Simulation in nursing education: why bother

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Simulation in nursing education why bother?
Maggie Nicol Professor of Clinical Skills CETL
Director St Bartholomew School of Nursing
Midwifery
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Centre for Excellence in Teaching Learning
(CETL) Clinical Communication Skills

• 3.15 million over 5 years
• Healthcare students at City University Queen
  Mary, University of London
• Enlarge existing interprofessional Skills Centre
  - now 11 multipurpose skills labs communication
  skills suite
• New simulators, filming and video analysis
  equipment
• 2 facilitators and a learning technologist
• Clinical skills bus

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• Mobile skills facility to take the Skills Lab to
  the students and staff in the placements
• Driver/Facilitator to support lecturers and
  facilitate student self-directed learning

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• In nursing 50 of the 3 years (2300 hours) is
  spent in clinical placements. Why do we need
  simulation?
• Learning in clinical placements is considered to
  be superior but .

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Learning in placements

• Poor performance now teaching others!

• Repeated unsupervised performance mistakes
  become permanent

• Unstructured learning in the clinical
  placements learning by osmosis

• Self-directed practise reinforcing poor
  techniques if unsupervised

• Demonstration of some skills in university

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• Practise makes perfect
• Practise makes permanent!
• Only well supervised practise with constructive
  feedback makes perfect

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Learning with simulation feedback

• Expert performance teach others

• Repeated rehearsal to achieve mastery

• Supervised practice with feedback in the
  placement

• Assessment of competence

• Self-directed practise until proficient,
  ideally with video analysis/feedback

• Demonstration and supervised practise

• Books, DVDs etc - Preparing to learn

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Hierarchy of skills learning
10 9 8 7 6 5 4 3 2 1 0
Supervised clinical practice with feedback
Learning in simulation with feedback
Unsupervised clinical practice
Demonstrations DVDs
Manuals and books
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Benefits of simulation

• Patients clients are not exposed to complete
  novices
• Safe environment where mistakes become learning
  opportunities
• Complexity can be controlled according to the
  learning outcomes
• Confidence can be built before contact with real
  patients

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Benefits of simulation

• Exposure to required skills can be guaranteed
• Sophisticated simulations make it feel realistic
  but safe
• Able to stop the action to make links with
  theoretical knowledge and test learning
• Allows students staff to develop and maintain
  rarely used but essential skills (e.g. CPR)

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Benefits of simulation

• Students can repeat the skill as often as
  necessary to develop confidence
• Allows student to learn at their own pace
• Allows students to experience being on the
  receiving end
• Students can express their fears and ask
  difficult questions
• Students can make mistakes and appreciate their
  consequences without harm to the patient

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The road to competence? Well, its plainand
simple to express
Err and err and err again
but less and less and less. Piet Hein, Danish
inventor and poet
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Disadvantages of simulation

• Skills Lab are costly whereas clinical placements
  are free
• High fidelity simulators cost thousands
• It is hard to measure the cost-effectiveness of
  using simulation
• Time consuming to prepare realistic simulations
• Hard to simulate the whole experience to set the
  skills in context

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Clinical placements why bother?

• Learning in simulation and learning in clinical
  placements Do we need both?
• Yes
• But .
• Maybe some of the placement time should be
• spent learning in simulation?

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NMC Simulation Project

• 13 pilot sites across UK
• All branches and all years of nursing involved
• Up to 7 days (or equivalent) of practice hours to
  be spent learning in simulation
• Report due in September 2007

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Conclusion

• Simulation should be regarded as an essential
  stage in the process of learning clinical
  communication skills
• Simulation can provide opportunities for
  realistic inter-professional learning that are
  difficult to arrange in real clinical practice
• Learning in simulation will never replace
  clinical placements but
• Simulation can be far more effective than brief
  voyeuristic visits to specialist areas (e.g.
  maternity units) or simply being there in
  clinical area

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Conclusion

• Use of simulation is ideal to prepare students to
  enable them make best use of learning in
  placements and achieve the NMC standards of
  proficiency for safe and effective practice
• Use of simulation is ideal to de-brief students
  and help them to make sense of practice
• As clinical placements come under increasing
  pressure research is needed to determine
• What can best be learnt using simulation?
• What can students only learn in real practice?
• How do we best prepare them to make sure that
  they do?

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Maggie Nicol maggie.nicol.1_at_city.ac.uk