Simulation in Nursing Education: A Review of the Research

In recent years, high-fidelity simulation in nursing education has become an increasingly popular educational tool. Is simulation a new technique? Does simulation have positive learning outcomes? Is there evidence-based research to substantiate the use of simulators in education and particularly in nursing education? This discussion will look at several studies and attempt to answer these questions. According to Webster's (2003) to simulate is "to look or act like. " In the broadest sense this would include not only mechanical simulators but also role playing, scenario settings, and case studies, to mention a few types of simulation. Using this definition we realize simulation in nursing education has been around a long time--whether it has involved using oranges to practice intramuscular and subcutaneous injections, learning CPR on a static manikin, inserting foley catheters in a manikin in a lab setting, or role playing major mental disorders and communication skills in mental health. These are all simulations in one form or another, and what they have in common is that they are done in an artificial situation so the student or staff member is later able to practice safely in the clinical setting. Ward-Smith (2008) noted that the first documented use of higher level simulators was with pilots during World War II. They continue to be used today to train pilots in simulated situations such as loss of power, engine failures, and poor weather conditions. Safety is the reason behind using simulators in pilot training as well. In 2003 the Institute of Medicine adapted simulation as a teaching methodology to be used in programs in education (Ward-Smith). In nursing, there is limited research on the effectiveness and outcomes when using simulators and simulations. In healthcare the emphasis is on giving accurate and safe care to patients, and simulators and simulations allow for the practice of this important goal in a less threatening environment. In 2003, the National League of Nurses (NLN) endorsed the use of simulations in order to prepare students in critical thinking and self-reflection as well as preparing them for the complex clinical environment. In 2007, with a grant funded by the Laerdal Medical Corporation, the NLN began a three-year research study on the use of simulation in nursing education. The project, called the Simulation Innovation and Resource Center (SIRC), involved educators from the United States and also eight international educators from Australia, Canada, Chile, Japan, Norway, Scotland, and China (Hovancsek, Jeffries, Escudero, Foulds, Huseb, Iwamoto, et al., 2009). The goal of the project was to develop web-based courses that use high technology simulations. Out of this study came a resource center web site that assists educators with scenario design (http://sirc.nln.org/). According to Hovancsek et al. (2009), patient safety has become a priority concern, and the use of simulators can prepare nurses for mock disasters that involve other professionals such as military, police, firefighter, paramedics, and physicians. Interdisciplinary mock drills are held to better prepare communities for disasters. The study found the demand for higher quality healthcare both nationally and internationally has increased and the use of simulation will improve health care (Hovancsek et al.). Lasater (2007) points out that the nursing shortage has resulted in a more diverse group of students being interested in nursing. At a time when there is a critical need for nurses, nursing education faces a critical shortage in nursing faculty. In spite of the inconsistent practice experiences students receive, the demand is present for a higher level of knowledge upon entering the professional work arena. In order to study simulation and clinical judgment, Lasater conducted an exploratory study that looked at four dimensions of clinical judgment development and the interaction between them. …