Using Simulation in Nursing Education

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Using Simulation in Nursing Education

• Pedagogy, Research and Curriculum
• Professor Di Marks- Maran
• Visiting Professor of Nursing Education
• Kingston University/SGUL and
• Managing Director, Marks- Maran Associates Ltd

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Focus for this presentation

• The pedagogy of simulation
• Researching simulation
• Simulation-based curriculum

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Simulation in healthcare education

• Critical care/high dependency (Eaves Flagg
  2001 Morton 1997 Rauen 2001 Weis
  Guytin-Simmons 1998 Vandry Whitman 2001)
• Clinical judgement skills (Rhodes Curran 2005)
• Health assessment skills (Wilson et al 2005)
• Neonatal nursing skills (Mello 2004)
• Peri-operative care (Grailing Rusynko 2004)
• Medical education (Gaba De Anda 1988 Good et
  al 1992 Gordon 2000)

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Types of simulation

• High Fidelity simulation
• Low fidelity simulation

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The Pedagogy of Simulation - 1

• Kerka (1997) meta-analysis of learning in
  students on vocational/ professional
  (role-related) education and training courses
• Studies included in this meta-analysis
• Billett (1996)
• Schumann (1996)
• Lave (1996) and Lave Wenger (1991)
• Farmer, Buckmaster LeGrand (1992)
• Hart-Landsberg, Brauger Reder (1992)

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The Pedagogy of Simulation - 2

• Tenets associates with situated learning
• Learning is grounded in the actions of everyday
  situations
• Knowledge is acquired situationally and
  transferred to similar situations
• Learning is a result of social processes
• Learning is situated in action

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The Pedagogy of Simulation - 3

• Knowledge is created and made meaningful
• by the context in which it is acquired.
• (Farmer, Buckmaster LeGrand 1992, p. 46)

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The Pedagogy of Simulation - 5

• Students on role-related (professional/
  vocational) courses require a pedagogy that
• Enables the transfer of learning from classroom
  to the work setting
• Provides opportunities for students to learn
  actively by doing
• Provides immediate feedback on learning
• Provides authentic activities guided by experts
• Is situated in a culture of practice
• Is embedded in the social context where new
  knowledge will be used
• Involves learning interactively with others

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The Pedagogy of Simulation - 6

• It is not the simulation that makes the
• learning it is the pedagogy of
• simulation that makes the learning
• The pedagogy of situated learning is the
  pedagogy of simulation

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Evaluating simulation

• There is a difference between
• Evaluation
• and
• Evaluative Research

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Evaluative research - 1

• Six evaluative research fields (Scriven 1999)
• Programme/partial programme evaluation
• Personnel evaluation
• Performance evaluation
• Policy evaluation
• Proposal evaluation
• Product evaluation

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Evaluative research - 2

• Aspects of programme/partial programme
  evaluative research
• Use
• Usability
• Impact
• Sustainability
• Quality (merit)

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Research into simulation - 1

• Systematic review of the use of simulation in
  medical education (Issenberg et al 2004)

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Research into simulation - 2

• Heterogeneity of research designmake a
  quantitative synthesis of the research evidence
  impossible.
• (Issenberg et al 2004)

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Research into simulation - 3

• fail to report means, standard deviations
  and reliability coefficients making a
  quantitative synthesis of the research evidence
  impossible.
• (Issenberg et al 2004)

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Evaluative research into simulation

• Evaluative research into the use of simulation
  is not a medical endeavour
• It is an educational endeavour!
• Requires educational evaluation research
  design

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Findings from Issenberg et al (2004)

• High fidelity simulation facilitates learning
  when used in the right conditions
• Simulation complements but does not duplicate
  learning on real patients in the real work
  setting
• The majority of evaluations carried out to date
  are impact evaluations
• Simulation is best used to prepare students for
  real patient contact
• Simulation provides a safe and forgiving learning
  environment

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Simulation in nursing education

• Radhakrishnan et al (2007)
• Seven areas of nursing practice
• Basic assessment skills (e.g. vital signs)
• Safety (including patient identification)
• Prioritisation skills
• Problem-focussed assessment of need
• Ensuing interventions after assessment
• Delegation
• Communication

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Findings - Radhakrishnan et al (2007)-

• Experimental group scored significantly higher
  for assessing vital signs and for patient
  identification
• All other categories, no difference from control
  group

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Evaluative Research Design

• Case study evaluation (Tellis 1997 Yin 1994)
• Realistic evaluation (Pawson Tilley 1997)
• Constructivist/Fourth Generation Evaluation
  (Lincoln Guba 1989)
• Action research evaluation (Wadsworth 1998)
• Utilisation-focussed evaluation (Ngambi Brown
  2004)
• Context-process-Product evaluation (CIPP)
  Stufflebeam 2000)

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The place of simulation in the curriculum

• Currently simulation is an add-on to existing
  curricula
• Programme for Nursing Curriculum Integration
  (PNCI)
• A vision for a future curriculum with simulation
  as the starting point