Nursing What Effect Does Simulation 'Literature Review' chapter

Excerpt from 'Literature Review' chapter :

Learning in adults is most effectual when the environment is both participative and interactive. Another important characteristic is that learners obtain instantaneous feedback. Teaching methods that necessitate a learner to think though data or information and come to a conclusion or forecast an outcome are more valuable than is reading or lecture. "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" (Rauen, 2012).

Conventional teaching methods stress linear thinking as a single concept is taught at a time. In physiology and critical care courses, the body is divided into organ systems and studied. Even though this method is suitable to help learners dissect intricate information, organ systems do not function in separation from one another. "For instance, in a critical care course, new cardiac surgery nurses learn about ventilator mechanics, hemodynamics, and renal pathophysiology in separate lectures. Thus, novice nurses may have difficulty understanding why chest wall bleeding in a postoperative patient who is receiving mechanical ventilation is treated by increasing positive end-expiratory pressure, resulting in decreases in the patient's cardiac and renal outputs as well as a decrease in blood pressure. Grasping the nursing care priorities for such a patient requires an integrative or circular type of thinking about physiology, pathophysiology, and treatment because the priorities are interrelated" (Rauen, 2012).

Simulation Labs

Labs are comprised of scenarios using computerized, life-like manikins that mimic body functions -- such as bleeding, breathing, blood pressure and heart rate -- and corresponding patient responses. Simulation training seeks to:

Allow nurses to practice procedures on manikins before administering them on live patients. This way, there is no risk to the health and safety of human patients and themselves.

Foster confidence and comfort with mastering new skills. Nurses are able to make mistakes and learn from them, and practice procedures multiple times so they can review their decisions and techniques.

Train for situations and health conditions that may not present themselves during a clinical learning situation.

Keep nursing students on track to meet their clinical schedules so they don't fall behind should they miss traditional clinicals due to illness or other reasons. Ensuring students can get the practice they need is a major consideration when there's a demand to get as many nurses in the field as possible (Rinehart, 2011).

Standardizing nursing education, including simulation labs, can help current and future nurses learn similar processes and outcomes based on evidence-based practice. While simulation labs are designed to train in specific processes and outcomes, they're meant to be a tool, not a total replacement for clinicals. They're created to be as close to real life as possible, supplementing traditional clinical experiences. By incorporating these high-fidelity simulations into the main curriculum, students can learn skills in a safe, controlled environment. This way nurses will be better prepared to apply those skills in a real work setting, whether it's a hospital, nursing home or clinic, and to more easily take on the extra layers of responsibilities (Rinehart, 2011).

Concept being studied

The utilization of simulation in nursing education is not a new experience (Pacsi, 2008). Nurse educators use a diversity of instructional techniques that use simulation activities. "Role playing, game playing, computer simulations, human patient simulators, and case studies can all be utilized to simulate actual patient scenarios and are all examples of simulation" (Bastable, 2008). Numerous factors have influenced the surfacing of simulator use in nursing education. Low-fidelity simulation characteristically includes learning activities, such as case studies, that imitate patient care scenarios but do not use actual patient care equipment. Nursing educators do use low-fidelity simulators. For instance, low fidelity mannequins are not computerized, and they do not react to nursing interventions. In contrast, high-fidelity simulators are computerized, and they imitate human vital signs such as respirations and pulses. Nurse educators have used mannequins, case studies, and other forms of low-fidelity simulation for a lot of years. Low-fidelity mannequins can be particularly helpful when nursing students are learning basic nursing skills, such as blood pressure measurement. In addition, low-fidelity mannequins can be used when nursing students are learning only one exact skill, such as wound dressing changes (Bastable, 2008).

Low-fidelity simulation, such as case studies, can assist to supplement lecture content or guide group discussions. A case study presents a patient situation and then asks students to answer a series of questions connected to that particular patient care condition. Most nursing staff use case studies during class time to assist group discussions; however, case studies can also be assigned to students to complete on their own. Case studies are a frequent example of low-fidelity simulation use in nursing education. Using case studies to demonstrate patient care situations allows nurse educators to help students to apply information to clinical care issues in a low stress environment. "Students can answer and ask questions as they work through the scenario and explore the different patient care regimens that might be prescribed" (Bastable, 2008).

"The use of high-fidelity simulators has increased in the past 10 to 15 years" (Pacsi, 2008). High-fidelity simulators are computer driven and students make use of real patient care equipment to react to changes in the simulator's health condition. High-fidelity simulators are able to imitate realistic patient reactions. For instance, a simulator can be programmed to exhibit the signs and symptoms of cardiac arrest. Students are trained to react to this by performing chest compressions with the correct force and depth. If the compressions are done correctly, the simulator's cardiac standing will get better. If students fail to carry out chest compressions or do not execute them correctly, the simulator's cardiac status will get worse. High-fidelity simulator use has several advantages. According to Bastable (2008), "Across disciplines, unpredictable situations cause critical thinking challenges, including making the right assessment, taking timely action, and performing competently" (p. 325). Nursing students are able to practice the essential skills in a safe, controlled environment. When faced with the same crisis in real life, these same nursing students will have developed and practiced some of the skills to productively manage the circumstance (Soucy, 2011).

Theoretical Framework

Critical thinking expansion is a vital part of nursing students' educational experiences. Critical thinkers must be able to categorize, infer, chart, assess, produce, and frequently create new ideas or solutions. It can be challenging to teach students to think critically, particularly when they are confronted with a critical patient care situation. Critical thinking is measured to be a higher order cognitive skill. It is a priceless skill for nursing students because nurses must productively manage multifaceted patient situations. Additionally, effectual critical thinkers can apply accessible knowledge to new circumstances. Using a teacher-centered advance to learning, such as lecturing, may not encourage critical thinking skill development. When nursing educators utilize a student centered advance to learning, critical thinking skills can be developed and improved. Additionally, when students aggressively participate in learning activities, their aptitude to keep hold of knowledge, make deductions, and put together new knowledge gets better. Utilizing human patient simulators in nursing education encourages student commitment and contribution in learning (Benner et al., 2010).

The epistemology of higher education is influenced by Knowles' (1970) adult learning theory. Knowles' posits that children and adults learn in a different way, are motivated to learn by dissimilar factors, and have different learning potentials. Adult learners are fundamentally motivated and must comprehend the significance of what they are learning. Adult learning is toughened when the learning environment is student-centered and when students are given the occasion to apply what they have learned to a practical situation. Knowles' adult learning theory balances both the empirical and simulation learning theories. Conventional teaching methodologies may not lend themselves well to simulated learning situations. The theoretical make up of experiential learning match the ideologies connected with simulated patient scenarios used as instruction. Experiential learning encourages students to learn by reflecting on an occurrence. Instead of just listening to a lecture and then trying to use their imagination to develop an understanding of a patient care matter, students participating in simulated activities are employed in the learning process and can reflect upon this knowledge to recognize further learning needs, decide what worked well, and to remember their actions when coming across a similar patient issue in real life. With effective leadership from a staff member, nursing students are capable to integrate suitable responses to urgent patient care scenarios into their existing knowledge base. "Students will remember techniques and appropriate responses with more accuracy after engaging in simulated learning activities that incorporate all of the steps of experiential learning" (Soucy, 2011).

Nursing staff members profit from a theoretical framework that can be used as a channel to assist them in developing effectual simulated learning situations and activities. "The National League for Nursing sponsored the development of a theoretical framework that is used by nurse educators to ensure the proper utilization of human patient simulators…

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