Before the dawn of the 20th Century, nurses received their training in rudimentary clinical settings, some of which were hospitals in battlefields. It wasn’t until 1911 that Mrs. Martha Jenkins Chase designed “state-of-the-art” dolls or mannequins with knees, hips, elbows and shoulders that helped nursing students learn basic skills.
A rise in morbidity and mortality among hospitalized patients heightened concerns about professional competency. Nurses and other health care professionals came under increased scrutiny to provide safe and effective care. One possible response to this concern was the development and use of simulators to train nurses before their entrance to a hospital setting. Science and Technology had developed along parallel lines until then, and their confluence in the '90s resulted in new “state-of-the-art” mannequins which elevated nursing education to new heights. Realistic mannequins give nursing students the opportunity to participate in designed learning activities in a safe, controlled environment.
“The use of patient simulation helps in the prevention of medication errors, develops critical thinking and clinical decision-making skills,” said Meghan Jones, assistant clinical professor at the Auburn University School of Nursing (AUSON). “It stresses the use of effective communication skills, and the importance of teamwork.”
At AUSON, the Engaging Active Group Learning Environments in Simulation (EAGLES) program occupies 20,000 sq. ft. of space in their new building. The Simulation Center (SC) includes skills lab and multiple simulation suites that mimic actual hospital, clinic and community settings. The environment in the SC is made real by the availability of functioning headwalls, hospital beds, gurney, birthing bed, infant warmer, IV pumps, mini-infusers, thermometers, oximeters, etc. and a large variety of disposable supplies. In addition to the SC, students have access to a practice lab.
The SC houses one community clinical room that resembles a home, 7 hospital rooms with the potential to accommodate 9 beds, and 4 Objective Structured Clinical Examination or OSCE rooms that resemble a doctor’s office or clinic-setting with an exam table, sink, counter top, and other equipment used by primary care providers.
“The simulation suite houses medium and high fidelity simulators,” said Jones. “The high fidelity simulators vary in function, but have more features than the medium fidelity, including blinking, chest rise and fall with each breath, ability to palpate all pulses, etc. We have simulators across the lifespan including newborns, babies, child, and adult. When possible, we purchased mannequins and simulators in a variety of skin tones to allow for diversity.”
Prior to their entry into the simulation suite, students receive a pre-briefing that include instructions about learning objectives, performance expectations, along with patient-specific reports. When they enter the suite, they assume the care of their patients in a given scenario—clinic, hospital or community setting. This experience is followed by a de-briefing session with fellow students and instructors.
Faculty are assigned to different roles including pre-brief, clinical instructor, mannequin operator, and debrief. Roles are determined based on faculty experience and training in simulation. One of the hallmarks of simulation is the concept of psychological safety when assigning faculty roles.
The faculty create a safe environment for the learner to engage in a scenario, be challenged and held to a high standard, but without fear of intimidation or humiliation. There are many factors that contribute to an environment of psychological safety, including what roles faculty portray. A course leader is typically assigned a role in pre-brief, ground rules, orient students to the environment, and deliver patient report.
Studies indicate positive effects of simulation on knowledge acquisition and skills training. A study, published in the July 2014 Journal of Nursing Regulation, found that students who spent 50 percent of their time in simulation education scored higher than a control group on assessments of mental health, medical-surgical, maternal-newborn, and community health nursing.
The use of the SC for training nurses have reduced the percentage of human errors in clinical settings. The opportunity to practice their clinical and decision-making skills through various real-life situational experiences is incomparable.
