- Email: [email protected]
Simulation education: A primer for professionalism
Teaching and Learning in Nursing (2014) 9, 126–129
www.jtln.org
Simulation education: A primer for professionalism Nancy Hinchcliffe Duphily DNP, RN-BC, CNS⁎ Fitchburg State University, Fitchburg, MA 01420, USA KEYWORDS: Professionalism; Simulation; Nursing education
Abstract Professionalism embraces a set of attitudes, skills and behaviors, attributes, and values expected from those to whom society considers an expert. Research has shown that simulation-based training can improve student learning and, therefore, patient care (Cant & Cooper,2010; Harder,2010). With the outcomes of improved student learning and better patient care, can simulation foster professionalism as well? The purpose of this article is to highlight the benefits of a simulation scenario in fostering the development of professionalism in nursing students. Published by Elsevier Inc. on behalf of National Organization for Associate Degree Nursing.
1. Introduction When asked, “How did you learn to act like a nurse?” most students, graduates, and practicing nurses will not think back to a lecture in school on professional values. Instead, they talk about role models and mentors, of nurses they observed in the clinical setting, of their clinical instructors and faculty, and of peers and patients who taught them something about what it means to be a nurse. Faculty in nursing education are charged with the daunting task of equipping students with the skills to think critically. The intent is to empower students to advance beyond simply “knowing”; that is, to synthesize and apply knowledge as they use the nursing process to deliver professional, responsible, individualized nursing care (Kaddoura, 2010). However, even in the most cooperative learning environments, curricular content is often delivered in fragments. In the maternal child health classroom and clinical experience in our nursing program, students are introduced to concepts such as hemorrhage, hypovolemia, intravenous replacement fluids, assessment of the uterine fundus and lochial flow, urinary catheterization, and indications for the
* Corresponding author. E-mail address: [email protected]
use of oxygen. Yet, when challenged to prioritize, put the pieces together, and professionally intervene in an emergency situation, many students often do not know where to begin. Simulation provides a valuable addition to the traditional teacher-centered approach to nursing education, with emphasis on the learning needs and preferences of contemporary nursing students (Cant & Cooper, 2010; Harder, 2010). The sophisticated computer technology of the patient simulator has appeal for today's learners. Contemporary students represent the computer savvy Generation X and Generation Y, having grown up with gaming systems, computers, and the Internet. Individuals from these generations typically possess a natural attraction to technology and are accustomed to fastpaced communication. Simulated learning experiences permit faculty to introduce students to situations that they may never see in their clinical practicum experiences. Because students are placed in a variety of settings for their clinical experiences, there may be a lack of consistency in learning opportunities across clinical environments and among students. Use of the patient simulator enables faculty to provide structured, consistent simulation laboratory experiences (Waxman, 2010). Simulation helps students see the “big picture.” From the scenario itself to the debriefing sessions, students are able to see the “gaps” and to recognize those areas upon which they can improve their practice (Blum, Borglund &
http://dx.doi.org/10.1016/j.teln.2014.03.003 1557-3087/Published by Elsevier Inc. on behalf of National Organization for Associate Degree Nursing.
Simulation education Parcells, 2010). In this way, the student moves closer to begin understanding the meaning of “professionalism” in nursing. The core values of professionalism include honesty and integrity, altruism, respect, responsibility and accountability, compassion and empathy, dedication, and self-improvement (Hendelman, 2009). In advancing student understanding of the concept of professionalism, often presented in introductory nursing school lectures as an abstract concept to novice students, simulation helps thread those core values throughout the educational experience (Leduc & Kotzer, 2009; Wagner, Bear, & Sander, 2009). Research has shown that simulation-based training can improve student learning and enhance the quality of patient care (Cant & Cooper, 2010; Harder, 2010; Sullivan, Hirst, & Cronenwett, 2009). It is an opportunity to carry over into practice those theories learned in lecture and laboratory in a safe, controlled environment, enabling the student to recreate real-life situations. Simulation is a means of evaluation in a nonpunitive environment, where unsafe practices can be identified without harm to a patient (Sullivan et al., 2009). With its emphasis on the importance of collaboration in providing care for patients, simulation encourages the learner to practice as a member of the health care team (Jeffries, Bambini, Hensail, Moorman, & Washburn, 2009; Kaddoura, 2010; Kardong-Edgren, Starkweather, & Ward, 2008). Working in small groups with the simulator, students may be assigned specific roles such as primary nurse, secondary nurse, supervisor, recorder, or observer. Their study of the nursing process unfolds in the simulation scenario. Here, learners assess the patient and the situation, identifying pertinent information to be shared with the primary health care provider. Students then determine appropriate nursing interventions and are able to carry out orders from the health care provider. They evaluate patient responses and the outcomes of their assessments and interventions. In addition, learners can be taught to identify areas of potential error risk during patient condition changes and handoffs during shift report, transfer, and discharge. The importance of effective communication can be emphasized and practiced through accurate reporting of medications and aspects of the treatment plan through simulated handoffs. This experience helps students recognize the importance of critical thinking and the nursing process in the acquisition of communication, collaboration, delegation, and conflict resolution skills for safe, professional nursing practice (Bambini, Washburn, & Perkins, 2009; Baxter, Akhtar-Danesh, Valaitis, Stanyon, & Sproul, 2009; McKeon, Norris, Cardell, & Britt, 2009).
2. The scenario With the guidance of a skilled, supportive nursing laboratory coordinator, the junior nursing faculty team in our nursing program has incorporated simulation as part of
127 both clinical and classroom responsibilities in the maternal–newborn course. Such a scenario takes place during the latter part of the semester, when the “complications” content is introduced and discussed. One such complication involves the newly delivered mother experiencing a postpartum hemorrhage. Students are given a preliminary introduction to the scenario before the session. Roles are randomly assigned to include a primary nurse, secondary nurse, night nurse, nursing supervisor, and visitor. Remaining students function in the role of observers, viewing the scenario from a separate room where the session is “streamed.” Before the 20-minute session begins, those individuals who are in the scene itself are given the opportunity to enter the actual physical environment to orient and familiarize themselves to the setting. The scenario begins as both primary and secondary nurse (designated as a newly graduated nursing “orientee”) enter the postpartum mother's room following report from the 11 pm–7 am night nurse, prepared to complete a mother baby assessment. As the scene progresses, the patient's subjective symptoms include “feeling lightheaded” and “feeling wet”; objective data reveal a boggy fundus positioned above the umbilicus, along with rapidly deteriorating vital signs. Students are challenged here to recognize this as a postpartum hemorrhage and react to the emergent situation.
3. Debriefing It is important to provide students with an opportunity to evaluate their experience with the patient simulator as an instructional strategy. This may be accomplished as part of the debriefing session or included as a component of the maternity course evaluation. Debriefing clarifies, amplifies, and highlights each component of the simulation educational experience. The process of debriefing is used to correct any misinformation or improper practice techniques the students may demonstrate (Neill & Wotton, 2011). Feedback assists students to integrate correct behaviors into their skill set. Through simulation scenarios, gaps in knowledge are identified. In the debriefing process, students are asked to reflect on their own skills and knowledge. They identify what they have done well and which areas need improvement (Baxter et al., 2009). Because there are multiple activities occurring throughout the simulation and students may be focused only on their specific roles, debriefing can be used to review key points about the simulation. This includes discussing the events that occurred, interviewing students regarding their opinions of what transpired to validate what they know and affirming what they are currently doing well. Further discussion includes consideration of what the student might do differently if given a chance to repeat the scenario (Neill & Wotton, 2011).
128 In the debriefing of our scenario, professional growth was identified and articulated by the students themselves in the following areas: Assessment skills: “Recognition early on of a developing problem.” Nursing skills: (Not an exhaustive list) “communication, vital signs, medications, IV fluids, catheterization, oxygen administration.” Prioritizing: “I started to panic…what needs to be done first?” Role playing: (From a student audience member) “I was so impressed by the other students' actions…stepping up to the plate…getting right into the situation…I don’t know if I would be able to step into their shoes as well if it were me in the hot seat.” Importance of team: “We needed each other for support…we needed help to safely care for this patient.” Delegation and management of resources: Recognizing that “one person cannot do it all.” Communication: With patient, nurse, supervisor, doctor, family… “do you think we will ever get to this skill level?” Decision making: “She (student as primary nurse) seemed so calm through it all!” Ethics/Patient advocacy (beneficence, fidelity, justice, respect for the patient and family members/visitors present): “I noticed how the secondary nurse kept the patient informed each step of the way.” Conflict resolution: Dealing with members of the health care team, patients, and family members: “As the supervisor, he was very convincing in the role…he very professionally and confidently explained the reason to the visitor that she had to leave.”
Debriefing makes our nursing students feel that their opinion matters. Moreover, each time the scenario is carried out, the feedback is documented and collated, and improvements are made. These changes are based on debriefing sessions, meetings with nursing faculty colleagues, and documenting students' evaluations of the scenario. Feedback generates the data needed to support the use of this teaching methodology. Students' “takeaway” from the experience includes surprise that their opinion is valued, importance of the team, collaboration with other health care providers, delegation communication, and patient advocacy. Students have also expressed an interest to participate in the development of future simulation scenarios. The ability to listen to, accept, and act on the constructive feedback of others is key to professionalism in practice. The data collected from three years of simulation evaluations demonstrates to the administration that simulation is valued by the students, who are now asking for more. Student feedback supports the need to “grow” this educational strategy. Their input reinforces the need to fund supplementary faculty positions to staff the laboratory, to allocate more space for creating additional simulation laboratories, and to provide faculty with professional development opportunities to learn more about simulation's role in the education of contemporary nursing students.
N.H. Duphily In addition, the simulation (SIMS) experience brings students closer to the acquisition of significant professional nursing skills. In turn, this creates a clearer understanding of the professional role. Where better to practice and refine skills in a controlled, safe setting where nursing students can examine and improve their practice?
4. Implications/Suggestions for future research Recommendations for future research related to simulation and its contribution to the acquisition of professionalism include the dissemination of “success stories”, encouraging faculty to publish and present current, innovative methodologies regarding the incorporation of simulation education into the curriculum. Nursing faculty should consider allotting more time in their curriculum to integrate simulation education as a valuable adjunct to teaching and learning methodologies. Replication with a larger sample and expansion of the simulation scenario to include additional programs of nursing are recommended as a means of improving statistical reliability. Typically one individual is responsible for the daily operation of the simulation laboratory, which includes maintenance of the SIMS manikins, scheduling teaching sessions, providing open laboratories, giving tours, ordering materials, and organizing remediation. Support by faculty, administration, stakeholders, and partners to assist overburdened simulation laboratory staff is proposed as an investment into the future of simulation in academia. As well, nursing faculty should be afforded the opportunity to attend conferences related to integrating simulation education into the curriculum, along with education on the benefits of “buying into” this valuable adjunct to traditional nursing education. Finally, partnerships should be created among faculty and administration, affiliated health care organizations, and in-service education to collaborate on the use of simulation for professional development of both nursing students and staff nurses.
5. Conclusion Professionalism embraces a set of attitudes, skills and behaviors, attributes, and values expected from those to whom society considers an expert (Hendelman, 2009; Leduc & Kotzer, 2009). Simulation provides the opportunity to carry over into practice those theories learned in lecture and laboratory in a safe, controlled environment, enabling the student to recreate real-life situations, bringing them closer to an understanding of professional nurse's role. Simulation is a means of evaluation in a nonpunitive environment, where unsafe practices can be identified without detrimental effects on a patient (Sullivan et al., 2009). The major advantage of using the patient simulator as an instructional strategy in nursing
Simulation education education is that it provides opportunity for active and interactive learning without risk to an actual patient. Learners can be permitted to make mistakes without fear of harming a live person (Cant & Cooper, 2010; Harder, 2010). Professionalism can be taught in nursing education but not just in the classroom and not by role modeling alone. Learning happens everywhere. Professionalism can be instilled by encouraging faculty and students to have conversations about real-life events that challenge ideas about what it means to be a nurse. This need not be an isolated lecture on responsibility to patients as a fundamental principle of professionalism. It can, however, be about a faculty demonstrating through a simulation scenario nursing's professional commitment to patients or concern conversations in a debriefing session about actions that reflect a lapse in professional behavior. The greatest challenge for students today is to make the transition from passive to active learners, to recognize events that reflect professional behavior, to talk with others about them, and to then become their own teachers of professionalism.
References Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nursing Education Research, 30(2), 79−82. Baxter, P., Akhtar-Danesh, N., Valaitis, R., Stanyon, W., & Sproul, S. (2009). Simulated experiences: Nursing students share their perspectives. Nurse Education Today, 29, 859−866. Blum, C. A., Borglund, S., & Parcells, D. (2010). High-fidelity nursing simulation: Impact on student self-confidence and clinical compe-
129 tence. International Journal of Nursing Education Scholarship, 7(1), 1−14. Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing, 66(1), 3−15. Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49(1), 23−28. Hendelman, W. (2009). Medicine and professionalism. Downloaded from www.med.uottawa.ca/students/md/professionalism/eng/about.html. Jeffries, P., Bambini, D., Hensail, D., Moorman, M., & Washburn, J. (2009). Constructing maternal-child learning experiences using clinical simulations. JOGNN, 38, 613−623. Kaddoura, M. (2010). New graduate nurses perceptions of the effects of clinical simulation on their critical thinking, learning and confidence. The Journal of Continuing Education in Nursing, 41(11), 506−516. Kardong-Edgren, S. E., Starkweather, A. R., & Ward, L. D. (2008). The integration of simulation into a clinical foundations of nursing course: Student and faculty perspectives. International Journal of Nursing Education Scholarship, 5(1), 1−16. Leduc, K., & Kotzer, A. (2009). Bridging the gap: A comparison of the professional nursing values of students, new graduates and seasoned professionals. Nursing Education Perspectives, 30(5), 279−284. McKeon, L. M., Norris, T., Cardell, B., & Britt, T. (2009). Developing patient-centered care competencies among prelicensure nursing students using simulation. Journal of Nursing Education, 48(12), 711−715. Neill, M., & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: A literature review. International Nursing Association for Clinical Simulation and Learning, 7(5), 161−168. Sullivan, D. T., Hirst, D., & Cronenwett, L. (2009). Assessing quality and safety competencies of graduating prelicensure nursing students. Nursing Outlook, 57(6), 323−331. Wagner, D., Bear, M., & Sander, J. (2009). Turning simulation into reality: Increasing student competence and confidence. Educational Innovations, 48(8), 465−467. Waxman, K. T. (2010). Development of evidence based clinical simulation scenarios: Guidelines for nursing educators. Journal of Nursing Education, 49(1), 29−35.
www.jtln.org
Simulation education: A primer for professionalism Nancy Hinchcliffe Duphily DNP, RN-BC, CNS⁎ Fitchburg State University, Fitchburg, MA 01420, USA KEYWORDS: Professionalism; Simulation; Nursing education
Abstract Professionalism embraces a set of attitudes, skills and behaviors, attributes, and values expected from those to whom society considers an expert. Research has shown that simulation-based training can improve student learning and, therefore, patient care (Cant & Cooper,2010; Harder,2010). With the outcomes of improved student learning and better patient care, can simulation foster professionalism as well? The purpose of this article is to highlight the benefits of a simulation scenario in fostering the development of professionalism in nursing students. Published by Elsevier Inc. on behalf of National Organization for Associate Degree Nursing.
1. Introduction When asked, “How did you learn to act like a nurse?” most students, graduates, and practicing nurses will not think back to a lecture in school on professional values. Instead, they talk about role models and mentors, of nurses they observed in the clinical setting, of their clinical instructors and faculty, and of peers and patients who taught them something about what it means to be a nurse. Faculty in nursing education are charged with the daunting task of equipping students with the skills to think critically. The intent is to empower students to advance beyond simply “knowing”; that is, to synthesize and apply knowledge as they use the nursing process to deliver professional, responsible, individualized nursing care (Kaddoura, 2010). However, even in the most cooperative learning environments, curricular content is often delivered in fragments. In the maternal child health classroom and clinical experience in our nursing program, students are introduced to concepts such as hemorrhage, hypovolemia, intravenous replacement fluids, assessment of the uterine fundus and lochial flow, urinary catheterization, and indications for the
* Corresponding author. E-mail address: [email protected]
use of oxygen. Yet, when challenged to prioritize, put the pieces together, and professionally intervene in an emergency situation, many students often do not know where to begin. Simulation provides a valuable addition to the traditional teacher-centered approach to nursing education, with emphasis on the learning needs and preferences of contemporary nursing students (Cant & Cooper, 2010; Harder, 2010). The sophisticated computer technology of the patient simulator has appeal for today's learners. Contemporary students represent the computer savvy Generation X and Generation Y, having grown up with gaming systems, computers, and the Internet. Individuals from these generations typically possess a natural attraction to technology and are accustomed to fastpaced communication. Simulated learning experiences permit faculty to introduce students to situations that they may never see in their clinical practicum experiences. Because students are placed in a variety of settings for their clinical experiences, there may be a lack of consistency in learning opportunities across clinical environments and among students. Use of the patient simulator enables faculty to provide structured, consistent simulation laboratory experiences (Waxman, 2010). Simulation helps students see the “big picture.” From the scenario itself to the debriefing sessions, students are able to see the “gaps” and to recognize those areas upon which they can improve their practice (Blum, Borglund &
http://dx.doi.org/10.1016/j.teln.2014.03.003 1557-3087/Published by Elsevier Inc. on behalf of National Organization for Associate Degree Nursing.
Simulation education Parcells, 2010). In this way, the student moves closer to begin understanding the meaning of “professionalism” in nursing. The core values of professionalism include honesty and integrity, altruism, respect, responsibility and accountability, compassion and empathy, dedication, and self-improvement (Hendelman, 2009). In advancing student understanding of the concept of professionalism, often presented in introductory nursing school lectures as an abstract concept to novice students, simulation helps thread those core values throughout the educational experience (Leduc & Kotzer, 2009; Wagner, Bear, & Sander, 2009). Research has shown that simulation-based training can improve student learning and enhance the quality of patient care (Cant & Cooper, 2010; Harder, 2010; Sullivan, Hirst, & Cronenwett, 2009). It is an opportunity to carry over into practice those theories learned in lecture and laboratory in a safe, controlled environment, enabling the student to recreate real-life situations. Simulation is a means of evaluation in a nonpunitive environment, where unsafe practices can be identified without harm to a patient (Sullivan et al., 2009). With its emphasis on the importance of collaboration in providing care for patients, simulation encourages the learner to practice as a member of the health care team (Jeffries, Bambini, Hensail, Moorman, & Washburn, 2009; Kaddoura, 2010; Kardong-Edgren, Starkweather, & Ward, 2008). Working in small groups with the simulator, students may be assigned specific roles such as primary nurse, secondary nurse, supervisor, recorder, or observer. Their study of the nursing process unfolds in the simulation scenario. Here, learners assess the patient and the situation, identifying pertinent information to be shared with the primary health care provider. Students then determine appropriate nursing interventions and are able to carry out orders from the health care provider. They evaluate patient responses and the outcomes of their assessments and interventions. In addition, learners can be taught to identify areas of potential error risk during patient condition changes and handoffs during shift report, transfer, and discharge. The importance of effective communication can be emphasized and practiced through accurate reporting of medications and aspects of the treatment plan through simulated handoffs. This experience helps students recognize the importance of critical thinking and the nursing process in the acquisition of communication, collaboration, delegation, and conflict resolution skills for safe, professional nursing practice (Bambini, Washburn, & Perkins, 2009; Baxter, Akhtar-Danesh, Valaitis, Stanyon, & Sproul, 2009; McKeon, Norris, Cardell, & Britt, 2009).
2. The scenario With the guidance of a skilled, supportive nursing laboratory coordinator, the junior nursing faculty team in our nursing program has incorporated simulation as part of
127 both clinical and classroom responsibilities in the maternal–newborn course. Such a scenario takes place during the latter part of the semester, when the “complications” content is introduced and discussed. One such complication involves the newly delivered mother experiencing a postpartum hemorrhage. Students are given a preliminary introduction to the scenario before the session. Roles are randomly assigned to include a primary nurse, secondary nurse, night nurse, nursing supervisor, and visitor. Remaining students function in the role of observers, viewing the scenario from a separate room where the session is “streamed.” Before the 20-minute session begins, those individuals who are in the scene itself are given the opportunity to enter the actual physical environment to orient and familiarize themselves to the setting. The scenario begins as both primary and secondary nurse (designated as a newly graduated nursing “orientee”) enter the postpartum mother's room following report from the 11 pm–7 am night nurse, prepared to complete a mother baby assessment. As the scene progresses, the patient's subjective symptoms include “feeling lightheaded” and “feeling wet”; objective data reveal a boggy fundus positioned above the umbilicus, along with rapidly deteriorating vital signs. Students are challenged here to recognize this as a postpartum hemorrhage and react to the emergent situation.
3. Debriefing It is important to provide students with an opportunity to evaluate their experience with the patient simulator as an instructional strategy. This may be accomplished as part of the debriefing session or included as a component of the maternity course evaluation. Debriefing clarifies, amplifies, and highlights each component of the simulation educational experience. The process of debriefing is used to correct any misinformation or improper practice techniques the students may demonstrate (Neill & Wotton, 2011). Feedback assists students to integrate correct behaviors into their skill set. Through simulation scenarios, gaps in knowledge are identified. In the debriefing process, students are asked to reflect on their own skills and knowledge. They identify what they have done well and which areas need improvement (Baxter et al., 2009). Because there are multiple activities occurring throughout the simulation and students may be focused only on their specific roles, debriefing can be used to review key points about the simulation. This includes discussing the events that occurred, interviewing students regarding their opinions of what transpired to validate what they know and affirming what they are currently doing well. Further discussion includes consideration of what the student might do differently if given a chance to repeat the scenario (Neill & Wotton, 2011).
128 In the debriefing of our scenario, professional growth was identified and articulated by the students themselves in the following areas: Assessment skills: “Recognition early on of a developing problem.” Nursing skills: (Not an exhaustive list) “communication, vital signs, medications, IV fluids, catheterization, oxygen administration.” Prioritizing: “I started to panic…what needs to be done first?” Role playing: (From a student audience member) “I was so impressed by the other students' actions…stepping up to the plate…getting right into the situation…I don’t know if I would be able to step into their shoes as well if it were me in the hot seat.” Importance of team: “We needed each other for support…we needed help to safely care for this patient.” Delegation and management of resources: Recognizing that “one person cannot do it all.” Communication: With patient, nurse, supervisor, doctor, family… “do you think we will ever get to this skill level?” Decision making: “She (student as primary nurse) seemed so calm through it all!” Ethics/Patient advocacy (beneficence, fidelity, justice, respect for the patient and family members/visitors present): “I noticed how the secondary nurse kept the patient informed each step of the way.” Conflict resolution: Dealing with members of the health care team, patients, and family members: “As the supervisor, he was very convincing in the role…he very professionally and confidently explained the reason to the visitor that she had to leave.”
Debriefing makes our nursing students feel that their opinion matters. Moreover, each time the scenario is carried out, the feedback is documented and collated, and improvements are made. These changes are based on debriefing sessions, meetings with nursing faculty colleagues, and documenting students' evaluations of the scenario. Feedback generates the data needed to support the use of this teaching methodology. Students' “takeaway” from the experience includes surprise that their opinion is valued, importance of the team, collaboration with other health care providers, delegation communication, and patient advocacy. Students have also expressed an interest to participate in the development of future simulation scenarios. The ability to listen to, accept, and act on the constructive feedback of others is key to professionalism in practice. The data collected from three years of simulation evaluations demonstrates to the administration that simulation is valued by the students, who are now asking for more. Student feedback supports the need to “grow” this educational strategy. Their input reinforces the need to fund supplementary faculty positions to staff the laboratory, to allocate more space for creating additional simulation laboratories, and to provide faculty with professional development opportunities to learn more about simulation's role in the education of contemporary nursing students.
N.H. Duphily In addition, the simulation (SIMS) experience brings students closer to the acquisition of significant professional nursing skills. In turn, this creates a clearer understanding of the professional role. Where better to practice and refine skills in a controlled, safe setting where nursing students can examine and improve their practice?
4. Implications/Suggestions for future research Recommendations for future research related to simulation and its contribution to the acquisition of professionalism include the dissemination of “success stories”, encouraging faculty to publish and present current, innovative methodologies regarding the incorporation of simulation education into the curriculum. Nursing faculty should consider allotting more time in their curriculum to integrate simulation education as a valuable adjunct to teaching and learning methodologies. Replication with a larger sample and expansion of the simulation scenario to include additional programs of nursing are recommended as a means of improving statistical reliability. Typically one individual is responsible for the daily operation of the simulation laboratory, which includes maintenance of the SIMS manikins, scheduling teaching sessions, providing open laboratories, giving tours, ordering materials, and organizing remediation. Support by faculty, administration, stakeholders, and partners to assist overburdened simulation laboratory staff is proposed as an investment into the future of simulation in academia. As well, nursing faculty should be afforded the opportunity to attend conferences related to integrating simulation education into the curriculum, along with education on the benefits of “buying into” this valuable adjunct to traditional nursing education. Finally, partnerships should be created among faculty and administration, affiliated health care organizations, and in-service education to collaborate on the use of simulation for professional development of both nursing students and staff nurses.
5. Conclusion Professionalism embraces a set of attitudes, skills and behaviors, attributes, and values expected from those to whom society considers an expert (Hendelman, 2009; Leduc & Kotzer, 2009). Simulation provides the opportunity to carry over into practice those theories learned in lecture and laboratory in a safe, controlled environment, enabling the student to recreate real-life situations, bringing them closer to an understanding of professional nurse's role. Simulation is a means of evaluation in a nonpunitive environment, where unsafe practices can be identified without detrimental effects on a patient (Sullivan et al., 2009). The major advantage of using the patient simulator as an instructional strategy in nursing
Simulation education education is that it provides opportunity for active and interactive learning without risk to an actual patient. Learners can be permitted to make mistakes without fear of harming a live person (Cant & Cooper, 2010; Harder, 2010). Professionalism can be taught in nursing education but not just in the classroom and not by role modeling alone. Learning happens everywhere. Professionalism can be instilled by encouraging faculty and students to have conversations about real-life events that challenge ideas about what it means to be a nurse. This need not be an isolated lecture on responsibility to patients as a fundamental principle of professionalism. It can, however, be about a faculty demonstrating through a simulation scenario nursing's professional commitment to patients or concern conversations in a debriefing session about actions that reflect a lapse in professional behavior. The greatest challenge for students today is to make the transition from passive to active learners, to recognize events that reflect professional behavior, to talk with others about them, and to then become their own teachers of professionalism.
References Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nursing Education Research, 30(2), 79−82. Baxter, P., Akhtar-Danesh, N., Valaitis, R., Stanyon, W., & Sproul, S. (2009). Simulated experiences: Nursing students share their perspectives. Nurse Education Today, 29, 859−866. Blum, C. A., Borglund, S., & Parcells, D. (2010). High-fidelity nursing simulation: Impact on student self-confidence and clinical compe-
129 tence. International Journal of Nursing Education Scholarship, 7(1), 1−14. Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing, 66(1), 3−15. Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49(1), 23−28. Hendelman, W. (2009). Medicine and professionalism. Downloaded from www.med.uottawa.ca/students/md/professionalism/eng/about.html. Jeffries, P., Bambini, D., Hensail, D., Moorman, M., & Washburn, J. (2009). Constructing maternal-child learning experiences using clinical simulations. JOGNN, 38, 613−623. Kaddoura, M. (2010). New graduate nurses perceptions of the effects of clinical simulation on their critical thinking, learning and confidence. The Journal of Continuing Education in Nursing, 41(11), 506−516. Kardong-Edgren, S. E., Starkweather, A. R., & Ward, L. D. (2008). The integration of simulation into a clinical foundations of nursing course: Student and faculty perspectives. International Journal of Nursing Education Scholarship, 5(1), 1−16. Leduc, K., & Kotzer, A. (2009). Bridging the gap: A comparison of the professional nursing values of students, new graduates and seasoned professionals. Nursing Education Perspectives, 30(5), 279−284. McKeon, L. M., Norris, T., Cardell, B., & Britt, T. (2009). Developing patient-centered care competencies among prelicensure nursing students using simulation. Journal of Nursing Education, 48(12), 711−715. Neill, M., & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: A literature review. International Nursing Association for Clinical Simulation and Learning, 7(5), 161−168. Sullivan, D. T., Hirst, D., & Cronenwett, L. (2009). Assessing quality and safety competencies of graduating prelicensure nursing students. Nursing Outlook, 57(6), 323−331. Wagner, D., Bear, M., & Sander, J. (2009). Turning simulation into reality: Increasing student competence and confidence. Educational Innovations, 48(8), 465−467. Waxman, K. T. (2010). Development of evidence based clinical simulation scenarios: Guidelines for nursing educators. Journal of Nursing Education, 49(1), 29−35.