Placing individuals into situations that either commonly or rarely occur, without harm to themselves or others, is a very powerful tool for educators. Facilitating the transfer of knowledge; changing, modifying or enhancing behaviors and skills; and replicating this time and time again, exactly reproducing the initial criteria of the event,that is simulation.
Modern-day use of nursing simulation began as early as 1847 and surged in the early 1960s with the introduction of Laerdal’s “Resusci Anne” to teach cardiopulmonary resuscitation (CPR). Progress plateaued in the 1980s, when the first forms of today’s high-fidelity simulation mannequins were developed at Stanford Medical School. Innovation continued through the 1990s, with wide scale implementation and a larger patient-safety focus beginning in the early 2000s.
With advances in new technology and interoperability, we’re now at the precipice for the third stage of healthcare simulation education, where the classroom needs to mirror the true healthcare environments students will soon face. Implementation of functional, real world technology allows for increased patient safety, reduced rates of medication errors, and enables nurses to hone their skills in more realistic training environments, increasing the transferability of those skills to the workforce. Few environments are as technical as the hospital, requiring high levels of technology integration in the educations programs supporting the industry.
Learning from Mistakes
In response to To Err is Human, a report from the Institute of Medicine,1 nursing educators began to develop programs that would allow students to cultivate patient care skills without putting patients at risk. Not only does this allow educators to control the scenarios and situations that students encounter, they are also able to closely monitor their students and reflect upon the experience. This enables students to learn from their mistakes without endangering patients, and receive valuable feedback from educators during the experience or in post-review. Reflective learning has been identified as the true value of nursing simulation education, according to a study in the Journal of Nursing Education. 2
Beyond allowing for a more reflective learning process, new simulation models allow nursing students to recognize potential warning signs and practice their response on an anatomically correct model. Because the situation is controlled, educators can escalate the difficulty of a case as the students build their skills, allowing them to encounter cases they may never see in their clinical practicum experiences.
Simulation allows students to repeat the same experiences, building muscle memory and boosting confidence in patient-care abilities. The recent National Council of State Boards of Nursing National Simulation Study shows that nurses who received up to 50% simulation experience will do as well, if not slightly better, than students who receive the more traditional 10% simulation experience. 3
Reducing Medication Errors
In 2007, the Institute of Medicine issued a report concluding that 1.5 million preventable medication errors occur each year in the United States.4 The announcement prompted the Joint Commission for Patient Safety to elevate ‘improving the safety of medication use’ to their third goal, 5 and educational tools have evolved to reflect this. Simulation education offers nursing students the ability to identify the appropriate drugs for each situation, determine safe dosages, calculate dosages, properly identify the patient, properly administer the medication, and observe for side effects, all in a safe and controlled environment.
Incorporating up-to-date medication management systems in simulation learning centers provides the same prompts and checks nurses would face on the hospital floor. By doing this in a simulated setting, checking medications and verifying them at the point of release and the point of care becomes an automatic response for nursing students. After graduation these same nursing students, now registered nurses, become the catalyst for ensuring that medication errors are reduced at the patient level and become change agents at the system level.
Transferring Technical Skills
New partnerships and innovations around interoperability are creating life-like health IT systems in simulation centers, which interact with each other just as equipment would in the hospital. Nurses are able to retrieve medications from a medication management system that interfaces with the electronic health record systems. This allows for bedside barcode medication administration, preserving the six rights of medication administration to the simulated patient.
Elevating the technology available to simulation centers provides better education for nurses, improving patient safety, reducing medication errors, and making simulation more similar to real world experiences. When nurses can recognize tools used in their education in a patient care environment, the skills they developed in school are more transferable to the real world. This helps put nurses in a patient care role at the bedside more quickly, where they are most needed.
All other areas of simulation have advanced to increase the quality of education nurses receive. The necessity of technology tools that fully integrate into this educational environment, mimicking real world integration on a hospital floor, can no longer be disputed.
Justin Allen is Director of the Hart Simulation Center and the Emergency Medical Services and Management Program at Lees-McRae College in Banner Elk, N.C
1. Institute of Medicine. To Err is Human: Building A Safer Health System. November 29, 2009. Online. https://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx Acessibility verified March 5, 2015.
2. Waxman KT. The development of evidence-based clinical simulation scenarios: guidelines for nurse educators. J Nurs Educ. 2010;49:29-35$
3. Hayden, J. et al. The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education.” Journal of Nursing Regulation. July 2014. Online. https://www.ncsbn.org/685.htm. Accessibility verified March 5, 2015.
4. Asden, P. et al. Preventing Medication Errors. Institute of Medicine. 2007. Online. http://www.nap.edu/openbook.php?record_id=11623 Accessibility verified March 5, 2015.
5. The Joint Commission. National Patient Safety Goals Effective January 1, 2015. Online. http://www.jointcommission.org/joint_commission_measure_sets_effective_january_1_2015/ Accessibility verified March 5, 2015.