As nurse educators, we are constantly engaged in a journey of searching for the most effective strategies to facilitate learning. We have faced many hurdles along the way, not the least of which include the increasing demand for our graduates in the face of the global shortage of nurses coupled with the ever-growing challenges of finding suitable clinical experiences. We are constantly reviewing, revising, and transforming our curricula, exploring new clinical models, and reconsidering the most effective way to teach nursing students all that is needed to work in a complex health care system and to provide optimal, quality patient outcomes. The emerging clinical simulation technology has made our simulation laboratories more realistic, but we need to wonder whether the increase in sophisticated technology really makes any difference to student learning and outcomes. With the increased emphasis on evidence-informed practice, we need to consider the evidence on clinical simulation for nursing education. There has been exponential growth in clinical simulation laboratories worldwide, with many descriptive articles appearing in the literature over the past 5 years. Yet the research into the effectiveness of clinical simulation for nursing remains in its infancy. This special issue of the Journal of Nursing Education is one response to the call for more rigorous research into all aspects of clinical simulation for nursing.
In this issue, readers will find articles to inform their practice, be it from a literature review on the practicalities of establishing a simulation laboratory to original research on the effects of simulation on nursing students’ critical thinking and confidence. Readers will encounter unique approaches to using simulation to enhance learning in more traditional courses and different kinds of environments where simulations can be incorporated within a nursing program. Among the many excellent articles included in this issue, Rash (2008) describes how simulated health promotion is being taught using an online platform, Shawler (2008) describes creative teaching strategies using standardized patients when working with psychiatric mental health nurse practitioner students, and Thompson and Bonnel (2008) describe integrating high-fidelity simulations into an undergraduate pharmacology course. The creativity and innovation demonstrated by the authors provide some direction to meet the challenges we face.
Today, nursing students, clinicians, and educators alike appear to be strongly identifying with the importance of incorporating simulations into courses and enhancing clinical practicum time for well-designed, standardized, clinical opportunities provided in a safe, nonthreatening simulated learning environment. Schools of nursing worldwide are responding to these issues; thus, nursing faculty need to be prepared to incorporate this new teaching-learning pedagogy into the nursing curriculum. Many schools of nursing are now including simulation days, simulated clinical experiences, and mandatory competency skill check-offs in a simulated environment within their curricula (Jeffries, 2007). Regulatory bodies are beginning to show an interest in clinical simulation. For example, in the United States, many states, including Florida and California, have set mandates on the percentage of clinical hours that can be obtained through simulations (Nehring, 2008). Although the positions and regulations set by these bodies on clinical hours and the use of simulation vary by country (and by state and province), all accrediting bodies consider clinical experience as one aspect of their reviews. In these reviews, the need for evidence-informed outcomes is crucial before too many principles and guidelines can be set.
The future calls for more rigorous testing of our hypotheses and practices in simulation use. In clinical nursing education, what cannot be simulated or taught in a simulated environment? What different aspects of simulation are the most important? When are live actors (i.e., standardized patients) more effective? How much contact with live patients can we replace before we affect student outcomes? Does simulation ultimately make a difference to patient safety by helping to prepare graduates to face the unexpected? Whatever the future, we know that the landscape of nursing education has changed, and it will continue to evolve as we all move into a world with more sophisticated technologies.
Janet Landeen, PhD, RN
McMaster University School of Nursing
Hamilton, Ontario, Canada
Pamela R. Jeffries, DNS, RN
Indiana University School of Nursing
- Jeffries, P. 2007. Clinical simulations in nursing education: Valuing and adopting an experiential clinical model. Create the Future, 4(7). Retrieved August 24, 2008, from http://www.nursingsociety.org/Publications/Newsletter/Documents/CTF_V4_7.pdf. .
- Nehring, WM2008. U.S. boards of nursing and the use of high-fidelity patient simulators in nursing education. Journal of Professional Nursing, 24, 109–117. doi:10.1016/j.profnurs.2007.06.027 [CrossRef]
- Rash, EM2008. Simulating health promotion in an online environment. Journal of Nursing Education, 47, 515–517.
- Shawler, C2008. Standardized patients: A creative teaching strategy for psychiatric-mental health nurse practitioner students. Journal of Nursing Education, 47, 528–531.
- Thompson, TL & Bonnel, WB2008. Integration of high-fidelity patient simulation in an undergraduate pharmacology course. Journal of Nursing Education, 47, 518–521.