Use of High Fidelity Simulation in Nursing Education

Investing in Education

Nursing education and simulation has evolved from using replica models and manikins to standardized patients. In order to help our students further develop, refine and apply knowledge and skills in a realistic clinical situation, the Nursing Department made a commitment to invest in high fidelity simulation. These simulators are computerized, interactive, life sized manikins that can be programmed to provide realistic patient response and outcomes to nursing care.

Banking the Dividends

High fidelity simulation keeps our students motivated and wanting to learn. Research shows that today’s students like this kind of technology and that nursing students embrace a “hands on approach” to learning. Simulation offers students an opportunity to experience a situation that is too rare or too risky for them to participate when in the clinical setting. It also allows students to reflect upon the consequences of their actions in a safe environment and without harming a patient.

One of the biggest challenges we face as nursing teachers is the lack of clinical areas and control over the types of clinical experiences a student will have or the circumstances under which nursing care can be monitored, learned or practiced. For instance, third year nursing students are taught about the complications of diabetes, yet the likelihood of all students having this particular clinical experience during their clinical rotation is unusual. Simulation addresses this issue by granting all students an opportunity to learn and participate in nursing care using structured simulation lab experiences instead of trying to find appropriate and/or rare patient care opportunities in a health care setting.

The main drawback of high fidelity simulation is the time commitment required to learn, adapt and implement this new technology. Although our simulators provide us with pre-programmed scenarios, many of these scenarios are considered too high level for our students. Consequently, the adaptation and creation of new scenarios are therefore required to meet our student learning needs and course objectives.

Reaping the Rewards

Each manikin comes with a tablet, wherein physiological data is programmed and altered at the teacher’s discretion. These interactive manikins are capable of realistic physiologic responses, including blood pressure, respiration, pulses, heart sounds, breath sounds, eye movement, and pupillary reaction. Additionally, they can respond to questions posed by the learner either through wireless streaming audio capabilities or by stored vocal responses.

For example, to mimic a patient with severe pneumonia, the manikin would be programmed to have an increase in respirations and possible mild cyanosis (a bluish discoloration to the lips and around the mouth, indicating a lack of oxygen). If a student were to listen to the manikin’s lungs with their stethoscope, they would hear abnormal lung sounds.

Gloria and Lyne with students during a lab simulating a pulmonary embolism

Recently, a scenario was developed to allow students the opportunity to integrate and use the theory they were taught in an emergency measure lab. This lab was evaluated as a highly valuable learning experience by the students. The lab was designed to first introduce theory via an interactive clicker/lecture format, followed by a simulation scenario. Both Hal and Susie (our adult simulators) were programmed to imitate a pulmonary embolism, resulting in a cardiac arrest.

In this particular scenario, the students were placed in small groups to promote group discussion, collaboration and peer learning. The teacher manually altered the physiological data based on the group’s analysis of the scenario, interventions and group progress. Throughout the scenario, students received instant feedback and could also observe changes that occurred in the simulated patient’s condition as a result of their intervention. If students intervene inappropriately, simulation allowed for repeat practice, self reflection and learning in a non threatening environment.

A Clean Bill of Health

In summary, the simulators have become an integral part of the nursing curriculum at John Abbott for the following reasons:

1. They complement traditional lecture methods.
2. They allow the teacher to present complications that are rarely seen in the clinical environment.
3. They foster learning and develop critical thinking by having students assess and analyze a situation in a nonthreatening environment which allows students to make mistakes, while offering them an opportunity to repeat practice, consolidate learning and develop competence.
4. When used properly, a simulation provides students with teacher feedback as well as feedback from the simulation itself.
5. Simulations improve skills such as communication, interprofessional relationships, and decision making. They promote peer learning as students discuss the situation.

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