Magazine article Distance Learning

Simulation as a Teaching Technology: A Brief History of Its Use in Nursing Education

Magazine article Distance Learning

Simulation as a Teaching Technology: A Brief History of Its Use in Nursing Education

Article excerpt


According to Gaba (2004), simulation is a technique rather than a technology that is able to provide realistic environments or practice proxies for the purposes of learning, training, and practice. Given its application in nursing education, and its current reliance on, and amalgamation with, sophisticated computer driven machinery the argument that simulation is also a technology can be made. Simulation is effective at bringing to life representative clinical encounters in a safe educational setting where no harm can come to patients. It can-and has been-successfully applied for the teaching and training of novice learners as a way to introduce concepts or skills, as well as for seasoned providers to provide a safe environment where deliberate practice, mastery, and upkeep of skills can occur.

Simulation can be used for teaching or practicing both technical skills (insertion of intravenous catheters, or suturing for example) and nontechnical skills (communication and teamwork). A combination of full body, high and low technology simulators (mannequins designed to depict humans), body part or body system-specific task trainers (models of specific body areas or systems), standardized patients (actual humans who are trained to portray illnesses for the purpose of practice taking a health history or health assessment), and virtual reality can be used as part of a simulation-based education program.

Simulation training can be immersive, where environments are set up to mimic clinical settings. These are usually replete with working medical equipment, simulated or real medications, and high-technology computer driven simulators. The use of confederates portraying other healthcare providers or family members may also be incorporated into simulation encounters for the purposes of improving realism and or as scenario guides to keep learning on track (Sanko, Shekhter, Kyle, Benedetto, & Birnbach, 2013). Immersive simulation encounters allow learners to work through scripted scenarios with defined learning objectives. Alternatively, task-specific simulation encounters that utilize low-technology task trainers and usually no scripted scenario or confederate allow learners to work through complex or technically difficult skills for the purposes of practice and refinement. Hybrid techniques can also be applied (the combination of two simulation modalities [a standardized patient and a task trainer, or virtual reality and a task trainer]) to provide educational opportunities where both technical and nontechnical skills can be taught or practiced simultaneously. Simulation may further be used as a way to assess a learners' aptitude, and can provide a realistic platform to measure competence prior to clinical practice or graduation from a program of study.

Simulation uses experiential learning as a foundational principle (Kolb, 1984), but has welcomed new frameworks, with the NLN-Jeffries simulation framework being the most notable nursing theory developed in simulation-based education. This framework guides the design, implementation, and evaluation of simulation-based practices in nursing education (Jeffries, 2005). Simulation-based education tends to be carried out in three distinct phases beginning with prework or briefing, followed by a hands-on/psychomotor or immersive experience, and culminating with a debriefing (Aebersold & Tschannen, 2013). The use of a phased approach allows participants to have a conceptual introduction to a topic or skill, followed by an opportunity to anchor the concept through a realistic firsthand experience where psychomotor, cognitive, and affective domains of education are utilized, and ending in a debriefing session. Debriefing is typically guided by a content expert and includes feedback, discussion, and time for learners to reflect on the experience. Simulation definitions and commonly used terminology are provided in Table 1.



Simulation as a teaching technology in nursing education has a long history spanning well over a century and a half. …

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