Just as a pilot can simulate a landing “under the hood” in a classroom setting, an increasing number of hospitals and nursing schools are using patient simulation as a learning technique and competency-based assessment method. High-fidelity patient simulation (HPS) refers to the use of computerized manikins that simulate real-life scenarios. Long used in medical schools and the military, HPS is quickly becoming essential for many nursing schools. It promotes skills acquisition, aids development of clinical judgment, and teaches students about complex clinical situations with lifelike examples. HPS provides an invaluable safety net for learning, allowing students to acquire and develop critical-thinking and decision-making skills without exposing patients to unnecessary risk. (See How HPS meets current challenges by clicking the PDF icon above.)

Setting up the HPS lab

In 2007, the nursing program at the University of Hawaii at Hilo acquired two HPS manikins—an adult and an infant. Faculty members, who were excited to gain a new teaching method that integrates simulation as a learning tool, began to develop teaching strategies to enhance students’ clinical experiences. Although HPS doesn’t replace all clinical experiences, it gives students the chance to practice basic skills and assessments and to gain confidence in clinical situations. As students progress through the program, simulations become more complex to teach higher-level skills.

One of the first challenges we faced was setting up the nursing laboratory to teach students with this new technology. Fortunately, a local hospital had recently acquired a simulation manikin, so we began a dialogue of collaboration. Our faculty toured other nursing labs to
determine what modifications our lab would need; they identified a one-way viewing room and integration of audio and visual communication.

Once the lab was set up for HPS, faculty attended a workshop on how to use the computer and manikins. A hospital coordinator became our community partner and joined us in the training. Although this was a new way of teaching, faculty were excited about it and eager to learn how to implement it. After talking to other educators who used HPS, reviewing relevant literature, and adapting several scenarios for simulation, we decided to jump right in and implement the technology into our adult health nursing course.

Putting HPS to work

We divided students into two equal groups, A and B. Group A planned a clinical scenario for an assigned ailment, such as diabetic ketoacidosis; group members designed a scenario and manipulated SimMan, a high-fidelity adult manikin, from the control room. Group B was in the simulation room during the scenario and responded with nursing interventions. This approach required Group A to learn and apply critical thinking to the scenarios. Because they didn’t know how Group B would respond, they had to gain an in-depth understanding of the assigned ailment to lead the scenario effectively. They were charged with adapting to the scenario based on critical thinking.

The groups then switched roles and used a different scenario. The instructor’s role was to guide and coach the groups so their planning and responses remained accurate, realistic, and logical. In a post-scenario conference, students discussed the cases from both perspectives.

Empowering students

After using HPS, students reported they felt increased confidence and less anxiety in patient-care situations. This supports the theory underlying simulation training—that experience promotes learning. Especially in today’s healthcare climate, students need to be highly prepared before entering real-life clinical patient settings.

For many nursing students, entering a clinical setting is their first experience working with and caring for another person. HPS technology enables faculty to create a realistic clinical setting where active learning can occur with no threat to patient safety. Errors can be reviewed and students can learn from them in a positive way. As various clinical situations are presented, students are enriched with a wide range of learning experiences based on their identified learning needs. (See Fostering a meaningful simulation experience by clicking the PDF icon above.)

What’s more, research shows didactic learning gained from simulations is retained longer than knowledge gained through lectures. The few studies that have investigated skills using simulators or simulations found this teaching method sometimes leads to quicker skill acquisition than conventional methods.

The simulation learning method provides a deeper understanding of the subject matter, engages students in different roles, and adds new aspects of critical thinking. In teaching and practice, HPS can bridge the gap between competency-based practice and student learning. Faculty commitment to the new technology and community and student support for HPS helped us overcome the challenges we faced in implementing the program, such as finding space for the manikins, learning the computer programs, and developing simulations.

Today’s practicing nurses are challenged by a rapidly changing healthcare arena that demands highly skilled and adaptive responses. HPS can help the novice nurse become an expert nurse while fostering a commitment to lifelong learning.

Selected references

Cant RP, Cooper SJ. Simulation-based learning in nurse education: systematic review. J Adv Nurs. 2010;66(1):3-15. doi:10.1111/j.1365-2648. 2009.05240.x.

Harlow K, Sportsman S. An economic analysis of patient simulators clinical training in nursing education. Nurs Econ. 2007;25(1):24-29, 3.

Leonard B, Shuhalber E, Chen R. Nursing student perception of intraprofessional team education using high-fidelity simulation. J Nurs Educ. 2010;49(11):628-631.

Stokowski L. Simulation training in neonatal resuscitation: practice makes perfect. Medscape Today: Medscape Nurses. Posted July 25, 2006. Updated July 18, 2006. www.medscape.com/viewarticle/541371. Accessed March 30, 2011.

Weaver A. High-fidelity patient simulation in nursing education: an integrative review. Nurs Educ Perspect. 2011;32(1):37-40. doi:10.5480/1536-5026-32.1.37.

Jeanie L. Flood and Joan Nalani Thompson are associate professors and Eileen Lovell is an assistant professor at the University of Hawaii at Hilo School of Nursing. Susan Field is an assistant professor at the University of Hawaii at Manoa School of Nursing and Dental Hygiene in Honolulu. Katharyn Daub is a director and professor at the University of Hawaii at Hilo School of Nursing.