The Nursing and Midwifery Council’s (NMC) new proficiencies for registered nurses are hot of the press, so to new thinking and guidance about the use of simulation within pre-registration nursing curriculums.
Prior to the new standards being launched, there was a cap of 300 hours that could replace or count towards practice hours. In the new standards there is no limit, instead opting for a less prescriptive approach that will allow greater innovation and development of worthwhile learning experiences for students. This brings great opportunity but also challenge at a time of unprecedented change for universities, with turbulent recruitment and the inevitable service transformation that brings. Practice partners are also in a period of change with increasing complexity and demands on services as well as new and changing roles and responsibilities within the workplace that required different and evolving levels of competence.
Simulation is an approach to learning that seeks to mimic ‘real-life’ situations in a safe environment. Simulation uses a variety of techniques such as videos, low to high fidelity/technology, virtual and augmented reality, gaming, role play and many more. Simulation can focus on developing psycho-motor skills, communication skills, human factors and as well as clinical reasoning. Debriefing from simulation is considered a very important aspect of the simulation experience, arguably the most important. A tool which seeks to structure a process of reflection with learners, it allows a forensic review of a learners thinking and actions in a given situation. Debriefing if done correctly explores the relationships between the scenario background, the rationale for any interventions or omissions, the associated factors that may have influenced decisions being taken and what should be done again or be done differently. It also provides a platform and opportunity to develop further learning activities for students that will continue the learning beyond the simulation experience.
As the expectations upon newly qualified nurse grow, so to the importance of providing a range of opportunities for pre-registration students to gradually develop their confidence and competence in demonstrating the knowledge, skill and attitude required of a registered nurse. Educators can be constrained by a range of factors that can preclude effective simulation activity. These might include; access to the correct or appropriate space, equipment, enough staff to facilitate or enough time to provide consistent, correctly sized groups for simulated activity.
While facilitators will often evaluate how students feel and what they perceive they have gained from the experience, evidence remains scanty in demonstrating links between simulation activity and outcomes. Students generally like the opportunity to rehearse the delivery of care in this way, identifying perceived improvements in confidence and competence. We also know that not all students take it seriously, partly due, I would suggest, to the way simulation is set up when dealing with large numbers of students. There are also a smaller number of students who are absolutely terrified by the prospect of simulation often through a bad experience or a misunderstanding of what simulation seeks to do.
Simulation is a valuable approach to learning for all healthcare students. Much of the discussion in higher education is about how much simulation we do. I would argue it is less about the volume and more about the quality of the simulation undertaken with students that truly allows confidence, competence, critical thinking and clinical reasoning skills to be developed.
Hopefully through this twitter chat we will get a chance to hear and understand what students think about their experiences of simulation and take the opportunity to start the conversation about how we should approach simulated learning for pre-registration students ahead of universities undertaking their upcoming validations against the new NMC pre-registration education standards.
By Gary Francis (Associate Professor, Practice Skills & Simulation, London South Bank University)