Simulation:

current status in nurse education

Julia D Roberts, Alison E While and Joanne M Fitzpatrick

This paper suggests that in the light of recent developments in nurse education a review of available teaching and evaluation strategies is required. It is further suggested that the use of simulation for both teaching and evaluation purposes has much potential which has as yet to be fully exploited in nurse education.

critical

INTRODUCTION Over the last decade there have been a variety of innovations in nurse education culminating in the implementation

of Project

initiative

to repeated

has

evaluation

lead

2000.

of available teaching

light of changing

Each new

calls

for

strategies

needs (Alexander

the

in the

1984; Faulk-

ner 1986; Nolan 8c Jones 1987). Such an evaluation has, however, been somewhat slow to emerge

leaving a number

at present strategy,

of teaching

under utilised. Simulation the

full

potential

strategies is one such

of which

Project 2000 and undergraduate

in both

courses has yet

to be exploited. Rapid technological levels of complexity

development,

for

capable of reflective 1983).

Keflection

increasing

and an expanding

ledge base have accelerated to the demand

thinking

coupled

and decision-making

a competent practice

requires

know-

the need to respond practitioner

(Gott 1982; Schon the development

Julia D Roberts BA MA RGN RNT Lecturer, Alison E While BSc MSc PhD RGN RHV Senior Lecturer and Joanne M Fitzpatrick BSc RGN, Research Assistant, Department of Nursing Studies, King’s College, University of London, Cornwall House Annex, Waterloo Road, London SE1 8TX, UK (Requests for offprints to JDR) Manuscript accepted 8 April 1992

of

with problem-solving

skills. Competency,

within

the nursing practice context, refers to the ability to meet or surpass prevailing standards of adequacy

for a particular

activity

Competency-based nurse requires, as a pre-requisite, desired

outcomes,

(Butler

1978).

education therefore the establishment of

an emphasis

upon perform-

ance, the development

of clinicaljudgement,

simply

skills, and the stating

psycho-motor

not of

acceptable standards of performance linked with established evaluation criteria (SwendsenBoss for

1985). nurse

quiring

Within

this context,

education

is clearly

as it does far reaching

the challenge enormous,

changes

re-

in curri-

culum design and content if the ambitions of Statutory Instrument No. 1456 (1989) are to be realised. One way forward

is to accelerate

trend towards an increased

the current

emphasis

upon the

process as well as the product of the educational experience (Dewey 1958; Rogers 1983). Traditional teaching methods, however, fit uneasily with such a move, yet to date many nurse teachers lack sufficient expertise to deal confidently with alternative strategies, specifically with those of an experimental

nature

(Burnard

1989). The limited use of simulation as both a teaching and evaluation tool is a feature of this phenomenon. 409

410

NURSE EDUCATION TODAY

SIMULATION

DEFINED

Problems of definition emerge in any analysis of simulation as an educational strategy (Boocock 8c Schild 1968; Jones 1980). Throughout this paper the term ‘simulation’ refers to the representation of elements of social or physical reality in order to facilitate a clearer understanding of an actual situation (Duke 1986). The use of simulation as an instructional tool dates back to the turn of the century and its extensive use in military training (Jones 1982; Megarry 1977). In the 1950s management courses in the USA incorporated simulation exercises into their training programmes. Its use in formal education as both a teaching and evaluation strategy became common in the 196Os, particularly at the elementary and secondary levels (Maidment & Bronstein 1973). This period also marked the first attempts at incorporating simulation exercises into undergraduate medical school curricula (Barrows 1968). The overall response to the use of simulation in higher education has varied over time. The early optimism of the 1960s has been replaced by a degree of caution. Over a decade of research has provided inconclusive evidence as to the effectiveness of simulation as an educational tool. (Barnett 1984; Megarry 1977; Winer & Vksquez-Abad 1981). There are also issues of cost effectiveness and time. Many manufactured simulation packages are expensive and the time required for a simulation exercise may exceed that needed for more conventional teaching methods. These factors have resulted in a more realistic appraisal of the advantages and disadvantages of simulation as a teaching and evaluation strategy (Bredemeir & Greenblat 198 1; Kuben & Lederman 1982). At present the use of simulation in nurse education is limited. This reflects a variety of problems which include: concern with the lack of conclusive empirical evidence vis-&vis the effective use of simulation in education (Greenblat 1975; Klein & Fleck 1990; Megarry 1977; Vansickle 1978), nurse teacher’s limited knowledge and experience of experiential learning techniques (Burnard 1989) and the large

number of available simulations with little to guide the novice in selecting material (Dukes & Seidner 1978; Jones 1980).

SIMULATION AND PSYCHOMOTOR SKILLS TRAINING Discussion surrounding the teaching and learning of psycho-motor skills centres upon the most appropriate location for the acquisition of those skills, with the debate focussing upon the advantages of a laboratory versus a clinical setting (De Tornyay & Thompson 1987; Goldsmith 1984; Sweeney et al 1982). Unfortunately the debate is informed by limited empirical evidence. Gomez and Gomez (1987) conducted a comparative study which assessed the measurement by two student nurse groups (n = 63) of systolic and diastolic blood pressure using the brachial artery. One group was taught in the skills laboratory, while the other was taught on a gynaecological ward and the assessment of performance took place in a nursing home for the elderly. The students taught in the clinical area had superior scores (p =