GOVERNMENT COLLEGE OF NURSING

JODHPUR

Class Presentation
On
Simulation in Nursing Education

Submitted To Submitted By
Mrs. Nisha Khichi Bhanwar Lal Dewna
Lecturer M.Sc. Nursing Previous
GCON Jodhpur GCON Jodhpur
 Simulation in Nursing Education
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.

DEFINITION

“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.

CONCLUSION

Simulation establishes a bridge between theory and Practice through simulation student are able to
understand skill, because they can see it and apply it on a patient simulator without harming.

BIBLIOGRAPHY

1. Basavanthappa BT, “Nursing Education” 2 nd Ed. Delhi 2009 JAYPEE Brothers Medical Publishers(P)
LTD. Pp.499-503
2. Sanatombi D.E , “Manipal Manual of Nursing Education”1st Ed.Delhi 2006CBS Publisher &
Distributors PVT. Ltd. Pp.189-196.
3. Neeraja KP, “Text book of Nursing Education”1 st 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.