Innovations in Clinical Simulation: Application of Benner's Theory in an Interactive Patient Care Simulation

Article excerpt

ABSTRACT This article introduces the University of Maryland Baltimore School of Nursing clinical simulation protocol structure and lessons learned while using this protocol in a mandatory learning experience for over 190 adult health students. Students use a SimMan[TM] manikin in a high-fidelity, interactive clinical simulation to provide care to "unstable patients:' Benner's concepts regarding the performance characteristics and learning needs of nurses with varying levels of clinical competency were incorporated into the development of the simulation. The simulation provides a positive learning experience in which students refine their patient management skills and collaborate with multidisciplinary team members to resolve common postoperative problems.

Key Words Clinical Simulation--Nursing Education--Teaching Methods--Nursing Theory--Benner's Professional Advancement Model--Learning Laboratories


NURSE EDUCATORS have long relied on clinical rotations to provide rich contextual and experiential learning for students. The nature of clinical learning, however, is that clinical opportunities vary depending on the care needs of the available patients. Educators are also challenged in providing safe opportunities for students to practice patient-monitoring functions and effective management skills in rapidly changing patient situations. Simulations that provide structured experiential learning opportunities can support clinical learning in these two critical domains. * The University of Maryland Baltimore School of Nursing (UMB SON) has developed a unique enrichment experience for adult health nursing students that uses highly interactive patient care simulations. This experience, which challenges students to identify and resolve multiple common postoperative patient problems, applies Benner's concepts regarding the performance characteristics and learning needs of nurses at differing levels of clinical competency (1). Students at various levels gain new insight into their perceptual awareness of emerging clinical problems, develop strategies for patient management, and practice the communication skills necessary for collaborative problem solving with members of the multidisciplinary health care team. * THIS ARTICLE REVIEWS THE PHILOSOPHICAL FOUNDATION OF THE SIMULATION PROTOCOL AND PRESENTS EXAMPLES OF ITS USE IN A MEDICAL-SURGICAL SCENARIO. IMPLICATIONS REGARDING THE USE OF THIS PROTOCOL FOR STUDENT TEACHING, COMPETENCY EVALUATION, AND RESEARCH ARE DISCUSSED.

History and Background Simulation is the artificial representation of a phenomenon or activity. This constructed reality allows participants to experience a realistic situation without real-world risks (2). The use of simulation as an educational technique has been widely adapted by the military and health care fields for both training and performance evaluations and is the key method of training for mass casuality and catastrophic event responses.

Nursing's early use of simulation included teaching psychomotor skills and competency testing. Use in nursing curricula has expanded to include the development of critical thinking and the practice of skills within the affective domain (3). Clinical simulation is now incorporated into certification or licensure examinations for certain health care providers. For example, physician licensing exams include 10 hours of simulated patient encounters (4), and radiation technicians and nurse first assistants use clinical simulations to demonstrate competency (5,6).

At the UMB SON, simulation has been used for learning and competency evaluation in both the undergraduate and graduate programs for a number of years. The school has multiple simulation labs for teaching assessment skills and evaluating clinical procedures. Work with interactive teaching simulations has included the use of a Laerdal SimMan[TM], a computerized, physiologi cally competent manikin, for mock resuscitations and scenarios containing a multitude of patient problems and complex care needs. …