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Simulation Promotes Patient Safety

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ALMOST LIKE REAL: Two Wisconsin Lutheran College nursing students (from left), Amanda Kamla and Kristen Luebbe, pause during a clinical exercise with a patient simulator in the nursing laboratory at the Milwaukee campus. Photo courtesy Wisconsin Lutheran College
While the idea of training and practice is not a new concept in nursing education, the methods and settings for nursing student preparation have changed in recent years. In the newly created nursing program at Wisconsin Lutheran College (WLC), Milwaukee, a three-sided education approach - course work, clinical experience and nursing laboratory simulation - is the foundation of learning in the junior and senior year of the program, which is graduating its first 4-year class in the fall.

Course work in nursing theory and concepts is presented to students in a traditional classroom format. At WLC courses are divided into categories based on specific patient populations: adult, geriatrics, pediatrics, obstetrics, mental health, community health and global health. Clinical experiences in various settings support the course work and provide students with the opportunity to apply knowledge in actual healthcare environments, including long-term care facilities, acute care hospitals, clinics and the community.

Then There's Simulation

The third leg of the WLC nursing program is simulation. While time spent in the actual clinical environment is invaluable to student learning, it is understood simulation provides another important component to learning.  

Described as a replication or mock-up of reality for purposes of learning, simulation provides opportunities for students to react to realistic patient scenarios in a safe and controlled environment.

Patient situations ranging from simple to complex are created and executed in a lab setting. The student is expected to assess the patient and respond by implementing interventions appropriate for the patient and circumstances.

Endless scenarios can be created facilitating student assessment and participation; repeating actions reinforces learned behaviors. A study sponsored by the National League for Nursing and Laerdal Medical between 2003 and 2006, found students most actively involved in the simulation experience had a higher perception of active learning and a higher level of satisfaction with their learning experience. These students also reported greater confidence in their ability to care for patients. (Jeffries, P.R., (Ed.). (2007). Simulation in nursing education. New York: National League for Nursing.)

High Fidelity

The degree to which the situation, equipment and environment create reality is described as the "fidelity" of the simulation. A round-table student discussion of a paper-based case study is considered low-fidelity, while the use of high-end computerized patient simulators requiring hands-on student activity is high-fidelity, according to Simulation in Nursing Education.

Many nursing schools have begun to create nursing simulation laboratories where students can practice patient care skills before they begin clinical experiences with actual patients.

At WLC, six patient care areas in the nursing laboratory provide a realistic venue for students to gain familiarity with healthcare environments. Exam tables, hospital beds and healthcare equipment add to the surroundings.

The lab is also home to five middle-fidelity patient simulators - three adults, a child and an infant. All five come with interchangeable parts that can be set up to replicate various wounds, stomas, skin issues, amputations, and allow the patient to be male or female.

Students can administer medications to the simulators, insert tubes and catheters, check blood pressures, heart rates and rhythms, listen to lung and bowel sounds, and give injections. Pre-programmed sounds in the patient simulators, such as coughing, moaning and shortness of breath, add to the reality of the students' experience.

Quality Increases

In the past decade patient safety and quality of care has been a driving force in healthcare. Complex systems and advanced technology have contributed to the creation of settings where patient safety is often at risk.

Quality improvement groups, such as the Institute for Healthcare Improvement (IHI), have taken on multiple research projects in an effort to find effective solutions for challenging healthcare situations. The Joint Commission has published annual National Patient Safety Goals since 2003 that mandate programs and processes needed to improve patient safety, accelerating efforts to add patient safety education to health professions education curricula.

In 2005, a patient safety project called Quality and Safety Education for Nurses (QSEN)WE was created to support nursing schools' efforts to implement patient safety concepts into curricula. Through funding from the Robert Wood Johnson Foundation, the first two phases of the project involved the development of materials, strategies and training for nursing school faculty. The third phase, which runs 2009-2012, includes regional conferences for nursing faculty on the QSEN concepts and implementation into nursing school programs.

In 2008, the IHI launched IHI Open School, an online network and collection of educational resources on patient safety and quality improvement for students seeking degrees in health fields. These programs were developed with the understanding health profession students need this education before they enter the workforce. They need the concepts, but they also need the ability to apply what they have learned.

Simulation is the vehicle for incorporating education of patient safety principles into the educational setting. The next generation of nursing graduates must be adequately prepared to provide safe patient care within complicated, fast-paced and technical environments. Simulation is an important part of student preparation and the key to equipping students with the knowledge, skills and the practice time for becoming safe and effective healthcare professionals.

Sheryl Scott is assistant professor of nursing, Wisconsin Lutheran College, Milwaukee.


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