This page offers information and tools for those interested in using simulation in their nursing education curriculum.
The Many Degrees of Fidelity in Simulation of Clinical Practice
Simulation in nursing education comes in three levels of fidelity- low, medium and high fidelity.
Fidelity indicates the degree of realism or exactness of the simulation experience (Seropian, Brown, Gavilanes & Driggers, 2004). The degree of fidelity an experience or scenario demonstrates can be divided into low, moderate, or high.
Here is a breakdown of all three:
Low-fidelity has been defined as simulations that are static and lack realism (Seropian et al., 2004). Examples of low- fidelity would be what are referred to as “task trainers” technology such as a prosthetic arm that can be used to learn how to administer intramuscular injections or take blood pressure readings or a prosthetic abdomen which can be used for students to demonstrate how they perform a wound dressing change.
Moderate Fidelity Simulatiom increases the realism through the use of a prosthetic device or unit to mimic reality. An illustration of a moderate-fidelity device would be a lung and heart chest torso that has the capacity to produce both normal and abnormal heart and lung sounds upon auscultation with a special stethoscope.
High Fidelity Simualtion includes computerized mannequins that are operated by a technologist from another location to produce audible sounds and to alter and manage physiological changes within the mannequins such as altering the heart rate, respirations, chest sounds, and saturation of oxygen as a few examples. The scenarios offer students a chance to practice inter-professional teamwork principles which are widely encouraged as a method to improve patient care and safety (Bray, Schwartz, Weeks & Kardong-Edgren, 2009).
Bray, B., Schwartz, C. R., Weeks, D. L., & Kardong-Edgren, S. (2009). Human patient simulation technology: perceptions from a multidisciplinary sample of health care educators. Clinical Simulation in Nursing, 5, 145-150. Doi:10.1016j/ecns.2009.02.002.
Seropian, M. A., Brown, K., Samuelson Gavilanes, J., & Driggers, B. (2004). Simulations: not just a manikin. Journal of Nursing Education, 43(4), 164-169. draft 7/4/10 by Evans Delete
How does one begin creating simulation scenarios?
Good sources are:
Childs, J.C., Sepples, S.B., & Chambers, K. (2007). Designing simulations for nursing education. In P.R. Jeffries (Ed.), Simulation in nursing education: From conceptualization to evaluation (pp.1-9). New York: National League for Nursing
Halstead, J. A. (2006). Evidence-based teaching in clinical simulation. Clinical Simulation in Nursing Education,2, 5-8.
Jeffries, P. R. (Ed.). (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing.
Jeffries, P. R., (2005). A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103.
Jeffries (2005) has created a Simulation Model which takes into consideration:
A-
1. The instructor/teacher- demographics
2. The student- program, level and age
3. And the Education Practices – active learning. Feedback, student/faculty interaction . collaboration, high expectations, diverse learning and time on task
B
The above three are inter-phased and inter-related on each other- which in turn help produce Design and Characteristics and Simulation ( the intervention)
1. which has specific objectives
2. Fidelity
3. Complexity
4. Cues
5. Debriefing
C.
This lead to the outcome which is based on all four components- the instructor, student, educational practices and design and characteristics and simulation. Outcomes may include the following:
1. Learning (knowledge)
2. Skill performance
3. Learner satisfaction
4. Critical thinking
5. Self- confidence
-- An educator’s clinical expertise can be an excellent source for creating simulation scenarios both from theoretically and experientially (Childs, Sepples & Chambers, 2007).
Evidence based teaching should be incorporated into the creation of simulations. Teaching and learning expansions require an evidence based approach when using high fidelity simulation technology. In this manner educators can develop best practices in teaching with clinical simulations and seek out key elements and quality gauges to advance and work towards consistent student outcomes (Halstead, 2006)
