CONCEPT ARTICLE

Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 41-44

Model in professional nursing edification

K Kannan¹, Joseph jeganathan², Nagarajaiah^3
1 Clinical Instructor, College of Nursing, NIMHANS, Bangalore, India
² Assistant Professor, Aladi Aruna College of Nursing, TN, India
³ Former Additional professor, department of Nursing, NIMHANS, Bangalore, India

Correspondence Address:
K Kannan
Clinical Instructor, College of Nursing, NIMHANS, Bangalore
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-1505.262423

Teachers and employers alike are seeking a solution to this fundamental problem of the limits of classroom education. Simulation education may hold the answer.
Nursing education has long utilized simulation in some form to teach principles and skills of nursing care. Simulation activities involve controlled representations of actual clinical events. This strategy allows the learner to experience “real world” patient situations without risk. Learners are required to assess and interpret the situation, and make decisions based on information provided.

Introduction

1. To help students practice decision-making and problem solving skills and to develop human interaction abilities in a controlled and safe setting.
2. By means of active involvement in a simulation exercise, a game, or a role-playing situation, the student achieves cognitive, affective and psychomotor outcomes.
3. Students have a chance to apply principles and theories they have learned and to see how and when these principles work.

1. Simulations can help nursing students gain skill in applying the nursing process eg. They can practice gathering and analyzing data, setting priorities, sending and evaluating outcomes.
2. Learn to solve problems efficiently with minimal wasting of time and resources.
3. Decision-making skills can be fostered via simulation eg: The results are undesirable: they can backtrack and look at the factors that led them to a poor decision. The instructor and classmates (if a group is involved) can help the students gain insight in to why a decision was effective.
4. In clinical set up and clinical teaching simulation helps to ensure patient safety, promote better preparation of new nurses, support innovative teaching strategies, overcome faculty and preceptor shortages and lack of clinical sites.

1. Written simulation:The written simulation is designed as a type of exam that tests a candidate’s practical knowledge using real life personal training situations. It assesses decision making skills in the areas of designing, implementing, and modifying an exercise program. Individual uses either paper or pencil latent image format.



• Purposes
• Problem solving: it is a process that involves manipulation of or operations on previous knowledge.
• Decision making: Decision making in teaching may be viewed as the process of selecting a teaching method among several alternatives in order to accomplish a desired result i.e., providing real- situation.
• Evaluation: To evaluate student’s ability to apply the skill



2. Audiovisual simulations: An entire simulation can be placed on videotape. Management vignettes can be dramatized and filmed. Questions can be posed for the viewer’s right on the screen, and the alternative outcomes, dependent, on which approaches to a solution are chosen, can be all taped.
3. Live stimulated simulations: Lincoln, Layton and Holdmen (1978) described their experiences with simulated patients. The patients were healthy people, usually students, who were trained in the role they were to play. Simulated patient used their own history as much as possible but memorized and added the elements of the simulation. Nursing students found the experience to be beneficial. They would be much more relaxed and confident when meeting their first real patient.^[1],[2]

1. Should be driven by the educational goal/objective
2. Should match the level of the student
3. The higher the realism, the more effective it is in engaging the student

• Step 1: First of all the teacher must assign letter (A, B, C) designation to all the members of the group and develop a system of rotating the role assignment by letters so that each individual has the opportunity and as a chance to be actor, foil and observer.
• Step 2: It includes planning, preparation and deciding the topic of the skill to be practiced through simulated technique. The teacher should carefully and intelligently select and appropriate topic for each actor according to his knowledge and interest in the subject.
• Step 3: The teacher should decide in advance as regards the name of the member of the group who will start conversation. A detailed schedule for actor interaction should be drawn.
• Step 4: The teacher should decide the procedure of evaluation and decide on what kind of data the observer is going to record and who their data and opinions can best be presented to the actor when the interactions stops.
• Step 5: Conduct the first practice session on a topic or skill you decide. Provide the actor with feedback on his performance and be prepared, if necessary, to alter the procedure for the second in order to improve the training procedure. As soon as the practice sessions are working smoothly and each person has opportunity to be actor, increase the difficulty of the task by privately instructing the foils or restricting the instructor’s role.
• Step 6: This is the last step in simulation. Now the teacher should be prepared to alert the procedure, change topic and move on the next skill so as to prevent a significant challenge to each actor and to keep interest as high as possible. The task should be neither high nor too easy for the participants^[3].

1. Feedback –Students can receive feedback on the appropriateness of their action during simulation
2. Repetitive practice- Student can able to repeat the simulation unless they become competent in gaining skills.
3. Curriculum integration- It integrates various subjects while implementing simulation techniques.
4. Range of difficulty level- low fidelity simulation can be used for students of lower levels and high fidelity can be used for advanced procedures.
5. Multiple learning strategies- It actively engages the learner in the application of knowledge and skills involving various learning techniques.
6. Capture clinical variation- it makes the students aware about variations involved in interventional skills.
7. Controlled environment- The teacher can reorganize or modify the environment in which the simulation is practiced.
8. Individualized learning- It motivates the students to learn the pre requisite content before tackling the simulation.
9. Defined outcomes or benchmarks- It presents the learner with more life model of the real world.
10. Simulator validity- the validity refers to those objectives to which the learning measures expected to achieve.5,6.

1. It reduces the complexities of real life situations to a level that can be dealt with by beginners.
2. A patient situation with multiple interacting variables and asking that student to enact the professional role is ludicrous.
3. By controlling some of the variables, the situation is still close to reality. The student is not overwhelmed and can concentrate on reacting to a few variables at a time.
4. Simulation techniques are fun and interesting; they can motivate people to learn.
5. Students see how theories that sometimes seem dry and settle can really be useful and absorbing.
6. Simulation appears to both slow and fast learners and apparently is effective for all types of students.
7. Everyone can learn from the people who are successful in solving simulated problems or from players who win a game.
8. Students also learn from the faculty member who is guiding the simulation and leading discussions.
9. Simulations could be structured that all possible mistakes would be made and students would never make those same mistakes in the real world.
10. The students may be able to transfer the learning to real clinical settings.
11. It encourages creative and divergent thinking.
12. Students can experiment with a whole gamut of solutions to a problem or with a variety of nursing interventions to meet a patient’s need.
13. Three-dimensional and concept of reality.
14. Size allows close examination.
15. Good for magnified situation (e.g. middle ear mechanism)
16. Can be used to demonstrate function as well as construction.
17. Can permit learning and practice of different technique.
18. Some can be made with local material7,8.

1. Simulation is costly in terms of both time and money
2. Games applicable to nursing can cost hundreds of dollars each.
3. Simulation cannot be devised in a fraction of time.
4. Simulation techniques also consume a lot of classroom time.
5. Simulation technique can be overused.
6. Acquisition of necessary factual content and would result in boredom.
7. It is possible that emotions may be aroused to an undesirable degree, especially with role-playing.
8. Not every instructor feels comfortable using simulation strategies. Requires all the information you need in front of you on a notepad.
9. The processes and outcomes of simulation methods are not always predictable.
10. Craftsmanship required for local construction.
11. Usable for small groups
12. Models often easily damaged.
13. Never same as performing technique on a patient. Beware of faulty learning^[9],[10].

Conclusion

References

1.	A. R. Rather (2004) Essentials of Instructional Technology, 1st ed , discovery publishing house,New Delhi,109-129
2.	Marilyn H. Oermann, Kathleen T. Heinrich, (2007) Annual Review of Nursing Education, Challenges and New direction in nursing, Volume 5, Springer publishing company USA, 8-23.
3.	R.S.A. Susikaran, (2014) Learning Through Simulated Teaching, the dawn journal, vol. 3, no. 1, January - June 838-40.
4.	Samy A Azer , (2005) The qualities of a good teacher: how can they be acquired and sustained, Journal of the Royal Society of Medicine . Feb; 98(2): 67-69.
5.	Issenberg et al, (2005), Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review,The online platform for Taylor & Francis Group content, Medical Teacher,Volume 27, Issue 1,10-28.
6.	Billings DM and Halstead JA (2005), Teaching in Nursing a Guide for Faculty, 2nd ed., WB Saunders Philadelphia.
7.	Francis M. Quinn (2001), Principles And Practice Of Nurse Education, 4th ed., Nelson Thorns Limited United Kingdom, 382-384.
8.	Hoffmann RL and O’ Donnell, JM., and Kim Y (2007), The Effect Of Human Patient Simulators On Basic Knowledge In Critical Care Nursing With Undergraduate Senior Baccalaureate Nursing Students, Simulation In Health Care; journal of the society for simulation in healthcare, 2(2), 110-115
9.	Neeraja KP (2007), Textbook of Nursing Education, 1st ed., Jaypee Brothers Medical Publishers Pvt Ltd., New Delhi, 285-288.
10.	Barbara KB. Interaction, Unscripted: An Effective Use of Drama to Simulate the Nurse-Client Relationship Journal of Psychosocial Nursing and Mental Health Services. 2011; 49(5):28-32.