Perceptions of Nurse Educators Using Simulation in Teaching - Essay Example

Nurse Educators’ Perceptions Using Simulation in Teaching: Change in Technology by Marline A Concept Paper Submitted to the Abraham S. Fischler School of Education in Partial Fulfillment of the Requirements For the Degree of Doctor of Education Nova Southeastern University 2013 Table of Contents Page Simulation is an education technique that is often used when an instructor wants to provide a realistic method to students. It is particularly valued in nurse education because it is thought to “replicate clinical practices in a safe environment” (Cant & Cooper, 2010, p. 3). The focus of this study will be on how educators perceive simulation and whether it is helpful to them in teaching nursing. The research will be conducted with nurse educators on the campus of a large, private and co-eduacational American university who are employed in the college of nursing. Currently, simulation activities are used in the nursing department to help students understand what they need to do in various nursing situations. The college provides students with preparation for real patient interactions through their patient simulators which are designed to provide the “knowledge, skill, and training required to enter, or continue growing, in the nursing practice” (Ma, 2012, par. 3). Simulation has become a very important aspect of training nurses and helping them understand the needs of their patients. Also, simulation can provide a opportunities for students to gain understanding, through simulation, by allowing them to experience and function in an environment, which is appropriate to the real situation. It assists students to understand problems that may arise during their careers and to respond in a safe and effective manner to meet these challenges Research has been done on the use of simulation in a wide variety of fields. In nursing Cant and Cooper (2010, p. 3) note that it is popular on training programs but that “its effectiveness is unknown.” A question remains, therefore, regarding how well this information gathered through a simulation exercise translates to the real life situation. The focus of this research will be to understand the lived experience of faculty members who are using simulation in the classroom. It will use a phenomenological design and face-to-face interviews will be conducted with 15 nurse educators. Background and Justification Beuchesne and Douglas (2011) state that simulation in nursing has happened over time as a way to help teach students work more effectively with patients and to improve quality care. Simulation has also been used to provide a safe way for new nursing students to gain an understanding of how to practice as a nurse, and it helps them to reduce the number of errors that occur with patients (Beuchesne & Douglas, 2011). Errors offer a significant opportunity for learning, particularly when they are followed up with de-briefing, since it is only through deeper reflection on actual experience that learners gain a thorough understanding of the implications of what they are doing (Dreifuerst, 2009). Wilford and Dyle (2006) state that simulation started in education over 40 years ago, and the first simulators were computer-based rather than the sophisticated programs that are in use today. Also, students who use simulation must “suspend reality and interact with the simulator as though it was a real patient” (p. 607) if they are to gain the most from the exercise. The need for simulation has grown because it is has been regarded as a more cost effective way for universities to test students and provide them with realistic situations; There has been some evidence, according to Lasater (2007) that students gain extra value from simulation with high fidelity simulation, especially in the area of diagnostic skills and clinical judgement. This study found that practice with the simulator brings increased confidence, and the context of the classroom, with peers and tutors provides enhanced support for review and reflection. There still remains, however, a question of whether these simulations provide other transferable skills which apply equally well in the real clinical context (Murray et al, 2008). The research problem. The problem is that most of the studies on simulation in nursing education examine the issue from the point of view of learners, and not from the point of view of educators and colleagues who must evaluate how well these simulations prepare students for real life situations. Many colleges and universities are investing money into the use of simulation. There is a large amount of information about how the simulation is working, but it is generally from the point of view of those people who are using the simulation. There is little information coming from the educators who are using the simulation. The research will explore the lived experience of nurse educators who are using simulation to assist nursing students. In many situations, simulation provides a better opportunity when resources for hospitals are changing (e.g., hospitals closing, nursing shortages) and where there can be little opportunity for students to have a real clinical experience (McNeal, 2010). Simulation becomes a cost effective option in these situations, but it important to understand how simulation is working and whether it is allowing students to learn well enough to transfer their skills to a real work environment. Simulation can only be a good option if it allows students to transfer the skills they have acquired into the reality of clinical practice in a safe and effective manner. Deficiencies in the evidence. According to Lunce (2006) the purpose of educational simulations is to create an opportunity for students to problem solve, test theories, provide experiential learning, and help them learn ways to work more effectively with patients. Another important purpose is to allow students to practice, and gain technical competence through repetition, and even to learn from mistakes, while protecting patients from the consequence of any lack of skills or mistakes that are inevitably made in the early stages of learning. There are as yet few empirical studies on the effectiveness of simulation training aiming to test whether students using stimulation for educational purposes were able to transfer the knowledge to real life situations. One article on the use of simulation to train for the management of preeclampsia and eclampsia found that obstetric nurses’ overall self-efficacy with preeclampsia and eclampsia management significantly improved with high fidelity human simulation training, concluding that “other high-risk low-incidence obstetric emergencies may also be suitable topics for simulation training” (Christian, 2013, p. e369). Audience The results of this study are intended for nurse educators who are using simulation in their classrooms. The information provided may allow these educators to contribute more information about their experiences in simulation and how students use this information in real clinical situations. The results of the study may also assist administrators who are responsible for deciding upon the use of simulation in the classroom to understand whether simulation is effective in real situations. Definition of Terms Educational Simulation: An educational simulation is an online or physical experience where learners are able to go through a series of steps or a series of procedures that models what they would do in a real-world situation. In nursing, the simulation presents students with an opportunity to work with patients without risk. A simulation also allows the student to understand the situations they may face in a real life situation (Ward, Mukherjee & Hai-Jew, 2012; Ma, 2012). Phenomenological research: Phenomenological research attempts to understand participants’ “perceptions, perspectives and understanding” of a specific situation (Leedy & Ormrod, 2010, p. 141). This means that it is important to gather as much detail as possible about the way the participants think and talk about the topic in question. If possible, narratives and dialogues in the participants’ own words should be sought, so that the researcher can interpret the nuances of meaning that lie behind the choice of words and the way the person chooses to present information. This is not so much based on quantitative data, and it does not matter that much of the materil gathered will be rather qualitative and subjective in nature. The point of this approach is to gain multiple perspectives as accurately as possible and see the issue from all of these points of view, even if some of the results turn out to be contradictory. This method is a good way to capture the complexities of human social interactions. Fidelity: “Fidelity also refers to the realism of learner interaction facilitated by the simulation as well as the type and frequency of feedback provided” (Lunce, 2006, p. 38). Purpose of the Study The purpose of this phenomenological study is to describe the lived experience of 15 participants who are professors using simulation in their classrooms with nursing students. Simulation widely believed to be an important aspect of many types of classrooms because it provides an opportunity for students to learn valuable skills needed for real life situations. The purpose will also be to discover, from their point of view, whether they feel that simulation is working to help students in real life situations or not. Chapter 2: Literature Review Theoretical or Conceptual Framework The conceptual framework for this qualitative research study is phenomenology. The process of understanding the lived experience of the novice faculty assumes that the most important aspect of what is learned from participants is their perception of an event or phenomenon. This line of thinking follows from the early philosophical work of Husserl (1931). Husserl further suggested that the researcher can understand this process through noticing the reasoning and intuition from the individual by having discussions with them in their own setting. Husserl believed that phenomenology was a rigorous science that was focused on a description of the phenomenon instead of an explanation of it. Moustakas (1994) further conveys that phenomenology is scientific in nature, and the researcher attempts to identify the themes within the discussions provided by the participants in hopes of developing a deeper meaning to what has been said. In listening to participants, phenomenology attempts to eliminate bias where possible and to help the researcher organize the information received in a way that can be transmitted to a deeper understanding. By receiving different perspectives from a variety of participants, a researcher is more apt to identify the essence of the meaning that the phenomena has for the participants (Moustakas, 1994). Phenomenology also uses the process of questioning the way that people see the world so the researcher can gain more information from an “insider’s perspective” (Leedy & Ormrod, 2010, p. 141). Synthesis of Findings In researching this topic, most articles that were found were from the perspective of students who were participating in the various simulations. The first aspects of the information found describe the history of simulations and provide information about how simulations should be done in the classroom. For example, McNeal (2010) states that the use of simulation in education dates back to aviation. Simulations were used to teach pilots how to fly and were important to the advancement of aviation. Other industries that have used simulators include transportation, space exploration, and also nuclear power. All of these industries found it important to create an opportunity for students to understand how to handle materials, how to safely handle chemicals, and how to execute certain skill levels before they went into the field on their own. Because of the shortage of nurses in many hospitals, the fact that some facilities have had to close, and because patients are staying longer in the hospital than in the past, the need for simulation in nursing has increased (McNeal, 2010). Simulation exercises are supposed to provide an environment where students can gain experience without risk. They are supposed to be able to take what they learn in the simulation environment and apply it to real life situations. Lunce (2006) stated that the purpose of simulation is to motivate the learner to work on their problem solving, to test hypotheses, to gain experience in the learning process, to construct schemas, and to develop mental models that they can use in practice (Lunce, 2006). One type of simulation that is used in education is the physical simulation where nursing students are able to interact with mannequins that are programmed to make noises and to provide some of the issues that patients would view in a real-life environment. Ladd, Grimley, Hickman, and Touhy (2013) stated that simulations can also be used to help students understand what to do in an end-of-life situation. All of these studies show how to do simulations and why they are important, but they do not show whether or not the skills that students learn during simulation are actually transferred to a clinical work environment. Simulations are also pedagogically useful because they allow learners to engage in repetitive practice, and the simulator permits individualized learning according to the needs of each student (McGaghie et al,m 2010, p. 52). With increasing sophistication in the kinds of tools available for simulations, from the aviation domain’s flight simulator to the anatomically accurate manniquins used in nursing and midwifery, different types of exercise and a range of difficulties can be set up in order to meet the needs of each specific group of students. It has been noted, however, that the way educators approach the exercise is crucial to its success, since many situations require a complex mix of technical and communicative skills which can only be practiced in scenarios where individuals take up defined roles and work in teams (Nikendei et al., 2005). Furthermore, an overemphasis on the properties of the simulation tool, and its ever improving fidelity to the real life situation leads often to a situation where educators seek to teach ever more advanced skills using simulations, rather than exploiting its potential for thorough training of basic skills, and for recap and practice of skills learned many months or years ago (Salas et al, 2009). Simply setting down a certain amount of time to be spent in a simulation is not sufficient to guarantee its educational effectiveness. It is important to consider how a simulation tool is used by learners and to follow up its use with observations and feedback in order to ensure that lessons are learned. Simulation Effectiveness From Student and Faculty Perspectives Many researchers have studied simulation from the student and faculty perspectives. Most of these articles provide information about simulation in the teaching setting, but do not provide information about how these skills are implemented in the clinical real-life setting. It has been pointed out that the traditional apprentice method of learning, whereby a learner accompanies a more experienced practitioner and learns in the actual clinical context, is constrained partly by chance, and there are always operational considerations and patient safety considerations which take priority over the learner’s needs (Ziv et al, 2000, p. 493). Simulation, on the other hand, can be designed to present predetermined set of conditions or scenarios, which in theory at least provides better coverage of required skills. Emergency room care is one area which has been studied in relation to the use of simulation, perhaps because here more than in any other clinical area there is high ambiguity, rapid change, a wide range of potential clinical issues and a need for fast decision making and close teamworking. Satish and Streufert (2002) recommend simulations for both individuals and teams in this context, so long as they are designed to include thought and decision making processes as well as technical skills. In another example based in higher education, Kardong-Edgren, Starkweather, and Ward (2008) provided three simulation exercises in their study to understand the perspectives from both students and faculty. A total of 100 students went through the simulations and the faculty members were each responsible for 10 students. Students and faculty found simulation difficult to understand at first, and the instructions had to be read more than once. Once both faculty and students understood what was expected, they were able to move through the simulation. One point that the authors made was that faculty had different ways of leading students through the scenarios, which meant that students did not receive the same experience from all faculty. Lewis and Ciak (2011) provided research where the purpose of their study was to analyze whether simulation experiences in a laboratory had an impact on student satisfaction with the exercises and whether it improved their critical thinking, self-confidence, and their cognitive learning. There were 63 students who participated in the study over four semesters. The results of the study showed that students were positively impacted through the simulation, and their self-confidence and cognitive learning increased. The study had mixed results in the area of critical thinking with some students feeling they were able to understand what they needed to do better, while others were not sure. The authors suggested that 63 students may have been too small a sample to gain an understanding of the impact on critical thinking. Conrad, Guhde, Brown, Chronister, and Ross-Alaolmolki (2011) also researched working with students in the laboratory setting. The reason that simulation is important, according to the authors, is because many clinics are closing, there is a lack of nurses in some areas, and patients are staying longer in hospitals. Simulations allow students to gain clinical opportunities in light of these situations. Conrad et al. also stated that simulation is an essential part of any nursing program because it helps students learn to think critically, understand what they must do in specific situations, and how to solve problems for their patients. Eggenberger, Keller, Chase and Payne (2012) measured the ability for students to gain the concept of caring in simulation programs. For their measurement, they modified the Coates’ Caring Efficacy scales and renamed them as Caring Efficacy Scale-Simulation Student Version (CES-SSV) and Caring Efficacy Scale-Simulation Faculty Version (CES-SFV). The authors stated that although they adapted these scales, and the scales suggest that there can be a positive move toward caring in simulation, the exercise does not take the place of a real-life situation. In nursing, caring is an integral part of building a relationship between nurses and students, but it is something that can only be taught through interaction with real clients (Eggenberger et al., 2012). Simulation is used in a variety of ways, as stated previously, and one important area is within the laboratory. What is clear in these studies is that students can learn many different things from simulations, but whether or not students go on to transfer the skills and knowledge they have learned into clinical practice is not yet known. Indication of Shortcomings in Research The review of the literature provided information that simulation is important to nursing, and a few studies were found to show that some individual skills were transferred from the simulation context to the clinical context (Lasater, 2007; Christian, 2013). There was a significant amount of literature also which discussed how simulation was helpful in the laboratory. This is a rather patchy result which indicates that further research is needed in order to explore this area more thoroughly, and in particular there is a need for more empirical work to complement the review articles which make up the majority of the literature on the topic. Eggenberger et al. (2012) concludes, however, that there are certain factors that simulation cannot help the student learn, one of which is to teach them how to care about people. In the health domain, as in aviation and other high risk areas, simulation is used mainly to teach the practical skills, but not necessarily the people skills. In the business and education fields, however, more elaborate team based scenarios and games are used to build complex simulations which are designed to elicit people skills as well as technical capabilities (Aldrich, 2005). Critique of the Literature Most of the studies analyzed for the research review were qualitative in nature. Most of the study participants were faculty in different areas of nursing, and they were asked about their views of simulation in the laboratory setting. Some researchers interviewed students who were going through the process. According to Leedy & Ormrod (2010), phenomenological research, by its nature, is conversational, and the researcher is looking for themes that emerge from the discussion. Because of this, it is important for a qualitative researcher to find ways to bracket their emotions and preconceived ideas about their topic in order to provide a purer idea of the participant experiences (Beech, 1999). Research Questions There are three research questions that will drive this research: RQ 1: What are the lived experiences of nurse education faculty involved in simulation in the laboratory setting? RQ 2: What are the lived experiences of students in the nursing program as they move into real-life clinical settings, according to the perceptions of novice faculty? RQ 3: What are the lived experiences of nursing faculty as they prepare students for work in clinical settings, using simulation? Chapter 3: Methodology The purpose of this qualitative, phenomenological study is to interview 15 nurse educators to understand their lived experiences of using simulation in their classrooms. The interviews will be 1 to 2 hours long and include questions about how they feel simulation will translate from the classroom to real-life clinical settings. The educators are between the ages of 35 and 55 and are working at the university. Prior to accepting the job in the nursing program, all teachers were experts in the field of nursing, but they had not used simulation prior to their current position so this was a new technology for them. Educators will be chosen from the staff in the nursing department at the Abraham S. Fischler School of Education. Teachers will be asked to participate voluntarily, and permission from the head of the department will be obtained. Each teacher will sign a consent form informing them about the study, what it entails, and how the information will be used. Teachers will participate in 1- to 2-hour interviews in order to gain the most information from them (Creswell, 2009). Qu and Dumay (2011) stated that the interviewing process in qualitative interviewing requires intense listening skills, taking notes well, and the interviews should be well planned and organized. In looking at the interviewing process, the researcher will ensure that there is enough time for each interview, and because a tape recorder will be used to record the interviews, any notes that are taken will be secondary to the interviews. Selecting the Sample The method for obtaining the sample will be purposive sampling because the researcher will be speaking to people who already have some knowledge of the topic of the study. Coates (2011) provided more information about purposive sampling and stated that purposive sampling is done with participants who already have some knowledge in the subject under study. Because the participants already have some information in nursing, this will help them bring more information to the study because they will understand what skills students need to learn from simulation, to be successful in real-life nursing situations. Procedures Design. The design for this study will be a heuristic phenomenological design. According to Moustakas (1990) the heuristic phenomenological design starts with a question that the researcher wants to answer. In this process, the researcher is answering a question that has been puzzling to him or her or that has been a challenge to them personally. This design fits the approach because the researcher is interested in how simulation transfers to real life situations. There are six phases of heuristic research. The first procedure has been completed because the researcher identified the problem to be studied. In the second procedure, the researcher will be immersed in the concept of simulation by doing research and talking to novice teachers who may be interested in participating in the study. In the incubation procedure, the researcher will remove himself or herself from the question and reflect on any ideas that come to mind while standing back from the process. In the third procedure, the researcher will think about what has been said in the interviews and will use intuition to identify the themes that can be derived from the participant interviews. The researcher will listen to interviews and read the transcripts of the information to find these themes. In the fourth procedure, the researcher collects detailed aspects of the interviews to use in the report that will describe for the reader what was found. The fifth procedure will be to take the information found in procedure four and bring it into the research report. The final procedure is to bring the information together and present the results of the study. Data Analysis. The data analysis will use a five step process developed by Leedy and Ormrod (2010). The five steps in this process are: (a) organize the details; (b) categorize the data; (c) interpret single instances of themes; (d) identify patterns in the themes; and (e) synthesize any generalizations. To organize the details, transcripts of the audiotapes will be created. The data will be categorized according to the themes that the transcripts present. This information will be put into a Microsoft Word document. The Word document will be printed out, and the researcher will interpret single instances that show up as themes. Because there are only 15 participants, the extrapolation of the data will be done by hand. From the Word document, the researcher will identify patterns in the themes and synthesize any generalizations. Limitations. One of the limitations of this study is that there are only 15 participants. The study will be too small to make generalizations about all teachers who use simulations. Researcher bias can limit phenomenological studies so it is imperative for the researcher to be able to bracket emotions and any preconceived ideas about the research (Beech, 1999). Another limitation, according to Maxwell (2012), is that the participants may have difficulty understanding what the researcher needs and they may have difficulty answering questions because they are afraid of repercussions. References Aldrich, C. (2005) Learning by Doing: A Comprehensive Guide to Simulations, Computer Games and Pedagogy in e-learning and Other Educational Experiences. San Francisco: Pfeiffer/Wiley. Beech, I. (1999). Bracketing in phenomenological research. Nurse Researcher, 6(3), 35. doi:10.1177/1473325010368316 Beuchesne, M. A., & Douglas, B. (2011). Simulation: Enhancing pediatric, advanced, practice nursing education. 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