Using Low-Fidelity Simulation with Sophomore Nursing Students in a Baccalaureate Nursing Program
Sharpnack, Patricia A., Madigan, Elizabeth A., Nursing Education Perspectives
ABSTRACT Opportunities to achieve competency in the psychomotor and cognitive outcomes required of the nursing profession are limited due to shortages of clinical sites and situations. One solution is to use simulation to replicate some of the essential aspects of a clinical situation so it may be readily understood and managed when it occurs in reality. A program developed for sophomore students integrated the pharmacology, health assessment, and pathophysiology theory courses using low-fidelity simulation and computer-assisted instruction. The objectives of the program were based on Quality and Safety Education for Nurses competencies. The simulation strategies were evaluated using the Educational Practice Scale for Simulation, the Student Satisfaction and Self-Confidence in Learning questionnaire, and the Simulation Design Scale. The initial findings are encouraging for promoting active and diverse methods of learning, high and positive expectations for students, self-confidence, and collaborative team-building opportunities.
Key Words Low-Fidelity Simulation--Active Learning Strategies--QSEN--Nursing Education
ONE SOLUTION TO THE SHORTAGE OF CLINICAL SITES FOR BEGINNING NURSING STUDENTS IS TO USE SIMULATIONS THAT REPLICATE ESSENTIAL ASPECTS OF CLINICAL SITUATIONS. Given opportunities to practice clinical situations and be tested using simulation scenarios, students scored higher on self-efficacy and confidence than those who did not have this opportunity (Alinier, Hunt, Gordon, & Harwood, 2006; Wilson, Shepherd, Kelly & Pitzner, 2004). Simulations feel real, but students know that their "patients" are safe, thereby lessening anxiety (Medley & Horne, 2005). Their usefulness for teaching skills and evaluating the effectiveness of outcomes is apparent.
Although simulations are used as teaching strategies more than as methods for testing and evaluation (Jeffries, 2006), they can be an excellent evaluation tool for nurse educators. They allow for critical assessment of actions, student reflection on individual skill sets, and peer review and offer students the opportunity to critically analyze, reflect upon, and critique the clinical decisions made by others (Jeffries, 2007). Nonetheless, Medley and Horne (2005) note that the potential use of simulation technology for undergraduate nursing students is underestimated. Although clinical simulations are effectively accomplished using a range of low- to high-fidelity techniques, implementation has been seen as difficult, requiring extensive content, and educators may avoid developing simulations for the classroom environment.
The importance of simulation technology as an educational, testing, and evaluative tool was recognized by the dean and faculty of our baccalaureate program in northeastern Ohio. However, faculty required education and guidance to institute simulation strategies and, as a result, were disinclined to develop the limited resources available in the skills laboratory. The solution was to develop a pilot program at the sophomore level that integrates pharmacology, health assessment, pathophysiology, and clinical curricula with an evaluation program using low-fidelity simulation. This program was used as a foundation for implementation of simulation in upper-division courses.
Low-fidelity simulation creates a semblance of reality by using static manikins with props and techniques such as role playing (Jeffries, 2005). The literature supports the use of low-fidelity simulation and uncomplicated scenarios with introductory nursing students (Billings & Halstead, 2009). Low-fidelity simulation has also been effective in teaching and evaluating students in baccalaureate nursing programs (Johannson & Wertenberger, 1996; Wilson et al., 2004). Rystedt and Lindstrom (2001) contend that low-fidelity simulations may produce high-value principles because they focus on few, but critical, elements. …