Relatively new research in nursing simulation is supporting the ability for high-quality simulation to replace portions of student’s current clinical experiences. A study from the National Council of State Boards of Nursing found “substantial evidence that substituting high-quality simulation experiences for up to half of traditional clinical hours produces comparable end-of-program educational outcomes and new graduates that are ready for clinical practice” (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, p.S3). As clinical placements for student’s become more competitive, there are great opportunities for simulation to help alleviate some of the difficultly in filling a large number of hours in traditional clinical education. The desire to provide high-quality simulation for all of our students will require a strategically designed space to efficiently and effectively deliver clinical experiences in a simulated environment.
Our current facility has the resources necessary to deliver high-quality simulation; however, this may prove difficult to sustain as frequency of use increases. We currently have a high reliance on wireless technology, crammed quarters in debriefing sessions and limited tools for collaboration. A standard learning experience in this setting begins with a pre-brief which leads into the simulation and is followed by an instructor lead group debrief. The goal of simulation is to observe and then find teaching moments within the student’s current level of knowledge. As described by the book How People Learn, “the information on which to base a diagnosis may be acquired through observation, questioning and conversation, and reflection on the products of student activity” (Bransford, Brown & Cocking, p.134). I believe we can take steps toward improvement in the aforementioned areas by installing one-way mirrors connecting each simulation room and control/debriefing room, arranging furniture to establish a comfortable debriefing room and installing whiteboards throughout the space. Installation of one-way mirrors would eliminate the current reliance on wireless videoconferencing technology and space taken in both rooms by technology to establish a digital window into the room. Doing so would allow us to create a comfortable viewing room where students can observe their peers, rotate into the simulation themselves and then return to the observation room for group debriefing. During group debriefings whiteboards can be utilized to record and share what went well, what could use improvement and what can be done in the future in relation to the simulated case. Our students will continue to have a lecture component to their education, but as suggested by the Third Teacher+ group, “in addition to the traditional schools that prioritize linguistic and logical intelligence, learning environments should allow students to exercise their musical, spatial, bodily, naturalist, interpersonal, and intrapersonal intelligences” (O’Donnell, Wicklund, Pigozzi and Peterson, Architects Inc., VS Furniture., & Bruce Mau Design, p.59). Nursing simulation captures many of these components and, if designed properly, can improve upon the clinical experience and lead to better patient outcomes.
Stakeholders at all levels of our organization are necessary for this plan to come to fruition. Buy-in from administration is crucial to establish funding as well as to drive the change in schedule and curriculum to support high-quality simulation. Because simulation will be new for many of the individuals involved, professional development is necessary for all stakeholders involved in making the program a success. Administration, faculty and support staff all should have a vested interest to provide the best possible experience for our students. A great amount of time, money and resources are necessary to build and sustain the simulation experiences that could take the place of clinical hours. However, it is not required to immediately supplement half of our student’s clinical hours for simulation. With this in mind, the opportunity to pilot and grow at a steady pace could be the best scenario to manage the budget and establish best practices. The design of this learning environment can support a long-term plan for high-quality simulation and it will be crucial to revisit the design process as we continue to grow our simulation program.
Bransford, J., Brown, A.L. & Cocking, R. R. (Eds.), How people learn: Brain, mind, experience and school. Washington, D.C.: National Academy Press. Retrieved from http://www.nap.edu/openbook.php?isbn=0309070368.
Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries. (July 2014). The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. THE OFFICIAL JOURNAL OF THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING, Volume 5, Issue 2. Retrieved from https://www.ncsbn.org/JNR_Simulation_Supplement.pdf
O’Donnell, Wicklund, Pigozzi and Peterson, Architects Inc., VS Furniture., & Bruce Mau Design. (2010). The third teacher: 79 ways you can use design to transform teaching & learning. New York: Abrams.