When it comes to creating and running simulation scenarios, instructors have to choose whether to use actual medical equipment (such as thermometers, glucometers, bedside monitors, medication carts, and so on) or to use simulators that closely mimic medical equipment. One of the challenges in running scenarios with simulated participants, for example, is that healthy people create healthy readings on real equipment – and of course, manikins may not provide any feedback at all, depending on the model.
Screen-Based Simulation and Simulation Equipment
The advantages to using screen-based simulation and simulation equipment include:
- Allows for manipulation of results to show in an educational environment
- Allows for a physically safe environment
- Allows for remote use of equipment (from a debriefing room or behind a SimScreen)
- Allows for scenario and patient cases to be built in to showcase “series” of events
Real Medical Equipment
The advantages of using real medical equipment are:
- Students can practice on the exact units they will use in a real hospital environment or other clinical setting
- Muscle memory of key features and buttons on actual equipment
- True attributes of real product (weight, appearance, colors, etc.) to prepare student for real life use and what to expect/look for
- Instructor may already be aware and trained on real product, so no additional education is needed
We reached out to Wendy Crary, PhD, RN, CNE, for her thoughts on this issue. Dr. Crary is the Coordinator for the Nurse Educator Certificate Program at the University of Wisconsin Madison School of Nursing. She wrote the following:
The challenge [of healthcare education] is educating students to the level of competence for all aspects of the role considering the many subtleties of the human person; this is not a role that can be learned strictly through reading of a textbook or watching others perform the multitude of tasks embedded in that care. As Bonnel and Vogel-Smith (2010) share, “Because clinical practice is a fundamental element of nursing, teaching students to apply didactic content and skills to competent clinical practice is an essential element of their education.” (p. 175)
The challenge for educators is to develop critical thinking and clinical reasoning in the students. Our intention is to prepare competent graduates who are ready when they enter the workforce: Ready to use the technology in the patient care environment, based on a level of comfort that was achieved through repeated use and refinement of skills during hands-on learning. The use of innovative teaching strategies that complement the patient care environment is an evidence-based approach to teaching.
The college-level nursing student, in order to acquire skills and refine their knowledge base, has traditionally attended lecture courses, skills labs sessions, and practiced at the patient bedside during clinical rotations. Recently, concerns have arisen related to the current structure of nursing education related to direct patient care; practice on live patients, increased acuity of patients and related technology, inconsistent opportunity for student learning experiences due to limited clinical space and shorter inpatient stays (Decker, et al., 2008; Nehring, 2008; Gaba, 2004).
The potential pitfalls of limited access to live patient care situations is an issue across healthcare provider educational sectors as evidenced in the following statement from a respiratory medical journal by Brindley, Suen and Drummond (2007):
The Catch 22 of medicine has always been that we (educators) can only create and maintain “experts” if they are given the chance to practice; the chance to make their own decisions, and ultimately the chance to make and rectify their own mistakes. Simulation offers an exciting opportunity to compensate for decreased clinical experience, and perhaps even decrease malpractice. (pp. 23-24)
Students must perceive the learning as having reality as its base before they will become engaged. The challenge for educators is recreating the scenarios that mirror clinical reality and offering to students sustained deliberate practice opportunities that grow their ability in a deliberate manner and allow them to build autonomy and feelings of self-efficacy.
Recognizing the missing elements in the teaching environment is what prompted me to begin, and follow through to conclusion, the development of the Progra-Temp Simulated Thermometer and the GlucoSIM™ Simulated Glucometer (editor’s note: both distributed by Pocket Nurse®). Adding these two missing assessment tools will enhance the level of reality in the teaching environment by adding a layer of believability for the learner.
Dr. Crary is the Coordinator for the Nurse Educator Certificate Program. Professor Wendy M. Crary obtained her PhD in Leadership, Learning and Service in Higher Education at Cardinal Stritch University. Her area of research is focused upon students’ perception of learning in virtual patient interaction settings and in the High Fidelity Simulation learning environment Dr. Crary currently holds three patents for teaching tools she developed for use in the simulation learning environment. She has presented on her research at state, regional, national and international conferences.
Kurtis Kabel, Account Manager for Pocket Nurse, contributed to this blog post as well. Kurtis can be reached at firstname.lastname@example.org or on Twitter @KurtPocketNurse.
Bonnel, W., & Vogel-Smith, K. (2010). Teaching Technologies in Nursing and the Health Professions: Beyond Simulation and Online Courses. New York: Springer Publishing Company.
Brindley, P., Suen, G., & Drummond, J. (2007). Medical simulation: “See one, do one, teach one … just not on my Mom”. Canadian Journal of Respiratory Therapy. Fall 2007, 22-27.
Decker, S., Sportsman, S., Puetz, L., & Billings, L. (2008). The evolution of simulation and its contribution to competency. The Journal of Continuing Education in Nursing, 39 (2), 74- 80.
Gaba, D. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, (13), i2-i10 doi:10.1136/qshc.2004.009878
Nehring, W. (2008) U.S. boards of nursing and the use of high-fidelity patient simulators in nursing education. Journal of Professional Nursing, 24 (2), 109-117.