PRESENTATION ON: - SIMULATION IN NURSING

EDUCATION

SUBJECT: - NURSING EDUCATION

SUBMITTED TO SUBMITTED BY,

Mrs. NISHA KHICHI BHANWAR LAL DEWNA

NURSING LACTUROR M.SC NURSING
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PRESENTATION DATE: 09/04/2024

INTRODUCTION
A simulation presents learners with a more or less lifelike model of the
real world with which they interact in solving problems from an
adopted role perspective.

Simulations have been defined as an operating representation of

central features of reality. Simulation is as old as human beings on
earth. Not only human beings but even animals use the technique of
simulation to train their young ones to teach them to adjust in their
physical environment. The use of simulation in teaching is
comparatively very recent. Simulation has been in use since the man
on earth but its systematic use stated after the First World War in the
training of pilots in air force. The pilots were given all types of
experiences of actual flying in office room, on maps or on models
prepared to acquiring the trainees with the strategy of war fair.

DEFINATION

“An operating representation of central features of reality.”

Simulation: - as a strategy - not a technology - to mirror, anticipate, or
amplify real situations with guided experiences in a fully interactive
way.

Simulator: - "...replicates a task environment with sufficient realism

to serve a desired purpose"

History of simulation in nursing

It began with anatomical models and task trainers in the mid to late
1800s. Nurse trainees used limb models to practice bandaging,

bathing, and mobility needs. Demonstration rooms housed the models

and gave them room to work on techniques.

Uses of Simulation include the following:

Simulation technique can be used to achieve many learning objectives.

Simulations can help nursing student gain skill in applying the

nursing process. E.g. they can practice gathering and analysing data,
setting priorities, sending and evaluating outcomes.

Learn to solve problems efficiently with minimal wasting of time and

resources.
In the acquisition of communication skills. E.g.: students can put
themselves in the shoes of others (Patients, families, co-workers,
supervisors, and physicians) and learn something about these people's
feeling and how to interact effectively with them. They get immediate
feedback about how they affect other people learning communication.

 Simulation is also an avenue for attitude change. E.g. Discover of

factors about certain people and situations that they never
realized before and that will change their attitudes in the future,
and this can lead to more productive and acceptable behaviour.
 Decision-making skills can be fostered via simulation. E.g.
Discover of factors bout certain people and situations that they
never realized before and that will change their attitudes in the
future, and this can lead to more productive and acceptable
behaviour.
 Decision-making skills can be fostered via simulation. E.g. the
results are undesirable; they can backtrack and look at the
factors that led them to a poor decision. The instructor and
classmate (if a group is involved) can help the student gain
insight in to why a decision was effective.
 Simulation technique can be applied to the learning of
psychomotor skills in a college laboratory using mannequins and
hospital- type equipment, they are involved in a patient care
simulation.
 Used to evaluate the student learning and competence. E.g.
Written exams have been developed in a simulation format to test
the application of knowledge.

Characteristics of Simulations
A good simulation will:

1. Mirror real situations while providing control over extraneous

variables or constraints that might interfere with learning.

2. Provide a mix of experiences that can be replicated for successive

learners.

3. Provide a safe environment in which learning has priority over

patient care or system demands.
4. Focus on application rather than uncertain recall of knowledge.

5. Provide immediate feedback on performance.

Users of Simulations
1. Simulations are used to synthesize cognitive, psychomotor and or
affective content in the analysis and solution of real-life problems.

2. Simulations provide opportunities for the practice of problem

solving and decision making as well as psycho-motor and interactive
skills, within a controlled, low risk setting.

Types of Simulations
1. Oral Simulation

Reflect problem solving process by requiring a serious of

sequential interdependent decisions.

2. Written simulation
Individual uses either paper and pencil latent image format. The
Purposes includes Problem solving, Decision making, to evaluate
student's ability to apply the skill.

3. Audio visual simulation (Screen-based/PC-based simulation)

An entire simulation can be placed on videotape.

Management vignettes can be dramatized and filmed.
Questions can be posed for the viewers right on the screen,
and the alternative outcomes, dependents on which
approaches to a solution are chosen, can be all taped.
4. Use of high-fidelity mannequins or technologies
These constitute body blocks or body part blocks with characteristics
of life, which can respond to actions or interventions by the students.
They are used for representing the clinical reactions-symptoms of a
patient and for describing any conditions surrounding a case, for
example, tool stocks available (e.g., dressings, syringes, etc.) and time
limits available.

5. Low-fidelity mannequins
Use of low-fidelity mannequins capable of performing a small number
of particular tasks or processes, for example, a limb for
catheterization of a vessel, or mannequin for CPR learning.

6. Partial task simulators

This category includes models (e.g., hands-arms) used for
implementing a clinical skill-task that may be repeated by students.
Typical examples include “limbs” for intravenous catheterization of a
vessel, head and chest mannequins for placing an airway and faux
leather cushions for practicing wound suturing.

7. Virtual reality

Virtual reality is increasingly being adopted as a simulation

tool. In health professions, the simulation of virtual reality uses
computers and standardized patients to create a realistic
learning and evaluation setting.

8. Standardized patients - Volunteers playing the roles of

patients
These are trainees behaving in a particular way for realistic clinical
interactions. They are widely used for teaching and assessment in
nursing education, especially for communication purposes and for the
acquisition of skills, and they may provide feedback when requested.

9. E learning (usually knowledge testing, e.g., multiple tests)

Computer-generated simulators are representations of tasks or
settings used for facilitating learning. These include a simple
computer program demonstrating the operation of a device, e.g.,
anaesthetic machine, or something highly complicated, e.g., a detailed
setting for virtual reality, where the participants interact with virtual
patients or other healthcare professionals.

10. Hybrid Simulation

This type of simulation is defined as a type where two or more
simulation types are combined to produce a more realistic simulation
experience. A typical example is the use of portable devices by
standardized patients, where students are able to perform certain
procedures while interacting with a real person. For example, a
standardized patient may fix a suture training model (cushion) on
his/her arm, where the trainee can suture a wound; thus, while giving
the trainee the opportunity to obtain informed consent, explain the
procedure, etc.

Advantage of Simulations
 It actively engages learners in the application of knowledge and
skills in realistic situations.
 It is useful in promoting transfer of learning from the classroom
to the clinical setting.
 The controlled setting of the simulation makes it possible to have
consistency in learning experiences from learner to learner.
 Simulations permit application of theory to practice when access
to clinical settings is limited or impossible.
 Simulations can motivate learners to learn prerequisite content
before tackling the simulation, because they challenge learners
to integrate a large body of content.
 Students can receive feedback on the appropriateness of their
action during simulation.
 It provides participants to deal with the consequences of their
actions.
 Students can learn without harming the patient.

Disadvantages of Simulation
 Simulation is costly in terms of both time and money.
 Games applicable to nursing can cost hundreds of dollars each.
 Simulation cannot be devised in a fraction of time.
 Simulation techniques also consume a lot of class room time.
 Simulation technique can be overused.
 Acquisition of necessary factual content and would result in
boredom.
  It is possible that emotions may be aroused to an undesirable
degree, especially with role-playing.
 Not every instructor feels comfortable using simulation
strategies. Requires all the information you need in front of you
on a notepad.
 The process and outcomes of simulation methods are not always
predictable.
 Craftsmanship required for local construction.
 Usable for small groups.
 Models often easily damaged.
 Never same as performing technique on a patient. Beware of
faulty learning.

Principles of Simulation
1. Players take on roles, which are representatives or the real world
and them make decisions in response to their assessment of the setting
in which they find themselves.

2. The experiences simulated are consequences, which relate to their

decisions and their general performance.

3. The 'monitor' the results of their actin are brought upon the
relationship between their own decisions and the resultant
consequences.

Factors to be considered when deciding whether to use simulation in

particular situations like

Analyse the reality and the objectives

Use for cognitive objectives

Use of psychomotor objectives

Use for attitude and values

Use for interactive objective

Steps in Simulation
There is no hierarchy of following rigid steps in simulated techniques
in classroom learning. Ned Flanders has recommended the following
procedural steps in simulated teaching:

1. First of all the teacher must assign letter (A, B, C) designation to all
the members of the group and develop a system of rotating the role
assignment by letters so that each individual has the opportunity to
participate and as a chance to be actor, foil and observer.

2. It includes planning, preparation and deciding the topic of the skill

to be practiced through simulated technique. The teacher should
carefully and intelligently select and appropriate topic for each actor
according to his knowledge and interest in the subject.

3. The teacher should decide in advance as regards the name of the

member of the group who will start conversation. A detailed schedule
for actor interaction should be drawn.

4. The teacher should decide the procedure of evaluation and decide

on what kind of data the observes are record and who their data and
opinions can best be presented to the actor when the interactions
steps.

5. Conduct the first practice session on topic or skills you decide.

Provide the actor with feedback on his performance and be prepared,
if necessary, to alter the procedure for the second in order to improve
the training procedure. As soon as the practice sessions are working
smoothly and each person has opportunity to be actor, increase the
difficulty of the task by privately instructing the foils or restricting the
instructor's role.

6. This is the last step in simulation. Now the teacher should be

prepared to alert the procedure, change topic and move on the next
skill so as to prevent a significant challenge to each actor and to keep
interest as high as possible. The task should be neither high nor too
easy for the participants.

Role of the Teacher in Simulation

1. Planning: Planning begins with choosing or developing and
appropriate simulation that will meet course objectives. Assign some
reading for the students to do before class. Textbooks or library
resources should be pointed out to students so that they can prepare
for the simulation. Teacher is responsible for preparing environment,
it includes arrangements of chairs and tables, ventilations, lighting.

2. Facilitating: Teacher should function as a facilitator during the

actual process of the simulation. After introducing the activity, you
may take a backseat and talk relatively little. You must coach students
who are trying to find their way through a sticky problem and
encourage creative thinking and act as an information resource. Take
notes during the class so that in later discussion you can refer back to
specific strengths and weakness of the process.

3. Debriefing: Your role is the final discussion or debriefing session.

Immediately following the simulation when the information is fresh in
everyone's mind. You should briefly summarize what has take place.
Self-analysis can help students gain insight into why they made certain
decisions or took a specific course of action. In simulations where
emotions have run high, ventilation of feelings should be part of the
debriefing.

At the end of the discussion period you should point out how
principles and concepts have been applied and how the experience ties
into the learning objectives.

The Future of Simulation in Nursing Education

Nursing science and art constitutes a highly significant and integral
part of the health care system. Nurses and their training are
fundamental elements of the effectiveness of the system; therefore,
special attention is paid and must be paid. Any changes in the training
of nurses are interwoven with technological advances, and their
training is directly affected by any technological means available for
teaching.

The use of simulation as an educational strategy represents a great

challenge for nursing education. Simulation may improve health care
and patient safety. No patient who is alive is put at risk at the expense
of the trainee. Simulation provides standardization of cases, promotes
critical thinking, allows supervision of patient care, provides
immediate feedback, and helps students to assimilate knowledge and
experience. It is an ideal composition learning experience.

Probably the greatest change in nursing education is the introduction

of virtual simulation. Continuation and development of virtual
simulation constitutes a focal point for nursing science and for the
progress of nursing students. This requires investment of funds in the
establishment of appropriate laboratories by nursing schools, time for
simulation as provided for in the curricula, and educators who are
properly trained to create various scenarios and operate simulators.

The use of virtual simulation must become a part of the overall

simulation programme. Despite the fact that virtual and augmented
reality are at a quite early stage, this option will rapidly spread, as
soon as simulation-related technology becomes available and
affordable. The quality of simulation devices will provide
opportunities for training of students in skills that used to require
actual educators in the past, thus opening up new opportunities for
schools to reallocate their financial resources.

SUMMARY

Simulation is oldest mode of teaching in all fields. Simulation is

also an avenue for attitude change, improve decision making, learning
of psychomotor skills and used to evaluate the student learning and
competence. Mirror real situations while providing control over
extraneous variables or constraints that might interfere with learning.
Provide a safe environment in which learning has priority over patient
care or system demands. Provide immediate feedback on
performance.

CONCLUSION
The objective of nursing education, apart from the acquisition of solid
theoretical knowledge, is the acquisition of clinical skills, which are
necessary for graduate nurses to be promptly integrated into the
workforce. Integrated learning, critical thinking, and optimal
decision-making skills help nurses to provide quality health care. This
can be achieved through the inclusion of simulation in the education
process. Further development of simulation, along with other
educational methods may be of great assistance in the attempt made
by students to become integrated and successful healthcare
professionals.

BIBLIOGRAPHY
1. Basavanthappa BT, “Nursing Education” 2nd Ed. Delhi 2009
JAYPEE Brothers Medical Publishers(P) LTD. Pp.499-503
2. Sanatombi Devi Elsa, “Manipal Manual of Nursing
Education”1st Ed.Delhi 2006CBS Publisher & Distributors
PVT. Ltd. Pp.189-196.
3. Neeraja KP, “Text book of Nursing Education”1st Ed. Delhi 2003
JAYPEE Brothers Medical Publishers(P) LTD. Pp.285-288.
4. Konstantinos Koukourikos, “Simulation in Clinical Nursing Education”
Acta Inform Med. 2021 Mar; 29(1): 15–20.