M. & Halstead, A. (2005). Teaching in Nursing: A Guide for Faculty (2nd ed.). Philadelphia: W.B. Saunders. Bambini, D. et al (2009). Outcomes of Clinical Simulation for Novice Nursing Students- Communication, Confidence, Clinical Judgment. Nursing Education Perspectives 30(2), 79-82. Benner, P. (1984). From Novice to Expert-Excellence and Power in Clinical Nursing Practice. Menlo Park: Addison-Wesley Publishing Company. Broussard, L.et al (2009). Preparing pediatric nurses: The role of simulation based learning. Issues in Comprehensive Pediatric Nursing. 6 (32): 4-15. Comer, K. (2005). Patient care simulation: Role playing to enhance clinical understanding. Nursing Education Perspectives. 26(6): 357-361. Eaves, H. & Flagg, J. (2001). The US Air Force pilot simulated medical unit: a teaching strategy with multiple applications. J Nurs Educ.30 (40):110–115. Gaba, M. (2002). Two Examples of How to Evaluate the Impact of New Approaches to Teaching. Anesthesiology. 7(96):1–2. Fountain, R. & Alfred, D. (2009). Student satisfaction with high-fidelity simulation: Does it correlate with learning styles? Nursing Education Perspectives. 30(2): 96-98. Gaba, D. (2004). The Future Vision of Simulation in Health Care. Quality & Safety in Health Care 13: 2-10. Hoffmann, R. et al (2007). “The Effects of Human Patient Simulators on Basic Knowledge in Critical Care Nursing with Undergraduate Senior Baccalaureate Nursing Students. Simulation in Health Care” Journal of the Society for Simulation in Health Care 2(2):110-115. Jefferies, R. (2007). Simulation in Nursing Education-From Conceptualization to Evaluation. New York: National League for Nursing. Jefferies, R. & Rizzolo, A. (2006). Designing and Implementing Models for the Innovative Use of Simulation to Teach Nursing Care of Ill Adults and Children: A National, Multi-Site, Multi-Method Study. New York: National League for Nursing. Issenberg, S. et al. (2005). Features and Uses of High-fidelity Medical Simulations that Lead to Effective Learning: a Beme Systematic Review. Medical Teacher 27(1): 10-28. Kameg, K.et al. (2010). The impact of high fidelity human simulation on self-efficacy of communication skills. Issues In Mental Health Nursing. 31(5): 315-323. Kyle, R. Murray, W. (Eds.) (2008). Clinical Simulation: Operations, Engineering and Management. Burlington: Academic Press. Larew, C.et al (2006). Application of Benner’s theory in an interactive patient care simulation. Nursing Education Perspectives. 27(1): 16-21. McGaghie, W. et al. (2006). Effect of Practice on Standardized Learning Outcomes in Simulation-Based Medical Education. Medical Education. 40(1): 792-797. Morton, P. (1995). “Creating a Laboratory that Simulates the Critical Care Environment”. Critical Care Nurse 16(6): 76-81. Read More