High Fidelity Simulation in Nurse Education-revision

High Fidelity Simulation in Nurse Education




In recent years, high-fidelity simulation has played a growing role in nursing education. Few studies have addressed this technology, and research using quantitative design is significantly lacking (Solnick &Weiss, 2009). This article examines a review on current research on high simulation in nursing education and recommends areas for future study. Three articles chosen for the review are directly focusing on the effects of high fidelity simulation training on medical-surgical graduate nurse, using high fidelity simulation to bridge class room and clinical learning undergraduate pediatric nursing and high simulation and the development of clinical judgment.

Nursing education is constantly evolving as changes take place in health care delivery and as more is learned about knowledge acquisition and the use of technology. In the 1960s, technology changed the way high-risk flight training was taught, with computer-based simulation training gaining favor. In health care profession education, simulation use is often part of high-tech anesthesia or surgical training (Solnick &Weiss, 2009). Over the last few years, however, high-fidelity simulation (HFS) training using human patient simulators has been playing a larger role as part of teaching programs in nursing schools and continuing education. This type of simulation utilizes a computer-based mannequin, allowing experiential training of skills, knowledge, and decision-making, which builds confidence in a safe environment, transferable to real patient situations.

High fidelity patient simulation consists of an environment that accurately reflects a clinical setting where the center-piece of the environment is an interactive mannequin with the ability to respond to nursing interventions (Tschannen et al., 2009). The educators for nursing early prepare nurses to practice in a more dynamic and complex healthcare environments. Students graduating from nursing schools around the country often feel unprepared to meet the demands placed on them by the healthcare industry. According to Mahoney et al. (2013), nurse administrators are concerned about the practice education gap as it becomes harder for nursing education to keep up with the rapid changes in the contemporary practice environment.

Attendants are undereducated in the requests of clinical practice and nursing managers anticipate that graduates will securely and skillfully look after a full heap of intensely sick patients promptly upon graduation and licensure. Pediatrics is a particularly challenging population in which to prepare nursing students for future practice. Children make up 25% of the population in the United States, Federal Interagency Forum on Child and Family Statistics, 2007 and the rate of chronic health conditions among children in the United Stated increased from 12.8% in 1995 to26.6% in 2006. Pediatric clinical experiences can be stressful for nursing students due to the vulnerability of the population and the myriad of challenges that accompany a pediatric patient, including non-verbal patients, fear of the healthcare setting, and parental anxiety (Gaberson & Oermann, 2010). In addition, increased enrolment in schools of nursing has made it difficult to find clinical placement sites in specialty areas; including pediatrics.

A few numbers of studies have quantitatively descried the effect of simulation on learning outcomes. In most recent cases, one study explored pediatric simulation and learning outcomes in nursing finding no statistical difference in the mean final course grade for the group that had simulation experience and the student group that did not. It is argued that nursing students report a lack of self-confidence and apprehension about meeting performance expectations. The surety in the clinical set up has a direct impact on job satisfaction and repetition in performance of clinical skills leads to an increase in confidence by nursing students. Study shows that students report high satisfaction with their clinical experience as well as a greater confidence in their clinical skills. Nursing educators must make a shift to produce better prepared graduate nurses to meet the demands of healthcare. However the three articles are marred with a lot of limitations particularity on the aspect of the way the research studies were carried out, the qualifications of the authors involved and the way the entire research project was performed.

The Literature Research

Firstly, a quick search for ‘simulation training’ was done in University library database. This search gave 620 results; and most of the articles were available as full text. At that point, the search strategy was slightly modified to ‘nursing simulation training’; it returned more than 5000 results. So, it was found difficult to locate appropriate articles from University library. Later, a search of the database CINAHL for full text academic articles in the last 10 years about ‘simulation training’ gave 49 results. The article ‘The effect of high-fidelity simulation trainingon medical-surgical graduate nurses’ perceived ability to respond to patient clinical emergencies’ was downloaded from the database CINAHL. Next, a search of Google scholar was done and revealed more than 20,000 results. However, the other two articles were found in the firstpage of Google scholar. Following, articles titles were copied and pasted in the University library database and successfully located. Later, they were downloaded as a full text from the databaseScience direct. These three articles were preferably chosen because their content directly relate to the field of study‘clinical training’.

Article One

The author introduces the study research which is about using high fidelity simulation to bridge clinical and learning in undergraduate pediatric nursing. According to Nehring & Lashley (2010), high fidelity simulation sessions in the first article was done in a highly equipped simulation center within nursing school, which offered three adult high fidelity patient simulators, two infants, and one adult simulator with the capability of pregnancy simulation. The simulation center is set up with high fidelity patient simulators in one testing environment and one lab environment, which is built to facilitates a patient room and experience (Ghosh & Dimiduk, 2009). The lab environment has multiple simulators and large room along with some static mannequins.

The National League for Nursing, contrasted high devotion recreation and paper careful investigations and static mannequin situations supported the study. Understudies taking an interest in the high devotion understanding reenactment had more elevated amounts of fulfillment, esteemed the taking in experience, and saw the dynamic taking in, help, targets, and sentiment as more huge that the other two gatherings (Mahoney et al., 2013). Further studies validate that learning is enhanced and knowledge is retained after participation in human patient simulation (May et al., 2011). This study explores the benefits of human patient simulation of the pediatric acute care environment with traditional and non-traditional nursing students earning a Bachelor’s of Science in Nursing (BSN). This article manly concentrated on the simulation sessions that were only offered in conjunction with the Nursing Care of Children course. For all students, the nursing care of children course immediately follows the nursing of the childbearing family course, which focuses on maternal child health (May et al., 2011).

Apart from exposure to infants in that course, as it was the students’ first clinical course in pediatrics, and the simulation sessions were all focused on pediatric care issues. The evaluations included both open ended questions in order to provide both quantitative and qualitative feedback. There was a distinct focus on bridging the theoretical component of the course with simulation, as well as a decision making and communication (Sokolowski & Banks, 2011). Conventional and non-customary baccalaureate people have partaken in reproduced patient situations in conjunction with their pediatric coursework. In this article , the author did an extensive work based on research field that included , site visit and surveys, and based study on a wide variety of nursing schools, teachers, and students in order to offer recommendation on how to transform nursing education. According to Mahoney et al. (2013), the Carnegie National Nursing Education Study examined three dimensions of nursing education and formation: the learning of theory and scientific methods; the mastery of skillful practice; and the formation of professional identity and agency. These outcomes obtained from the study were that nurses are not well educated for the requirement of practice (Mahoney et al., 2013).

Mahoney et al. (2013) argues that sharp difference between classroom teaching and clinical teaching. Bringing up together the theoretical component and the clinical component helps students prepare for different situations and understand the problems associated with clinical illness. Furthermore, Mahoney et al. (2013) discusses a need to move education from a focus on critical thinking to clinical reasoning .This was not clearly brought out in this article because there was generalization of the whole process based mainly on clinical reasoning thus ignoring the real life application. According to Mahoney et al. (2013), four key recommendations for nursing programs to shift their thinking in order to bring about student learning. Focus on covering the non-contextualized knowledge to an emphasis on teaching for a sense of salience, situated cognition, and action in particular situations from a sharp separation of clinical and classroom teaching to an integration of the two, from an emphasis on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking. The focus was also directed from an emphasis on socialization and role taking to an emphasis on formation. This study presents information specific to the pediatric nursing education and presents quantitative and qualitative data regarding these objectives population.

Typically, this research has recommendations purely derived from a complex, mixed-methods study in nine different academic institutions (Stolovitch, Keeps & Rosenberg, 2011). The research is based on extensive field research based that encompasses, a visit of the site and surveys, therefore this study looked at variety of nursing schools, teachers and students in order to offer recommendation on how to effectively transform nursing education. However, this research was not satisfactory as it was met with different challenges and limitations during its implementation, for instance, the availability of high fidelity patient simulators were a big obstacle (Mahoney et al., 2013). There was difficulty in scheduling time to make simulators available as there were only adult and infant simulators available and some of the scenarios developed involved children. Even though, the use of a simulator makes the situation seem more real to students, and can therefore make it possible for their engagement in the experience, and I feel the best way was to talking through the critical thinking and assessment skills in a real life scenario as this would enhance the practical experience (Scott & Reynolds , 2010).

The level of the research was not up to the international research standards. This is because the actual studies were done depending on the availability of the lab since both environments were used for the extra credit simulations (Ezziane et al., 2012). Performing all sessions in the same style regardless of the setting even in the absence of a high-fidelity simulator was difficult. This forced them to use static mannequins alone and this could not yield the same results making it a limitation to the study process (Tschannen et al., 2009). Another big blow to this whole process was the time scheduling for both students and the instructors as they had to study at the same time. They were also force to work with a very busy simulation center. It made it difficult for the students given that the simulators were used by undergraduate students as well as graduate students. In addition, most of the sessions were scheduled for early morning or late evening hours which a gain was not a convenient time for the research.

Literature review of this article was however developed well by the author as detailed information and the full contribution about the research. The scenario development and implementation is also well exhausted in this article as the author clearly draws the development of a pediatric process (Fagan & Pandey, 2012). It is well elaborated with an aid of diagram that contained pediatric scenario development, classroom lecture pediatric course, student engagement in scenario, debriefing and student evaluation and faculty review.

Second Article

High fidelity simulation has a greater ability to give support and effect on the development of clinical judgment among the nursing students. According to Lasater (2007), the nursing education is currently facing many challenges and this has resulted in an increase in interest especially by diverse students. Health care reimbursement efforts to reduce acute care admissions and lengths of stay often produce inconsistent practical experiences and greater competition among regional programs for practice sites. Because of these problems nursing requires that nursing education should consider new plans for learning to prepare professional nurses to assume increasingly complex roles that require a higher level of critical thinking and clinical judgment skills than in the past (Lasater, 2007). The needed outcome of high fidelity simulation is for students to transfer what they learnt from the simulation laboratory to the clinical setting as they care for human patients. Hence, much of the discussion about the strength sand limitations of the students’ simulation experiences focused on the ultimate goal. The research identified some strength in using simulation for the student learning.

In this article for instance, the sampling method was used to collect data and the nursing students were involved in the study the data collection where the focus group took place at the simulation laboratory to bring the highest possible degree on memory from students (Mastal & Levine, 2012). The participants received consent forms to sign before the session, and the participants were given an opportunity for questions before the students signed them. All the Participants were given a small cash award and a gift card for a known coffee company as incentives for their participation. The research adopted Morgan’s (1997) principles for group facilitation; the author reviewed the clinical judgment definition as well as the conceptual framework used for the observations.

This was a good approach to research as the students willingly participated in the process because of the incentives given to them. Moreover, the forms that were provided made more formal and official. The procedure and the methodology use by the author was more elaborate as it involved a table constructed for characteristic of the study participants that was totaling to 50. This gave the details like the mean age of the participants that was ranging from residents and non international students and both male and female students (Fry & Kneebone, 2011). However the information about the participants was too much that it took the better part of the study more than the main course that was the outcome of the entire research.

High fidelity simulation served as an integrator of learning, that it brought together the theoretical bases from their classes and readings, as well as the psychomotor skills from skills laboratory and lessons learned from clinical practice, requiring them to critically and constantly think about what to do. This was touted in contrast to simply reading about a condition. The situations fostered conversations about the things that were so critical in practice but were missing from the reading or difficult to grasp only by reading (Lasater, 2007). Case in point, one member demonstrated that she knew patients obliging opiate operators could encounter a cardiopulmonary despondency emulating organization, but the awareness of the importance of monitoring vital signs, seemingly mundane and routine task was heightened by her participation in a scenario with a rapidly decompensate inpatient.

A second strength of simulation that was discussed several times during the focus group was the breadth of experience gained in the simulation laboratory. A member was assigned to a gastrointestinal surgery unit for her clinical practicum and was rarely exposed to pulmonary or cardiovascular patient except in the simulation laboratory (Lasater, 2007). Other group members identified that although the patient situations in the laboratory seemed extreme, the scenarios forced them to anticipate what could happen in the clinical setting. This was obviously useful in the development of clinical judgment. This anticipation was most often mentioned in conjunction with administering medications.

Although high fidelity simulation offers diverse students a forum in which to advance their clinical judgment skills, the research examining the effects of high fidelity simulation on the development of clinical judgment is scarce (Lasater, 2007). This study offers insights not previously described, the cultural and ethnic diversity of this group was limited. More research should be conducted with a broader cultural diversity of students to bring out their responses to the knowledge of high fidelity simulation and its effects on the development of clinical judgment. In addition, although high fidelity simulation seems to be a valuable component in the development of clinical judgment, more research is needed to connect performance in simulation with skill in real clinical practice settings (Ezziane et al., 2012. High fidelity simulation gives faculty the opportunity to observe students’ clinical judgment in a confined setting, thereby allowing for more attentive coaching, it may also present challenges to faculty who are more familiar with traditional teaching strategies.

Furthermore, necessitating the concept of clinical judgment will offer both students and faculty a basis for assessing evaluating and improving clinical judgment because growth and development is very important in learning outcomes (Fry & Kneebone, 2011). The human patient simulator had its own inherent limitations, which could affect the transfer of learning to the clinical setting. Some that were identified by the focus group participants included that the human patient simulator ways had a female voice, as the laboratory staff playing the roles were almost entirely women, but the participants also stated that this was a limitation they quickly forgot (Lasater, 2007). The patient simulator also had non- visual, nonverbal communication, such as grimaces or smiles. Certain kinds of assessments were not possible, such as a neurological examination, and although the simulator could be punctured with a needle for intravenous administration, it could not be cut to simulate an incision or wound, nor could it exhibit certain physical signs, such as swelling or color changes and thus many short comings.

However, critically analyzing this review, the focus is mainly on the experimental learning as many of the studies cited in this review represent a wave of classic educational research conducted in the 1980s focused on experiential learning, including some early simulation work (Lasater, 2007). On the other hand, these nursing programs began on a low fidelity simulation in the form of skills laboratories.

Article Three

The article is mainly concerned with the effect of high fidelity simulation training on medical surgical graduate nurses’ presumed ability to respond to patient clinical emergencies (Gordon & Buckley, 2009). The exploration was done on fifty therapeutic surgical graduate understudies who took part in high constancy immersive recreations. Surveys finished previously, then after the fact reproduction asked members to rate their apparent capacity and certainty and the result was that ninety four for every penny of members distinguished formal questioning as the most valuable part of the recreation experience given that nursing education programs are increasingly adopting simulation in both undergraduate and graduate curricula. Their primary motives for this included limited clinical placement positions, acceptance of simulation as useful tool to clinical teaching, and its potentiality in improving the clinical learning (Gordon & Buckley, 2009).

The researcher used a descriptive study design where students reported their confidence in response to patient clinical emergencies by critically reading and completing a questionnaire before and after participating in high-fidelity simulation training session (Cash et al., 2011). The students were approached and enrolled in a fourteen hour course of live lectures exploring the theoretical aspects related to clinical emergencies, that included management of patients in cardiac arrest and cardiovascular, respiratory, and neurological systematic assessment and management where student totaling to 50 completed the course during the stipulated time frame. All the students agreed to participate in the study and completed the questionnaire before and after the simulation. Permission and research Approval was received from the appropriate human research ethics committee of the University of the Study (Brown, 2011).

The data analysis of the research was organized in the chats which are not a better way of relying information as chats may be complex to interpret by many people and may generally affect the quality of the information about the study. The conclusion part of the research was also so brief and it concentrated on a different thing instead of focusing on the main purpose of the research which was on the effects of high fidelity simulation.

Author provided proper and detailed information on the abstract about the background, method of study, result and conclusion. However this study did not clearly provide the recommendation and the literature review which are integral parts of research analysis.

Some of the advantages that the author highlighted in this article included simulation in nursing education entails the participants practicing in a safe environment and under a variety of clinical situations and experiential learning can occur away from the clinical area, and at the same time consolidating nontechnical and technical skills (Headrick et al., 2012). These simulators are mostly used in large scale scenarios that place in participants in clinical situations (Gordon & Buckley, 2009). However, this is not effective because of the complexity of these immersive scenarios, this form of simulation is often unpredictable because participant behavior and performance cannot be ascertained, the scenarios constantly require contingencies that usually normally make it possible for staff training and increased resources. Moreover, these cases may be recorded and channeled live to same groups, adding to the difficulty (Gordon & Buckley, 2009). This exploration was not acceptable since the prime reason for this study was to assess the impact of immersive recreation on therapeutic surgical graduate learners’ trust in reacting to patient clinical crises. The focus was on assessing students’ technical and non-technical skills both before and immediately following simulation was to determine the effectiveness of simulation as a learning tool.

Although students reported increased confidence across a range of technical and nontechnical skills following immersive simulation, this did not necessarily translate to changed or improved behavior and skills during clinical emergencies in their places of work (Mastal & Levine, 2012). In addition, participants’ theoretical knowledge and technical abilities was not critically evaluated following simulation program because transference to the clinical setting of skills learnt and practiced during simulation remains the elusive goal of simulation in nursing education (Gordon & Buckley, 2009). The effectiveness of simulation compared to traditional teaching within graduate nursing education should be carried out through increased performance in the workplaces. A thorough evaluation of participants’ performance in the work environment during patient clinical emergencies was to clearly provide more evidence of the transfer and retention of high fidelity simulated learning, which did not materialized in this scenario.

Impact of Research on Clinical Practice

Bux (2009) explains that the high fidelity simulation on nurse education is particularly relevant to the national league of nursing as it explores the benefits of human patient simulation of the pediatric acute care environment with traditional and non-traditional nursing students earning a Bachelor’s of Science in Nursing (BSN). This article manly concentrated on the simulation sessions that were only offered in conjunction with the Nursing Care of Children, although the use of a simulator makes the situation seem more real to students, and can facilitate their engagement in the experience and skills in a real life scenario can be very helpful. This can be done without the benefit of a patient simulator, even though having the technology available to simulate the important signs and other assessment factors, such as wheezing in a child with asthma to improve the experience (Fagan & Pandey, 2012).

The second study high fidelity simulation and the development of clinical judgment students’ experiences concludes that new graduate nurses need clinical judgment skills to function in today’s complex care settings (Gordon & Buckley, 2009). The problems of real patient care possess present a challenge for quality facilitator oversight and assessment that are maintained in simulation settings. Although the study sample was small and limited to non-traditional students, the focus group method was useful in collecting an initial and close perspective of students’ experiences with high fidelity simulation.

The third study on the impact of high constancy reproduction preparing on medicinal surgical graduate medical attendants’ apparent capacity to react to patient clinical emergencies found that during simulated patient clinical emergencies, participants generally found a high degree of realism, increased confidence, and perceived ability in nontechnical and technical skills and working on a team (Ezziane et al., 2012). It also occurred that simulation combined with traditional teaching methods facilitated some aspects of learning, such as technical skill developments (Mastal & Levine, 2012).

Similarities and the difference of the Three Research Articles

There are several similarities cutting across the three research studies for instance the methods used to collect the data included sampling and questionnaires. The researchers used nursing students from different institutions to determine the effects of high fidelity simulation in health care centers (Stolovitch, Keeps & Rosenberg, 2011). In addition, the three articles touches on the benefits and the limitations of adopting the use of simulations on the nursing hospitals. In each of the research articles, more focus on technologies as their best practice on the nursing and even the entire health fraternity was given a priority. Concisely, the basis of the three authors was geared towards adoption and implementation of high fidelity simulation in nursing education (Wawrykowicz, 2009).

Articles two and three had tables used in their formats that gave them some similarities in the format in general. There were differences in the three articles that were observed, article three had chats that showed the results of the findings while the other two articles did not apply the use of chats in their entire study. Article three also did not have literature review that was used in the other two articles (Mastal & Levine, 2012).

It was also observed that the author in article two and three used tables in their format but in the first article there was no use of table the research format(Friedman et al., 2013).. These clearly brought sharp differences in the three articles.

Further Research

In an attempt to elaborate on the effect of high fidelity in the nurse education, the three articles failed to be clear on the sources of funding which did not fully meet the standards of making sense of the research. Their information was not touching on the specific source of funding for their research studies. Some researchers also failed to acknowledge the limitations they encountered during the research work and therefore they fell short of the standards required (Gaberson & Oermann, 2010). The researchers’ works are not fully satisfactory in the health care field hence better simulation should be able to bring all variables for a controlled maximum learning time, reduced ethical concerns, and allow for experimentation and self-improvement with opportunity for feedback citation. The successful implementation of high fidelity simulation requires a long term planning and successful classroom simulations require extensive planning (Hoadley, 2009).

Regardless of the institution that requires these techniques, it is imperative to do proper planning before deciding to do a simulation a day or two in of the actual activity. This is a definite setback of classroom simulation, since it requires educators to spend a great deal more time on their lesson plans than they normally would (Cash et al., 2011). In addition, teachers who decide to plan a simulation should not let this interfere with the preparation of other short-term activities and lessons. On the side of the cost, the expenses of operating simulation are one of the negative aspects of high fidelity simulation. Depending on the type of simulation chosen to run in the research operation, there are significantly high costs involved. In general, should run a simulation only if you are able to put together the required resources you need to make the entire research successful. An inadequately constructed simulation is hardly worth doing (Glen, 2013). It is not in order to start planning a simulation before you are certain you can pay for it (Ghosh and Dimmiduk, 2009). Despite the fact that low constancy reproduction mannequins have been around for quite a while, numerous organizations and colleges are currently embracing high devotion engineering for their nursing divisions in the human services fields. Currently, many hospitals have procured this costly teaching equipment to help their nurses in furthering their education. However, there are shortcomings to this type of teaching that are largely being assumed. A lot of study needs to be done to ascertain if the high fidelity simulation is actually something that is of benefit to nursing students and the health care fraternity. , some of when it is not successful, disadvantages need to be addressed and solved to make this tool in the most positive it can be.

The Key Methodological Issues

Research Samples

All the methodology use by the three authors was not satisfactory for instance in the third article only fifty participants successfully completed the study that means the rest either did not complete or left on the way therefore the outcome was not a true reflection the study, this is not in line with the standards for best practice (Ghosh & Dimiduk, 2009).

In determining the efficien