Established as a formal discipline and a prominent thread woven throughout nursing curricula, nursing simulation has made tremendous strides in the last decade in American nursing programs. It has also become an essential component for successful transition to practice within health care institutions. Pioneers in the development of nursing simulation have worked to develop a simulation theory, conceptual framework, simulation design template, evaluation tools, formal leadership and educational programs, certification for simulation experts, professional organizations, and standards of best practice to ensure the most effective outcomes (Adamson, 2015; International Nursing Association for Clinical Simulation and Learning, 2013; Jeffries, 2005, 2009, 2012; Jeffries, Rodgers, & Adamson, 2015; Kardong-Edgren, Adamson, & Fitzgerald, 2009).
The National League for Nursing (NLN) has created an opportunity to transform nurses from simulation specialists to simulation leaders through the Leadership Development Program for Simulation Educators. This yearlong program embeds formative knowledge related to simulation with networking, professional development, and project engagement to create an opportunity for nurses to develop into simulation leaders both nationally and internationally. Through the Simulation Innovation Resource Center (http://sirc.nln.org), the NLN offers educational courses for educators at all levels, for those beginning to implement simulation to those who are already proficient.
PROMOTING SIMULATION INTERNATIONALLY
One area nursing leaders could further nurture would be to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally as there are many lessons to be learned. There is also a need to promote simulation research internationally and to disseminate evidence-based practice standards for clinical simulation and learning. Faculty at the Frances Payne Bolton (FPB) School of Nursing have had the unique opportunity to establish academic exchange programs with schools of nursing across the globe, and our efforts to promote simulation now extend to five continents.
Our most recent efforts to disseminate evidence-based practice standards and simulation methods have been through our Dorothy Ebersbach Academic Center for Flight Nursing. In 2015, the program held its 13th annual Flight Nursing Summer Camp, attracting nurses from around the country, including 29 graduate nursing students enrolled in a master's degree nursing program from Puerto Rico. The weeklong interprofessional training focused on critical care updates, trauma, and emergency care within the critical care transport environment.
In Africa, FPB faculty have partnered with St. Raphael's Hospital School of Nursing and the Nurses Council of Tanzania to donate simulation supplies to support the development of simulation learning strategies. Faculty have also partnered with Med Wish International to lead several donation drives collecting textbooks, task trainers, and simulation supplies to support the development of nursing schools in South Sudan. Both of these initiatives exemplify how schools of nursing can have a positive impact on promoting clinical simulation learning by sharing simulation resources.
In Asia, FPB faculty are supporting simulation efforts at Hong Kong University, China; Wuhan University, China; Taipei Medical University, Taiwan; Aichi Medical University, Nagoya, Japan; and Tung Wah College, Hong Kong. The director of simulation has traveled to Japan to give weeklong workshops to nursing and medical faculty at Aichi Medical University. The FPB has been part of an academic exchange with Aichi Medical University School of Nursing for the past eight years.
During the February 2014 visit, FPB's director of simulation was asked to deliver an all-day presentation to a group of 58 nursing faculty, administrators, and educators from several universities and hospitals in Japan. The seminar focused on developing, integrating, and evaluating simulation activities in the academic and hospital setting and culminated with a live, high-fidelity simulation focused on effective communication and comfort care of a complex surgical patient. Faculty were fortunate to network with Laerdal Medical in Tokyo to have education service specialists to assist with the live demonstration. The demonstration exemplified the benefits of establishing a comprehensive educational experience using simulation to educate students on complex clinical management issues while addressing family expectations in real time.
In 2015, the director of simulation at FPB met with three faculty members from the College of Nursing at Sultan Qaboos University, Oman, for a private simulation session. Simulation consultation was also provided to the assistant director of the Medical and Health Sciences Program Department, Cultural Mission of Saudi Arabia, to discuss the possibility of establishing a special program to bring students from Saudi Arabia to FPB for flight simulation training. Our simulation director met with the dean from the College of Nursing-Riyadh, the dean from the College of Nursing-Jeddah, from King Saud bin Abdulaziz University for Health Sciences, Kingdom of Saudi Arabia, to discuss curricula, research, simulation, and clinical skills for students.
One FPB PhD graduate, currently at the University of Jordan in Amman, will partner with our simulation director to study the outcomes of diabetes simulation education program for RNs caring for individuals with diabetes. The director will also mentor the acting dean of the College of Nursing, Public Authority for Applied Education and Training, for the State of Kuwait for the 2015 to 2016 academic year.
In Europe, FPB has consulted on simulation development with Paracelsus Medizinische, a private university in Austria, and the University of Acaia de Henares in Madrid, Spain. In May 2015, FPB held its first annual Flight Nursing Summit entitled "From Tidal Waves to Terrorism: International Models of Care in Air Medical Transport and Roles in Disaster Response." Ivan Ortega Deballon, associate professor at Universidad de Alcala de Henares, was the keynote speaker. During his weeklong visit, he worked with the director of simulation to discuss the development of international flight simulations, research projects, and the possibility of establishing an academic exchange program with his university.
In South America, FPB's simulation director has met with faculty from Albert Einstein Nursing School in Sao Paulo, Brazil. The purpose was to discuss the possibility of establishing an academic exchange program in Brazil for undergraduate students' capstone experience.
DEVELOPING INTERNATIONAL EXCHANGES
The opportunity to collaborate with colleagues globally came about through a number of existing school and university initiatives. FPB has had substantial numbers of international students for more than 25 years, and our international alumni have become very accomplished in their own countries. Simulation has been one of the areas highlighted in our biannual newsletter, helping to spread the word about our expertise. Furthermore, our international office is expert at arranging study visits that extend from several days to two years or more, assisting with local logistics, housing, and schedules for site visits.
BENEFITS FOR THE LOCAL AND LARGER SIMULATION COMMUNITY
FPB faculty have benefitted through a better understanding of nursing education and practice in the collaborating countries. During each international program, there is the opportunity for mutual exchange and benefit, whether specific to simulation or a better understanding of how nursing care is delivered globally. The resource constraints for nursing education, regardless of the country, demand that creative and effective clinical education be developed.
FPB faculty believe that simulation education has the potential to gain momentum internationally, providing opportunities to enhance clinical education through the dissemination of evidence-based practice standards. Encouraging international participation within the NLN's Leadership Development Program for Simulation, the International Nursing Association for Clinical Simulation and Learning (INACSL), and the Society for Simulation in Healthcare (SSH)-would help to broaden and strengthen these initiatives. Furthermore, having simulation leaders on the boards of international nursing societies such as Sigma Theta Tau International and the International Council of Nurses would ensure that simulation initiatives are being encouraged globally.
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