Using Simulation for Patient Practice

Simulation is being used more and more in nursing schools as well as in other types of educational situations for experienced nurses.

Christine Park, MD, president of the Society for Simulation in Healthcare, a professor of anesthesiology and medical education and co-director of the Graham Clinical Performance Center at the University of Illinois at Chicago, took time to answer questions about simulation and how it’s being utilized in the nursing field.

“Simulation is a technique that creates a situation or environment to allow people to experience a representation of a real event for the purpose of practice, learning, evaluations, testing, or to gain understanding of systems or human actions,” Park explains. “In health care, we use an exciting array of methodologies, including simulated task trainers, mannequins, full-scale environments, virtual and augmented reality, and even simulated patients. That means we can simulate anything from an ‘arm’ for a nursing student to practice starting an intravenous line, to difficult conversations, to training interprofessional teams in hospitals, to testing system-wide patient safety solutions before deployment.”

So why should the nursing field use simulation as opposed to having nurses immediately working on actual patients?

“I find it helpful to think about how other high-risk industries use simulation. In commercial aviation, simulation is so integral to training that for certain aircraft, the pilot trains exclusively in simulation. When they fly the real aircraft for the first time, it’s with passengers,” says Park. “That might seem scary at first, but in health care, I believe we should strive for a similar goal—that we train extensively in simulation, to the point that by the time we interact with real patients, we are truly ready.”

This is exactly why simulation can help. For example, Park says that when there are new learners/new nursing students, it enables them to hone their skills before caring for real patients. That’s not to say that the way of working with actual patients initially is wrong, but it can provide the students with a sense of calm when they are trying procedures for the first time. It can help longtime nurses as well. “When it comes to more advanced learners and practicing providers, we can provide a safe environment where not only is it allowed to be imperfect, but we encourage the discovery of solutions through reflection on threats to safety in individual performance and systems vulnerabilities. This is the kind of process needed for robust lifelong learning,” says Park.

Currently, Park states, simulation is being used widespread in U.S. nursing schools and is gaining popularity in hospitals as well. “An example of impactful simulation in a hospital setting is the use of in-situ simulation, using the actual operating room or ICU, to practice ‘code blues,’ or disaster simulations in the Emergency Department,” she explains. “In large part, simulation for the practicing provider nurse is driven by their hospital, clinic, or whatever their practice environment is. As far as mandatory simulation for continuing education, we are beginning to see this in isolated pockets within health care, among certain medical specialties.”

Park believes that simulation use in nursing in incredibly important throughout each nurse’s career. “At first, it’s about learning the basic nursing skills—both technical and communication skills. It’s about optimizing performance in the work environment, and that includes interprofessional teamwork. But it doesn’t stop there,” states Park. “Throughout the 30 or more years in a nurse’s career, there are constantly new skills to be learned and skills to be refreshed and adjusted. Using simulation and analyzing our performance in simulated environments, we can discover how individuals, technology, and systems contribute to errors. Using data from both simulated performance and real outcomes data, we can discover our strengths, weaknesses, opportunities, and threats when it comes to patient safety. Ultimately, we can disseminate best practice.”