GOVERNMENT COLLEGE OF

NURSING,
JODHPUR

Topic:- Simulation in Nursing Education

Subject:- Nursing Education
 Submitted To:-
Sub
mitted By:-
Mrs. Nisha Khichi
Bhanwar Lal Dewna
Nursing Lecturer
M.Sc
st
. (N) 1 Year
GCON Jodhpur
GCO
N Jodhpur

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.

1. 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.
2. 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.
3. 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.
 4. 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.
5. 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

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

1. It actively engages learners in the application of knowledge and skills in realistic

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

Disadvantages of Simulation

1. Simulation is costly in terms of both time and money.

2. Games applicable to nursing can cost hundreds of dollars each.
3. Simulation cannot be devised in a fraction of time.
4. Simulation techniques also consume a lot of class room time.
5. Simulation technique can be overused.
6. Acquisition of necessary factual content and would result in boredom.
7. It is possible that emotions may be aroused to an undesirable degree, especially with
role-playing.
8. Not every instructor feels comfortable using simulation strategies. Requires all the
information you need in front of you on a notepad.
9. The process and outcomes of simulation methods are not always predictable.
10. Craftsmanship required for local construction.
11. Usable for small groups.
12. Models often easily damaged.
13. 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

1. Analyse the reality and the objectives

2. Use for cognitive objectives
3. Use of psychomotor objectives
4. Use for attitude and values
5. 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.

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.