Simulation in Nursing Education - Literature review Example

Running Headers: SIMULATION IN NURSING EDUCATION Name: Course: Institution: Instructor: Date: August 26, 2010. Introduction Simulation can be defined as the imitation of some real thing, process or state of affairs. It entails representing certain basic characteristics or behaviours of a selected abstract or physical system. In general terms therefore, simulation can be defined as a device or a technique that attempts to create characteristics of the real world. It allows the educator to have power over the learning environment through programming of the practice, availing feedback and reducing or introducing environmental disruptions. In health care, simulation may denote a device representing a simulated patient or even part of a patient, which can interact with and respond to actions of the learner. It can also refer to activities that imitate the reality of a clinical environment, which are designed to demonstrate procedures and promote critical thinking and decision making, (Lane, Slavin, and Ziv, 2001). Simulation is applied in many contexts such as technology, safety engineering, training, testing and education. Key issues in simulation involve the use of simplifying assumptions and estimates within the simulation, acquisition of legitimate source information regarding the relevant selection of basic characteristics and behaviours and validity and fidelity of the simulation results. Nowadays, simulation is taking an essential role in training and education of healthcare professionals. The use of physical three-dimensional simulation to make a replica of a life-like experience so as to advance the training of health care professionals is expanding at an unprecedented pace globally. The overall concern for enhanced patient safety, cost minimization as a result of human errors and ethical issues associated with training are not isolated from this phenomenon (Ziv et al.2000). Kohn et al. (1999) encourages all teaching institutions and health care organizations to take part in the development and the use of simulation for training learner practitioners. However, this will probably occur if there is adequate scientific evidence to support the suggestion that educating nurses using very reasonable simulation methods substantiates the expenses that can be involved. The setup, purchase, maintenance and running costs of patient simulators and that of the facilities and equipment required can sum up to a significant cost (Issenberg et al. 1999, Lane et al. 2001). Yet, over the recent past there has been an increase in the number of national and international simulation associations and societies, meaning that the patient simulator community is increasing. This has an implication that there are more benefits, compared to the costs incurred, associated with simulation. This essay seeks to give a better understanding regarding simulation outlining the benefits and challenges of applying simulation in educating nurses. Types of simulation There are several types of simulation, which include the human patient stimulator, standardized patients, virtual patients, screen based simulation and integrated models. The choice of simulation to use depends on the educational objective or goal. It should be in line with the level of the student. The higher the pragmatism, the more efficient it is in appealing the student. Implication of simulation in nursing education It is obvious that it would be unrealistic to think that graduates of a nursing education have got all the necessary training required for them to undertake a medical examination after they depart the doors of academia. Orientation courses and continuing education for the nurses are critical tools to help practitioners improve their expertise, knowledge and skills, in order to produce quality patient care and minimize errors. It is important to carry out competency evaluation on nurses in order to promote patient safety. The Institute of Medicine report recommended simulation as one of the best strategies that can be applied to prevent clinical errors. The report states that teaching institutions and healthcare organizations should take part in the development and use of simulation for the training of learner practitioners, crisis management, and problem solving, particularly when the latest and potentially hazardous equipment and procedures are introduced. Nursing education has used simulation to teach principles and skills regarding nursing care for quite some time. Models of whole body mannequins, diverse computer based learning programs and anatomic parts have provided educators with training tools for learners seeking to become professional nurses. Today’s complex health care environment requires that nurses are able to carry out quick assessments and clinical decisions. Modern trends in nursing education require that nurses are provided with more experimental learning opportunity than instruction, places more emphasis on outcomes requires the increased use of learning technology and is more evidence based. This is why simulation is recommended for modern nursing education, since it offers an extraordinary tool for nursing education for the twenty first century, helping nurses to manage unusual emergencies such as bio-terrorism acts without prior direct exposure. Benefits of utilizing simulation in nursing education Simulation is a situation or an event made to resemble a clinical procedure. It can be used to teach technology, assessment, theory, pharmacology and other skills. The underlying principle of using stimulation as an educational strategy includes the provision of immediate feedback, provision of standardization of cases, clinical decision making, integration of knowledge and behaviour, minimization of risk to a live patient and the use of psychomotor skills. The weight in simulation is normally on the integration and application of critical thinking, knowledge and skills. A class room setting requires that a student uses a paper and a pencil. Unlike a class room setting, simulation allows learners to study in an environment that is as close as possible to the actual clinical condition and gives them the chance to think on their feet and not in their seats. Compared to the actual clinical experience, simulation offers the learners the opportunity to practice rare and critical events. It reduces training variability and increases standardization. Every student is guaranteed experience and is a student centered learning. Simulation also allows independent decision making through critical thinking and offers the students the opportunity to make and learn from mistakes since it uses the concept of experiential learning. Simulation can be designed and manipulated and allows calibration and update. It is safe and respectful for patients and allows deliberative practice. This method has actually been proved to increase patient safety, reduce the costs associated with human errors and promote better preparation of new nurses. In the National Safety Goals for the year 2007, of the Joint Commission, improving the safety of the medication use is categorized as the third goal, preceded only by improving the accuracy of patient identification and improving the effectiveness of communication of caregivers. Research shows that medication errors are most probable to take place during the prescribing and administration stages and are attributed to several factors; confusion as a result of similarity in drug names, lack of understanding by patients about their medications, inappropriate medication dosage, incorrect administration site, all of which result from environmental disruptions, drug labeling and miscommunication. Simulation helps to combat all these problems and ensures learners have all the skills to help minimize medication errors. In summary, simulation as a method of nurse education offers the learners an environment that closely resembles the clinical situation. The learners can carry out practical experiments to back up whatever they have learned theoretically in the class room since it is proven that it is not enough for students to come out of class and be expected to have got all the necessary training. Thus, simulation gives them the opportunity to actually have a practical experience with a clinical setting. In such a way, costs incurred as a result of human errors are minimized, public safety is increased and also other ethical issues are addressed. Simulation effectiveness on critical thinking, knowledge, skills and self efficiency Simulation encourages nurse educators to teach students to think critically and go beyond the traditional practice of simply knowing, to the modern approach of application and synthesis of knowledge as they plan, implement, assess and evaluate nursing care. Simulation offers an alternative approach to the traditional teacher-centered nursing education, emphasizing on the preferences and learning needs of modern nursing students. It exposes students to situations that they may never have in their clinical practicum experiences. Simulation allows students to acquire the practical knowledge and skills required for nursing care through a setting that is close as possible to the actual clinical environment. The students are taught to critically think before carrying out any exercise with the main aim of promoting public safety and reducing errors. The skills and knowledge acquired make the learner self efficient such that students become professionals. They acquire all the required knowledge for nursing care. Therefore simulation is an effective method of impacting students with critical thinking skills and making them self sufficient. Challenges of using simulation in nursing education Research studies reveal that simulation in nursing education is very expensive. For instance, Issenberg et al. (1999) and Lane et al. (2001) highlight that maintenance and running, the purchase and setup costs of patient stimulators sum up to a significant cost. This method is also perceived by many to be unrealistic and offers limited realistic human interaction and thus, students may not take it seriously. Learning theories People learn through various ways. Human beings have the ability to learn through various ways, which are determined by a relation between experience and genetics. The balance between the two and how it actually happens is extremely controversial. This section analyses fundamental learning theories that are relevant to simulation. Constructivism Constructivism is a rich theory with several sub branches. The basic principle in this theory is that the learner does not have a blank mind, but has some knowledge about the subject. Therefore, when something new is inscribed into the mind of the learner, he makes a new meaning by incorporating the new knowledge into a pre-existing network of understanding. With experience, the conceptual tools, which human beings employ to conceptualize the world develop further. One of the sub branches of constructivism is the cognitive constructivism. It is also referred to as radical constructivism with regard to child development. These processes continue up to adulthood. Social constructivism, another branch os constructivism, places construction of meaning in a social setting. It implies that a person, maybe a child leans a form of knowledge that is socially acceptable through interaction and before internalizing this knowledge, it becomes the child’s own knowledge and its source in interaction is lost. Through practice and engagement in a community of practitioners, students increasingly become competent (Lave and Wenger, 1991). Androgogy This theory was proposed by Knowles (1990). He noted that adults are an abandoned group when it comes to education since most educational research targets children education. He developed this theory to explain how adults learn. He highlighted that adults are most ready to learn if they require learning a new concept in order to cope with real life. He also noted that adult learning focuses on problems rather than subject and that their past experiences will have a bearing on their present learning condition. Also, Knowles highlighted that adults see themselves as accountable for their own decisions and need to be seen as self directing. Other learning theories such as social learning, situated learning and experimental learning, build on constructivist theory and recommend a level of negotiation of understanding. Conclusion The application of simulation in nursing education is a reasonably new instructional methodology. The underlying principle of using stimulation as an educational strategy includes the provision of immediate feedback, provision of standardization of cases, clinical decision making, integration of knowledge and behaviour, minimization of risk to a live patient and the use of psychomotor skills. Through patient simulation, essential elements of safety of the patients can be emphasized such as evading medication errors. Exposing students to a variety of clinical conditions through clinical practicum experiments and patient simulations equips them with the ability to provide effective, safe care and work as members of the health care team and as the quote goes, tell me and I will forget, show me and I may remember and involve me, and I will understand, (Confucius, 450 BC). However, the challenge is for the healthcare organizations to embrace simulation as an instructional strategy and to hunt for its effective execution in nursing education programs. The potential benefits to learners outweigh the costs of training. Reference: Hegarty M K, Bloch M B 2002 The use of simulators in intensive care training. CurrentAnaesthesia and Critical Care 13:194-200 Issenberg S B, McGaghie W C, Hart I R, Mayer J W, Felner J M, Petrusa E R, Waugh R A, Brown D D, Safford R R, Gessner I H, Gordon D L, Ewy GA 1999 Simulation technology for health care professional skills training and assessment. Journal of the American Medical Association 282(9):860-866 Joint Commission on Accreditation of Healthcare Organizations. National patient safety goals. 2007 2006 [Accessed April 1, 2008]. Available at: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_npsgs.htm. Knowles (1990). The future vision of simulation in health care. National Academy Press, Washington DC. Kohn LT, Corrigan JM, Donaldson MS., editors. To err is human: building a safer health system A report of the Committee on Quality of Health Care in America, Institute of Medicine . Washington, DC: National Academy Press; 2000. Lane J L, Slavin S, Ziv A. (2001). Simulation in medical education: A review. Simulation & Gaming 32(3):297-314 Lave J, Wenger E. (1991). Situated learning: Legitimate peripheral participation. Cambridge Press, Cambridge. Rauen C. Using simulation to teach critical thinking skill: you can’t just throw the book at them. Crit Care Nurs Clinics N Amer. 2001; 13: 93–103. Rystedt H, Lindström B 2001 Introducing simulation technologies in nurse education: a nursing practice perspective. Nurse Education in Practice 1:134- 141. doi:10.1054/nepr.2001.0022 Ziv A, Small S D, Wolpe P R 2000 Patient safety and simulation-based medical education. Medical teacher 22(5):489-495 Read More