Grant MacEwan College Training nurses for the future

Students are demanding a more experiential education, and in response, programs such as Grant MacEwan college’s Baccalaureate nursing program in Edmonton, Alberta, are introduced to the context of nursing practice with the use of human patient simulation in their fi rst clinical nursing course in the fi rst year of the program.

MacEwan adopted the use of high-fi delity human patient simulators to create life-like client care situations that promote critical thinking and best practices, while heightening learning and mimicking clinical situations.

The learning experience for novice students simulates interaction with seniors in a continuing care environment and is focused on assessments, communication skills, and helping the student feel comfortable in the nursing environment. As students progress through the program, human patient simulation is used in each course with increasing complexity.

Overall, feedback from fi rst year students and faculty has been positive. Students confi rm that the simulation experience was a safe place to practice nursing skills, and helped them feel more confi dent and in control in their clinical practice. Studies have shown that novice students reported decreased anxiety and increased confi dence after a simulated experience and prior to their fi rst clinical day (Bremner, 2006).

Using hi-fi delity human simulation in continuing care

In the continuing care industry little is documented about the use of state-of-the-art simulation technology for staff education and professional development. Simulation technology uses advanced physically responsive mannequins with high-fi delity and digitally produced human sounds that allow the mannequin to talk, blink and respond like a real person.

Despite these technological advances, traditional didactic teaching methods – passive learning – which emphasizes memorization and results in less retention, continues to dominate staff education and development in health care (McCausland, 2004).

Simulation provides an experiential approach to the clinical experience, which, in turn, can help with self-monitoring and promote deliberation. A period of debriefi ng between instructor and student following the simulation is equally important to clinical learning. Debriefi ng provides a time for rigorous self-refl ection, a process that helps students recognize and resolve pressing clinical and behavioural dilemmas raised during the simulation and improve results in the future (Bremner, 2006).

Nurses want to keep up-to-date with continuing advances in nursing practice and agree that learning should be experiential and focus on the knowledge, skills and demands of the service being provided in order to deliver quality care (Wood, 2006; Minister of Public Works and Government Services Canada, 1999).

Nursing students in educational institutions have state-of-the art laboratories; computer programs; library data bases; seminars; refl ective journals; online learning; case study analysis; patient standardization programs; and, sophisticated human patient simulation programs to develop best practices, skills and critical thinking.

Graduates in their first year of practice often have difficulties in transitioning to the role of registered nurse because of poor organizational orientation and education strategies (Thomka, 2001). Even more discouraging is the lack of educational resources and time, once a new graduate begins working in a continuing care organization.

Educational strategies need to develop a nursing workforce that is fit for practice and fit for purpose. But, in order to recruit and retain nurses, greater emphasis needs to be placed on providing access to quality education, updated methods for training, and professional development (CNA, 2006; Alberta Long Term Care Association, 2005).

If new graduates are to be attracted to continuing care, it is critical that educational strategies during their first year support the professional values, attitudes and behaviours that are essential in achieving outcomes reflective of quality resident care.

Resources for continuing care staff education anddevelopment need to focus on cultivating a supportive learning environment that motivates nurses to positively influence the organization’s research culture and moves research findings into experiential learning. Moving research findings into a practice development environment in continuing care will ultimately improve the care residents receive (Fink, 2005). This requires both organizational and educational change.

Applying simulation to continuing care education

Increased resident complexity, disability and acuity means that continuing care nurses are expected to assess and manage emergency situations safely and effectively (Capital Regional District, 2005). Evaluations from students and registered nurses support that the nursing patient simulation experience has improved their critical thinking skills, health assessment practices, and self-confidence.

The potential personal, economic, and societal costs of poor clinical practice in continuing care environments are enormous. Simulations can help bridge the reality gap and bring a focussed ‘real’ life activity into the simulation environment. The biggest problem with continuing care education is that a registered nurse’s scope of practice is so broad that unless specific training for managing common emergencies is provided, they may not be able to handle them in the most efficient manner (Nelson, 2005).

Within many health care disciplines a simulation education program has wide potential, and can assist staff in the need for remediation, continuing competence, orientation, and on-going professional development. This form of training can also aid in transforming a team’s clinical care into best practices (Mahaffy, 2006).

Through carefully planned simulation scenarios, staff can also learn to improve their practice, knowledge and critical thinking skills.

Care interventions for specific health conditions can be built into simulation scenarios such as, the care of a person with dementia, management of difficult behaviours, urinary tract infections and management of pain.

Scenario themes can also focus on:

• Improving assessment skills;
• Managing emergencies;
• Understanding team collaboration and communication;
• Improving family interactions and,
• Managing safety in selected situations.

Throughout the simulation experience, the educator recognizes and encourages spontaneous opportunities for learning.

In 2002, an internal evaluation of student experience with human patient simulation in the baccalaureate nursing program lead MacEwan’s School of Nursing to formulate recommendations for integrating simulation into the curriculum. These recommendations are applicable to integration of simulation in any educational setting:

• All educators using simulation must be oriented to the technology and familiar with the use of simulation as a teaching strategy;
• Simulation should be carefully integrated into the curriculum with specific goals and objectives that support desired curriculum outcomes;
• A quality learning experience is crucial. Small groups of no more than two to three learners should be involved in each simulation and an instructor guided reflection, or debriefing, should follow immediately after each session;
• Ethical guidelines for the use of simulation should be developed for all learning situations;
• Ongoing research in the area of simulation in nursing education.

Patient safety is one of the most significant issues facing health systems around the world (Baker, 2004). This belief is echoed in the Canadian Patient Safety Institute’s 2005 report which calls for greater use of human patient simulation for teaching and learning in a team environment that reflects the work setting and that patient safety should be a common thread throughout healthcare education and for future practitioners.

We acknowledge that hi-fidelity human simulation can never replace a real clinical experience, nevertheless it does provide for a fun and exciting experience that combines knowledge, psychomotor skill and critical thinking development. Simulation is an acceptable means of evaluating individual and team performance, and needs to be explored further for training practitioners in continuing care.

Collaboration and formal partnerships between continuing care and educational institutions have the potential to improve expertise in teaching pedagogies and minimize costs in the development of a supportive experiential learning environment. Collaborating between simulation labs in educational institutions and health-care partners allows staff to improve their practice development and critical thinking skills.

A structured and well planned education and training curriculum in continuing care, can increase staff work satisfaction and is an important marketing tool in recruitment (Commonwealth of Education, Science and Training, 2001). Access to updated educational expertise, technology and professional development improves the quality of care and effective staff education and development, while reducing nurse’s stress from supervision.