Alamo Colleges
Simulation in Nursing Education:
Creating a Quality Simulation
Yvette Baxter MSN, RN
Faculty Development in the
Effective Use of Simulation
Objectives:

Identify factors in the educational and practice environment
which have contributed to the use of simulation in nursing
education.

Identify advantages to incorporating simulation as a clinical
teaching strategy.

Discuss strategies for maximizing simulation effectiveness and
student learning outcomes.

Identify the key goals of debriefing.
Academic and Healthcare
Environment

Shortages of clinical faculty and clinical sites.

Limited exposure to high risk, low volume clinical events

Complexity of the healthcare environment

Emphasis on patient safety

Technological advances offering sophisticated and realistic
clinical experiences in the laboratory setting

Need to better prepare new nurses for working in a complex
and technologically rich health care environment
Clinical Gaps

IOM (2003): hospital leaders, health plans, and practice sites
reported increasing skills deficits in new graduates reported

65-75% of new-to-practice nurses did not meet entry-level
competencies for clinical judgment (Ulrich et al., 2010)

The Future of Nursing: Focus on Education (2011) – the current
nursing educational system inadequate to prepare nurses with the
necessary competencies to provide high-quality care in increasingly
complex healthcare environment
Implications
Medical Error:
 Greater risk for errors in clinical practice
Increased Turnover:
 Gaps between preparation and practice requirements results in
stress and increased potential to leave the field
 The percentage of turnover of new graduates is estimated as
17.7% within one year, 33.4% within two years, and 46.3% by
the third year (Cho, Lee, Mark, & Yun, 2012)
The Deficits
Competencies in which new-to-practice nurses
scored lowest included:




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Interpretation of assessment data
Decision-making & application of nursing process
Identification of changes in patient status
Timely & appropriate follow-up
Initiative in management of care
Saintsing, Gibson, and Pennington (2011)
Clinical Simulation


A technique, not a technology
Immersion of the learner with enough realism to
suspend disbelief

Environment to develop knowledge, skills, and
clinical reasoning

A concept- based learning experience
Benefits of Simulation

Self-confidence

Learn from mistakes without risk to patient safety

Practice high risk, low incidence patient events

Identify gaps in knowledge /skills

Diverse learning

Real time/immediate feedback

Promotes critical thinking and decision-making skills

Safety, teamwork, communication, collaborative learning
Components for Creating a
Quality Simulation
 Faculty/Student
Preparation
 Scenario Selection, Writing, and
Testing
 Fidelity/Realism
 Debriefing
Simulation Effectiveness
“The patient simulation is only as effective as
the faculty who are using it. The creativity,
clinical knowledge, teaching expertise, and
technological abilities of the faculty are highly
influential in the effective use of patient
simulation"
(Durham and Alden, 2008, p. 3-237).
Faculty Preparation
Requires:

Student-centered approach

Preparation and comfort with scenarios and equipment

Understanding of the goals/objectives

Creativity, flexibility, & recognition of learning
opportunities

Participation in the design process/evaluation
Faculty Preparation

Understanding that mistakes will be made

Minimize competition

Small groups

Roles assignment and assumption of roles

Close observation of actions, interactions, and
decisions

MINDSET!!!
Learner Preparation

Understanding of simulation guidelines, objectives, & means
of evaluation

Establishment of confidentiality, trust, &consent

Pre-scenario study guide

Orientation to simulation environment

What is to be simulated

Once in the simulation, students should function as they
would in the clinical environment
Clinical Scenario Defined
“The plan of an expected and potential course of events
for a simulated clinical experience. The clinical
scenario provides the context for the simulation and
can vary in length and complexity, depending on the
objectives”
(International Nursing Association for Clinical Simulation and
Learning [INACSL], 2011).
Steps in Scenario Development




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Selection of topic and template
Identification of learning objectives
Story Writing (determination of concepts, cues, and
critical events)
Peer review/Validation
Pilot
Topic Selection
Idea Generation
 Course objectives
 Identified practice gaps
 Staff/student survey perceived learning
needs/clinical challenges
 Clinical experiences
 Case studies
 Legal cases
Source of Scenarios

Pre-programmed/purchased

Created by faculty/educators

On-line pre-written scenarios

Books
Free On-line Resources


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Healthy Simulation
http://healthysimulation.com/2018/free-nursingscenarios/
Kansas State Board of Nursing
http://www.ksbn.org/cne/SimulationScenarioLibrary.
htm
Massachusetts Nursing Initiative- Simulation Scenario
Library
http://www.mass.edu/currentinit/Nursing/Sim/Scenari
os.asp
Considerations for Scenario
Selection

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

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Knowledge level of student
Goals and purpose of the simulation
Level of complexity and fidelity
Number of participants/length of time
Experience and comfort level of facilitator
Availability of content expert
Setting and equipment needed
What Should be Incorporated in
My Scenario?

Safety and identified concepts/competencies

Evidence based practice and standards of care

Institutional policies and procedures

References
Writing the Story
Beginning:
 Description of the patient, event, setting, participants
 Information to be provided
Middle:
 Plot progression and contingencies
 Expected actions & timelines
 Cues
 Flexibility of facilitator
Ending:
 Logical and realistic transition maximizes fidelity
Validation & Piloting
Validation:
 Evidence –based : current journals, clinical guidelines, and
textbooks
 Checked for accuracy and believability
 Reviewed by content expert for validity and revised as needed
Piloting:
 Piloted with small group of targeted learners
 Feedback enables scenario revision for maximum effectiveness
 Information regarding timeline, areas where learners get
derailed, or aspects of the scenario learners find confusing
Fidelity

The degree to which simulators and simulations mimic
reality

Simulation experiences should be as realistic as
possible

Realism of scenario, staging, props enhance the
simulation experience
Realism
“The realism of any simulation depends upon multiple
factors, including the fidelity of the simulator, the
environment, props, and the description of the
scenario…as realism is enhanced, the effectiveness of
the scenario as a learning tool is increased”
(Durham & Alden, 2008, p. 3-234).
Staging
Staging
Debriefing:
“a conversation among two or more people to review a
simulated event or activity in which participants explore,
analyze and synthesize their actions and thought
processes, emotional states and other information to
improve performance in real situations”
(Center for Medical Simulation, 2009, p. 1).
Goals of Debriefing

Evaluate whether learning objectives met

Build on prior learning

Self-reflection/assessment

Communication/different perceptions/attitudes

Reinforce teaching points

Identify/ correct gaps in knowledge, skills, attitudes

Improve future performance
Phases of the Debriefing
Process

Reaction – opportunity to decompress and discuss emotional
response to the simulation experience

Analysis - provides a time for reflection, understanding, and
discussion of what went well and what didn’t

Summary/Closure – a summary of the experience is provided
and evaluation of the simulation as a learning experience
Role of Facilitator in Debriefing
Create a safe and trusting learning environment
 Provide support
 Permit opportunity for defusing emotions
 Guide the reflective process
 Provide feedback/observations
 Assist in assimilating new knowledge

Texas Board of Nursing (BON)
Position Statement on
Simulation
In 2010 the BON put forth a position statement to clarify
the role and limitations of simulation in order to
provide educators with guidelines for making
simulation educationally sound and meaningful.
Texas Board of Nursing (BON)
Position Statement on Simulation

Simulation provides a valuable adjunct to traditional clinical
learning.

To be effective the simulation must challenge learners to use
problem solving and critical thinking skills.

Each simulation experience should have clearly stated
objectives that are presented to learners PRIOR to engaging in
the experience.
Texas Board of Nursing (BON)
Position Statement on Simulation

Learners are required to prepare for a clinical simulation
experience in the same manner they would a hospital clinical
experience.

An orientation to the simulation technology and environment is
required.

The educator should act as a facilitator providing cues when
needed, but not as an active participant.

Unless an end of life scenario, the simulation should end with a
viable patient.
Acknowledgements
The Alamo Colleges wishes to extend a
special thanks to San Antonio College
nursing students Lori Hannasch, Renee
Howard, & Sylvia Muniz for lending their
time and services in the making of this
project!!!
Questions?
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