Friday, April 4, 2014

Simulation: An Intrinsic Element in Nursing Education

Technology plays a momentous role in every profession. It has crossed all the dimensions of healthcare field too. There is an obvious advancement in the technologies used in hospital settings as well as education settings. Starting from the assessment of patients  to the treatment modalities, a wide range of equipment has taken over the role of nurses. For example, Electronic health record has replaced the manual documentation of patient care. The electronic health record was integrated into the clinical workflow to maintain right documentation of patient details and care,  and to ensure safe, quality care to the clients. Similar to the clinical setting, technological innovations are advancing in the field of nursing education as well. The introduction of simulation in nursing has bridged the gap between classroom knowledge and clinical practice.
 
What is simulation and what role does it play in the nursing education? It is the imitation or replication of a situation or an event that one would confront in the real world (Sasser, 2011). Simulation has been used in the health care field for quite some time now. It has undergone an event of changes from the first life size manikin popularly known as Mrs Chase to the high fidelity full body patient simulators. A nurse gains knowledge through academic studies, practical sessions, case studies, conferences and so on. “I hear I forget, I see and I remember, I do and I understand.” This Chinese proverb applies to nursing education too. Nursing students learn theory in school and get their practical exposure in the clinical settings. In many cases students are unable to think critically and are anxious while providing care to the patients. Moreover, their confidence level is pretty low that affects their overall performance. Simulation plays a central role in today’s nursing education.




Nursing in Abroad:- Going back to early 1900s, nursing students practiced their skills on injection pads, IM injection on oranges and so on. After few years, the life size manikin Mrs Chase took over the nursing skill area and she became more popular nationally as well as globally. Over the years, the simulation or the simulators underwent appreciable changes and now it plays a crucial role in improving the nurses’ practical skills. There are different components of simulation which includes task trainers, computer based programs, games, partial task trainers, standardized patients, role play, instructor regulated simulators etc. Task trainers are partial manikins that are used to practice definite skills like catheterization, IM injection, suctioning and so on (Kyle & Murray, 2008). Standardized patients are well-trained individuals who mimic a role so that the nursing students can practice their skills of assessment and improve their communication skills. Integrated simulators are again divided into low fidelity, moderate and high fidelity manikins based on their functions. High fidelity manikins are used in the educational set ups to enable students practice and improve advanced nursing skills. These are instructor driven and allow students to practice their nursing , critical thinking, decision making and communication skills in a given patient scenario. Simulation is helpful in many ways. It improves essential nursing skills like critical thinking, decision-making, assessment and permits them to handle challenging situations in a safe and controlled environment. This in turn improves the student confidence in dealing with a similar situation in the near future. In addition, nursing students are allowed to make mistakes in a safe scenario.

In Nursing schools, before the simulation session the students are asked to complete pre-exercise or pre-simulation activities such as reading lessons, listening to a recording or going through a power point presentation as preparation. The instructor divides the students into small groups and gives them a scenario. The students are expected to use their nursing knowledge and other skills to encounter the situation within the given time frame. Later, after the simulation session, reflective  feedback or debriefing is done by the instructor to make the students realize their strengths and weaknesses. Debriefing session helps the student to review their performance and understand their mistakes, which helps them in advancing their existing skills. Similarly, simulation sessions are conducted in hospitals for medical professionals to upgrade their professional practice skills, promote patient safety and to improve teamwork.

In short, nursing simulation scenarios mimic real patient situations in a safe controlled environment. It promotes active learning, team building, communication skills and self-efficacy. Students assume the role of a nurse and take the responsibility of providing comprehensive care as the patient takes a turn for the worse. Learning from mistakes is one of the best ways to improve skills and moreover building confidence. Present nursing education has made many revisions and simulation classes are an integral part in the present curriculum. All the colleges and universities have introduced simulation-based trainings in their nursing curriculum to improve the student performance and to upgrade their nursing practical skills that would ultimately transform them to competent and intelligent nurses in the future.



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