Signs of Maturity [horizontal ellipsis] Simulations Are Growing and Getting More Attention
Welcome to Part 2 of theNursing Education Perspectivesspecial issue on clinical simulation. Having a second collection of peer-reviewed research articles focused on clinical simulation is evidence of how quickly we are moving forward in the area of simulation research.
As you read through the research and Innovation Center articles in this issue, you will see that we are obtaining more evidence, particularly in specialty areas.
Simulation Guidelines as an Indication of Maturity
Since the publication of Part 1 (Vol. 36, No. 5) two months ago, the National Council of State Boards of Nursing (NCSBN) introduced the NCSBN Simulation Guidelines for Pre-Licensure Nursing Programs (Alexander et al., 2015). These important guidelines further increase simulation presence and expectations and indicate greater maturity in the pedagogical and research areas. They are based on evidence from a relatively large number of nursing studies that have analyzed outcomes of simulations in pre-licensure nursing programs. I had the opportunity to be part of the amazing panel of experts, nurse leaders of professional organizations, and board regulators who helped create the guidelines. I applaud the NCSBN for bringing us together.
We have now a great number of systematic and integrative reviews providing support for simulation pedagogy and contributing to the guidelines created by the NCSBN expert panel. The guidelines provide assistance to: boards of nursing, to evaluate the readiness of pre-licensure programs to use simulations, particularly as substitutes for traditional clinical experiences, and nursing education programs, to help guide, direct, and facilitate an evidence-based program when simulations are integrated into pre-licensure nursing curricula. The guidelines are important. I call them critical considerations if your nursing curriculum will be incorporating simulations across the program.
Not only did the NCSBN come out with overall simulation guidelines, but in the landmark document there is also a Faculty Preparation Checklist. Educators and researchers involved with simulations know it is crucial to have faculty prepared to develop, implement, and evaluate simulations within the program. Not too long ago, there were very few programs or venues where faculty could be trained in all the critical components of simulation implementation. Today, however, we now have more formalized development programs in addition to the programs to become a Certified Healthcare Simulation Educator (CHSE) as well as the advanced certification (CHSE-A), created and offered by the interprofessional, international Society for Simulation in Healthcare (SSH) (http://www.ssih.org).
The Development of Standards and the Recently Published Simulation Theory
The International Nursing Association of Clinical Simulation Learning (INACSL) organization has also contributed to the maturity of simulations by developing standards to advance the science of simulation, share best practices, and provide evidence-based guidelines for implementation and training. As the leaders of the INACSL organization declare, adoption of the Standards of Best Practice "demonstrate[s] a commitment to quality and implementation of rigorous evidence-based practices in healthcare education to improve patient care by complying with practice standards" (INACSL, 2015). Currently there are nine INACSL standards: terminology, professional integrity of participants, participant objectives, facilitation, facilitator, debriefing process, participant assessment and evaluation, simulation-enhanced interprofessional education, and simulation design.
The recently published NLN Jeffries Simulation Theory (Jeffries, 2015), launched at the NLN Education Summit just a few months ago, contributes more to our growth, maturity, and sophistication in simulations. As we know, theoretical thinking is essential to developing nursing science and to our professional endeavors (Meleis, 2012). The theory was developed through theoretical thinking and testing as evidenced by the work done by many nursing education researchers. Building on the evidence from the past decade and more, a midrange theory on simulation development and implementation is a sign of maturity.
Current Research and Classroom Innovation
The research presented in this issue of Nursing Education Perspectives adds to the state of the science in simulation, further increasing our maturity in this area. Author Dr. Tonya Rutherford-Hemming describes how to determine content validity for simulation scenarios. Drs. Mary Fey and Louise Jenkins discuss widely sought-after debriefing practices.
Other articles in this issue describe specific types of simulations and their implementation in the nursing curricula. Major concepts crucial to nursing education are now moving into process-based simulation space, providing our learners the opportunity to experience the encounter or event prior to the actual experience, for example, in the event of death and dying. Megan Pfitzinger Lippe and Dr. Heather Becker focus on withdrawing care from a critically ill patient, while Dr. Candice Knight and colleagues help their students deal with grief following fetal demise. Dr. Annette Maruca and her co-authors describe how they use simulations for helping their learners experience empathy, and Susan Bryant and Kim Benson introduce students to caring for victims of elder abuse and intimate partner violence. Dr. Karen Zapko and colleagues set up simulations for learners to experience an interprofessional education disaster drill.
An essential component for any nursing curriculum is communication. Dr. Cynthia Foronda and her co-authors discuss their multisite study and its outcomes using the ISBAR tool. Connie Hogewood and colleagues describe an amazing clinical boot camp for preparing students for obstetric and pediatric simulations. And Dr. Rachelle Lancaster and colleagues describe how they put systems and structures in place to standardize the integration and measurement of simulation across the pre-licensure program. From far across the globe we learn about the Qatar consortium from Renee Pyburn and Joanne Davies.
Some of the focus in this issue is on preparing standardized patients. Dr. Marcie Swift and Tobey Stosberg discuss an interprofessional program to train pre-med, nursing, and theatre students to work as standardized patients while meeting a university course requirement. And Dr. Suzanne Smeltzer and colleagues examine the experiences of standardized patients with disabilities in an undergraduate nursing program through focus group and telephone interviews. Dr. Celeste Alfes compares outcomes with the use of role-playing and standardized patients in psychiatric mental health nursing. And Dr. Kathleen Tilton and her co-authors describe the use of virtual simulation for educating students about chronic care in community settings.
Yes, we have come a long way in the past decade. A little over 10 years ago, there were few contributions to the research providing evidence for developing and implementing simulations. Now, clinical simulations are garnering significant attention, as they should. They are becoming more mature and accepted since the evidence shows that simulations can substitute for real clinical practice when the conditions are right (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). Further, there is evidence linking simulation-based curricula to improved patient outcomes, the priority that nurses and other health care professionals strive for when creating and implementing new practices and strategies in education. Overall, simulation pedagogy is growing, maturing, and getting more attention.
Yes, we have come a long way in the past decade. A little over 10 years ago, there were few contributions to the research providing evidence for developing and implementing simulations. Now, clinical simulations are garnering significant attention, as they should.
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