Wendy Nehring, Associate Dean for Academic Affairs at Rutgers The State University of New Jersey’s School of Nursing, gave the day’s opening keynote presentation on ‘The state of the art of the use of simulation’. Her talk was focused on high-fidelity patient simulation, covering the rationale for proliferation of its use in nursing and other healthcare disciplines, the paradigm changes in nursing education, opportunities for professional development and the related research literature, before closing in looking at some future directions.
Part of the impetus is Institute of Medicine publications focusing on patient safety, in conjunction with technological advances influencing healthcare, such as pharmacogenetics, treatment options including robotics, telemedicine and advances in assessment technology. Much of the work on these developments has been lead by work from the military, such as PDA-based monitors (as per Star Trek) for monitoring patients and underwater telemedicine.
Education changes such as the knowledge explosion, choices in what to teach from the plethora available, the faculty shortage, decreasing numbers of clinical sites and the costs of using clinical sites, the need for students to develop clinical thinking and assessment skills all have an impact. Students need to be fit to practice in wireless, paperless hospitals, and to be able to develop active learning techniques within multidisciplinary group learning.
High fidelity patient simulation can address areas such as increased patient acuity and problems of students being able to access real patients within real clinical environments. The nursing literature has shown for several years the advantages and disadvantages of using simulators (often from within critical care courses, such as nurse anaesthesia), in how critical thinking can be increased within critical incidents, and the role of debriefing following on from the use of simulations on performance and student feelings about the experiences.
There is now a journal titled ‘Simulation in Healthcare’ and new organisations are emerging for people working in the field. In recent years, several US nursing organisations have suggested the need to explore simulations and virtual reality within clinical education. A recent survey of Boards of Nursing in the US states (Nehring, 2006) showed that a only small number of states (5, plus Puerto Rico) have made changes to regulations for the percentage of clinical time that can be spent with simulations. 16 states give permission for use of simulators within clinical hours, while in many others, regulations are silent on the issues, thus probably leaving the door open for potential use of simulators and other technology.
A range of simulations exist, including full-body, low-tech mannequins, task trainers, role playing and standardised patients, computer patient models, and high-fidelity patient simulators. Research into simulation as a teaching strategy and in knowledge acquisition have shown positive benefits to learning and retention of knowledge from simulations. Nehring suggests a model and new strategies are needed for research into the field, perhaps with a focus on patient safety.
In looking at future directions, she suggests that patient simulation will be increasingly used throughout all levels of nursing education, there will be standardised clinical evaluation, further development of standardised scenario development, and videostreaming on the Internet for virtual learning and debriefing.
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