Objectives:

By the end of this lecture each candidate will be able to:

 Define simulation
 Discuss why simulation important in nursing
 Identify purpose of simulation
 Explain principle of simulation
 Discuss types of simulation
 Identify principle for selecting type of simulation
 Discuss dimensions to consider when designing and setting up
simulation exercises
 Explain steps of simulation
 Define simulation fidelity
 Identify levels of simulation fidelity
 List advantages and disadvantages of simulation
Outlines:
 Introduction
 Definition of simulation
 Why simulation important in nursing?
 purpose of simulation
 Principle of simulation
 Types of simulation
 Principle for selecting type of simulation
 Dimensions to consider when designing and setting up
simulation exercises
 Steps of simulation
 Definition of simulation fidelity
 Levels of simulation fidelity
 Advantages and disadvantages of simulation
 Introduction:
 Simulation is a technique or device that to create characteristic of
the real world
 Simulation allows the educator to control the learning environment
through scheduling of practice, providing feedback, and minimizing
or introducing environmental distractions

Definition of simulation
 An educational technique that creates a situation or environment
to allow persons to experience a representation of a real event for
the purpose of practice, learning, evaluation, testing
 Activities that mimic the reality of a clinical environment and are
designed to demonstrate procedures, decision-making and critical
thinking through technique such as role playing and the use of
device such as interactive videos or mannequins
 Teaching strategy 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

Why is simulation important in nursing?

The use of human patient simulation as an instructional strategy can
enhance patient safety and optimize outcomes.
Providing a means of allowing nursing students to practice critical
thinking ,clinical decision making and psychomotor skills in a safe ,
controlled environment ,without potential risk to a live patient.
Purpose of simulation:
 To help student practice decision making and problem solving skills
 To develop human interaction abilities in a controlled and safe
setting
 Through an active involvement in a simulation exercise or role play
situation , the student achieves cognitive ,affective and
psychomotor outcomes
 It provides a chance to apply principles and theories student have
learned and to see how and when the principles work.

Principles of simulation
 Clear stated objective
 Actual patient care experience
 Proper orientation of proceedings /scenario
 Use of problem-solving and critical reasoning
 Simulation may refer to (a device representing a simulated patient
or part of patient

Types of simulation
1-Manikin-based Simulation:

 The use of manikins to represent a patient

 Their complexity varies from being just the physical shape of a
patient to incorporating complex electronic equipment for
generating physiological responses as ( heart sounds ,voice
interaction ,movement ,eye blinking ,seizures).
  Responses can be controlled manually by an operator or
programmed into the simulator using computers and software to
model the effects of pathological states and pharmacological
intervention

2-Part-task trainers:

 Are models used for repeated practice of

the technical components of a clinical
task

Examples:

 Arms for practicing intravenous cannulation

 Head and thorax models for practicing airway skills
 Synthetic skin pads for practicing suturing.

3-Simulated patients:

Also called patient actors or standardized patients

  A person who has been carefully coached the emotional
to stimulate an actual patient characteristics
 The simulation can not be detected by
skilled clinician
 In performing the simulation , the SP
presents the gestalt of the patient being
simulated ,not just the history but the
body language ,the physical findings ,and

4- Computer- based simulation

A simulation- based learning activity designed to provide an experience

with inputs and outputs exclusively confined to a computer, usually
associated with a monitor and a keyboard or other assistive device

 Learners can complete specific tasks in a variety of potential

environment use information to provide assessment and care,
make clinical decisions, and observe the results of action
 Feedback can be provided during and after interaction

 These may be as simple as a

computer program to
demonstrate the operation
of a piece of equipment,
such as anesthesia.
 As a complex as a detailed
virtual reality environment
in which participants
interact with virtual patients
or other health professional
machine .

 The Virtual I.V. is a comprehensive and fully interactive self-

directed learning system for training intravenous catheterization.
Virtual patients respond with bleeding, bruising, swelling, as well as
other patho-physiological reactions.

5- Hybrid simulation:

 The union of two or more modalities in

the same simulation with the aim of
providing a more realistic experience
 Hybrid simulation is most commonly
applied to the situation where a part task
trainer.
Example:

 Needle decompression model is realistically affixed to a

standardized /simulated patient, allowing for the teaching and
assessment of technical and communication skills in an integrated
fashion.
 Principles of selecting type of simulation to use:
 Should be driven by the educational objectives
 Should match the level of the student
 The higher the realism, the more effective it is in engaging the
student.

Steps of simulation:
1-Assignment on roles:

 A small group of 4 or 5 students teacher is selected

 The teacher should assign roles to all members (The role
assignments should be rotated within the group to give chance to
everyone
 Every member of the group gets an opportunity to be the actor
and the observer

2-Deciding the skills to be practiced

3- Preparation of work schedule

 The teacher decide who will teach first and who will observes
 The teacher should decide in advance who starts the conversation
 It is also decided how every turn by turn will be teaching and
observing the lesson
4-Determining the technique of observation:

 The teacher decided the procedure of observing the lesson

 How different type of data is to be observed and how are these
to be recorded
5- Organizing the first practice lesson:

 The first practice lesson is started and its observation are

recorded for judging the teaching behavior
 This is followed by discussion leading to feedback and
suggestion for improvement of the lesson

6-Alteration or procedure:

 This is the last step in simulation. The teacher should be

prepared to alert procedure ,change topic and move on the
next skill
 There is change of teacher, change of observer, change of
teaching skills and also change in the topic to be taught

Simulation fidelity
Definition:

 The physical, contextual, and emotional realism that allows

persons to experience a simulation as if they were operating in an
actual health care activity

Levels of fidelity:

1-Low fidelity simulation:

Used to build knowledge

 The simulation in this category will feel the least real to the
learner.

Example
 Task trainers designed for specific task or procedures such as IV
arms or CPR manikins

2-Mid fidelity simulation:

Used to build competence

 The simulation is more realistic and allows more opportunities for

learning

Example:

 Fully body manikins that mimic patients by having breath sounds,

bowel sound, and heart sounds
 Allow students to perform procedures such as IV insertion,
injections, NG tube insertion, tracheotomy suctioning and Foley
catheter insertions

3-High fidelity simulation:

Used to build performance and action

 These simulation are the most realistic and maximum interaction

of learners in an environment that closely resembles reality

Example:

 Fully body computerized manikins that replicate the

anatomy and physiology of a real patient. Many of these
manikins have the ability to talk which allows students to
develop communication and problem solving skills
Potential advantages of simulation:
 It is useful in promoting transfer of learning from classroom to the
clinical setting
 Simulation foster critical thinking & problem solving skills
 Simulation offer an excellent opportunity to learn from mistakes
 Simulation techniques are fun and interesting ,they can motivate
people to learn
 Is student-centered learning
 Students also learn from the faculty member who is guiding the
simulation and leading discussion
 It encourage creative and divergent thinking
 Provide a mix of experiences that can be replicated for successive
learners
 Is safe and respectful for patients
 Provide immediate feedback on performance
 Can be reproduced
 Can be designed and manipulated
 Offer opportunity to practice rare and critical events
 Reduces training variability and increase standardization
 Allows calibration and update
 Occurs on schedule
Disadvantages of simulation:
 It is costly in terms of both time and money
 Outcomes of simulations are not always predictable
 Need for many simulators
 Never same as performing techniques on a patient
 Limited realistic human interaction
 Some simulation does not have physical interactivity
References:
 A linier, G. (2007). Atypology of educationally focused medical
education simulation tools. P(243-250)
 Cant,R. (2016) .Simulation in nursing education systematic review.
journal of Advanced nursing
 Kivinen,E.(2014). Simulation fidelity in nursing practice.PPT