Intubate, Rinse, Repeat: Does patient simulation teach real-world nursing skills?

Happy Groundhog Day!

Ok, so I’m a few days late but that’s the beauty of Groundhog Day, if you forget something or make a mistake you get a chance to do it over correctly. At least that’s what I’ve been lead to believe by the 1993 movie starring Bill Murray. In Groundhog Day the movie, Murray’s character, Phil Connors relives a dreadful Feb. 2 over and over, making mistakes like robbing a bank, submerging a toaster  in the bathtub and being a self-centered, obnoxious person. He finally breaks the cycle when he learns from his mistakes and starts making the right choices like being less egocentric and treating others with respect.

If you think about it, Groundhog Day is a lot like the use of simulation technology in nursing education. The goal of simulation is to provide nursing students with realistic patient care experiences without real patients. Educators can program high-fidelity mannequins like Laerdal’s SimMan to replicate scenarios like a respiratory arrest or a cardiac event. Their SimMom can even give birth.

Through these simulation experiences, nursing students can practice their clinical and critical thinking skills. If a mistake is made, say you make a choice that kills your ‘patient,’ no harm comes to any actual human beings. After students run through a scenario, educators will often hold a debriefing where they discuss what was done, what could be done better and what was done right. Students get to learn from their mistakes and hone their critical thinking skills. At least that’s the hope of those using simulation in nursing education.

Yet, according the 2010 report “Simulation in Nursing Education: A Review of the Research” by Pamela G. Stanford of Nova Southeastern University in Fort Lauderdale, data on student outcomes and simulation education is minimal. Do nursing students who learn via simulation have better clinical- and critical-thinking skills than ones who learn the old-fashioned way? And how much simulation can replace hands on clinical time in a hospital with actual patients?

The National Council of State Boards of Nursing created its National Simulation Study to answer these questions. The study launched in the fall of 2011 and will follow new nursing students at 10 nursing schools across the U.S. After graduation, they will continue to be assessed for one year into their nursing practice.

This study may provide some insight into the effectiveness of simulation in nursing education. Other organizations like the National League of Nursing are focusing on the quality and use of simulation in nursing education. NLN’s Simulation Innovation Resource Center is a site where “nursing faculty can learn how to develop and integrate simulation into their curriculum, and engage in dialogue with experts and peers.”

Nurses and their IT counterparts can also get involved in simulation education quality with the The Society for Simulation in Healthcare. The society, whose membership is multi-discipinary, promotes “improvements in simulation technology, educational methods, practitioner assessment, and patient safety that promote better patient care and can improve patient outcome.”

Simulation is a growing tool that many say holds much promise. Let’s hope we see more and more data to back this anectdotal evidence up.

Example of a SimMan in use in nursing education:

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Jennifer Thew, RN, MSJ

Jennifer Thew, RN, MSJ, is a registered nurse and journalist who has covered healthcare issues and how they relate to the nursing profession. She began her nursing career as a neuroscience nurse at Rush University Medical Center in Chicago and then transitioned to journalism after receiving a degree from Roosevelt University in Chicago. She has edited and written numerous articles on a wide range of nursing and healthcare topics like Accountable Care Organizations, evidence-based practice and telehealth.

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  • Michael Armacost

    There are two thoughts that come to mind regarding your post.  First is that the current method of education is working – when evidence anecdotal and other wise proves this not be the case.  Second, the title of your post implies that there is ample opportunity to practice using simulation – and this is usually not the case.  Much of the published literature showing – no significant difference when simulation is used as a treatment – did not employ deliberate practice.  Having students in groups of 4 or more perform one or two scenarios as a group does not constitute practice.  As in the movie ground hog day, Bill Murray demonstrates deliberate practice by performing many, lots even, of practice cycles until he gets it right.  This rarely happens in medicine – in schools and especially in the clinical settings.  Deliberate practice is missing in most of medical practice – except in those specialties (internships and residencies) were thousands of hours or practice with feedback are employed with expertise as the endpoint.

  • Jennifer Thew

    Thanks for your thoughts Michael. You raise a great point about the need for repetition of skills, in simulation or other wise, to make the knowledge “stick.” 

  • Melinda S

    Yes i think its a very good way for getting nursing skills in real world. Given video is also very informative regarding nursing skills. Because any experiment on the real man can be very risky.

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