Filling the Gap: Clinical Simulations Prepare Students for the Nursing Practice

Most nurse educators agree that a gap exists between nursing education and nursing practice. To fill this gap, many of them have augmented new graduate nurses’ knowledge with blended learning, using clinical practice labs and clinical site experiences. Now, more nurse educators are turning to clinical simulations to help fill the gap—and with good reason.

Simulations in Orientation

Recent evidence supports the effectiveness of clinical simulations in increasing preparedness for practice. One study evaluated a pilot residency program for new graduate nurses and doctors of pharmacy that used patient simulations. The eight-week orientation program included a review of policies and procedures, small group discussions and practice lab simulations with Vital-Sim® simulators and two static mannequins, which had either cardiac monitoring capability or heart, lung and bowel sounds. The researchers used two instruments to obtain quantitative and qualitative data from the participants.

Overwhelmingly, participants reported that the program—especially the simulations—helped better prepare them to practice independently in the hospital. Most felt that the simulations accurately reflected patient care situations and promoted good communication skills, critical thinking and prioritization. 

More than 50% of participants ranked simulations the highest in helping to develop hands-on skills. Also, 70% felt that the program presented helpful information that was not covered in one-on-one care for real patients under their preceptor’s guidance. Participants not only rated simulations as their favorite part of the course, but also felt that they contributed the most to learning. In addition to developing the participants’ clinical practice, simulations also helped them gain resource utilization skills, policy and procedure awareness, and a sense of camaraderie with their co-workers.

Simulations in CPR Training

Another study compared the effects of two teaching methods on the initial acquisition—and later retention—of cardiopulmonary resuscitation (CPR) knowledge and skills. The control group received the standard review of American Heart Association (AHA) CPR for adults. The experimental group received the standard CPR review, plus high-fidelity simulation experience with a cardiopulmonary arrest scenario. To assess CPR knowledge before and three months after training, participants in both groups took a multiple-choice test based on the AHA exam for Basic Life Support. To assess CPR skills, they participated in mock codes that involved responding to a CPR mannequin lying on the floor.

Although this study was done with nursing students, its results apply equally to practicing nurses. Its assessments showed that the use of high-fidelity simulations significantly enhanced the acquisition of CPR knowledge as well as CPR skills. Simulations also significantly increased the retention of CPR knowledge and skills after three months.

Simulations in Blended Learning

Simulation labs give staff educators several ways to enhance nurses’ knowledge and skills through blended learning. Here are a few examples:

  • Practice in a safe environment— Create patient situations in the safe environment of the simulation lab, using a simulator that responds to learners’ decisions and actions. This gives learners a chance to perform assessments, make decisions and practice skills without fear of patient harm.
  • Return demonstration and observation— Assess learners using online or computerized tracking equipment, such as a high-fidelity mannequin. For example, have a nurse demonstrate how to perform chest compressions on a simulator that records the depth and speed of compressions.
  • Preceptor or mentor review— Facilitate the preceptor or mentor relationship with new staff by recording learners during simulation learning activities. For instance, videotape a new critical care nurse assembling the equipment needed for hemodynamic monitoring. After reviewing the recording, the preceptor or mentor can provide feedback to the nurse.
  • Debriefing— Engage in collaborative reflection after a learning experience, such as a simulation activity. During debriefing, act as a facilitator to help learners gauge their performance, using reflection, analysis, feedback and remediation (such as guided discussions or online reading assignments).

For more on clinical simulations and blended learning, check out the American Association of Critical-Care Nurses’ (AACN’s) Introduction to Blended Learning course. Call 866-416-6697 or email [email protected] for details.

Ackerman, A.D. Investigation of learning outcomes for the acquisition and retention of CPR knowledge and skills learned with the use of high-fidelity simulation. Clinical Simulation in Nursing. 2009, 5(6): e213-e222.
Young, P., and Burke, J. Evaluation of a multidisciplinary, simulation-based hospital residency program. Clinical Simulation in Nursing. 2010, 6(2): e45-e52.

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