JULIE ANN M. AFAN JULY 25, 2015

MSN-2 CLINICAL TEACHING

JOURNAL CRITIQUE

Simulation is an event or situation made to resemble clinical practice as closely as possible. Simulation can be used to teach

theory, assessment, technology, pharmacology, and skills. The emphasis in simulation is often on the application and integration of

knowledge, skills, and critical thinking. Unlike a classroom setting or a paper-and-pencil test, simulation allows learners to function in an

environment that is as close as possible to an actual clinical situation and provides them an opportunity to “think on their feet, not in

their seat. Simulation is an excellent teaching strategy for many skills but especially for critical care nursing. Learning in adults is most

effective when the environment is both participative and interactive. Another important feature is that learners receive immediate

feedback. The minute-to-minute care and monitoring of critically ill patients requires nurses to collect, analyze, and react to data and

information. Simulation is an excellent way to both teach and practice these skills.

Simulation is increasingly used in continuing and in-service education in healthcare staff-education settings. Because of the

increases in patient co-morbidity, acuity, and demand for safety, the healthcare system can no longer be sustained by, or satisfied with

nurses who remain at the beginner level. Competent nurses who gain expertise through experience are needed. Nurses routinely have

the most frequent and intense contact with patients; and it is the nurse who must be able to recognize changes in patient condition that

require early collaboration with other members of the healthcare team. It is not uncommon for the nurse to make the initial decisions

regarding a patient whose condition is rapidly deteriorating. Rehearsing and gaining experience through the use of simulation can help

the nurse gain confidence and knowledge about how to act in an emergency. Additionally, competent and even expert nurses in one

care setting may not be competent or expert in a new patient-population setting. Staff development educators should create carefully

crafted simulations that will assist in developing the expertise needed in a new setting. They can enable nurses to increase their

confidence as they move into new settings.

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. 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. 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 trainees to

participate in standardized simulations that depict issues most experienced by a given unit’s patient population. The use of patient

simulation in the training of healthcare providers is not limited to new students. There is also a need to maintain education in the health

professions.

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 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.

There are many barriers and limitations to using high fidelity human patient simulation. The major limitations of implementing

this technology to a curriculum include costs, the perceived lack of realism and lack of faculty training. Simulation helps in identifying

deficiencies in organizational structure and function and can be used as a tool for implementing change. Despite the shortcomings,

when used appropriately, simulation remains a useful modality for teaching, training and assessment in medicine especially for highly

challenging and high impact areas.

Simulation enables healthcare professionals to hone the clinical skills that are needed to provide safe care without harming

patients as they develop these skills. As educators and as practitioners of healthcare, we have an obligation to actively engage in

learning the pedagogy related to simulation-enhanced learning. We must inform ourselves about the currently available simulators to

prepare tomorrow’s healthcare professionals and also be informed advocates for using simulation in our own cubicles of learning and

beyond. Our patients trust us to care for them safely and skillfully. We must remain faithful to this trust and move forward using the

simulation techniques available to us today and developing new techniques for tomorrow.