Nursing Simulation: It's Not Just for Skills Anymore

Monday, 9 November 2015

William T. Campbell, EdD, MS, RN
Department of Nursing, Salisbury University, Salisbury, MD, USA

Ever since Mrs. Chase in 1911 nursing education has utilized the mannequin for skills. The earliest mannequins in nursing were used for transfers, positioning, and other non-invasive skills & learning activities. Following the lead of medicine, especially anesthesiology, they were now being used for the training of nurses instead of doctors. The mannequins used were very low fidelity and were literally dolls, but quickly became useful for skills demonstrations, practice, and testing while maintaining the important patient safety. They were often just skills trainers or partial torsos with an orifice or lumen to accommodate a tube’s insertion.

Computers and simulation changed that. This time following the lead of the airline industry, aeronautics, and the military computerized nursing simulation moved away from the screen and would begin to incorporate the mannequin in the role of the patient. Again, with patient safety as the ultimate goal, education of nurses was the desired outcome. The fidelity level of the mannequins began to increase, but the activities were still basic skills instruction.

Even with the higher fidelity mannequins and the technological advancement of simulation many nursing instructors remain at the skills level of simulation because that is how they learned and where they are comfortable. Tradition is ingrained and often difficult to overcome. Simulation must move beyond Mrs. Chase.

My Nursing Care of Children & Adolescents course utilizes 3 days of simulation in a 12 day clinical rotation. Twenty-five percent (and up to 50%) of clinical being simulation maintains a consistent level of clinical education & preparation and maintains competency for the licensure exam & for employment (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). The simulations increase in complexity as the semester progresses. The simulations have basic skills, but go far beyond. The simulations, scenarios, nurse’s reports, and physician’s orders are designed to introduce questions and situations that will demand interdisciplinary collaboration, reinforcement of the knowledge of medications using available resources, setting priorities, developing leadership skills, building team work, delegating interventions, and the application of critical thinking. The simulations are designed to be a learning experience and not an assessment of the student. By removing instructor grading the stress level is diminished and learning increases in a more positive environment.

This session will describe tasks & orders inserted into the simulation scenarios to encourage a higher level of learning. It will also report the students’ comments and reactions.