To understand better, simulation training is an educational approach wherein a real-life experience is replicated or amplified in a controlled environment. It makes for an interactive and immersive learning experience through practical application of learned theories. The first mannequin was built in 1911 to train nurses to perform physical tasks such as dressing, turning, and transferring patients. Over time we have progressed to  computerized mannequins that can imitate the body’s physiology. Simulation training has also been integrated in numerous nursing programmes such as those for  mental health specialization or  end-of-life care, etc. Anatomical simulation is an area of virtual reality that allows students to visualize patient anatomy by ‘virtually dissecting’ them.  Immersive virtual reality is currently represented by two major companies, Oculus, which makes the Oculus Rift, and HTC, which makes the Vive. Simulation training has also been integrated in numerous nursing programmes such as those for  mental health specialization or  end-of-life care, etc. Nursing institutes have started incorporating digital and game based simulation techniques such as Bodhi Health’s MEDGAMES and MEDLEARN virtual simulation platform for nursing students to practice procedure-based skills or conduct skill-based assessments.

A well-constructed simulation training programme can help student nurses experience “what if” scenarios, attain a problem solving attitude, manage crisis better, and observe the effects of techniques employed – all without repercussions. For the aforementioned reasons and more, simulation training plays a central role in nursing education. To ease out the process, we have created a reference checklist before you initiate simulation training for student nurses:-

Ensure You Have Secured the Required Permissions 

Simulation testing demands professional and ethical behaviour. Educators need to ensure that there is mutual respect, confidentiality, willingness to accept and share constructive feedback, and that the performance is consistent with the institution’s policies. Prepare a fiction contract  that outlines the importance and mutual  agreement of performing as if in a real clinical situation for the benefit of fostering an engaging learning experience. A talent release is a mandatory legal document you require to receive consent of photography and videography during the training.     

Define the Purpose of Your Simulation 

Healthcare simulation scenarios are created to address specific learning needs. Before creating a simulation, it is important to decide what information is needed and which part of the operation should be replicated to meet the objective. As stated by the International Nursing Association for Clinical Simulation and Learning (INACSL) the first step in scenario development is the completion of a need’s assessment. INACSL’s simulation design standard provides a sequential checklist for scenario development which can be used by clinical facilities, medical schools, and in postgraduate medical education. Once the learning objectives are clarified, it becomes easier to attain them through simulation training. Make sure that the objectives identified are limited in number and are specific or they might frustrate the learner and make the assessment complicated.        

Define the Metrics for Evaluation and Assessments

Simply creating a simulation lab space does not ensure that the best training practices are incorporated. While self-confidence can be argued as a measure of assessment, there are other methods to enhance effectiveness of the education strategies. Kirkpatrick model of training effectiveness is the most commonly used evaluation framework which includes four levels of assessments: 

• Reaction: The satisfaction derived from the training
• Learning: The increase in the skills and knowledge of the student
• Behaviour: The observed changes in the behaviour of the participants 
• Results: The outcome of the simulation

Applying the aforementioned framework can help an educator measure how well the simulation training worked  and how much it improved the learner’s knowledge, skills, ability in a medical setting. Training facilities could also create a survey to measure the effectiveness of the simulation training.     

Conduct Pre-briefing and Debriefing sessions

Efficient communication is the cornerstone of every learning experience. To enhance the effectiveness of the simulation-based training, conduct a pre-briefing session prior to the hands-on lesson through orientation tasks and learning engagement activities. This would enhance learner satisfaction, participation, and effectiveness of simulation practice. 

Debriefing sessions are conducted after the simulation to underline the thought process which would help improve future performance. Incorporating this practice as a habit would help both learners as well as educators to re-examine the simulated case experience, share their mental model, and foster the reasoning behind their clinical judgment.    

Prepare the Instructors and the Learners

To ensure a seamless learning experience, it is important to prepare the instructors before the simulation. Organize simulation review materials such as learning objectives, equipment setup, expected interventions, vocal scripts, debriefing points, etc.

Discuss the expectations from the simulation training scenario with the learners. This includes assigning roles and responsibilities such as the lead medic, PC operator, facilitator and the team members who would assist. Remind them to treat the simulator as they would a real patient – with respect and empathy. Explain to them that while the simulation would largely imitate a life-like scenario, some things may appear artificial, however, for the sake of learning, they are to be overlooked.       

Consider the Disadvantages 

Constructing a healthcare simulation from scratch is a daunting task that can get complicated with limited funding. Nursing state boards and other accrediting bodies expect simulation programmes to follow recognised national standards, which can be hard to get right in the first go. As discussed, it is also  difficult to measure the results from simulation training to gauge whether it was successful or not.

However, despite these initial hiccups adopting simulation training far outweighs its drawbacks. The trial-and-error approach through simulation training followed by analysis of training sessions, identification of errors, and discussions of emotions and feelings that influenced the trainees can help enhance their learning experience exponentially.

“Written by Siddhi Latey (Weloquent)”

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A peer-to-peer model can improve practicing nurses’ health and reduce stress, while simultaneously offering nurse practitioner students the opportunity to build their mental health education and get an honest look at the realities of their new workplace.

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