Maryland Nurse Journal - July 2022

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Page 16 • The Maryland Nurse Journal July, August, September 2022 Continuing Education Transforming Nursing Education Through Clinical Simulations By: Raquel Bertiz, PhD, RN, CNE, CHSE Objectives: • Describe the use of simulation in nursing education Background In recent years, healthcare and the nursing profession have been faced with multiple challenges, such as the increasing complexity of the healthcare environment and high patient acuity. Several studies describe an education-practice gap, where new graduate nurses have difficulty adjusting to professional nursing practice and threats to patient safety result (Kavanagh & Szweda, 2017). Kavanagh and Szweda (2021) describe a continuing decline in the initial preparedness of new nurses at a time when preparation is most needed and there are calls for long-overdue change in how nursing education is conceptualized and delivered. This echoes an earlier call by the Institute of Medicine (2011) to transform nursing education. Nurse educators consider traditional clinical experiences as the gold standard of clinical education. Several agencies wrote their position statements on the need to include experiences that will allow students in prelicensure nursing programs to practice in actual patient clinical situations (NCSBN, 2005). In traditional clinical education, a group of students is brought to the clinical site under the supervision of a clinical instructor. This model is currently used in prelicensure nursing education, but in recent years, nurse educators started to reflect on and systematically study this practice, searching for transformative ways to provide clinical education that will close the nursing education practice gap. A systematic review by Leighton et al. (2021) ended in an empty search of studies on traditional clinical education that utilized educational frameworks and measurement of learning outcomes. This is an alarming finding when the prevalent and regulated model of clinical education did not have empirical evidence documented in nine databases that were used for this search. To further provide a picture of the state of prelicensure nursing education, Kavanagh and Szweda (2021) report that only 23% of entry level nurses who passed licensure are deemed safe and competent to practice nursing. This highlights the education-practice gap noted by employers of new graduate nurses. More than ever, the pressure on nurse educators to consider other ways to provide clinical education that will close the education-practice gap is critical. Meanwhile, barriers to implementing traditional clinical education continue to rise, such as scarcity of available clinical sites, the randomness of clinical experiences, and the lack of autonomy of student nurses to practice. There is also an acute awareness of safety concerns when students are in actual patient care settings. The use of simulations to educate future nurses is presented as pedagogically sound, empirically based, and an educational practice guided by standards of best practice that is hoped will be an answer to the call to transform nursing education. Simulations-Based Nursing Education: Shifting the Paradigm of Clinical Education through Evidence-Based Practice Simulation-based education (SBE) is an educational methodology viewed by many nursing education experts as the “Trojan” horse that will break the barriers to transforming nursing education. In nursing education, “Simulation is a technique, not a technology, to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner” (NCSBN (2015) quoting Gaba (2004)). These are activities or events replicating clinical practice using scenarios, high-fidelity manikins, medium-fidelity manikins, standardized patients, role-playing, skills stations, and computer-based critical thinking simulations. Clinical simulations can occur in laboratory settings, virtually or screen-based, and in the classroom. Learners are prebriefed before a simulation experience to clarify learning objectives, lessen cognitive load prior to the clinical scenario experience and establish psychological safety. After the clinical simulation experience, learners are debriefed by a competent facilitator to guide them in reflecting on the experience and walk away with lessons that they will use in the future. In actual patient care settings, students are strictly supervised by clinical instructors and nurses, and the room for errors and mistakes is reduced. Students may not have the opportunity to implement clinical decisions autonomously, a competency that is necessary when they practice as professional nurses. Clinical simulation scenarios are selected to provide opportunities for students to safely learn and autonomously practice valuable competencies. SBE provides an opportunity for educators to design clinical experiences toward the development of essential nursing competencies for all learners. This will greatly reduce the inconsistencies of learning experiences and randomness of learning in traditional clinical education. Simulation-based education is supported by sound educational theories of constructivism, adult learning theories, experiential learning theories, and reflective practice. Robust educational frameworks are necessary for the pursuit of transformation in nursing education. In a short period, SBE in healthcare rapidly advanced as an empirically supported educational pedagogy. Theobald et al. (2021) performed a systematic review of the effectiveness of using simulation in the development of clinical reasoning in undergraduate nursing students. They found limited but high-quality evidence that simulation is an effective methodology for clinical education. The landmark national simulation study provides 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 ready for clinical practice. Alongside theoretical and empirical bases, there are standards and guidelines for implementing simulation-based education in nursing programs. The Healthcare Simulation Standards of Best Practice (INACSL, 2021) include all facets of SBE: professional development, prebriefing, simulation design, facilitation, the debriefing
July, August, September 2022 The Maryland Nurse Journal • Page 17 Continuing Education process, operations, outcomes and objectives, professional integrity and evaluation of learning and performance. The National Council of State Boards of Nursing simulation guidelines (NCSBN, 2015; Smiley, 2021) provide prelicensure programs guidelines in the implementation of simulations. Future Directions of Simulation Based Education in Maryland The Maryland Clinical Simulation Resource Consortium’s (MCSRC) goal is to increase the quantity and quality of simulations in prelicensure programs in Maryland. The use of simulations to replace a significant amount of clinical education for future nurses is a highly viable solution, not only to the scarcity of clinical placement but also to the education practice gap, where future nurses learn to be reflective, critical thinkers who can reason clinically and make sound judgments amidst complex patient care situations. The maximum benefits of simulations can only be achieved when nursing programs are supported to implement simulations following the standards of healthcare simulations.. Educators need to receive formalized education in simulation pedagogy and acquire competencies in applying the Healthcare Simulations Standards of Best Practice (International Association for Clinical Simulation and Learning, 2021). MCSRC has educated more than 300 nurse educators in academia and practice on simulation pedagogy through the MCSRC’s Simulation Education Leader’s (SEL) program. Simulation-based education is a powerful force in transforming nursing education and prelicensure nursing programs. MCSRC will continue to strengthen faculty competencies in simulation and support the development of various learning resources. Together, as nurse educators in academia and practice, alongside MCSRC, we aim to transform nursing education through simulations. References: Gaba, D. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 12(1). DOI 10.1136/qhc.13. suppl_1.i2 Hayden, J. K., Smiley, R.A., Alexander, M., Kardong-Edgren, S., & Jeffries, P.R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2),S3-S40,ISSN 2155-8256. https://doi.org/10.1016/S2155-8256(15)30062-4. International Association for Clinical Simulation and Learning. ( 2021). Healthcare simulation standards of best practice. https://www.inacsl.org/healthcare-simulation-standards Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington (DC): National Academies Press. https://www.ncbi.nlm.nih.gov/books/ NBK209881/ Kavanagh, J. M., & Sharpnack, P.A. (2021). Crisis in competency: A defining moment in nursing education. OJIN: The Online Journal of Issues in Nursing,26(1). Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nursing Education Perspectives, 38(2), 57–62. https://doi.org/10.1097/01. NEP.0000000000000112 National Council of State Boards of Nursing. (2005). Clinical instruction in prelicensure programs. https://www.ncsbn. org/Final_Clinical_Instr_Pre_Nsg_programs.pdf National Council of State Boards of Nursing. (2015). NCSBN simulation guidelines for prelicensure nursing programs. https://www.ncsbn.org/16_Simulation_Guidelines.pdf Smiley, R, A. (2021). National Council of State Boards of Nursing: An update on simulation regulation. https://www. ncsbn.org/2021SciSymp_rsmiley-simulation-regulation.pdf NCSBN Simulation Guideursinducation Theobald, K.A., Tutticci, N., Ramsbotham, J., & Johnston, S. (2021). Effectiveness of using simulation in the development of clinical reasoning in undergraduate nursing students: A systematic review. Nurse Education in Practice, 57. https:// doi.org/10.1016/j.nepr.2021.103220. Access the evaluation using the following address: https://forms.gle/67kCadukTKiRYcKFA This journal article has been awarded 0.5 continuing nursing professional development hours. The authors and planning team have no conflicts of interest to disclose regarding the content in this article. There will be no discussion or promotion of commercial interests, products, or services. To receive continuing education credit (certificate) for this activity, you must read the article and answer all assessment and evaluation questions. 1. What statement defines simulation-based education in nursing? A. It is a clinical teaching modality where learners are placed in clinical environments to care for real patients. B. It is a teaching-learning modality where learners experience a carefully designed clinical scenario in a laboratory or virtual environment. C. It is a teaching modality where students listen to lectures in class. D. All of the above. 2. Which element of simulation occurs after learners go through facilitated clinical scenario? A. Debriefing B. Reflection C. Written Examination D. Prebriefing 3. According to Kavanagh and Szweda (2021), who wrote on the Crisis of Competency of Nurses, newly graduated nurses who have passed licensure examination: A. are mostly practice ready B. are mostly not practice ready C. Are never practice ready D. None of the above The Maryland Department of Health invites all healthcare workers and environmental The CDC-developed training materials are FREE and were services staff to MD Project Firstline! designed to meet your learning style. Online Independent Study: Scan the QR code to visit the MD PROJECT FIRSTLINE site and select any of the FREE infection control courses. Earn a certificate for each course! Group Training Sessions: Our instructors can lead FREE in-person or virtual training sessions for your team members. Project Firstline can also provide you with the presentation materials to lead your own group sessions. Scan below to request a session or materials. mdfirstline@hqi.solutions. Scan to Visit Project Firstline Scan to Request Group Training
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