Simulation in Undergraduate Education

Simulation is an integral component of undergraduate nursing education because it allows for a safe, timely, and prescriptive approach to meet learning objectives at the levels of individual simulations, courses, and academic programs. This review of the literature provides an overview of steps taken to move simulation forward in undergraduate nursing education, and it highlights educational theories, research, best practices, and policy statements underpinning modern nursing simulation. This chapter outlines simulation and curriculum integration approaches and provides examples of participant, course, and program outcomes.

Evidence-Based Debriefing

Ongoing shifts in the healthcare system require practitioners who possess metacognitive skills to evaluate their decisions and the thinking and rationale guiding those decisions. In an effort to design learning activities that support metacognition in nursing education, undergraduate and graduate faculty, are embracing simulation-based education (SBE) as an effective teaching and learning strategy. SBE includes prebriefing, the simulation scenario, and debriefing, all of which are supported by psychological safety. Prebriefing precedes the entire learning process and is integral to engagement in the simulation and to the effectiveness of the debriefing. Debriefing provides educators with the opportunity to explore and develop those metacognitive skills with learners. In this chapter on evidence-based debriefing, the authors will explore the evidence and theories surrounding best practices in SBE, specifically the prebriefing and debriefing components of the learning experience. The chapter explores the theoretical foundation of SBE and theory-based debriefing; educational best practices of prebriefing as an integral part of an effective debriefing; theory-based debriefing models; research evidence of debriefing outcomes; evaluation of the prebriefing and debriefing process; and finally, provides recommendations on the priorities for further research in debriefing. Within this chapter, the term educator is inclusive of undergraduate, graduate, and professional development nurse educators and reflects the educator role in SBE.

Hospital-Based Simulation

This chapter discusses the current state of hospital-based simulation, including the unprecedented events of 2020's global COVID-19 pandemic. Hospital-based simulation training requires a new approach. The realities of social distancing and the operational demands of hospital staffing ratios warrant creative adaptations of traditional simulation training methods. Hospitals used simulation to improve patient outcomes by training healthcare staff and students through telesimulation, and tested systems and equipment using in situ simulation (ISS). Latent safety threats (LSTs) were identified and corrected to improve patient outcomes. Hospital-based simulation has been incorporated into newly licensed registered nurses (NLRNs) residency programs to prepare them for competent practice. Simulations are also used for preparing staff for low-incidence, high-risk medical emergencies or disasters, such as active shooter events. Hospital-based simulation training adds value to healthcare systems, but requires more evidence of its quantitative and qualitative impacts.

Three-Dimensional Printing: Collaborative Nurse-Led Research

Though three-dimensional (3D) printing is often touted as cutting-edge technology, it actually made its appearance in the 1980s. Since then, this technology has made significant progress from its humble origins of layering polymers to create simple structures to the more sophisticated printing with elements such as metals used to create complex structures for aircraft. This technology has advanced and been finely tuned largely in thanks to the engineering profession. The variance within the printers, software, and printing material allows for broad application beyond engineering and manufacturing. Healthcare and academic applications are beginning to get traction. The National Institutes of Health has established a platform for sharing 3D ideas to support biotechnology and modeling for healthcare. It makes sense that nursing programs would, minimally, utilize 3D printers to enrich their institutional simulation laboratory and to manufacture specialty materials for training students in a cost-efficient manner. Opportunities to collaborate with other academic departments and community partners in the development and production of timely and effective solutions to pressing healthcare needs enriches student learning, nursing programs, and their graduates. Faculty buy-in and purposeful integration throughout the curriculum are vital variables associated with the successful implementation of 3D printing in a nursing program. Additional benefits include opportunities for publications, presentation of papers, and interprofessional collaboration.

Evaluation of Simulation Outcomes

Simulation has been used in nursing education and training since Florence Nightingale's era. Over the past 20 years, simulation learning experiences (SLEs) have been used with increasing frequently to educate healthcare professionals, develop and increase the expertise of practicing professionals, and gain competency in key interprofessional skills. This chapter provides a brief overview of simulation evaluation history, beginning in the late 1990s, and the initial focus on learner self-report data. Using Kirkpatrick's Levels of Evaluation as an organizing model, four types of SLE evaluation are reviewed as well as suggestions for future research.

Human Simulation in Nursing Education

Although, human simulation methodology has its origins in medical education, nursing education has increased its use of simulated patient (SP) methodology to improve the education of nursing students across the curricula. This chapter will review the history of human simulation, introduce the human simulation continuum, and review different applications of SP methodology in undergraduate and graduate nursing education.

State of Simulation Research in Advanced Practice Nursing Education

Simulation is used in advanced practice nursing education for both formative learning experiences and summative competency testing. However, there has been a lack of cohesive data to support the use of simulation as a replacement for direct patient care hours. This chapter presents an overview of research designs and the leveled Kirkpatrick framework used in simulation research. Research articles evaluating the effect of simulation on advanced practice learners are presented by research design and Kirkpatrick level. There is evidence that simulation has a positive impact on Kirkpatrick Level 1 (Reactions) and Kirkpatrick Level 2 (Changes in Knowledge, Skills, and Attitudes). However, there is a tremendous need for evidence that simulation can impact Kirkpatrick Level 3 (Behavior) and Level 4 (Results and Outcomes).

Virtual and Augmented Realities in Nursing Education: State of the Science

The use of simulation in nursing education is an integrated part of the curriculum and has demonstrated the benefit for learning in nursing students at all levels. The next stage in simulation-based learning will utilize the wide variety of new technologies that are currently available, including virtual and augmented reality. The use of these new technologies brings with it a need for standard definitions, evaluation of its impact on learning, and new opportunities for research. Efforts are underway to standardized definitions and publish early findings on research using these new technologies. There are many opportunities available for nursing educators to create a new era of simulation-based learning methodologies by incorporating virtual and augmented realities in their curriculum. The state of the science is showing promising outcomes and commercial products are maturing.The utilization of these new technologies should be approached in the same way as other learning methodologies as many new ideas and ways of learning are emerging in this area. It will be critical for nursing educators and faculty to determine the optimal ways to utilize them.

Professional Development for Simulation Education

Professional development in simulation methodologies is essential for implementation of quality, consistent, simulation-based experiences. Evidence demonstrates that participation in comprehensive training positively impacts learner outcomes. There are many benefits to professional development, however, challenges exist requiring thoughtful planning, administrative buy-in, and fiscal support. While there are no established guidelines, the literature provides an ongoing consensus related to overall concepts and strategies for training in simulation. We describe a continuum of growth for simulationists, ranging from novice/advanced beginner, competent/proficient, to expert. As a novice, one must conduct a self-assessment of current strengths and create a development plan to advance simulation skills and knowledge. A simulationist should use evidenced-base guidelines, mentorship, and feedback to inform simulation practices. They should be knowledgeable of the standards of best practice, modalities, simulation design, learning theories, and professional integrity. Simulationists must seek ongoing advancement through certification, scholarship, and lifelong learning. This chapter describes the continuum of education and methodologies for the development of simulationists.

Simulation-Based Operations

Simulation pedagogy and the operations of simulation-based experiences have become an integral part of healthcare education. Academic and healthcare institutions constructed simulation centers or dedicated simulation spaces to provide simulation-based experiences for multiple health professions. Architectural designs resemble acute care settings that have the flexibility to change or include virtual reality and enhanced technology. Professional organizations have standards of best practice, credentialing requirements, and accreditation standards that support the need for high-quality, high-fidelity simulation experiences. Within healthcare education, simulation operation has become a specialty in itself that requires knowledge and experience of healthcare, education, and simulation pedagogy (INACSL Standards Committee, 2017). Simulation center administration needs an understanding of personnel management, including standardized patients (SPs), staff, faculty, and learners, as well as knowledge of budgeting, revenue streams, and technology. Personnel with unique skills and knowledge in engineering, healthcare, or information technology are required to support the simulation activities. Resources that manage inventory, supplies, equipment assets, and audiovisual requirements will increase efficiency and enhance fiscal responsibility. Technology assets such as high-fidelity human patient simulators can be used to enhance high-quality simulation, while audiovisual and data capturing software can be used for assessment, evaluation, and quality improvement. Simulation operations provides the infrastructure that supports the daily activities of simulation-based education.