Over the summer, we talked about what to expect in the simulation lab for Northeastern’s Direct Entry-Hybrid Nursing Program. Today, we’re taking it one step further and chatting with Carol Femia, RN, MSN. She facilitates nursing simulations for Direct Entry-Hybrid students in the Behrakis Health Sciences Center in Boston. Keep reading to get nitty-gritty details on what students do in the lab and how it prepares them for clinicals.
The purpose of the sim lab is to provide a safe environment where nursing students can learn skills performance and critical thinking. Similar to flight simulators where pilots learn to act and react to a variety of different scenarios, simulation in nursing allows the student to learn to act and react to a variety of patient care scenarios. They learn how to think on their feet and respond to unexpected emergencies. It also enhances nursing assessment, communication, problem-solving, delegation and prioritization skills.
Students get participation credit, but the sessions themselves are not evaluative. They’re intended to increase the students’ self-esteem, as with increased confidence comes increased competence and vice versa. Going back to the analogy of the flight simulator, if a pilot practices crash landing multiple times in a simulated environment, they’re far more competent and confident to handle this situation in real life.
Sim lab sessions are typically about an hour. A majority of the time is spent debriefing after the simulation has occurred. Much of the education gained occurs during this period of guided reflection or debriefing. They learn to recognize an abnormality, react to the situation, prioritize their actions and deal with the emotions of the situation.
Within Direct Entry-Hybrid as a whole, there are two simulation experiences in the first semester and two in the second. We’re currently working to expand these offerings.
There is so much more to simulation then just the physical tasks. Sometimes it’s as simple as having the manikin ask you questions such as, “Am I going to die?” Being presented with these challenging questions is a reality in nursing, and allowing students time to reflect on how they felt when thrown this type of question is a powerful learning experience. That said, students are able to practice skills such as listening to lung and bowel sounds, taking vital signs and assessing the patient. The SimMan provides the abnormal of these assessments. Hearing or seeing an abnormal assessment builds confidence in their assessment skills.
Students also have to use critical thinking – for example, deciding which type of oxygen delivery device is most appropriate for a patient’s condition/respiratory status. Cause and effect is quickly demonstrated by a downward trend in oxygen saturation if the inappropriate oxygen delivery device was chosen. This immediate cause and effect is not possible ethically to duplicate in a live clinical setting. We’ll also use other students as family members to get the students used to dealing with the “pushy wife” or “irate daughter.” It allows them to make mistakes in a safe environment.
They evaluate themselves and each other. During debriefing, faculty act as facilitators, but I initiate the debriefing by having a student observer give their reflection first. Students are less threatened by each other than they are faculty evaluations. Student success is measured by increasing their confidence and competence in the clinical setting. Clinical instructors often reflect on improved confidence and critical thinking after simulation scenarios.
When a student is struggling in the simulation, we’ll often cue them through humor, a family member or the patient themselves. If the student is really stuck, the family member might say, “Do you think you should call the doctor?”
By increasing confidence and competence. I often tell students that simulation is the place to make the mistake and that we sometimes learn best from mistakes. A student may go through many clinicals without ever having the occasion to hear stridor or a heart murmur, but student who’s able to successfully identify wheezing upon auscultation of SimMan’s lung sounds can go into the clinical setting with increased competence and confidence.