Types of Simulation in Nursing Education

Simulation first appeared in nursing in 1911 when Mrs. Chase, the first mannequin, was
used to teach students how to turn, transfer, and dress patients. Simulation techniques
have greatly advanced in the last 111 years, but the basic concept remains the same.

Simulation provides a realistic setting and safe environment for students to apply the
knowledge they learned in class. Then, they can use what they learned in simulation and
apply it to clinical practice.

Simulation might seem like it's one more complicated thing to add to your already full
plate as a nursing student. Consider the pros and cons of simulation, what to expect, and
how to complete them successfully.

Types of Simulation in Nursing Education

Nursing students may be familiar with types of simulation in nursing education, such as
standardized patients, role playing, and low-fidelity mannequins. Yet, nursing education
uses so many more types of simulation.

The online learning environment for nurses brought on by the COVID-19 pandemic

forced nursing programs to come up with new ways to teach students nursing skills.

1. 1
Unfolding Case Studies

Unfolding case studies change over a period of time in a way that the student
cannot predict. They help students practice their patient assessment skills.
Unfolding case studies allow students to dive deep into their patients' complex
situations, and because some of them are available at no cost, they are cost
effective.

Unfolding case studies may also prepare students to apply clinical reasoning and
critical thinking skills.

2. 2

High-fidelity Mannequins

High-fidelity mannequins are computer-controlled full-body mannequins. They

most closely replicate the responses, physiology, and anatomy of a patient.
Because they are the most adaptable form of simulation, high-fidelity mannequins
 are typically the most favorable. However, they are also one of the most
expensive.

3. 3

Low-fidelity Mannequins

Low-fidelity mannequins include two-dimensional displays, static models, and

partial-task simulators. They are the least real type of simulation. They can help
students build knowledge because they allow students to go at their own pace.
They can also help students learn a specific skill, such as cardiopulmonary
resuscitation or intravenous insertion.

4. 4

Partial-task Simulators

Partial-task simulators are a body part, such as an arm or a head, that allow
nursing students to practice a skill many times without causing wear and tear or
using more expensive equipment.

5. 5

Volunteers Who Act as Standardized Patients

Standardized patients are volunteers who behave in a realistic way to simulate

clinical interaction. Standardized patients can make practicing communication and
assessment skills more successful. Some of these skills include taking a patient
history, asking for informed consent, explaining a procedure, and giving bad news.

6. 6

Role-Playing

Role-playing asks students to act out a situation. Because role-playing does not
require any props or realistic surroundings, this method of simulation is relatively
low cost. Despite its low-fidelity, role-playing can benefit students, especially for
changing attitudes or team training.

7. 7

Virtual Reality

Virtual reality uses computers and standardized patients to create a realistic

simulation. This form of simulation is still new and gaining popularity in
 healthcare. Virtual reality can be used to teach patients about complex situations
with many people involved because some technologies allow students to care for
more than one patient at a time.

8. 8

E-learning

E-learning includes all simulations on the computer. These can be a video

computer program explaining how to use a device or a highly complicated virtual
reality situation where students interact with patients and other healthcare
providers.

9. 9

A Combination of Simulations

A combination of simulations uses two or more of the previous types of

simulations to create a more realistic simulation. It can also help students practice
more than one skill at a time. For example, an instructor could secure a suture
cushion to a standardized patient. In this simulation, the student can practice
suturing a wound while getting informed consent and explaining the procedure.

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Examples of Simulation Scenarios for Different
Classes
The American Nurses Association recommends that the most effective simulations
require faculty to coordinate what classes are going to use simulation scenarios. This
way, students only repeat key skills in multiple classes. Otherwise, they learn different
skills and experience new simulations in each of their classes. Below are examples of
common scenarios.

 Maternal Health

Students can perform newborn assessments using a newborn simulator or an

appropriately sized doll. Students learn how to care for a laboring pregnant individual,
especially in high-risk situations such as the pregnant patient hemorrhaging.

 Leadership Courses
Students benefit from role-playing scenarios of ethical dilemmas or nurse-to-nurse
bullying to learn useful strategies on how to deal with it.

 Pediatrics

Students can practice infant assessment in a clinical setting. Standardized patients can
act as parents or guardians with cultural differences to help students practice with
scenarios, such as with a parent or guardian who does not want their child vaccinated.

 Mental Health Nursing

Standardized patients help reduce students' anxiety and stress and build their
communication skills by listening to the patients and answering their questions correctly.

 Medical-Surgical I or II

Students practice recognizing the signs of stroke in an older patient who was admitted
to the hospital for another condition like surgery.

 Multiple Classes

Students may practice their skills in patient handoffs, handwashing, and medication
safety in multiple classes because those skills need repeating.

Preparing for Simulation

Faculty and students must prepare for the simulation, so students can get the most out
of the simulation experience. Faculty prepare when they set up the simulation in a way
that best helps students meet the objectives of the simulation. Students prepare in the
prebriefing stage when they gather information, ask questions, and make a plan of action
for the simulation.

 Faculty

Faculty design simulation scenarios that help students best meet the objectives of the
simulation and learn the skills they need to be successful. Simulation faculty need to be
trained in simulation and debriefing techniques, according to the National Council of
State Boards of Nursing Simulation Guidelines and the International Nursing Association
of Clinical and Simulation Learning (INACSL) Standards for Designing Simulation.

Other key standards from the INACSL:

  Create a case scenario that provides context for the simulation
 Begin with a prebriefing and end with a debriefing or feedback session
 Provide preparation materials and resources that help students meet the
objectives and outcomes of the simulation
 Use an approach based on the participant's level of knowledge, skills, and
experience as well as the outcomes of the simulation
 Structure the simulation to have a starting point that shows the initial
circumstances of the patient, structured activities for participant engagement, and
an endpoint (that is usually when learning outcomes are achieved)

 Students

Students prepare for the simulation in the prebriefing stage. The type of simulation will
help determine how students prepare. Some of the ways students can prepare for the
simulation include:

 Reviewing key nursing skills like surgical techniques or intravenous insertion

 Preparing a plan of care for the patient and questions for the patient or
parent/guardian
 Listening to the prebriefing
 Discussing their approach to the simulation with their classmates
 Researching the patient's condition

What to Expect in Nursing Simulation

Well-planned, effective simulation consists of three phases: prebriefing, simulation, and
debriefing. Faculty must plan for and students must participate in all three phases for the
simulation to be successful.

 Prebriefing: The prebriefing phase of simulation tells students what to expect. It sets

up the case scenario and the expected outcomes and objectives. The instructor should
set ground rules and remind students that it's okay to make mistakes. They will discuss
the mistakes in the debriefing.

 Simulation: The simulation phase should have a clear starting point that sets up the
context for the simulation. The activities are designed to help students learn skills and
practice what they would do in a clinical situation. They should be centered around the
participants and their level of knowledge, skills, and experience. The endpoint is usually
when the learning objectives are met.
  Debriefing/Evaluation: Debriefing immediately follows the simulation. During the
debriefing, students receive feedback from their instructor. They discuss mistakes and
ways to improve their skills next time. Students reflect on their own performance and
incorporate what they learned into their previous knowledge.

Pros and Cons of Simulation in Nursing Education

Simulations provide students with a safe environment to practice skills as much as
needed without harming patients. However, they can be costly, they cannot replicate the
clinical situation, and they can cause students to learn incorrect information if designed
poorly.

Pros

  Does not harm patients

  Real-time feedback
  Safe environment
  Lessens the need for clinical sites
  Can be repeated until the student masters the skill

Cons

  Can be costly
  Cannot replicate all the elements of a clinical situation
  Requires nursing faculty trained in simulation
  Can cause students to learn incorrect information if poor quality

Sources

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undergraduate education.
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ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No2-May-2018/Articles-
Previous-Topics/Simulation-Based-Learning-Undergraduate-Education.html
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 Fogg N. (2020). Transitioning from direct care to virtual clinical experiences
during the COVID-19
pandemic. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540562/
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competent healthcare
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Techniques.html
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education: Telenursing with virtual clinical
experiences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529906/
 INACSL standards of best practice: SimulationSM simulation
design. https://www.nursingsimulation.org/action/showPdf?pii=S1876-
1399%2816%2930126-8
 Increasing fidelity and realism in simulation for nursing
students. (2018). https://www.wolterskluwer.com/en/expert-insights/increasing-
fidelity-and-realism-in-simulation
 Koukourikos K, et al. (2021). Simulation in clinical nursing
education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116070/pdf/AIM-
29-15.pdf
 NCSBN simulation guidelines for prelicensure nursing education programs.
(2016). https://www.ncsbn.org/16_Simulation_Guidelines.pdf
 Unfolding cases.
(2020). https://www.nln.org/education/teaching-resources/professional-
development-programsteaching-resourcesace-all/ace-s/unfolding-cases

Page last reviewed September 12, 2022