Types Of Simulation In Nursing Education

Simulation entered nursing in 1911 with Mrs. Chase, the first mannequin, used to teach students how to turn, transfer, and dress patients. The technology has advanced enormously in the century since, but the idea hasn't changed: give students a realistic, safe setting to apply what they learned in class before they apply it on real patients.

Simulation can feel like one more thing piled onto an already full plate. Here's what the different types look like, what to expect, and how to get the most out of them.

Types of Simulation

You probably know standardized patients, role-playing, and low-fidelity mannequins. Nursing education uses many more, and the shift to online learning during the COVID-19 pandemic pushed programs to develop new approaches.

1. Unfolding case studies change over time in ways students can't predict, building patient assessment and clinical reasoning skills. Many are free, which makes them cost effective.
2. High-fidelity mannequins are computer-controlled, full-body models that closely replicate a patient's responses, physiology, and anatomy. They're the most adaptable form of simulation and usually the most favored, but also among the most expensive.
3. Low-fidelity mannequins include two-dimensional displays, static models, and partial-task simulators. They're the least realistic, but they let students work at their own pace and drill specific skills like CPR or IV insertion.
4. Partial-task simulators are a single body part, such as an arm or head, that let students practice a skill repeatedly without wearing down more expensive equipment.
5. Standardized patients are volunteers who behave realistically to simulate clinical encounters. They sharpen communication and assessment skills like taking a history, getting informed consent, explaining a procedure, and delivering bad news.
6. Role-playing asks students to act out a situation. It needs no props or realistic setting, so it's low cost, and it works well for shifting attitudes or training teams.
7. Virtual reality uses computers and standardized patients to build a realistic simulation. Still new but gaining ground, some VR tools let students care for more than one patient at a time.
8. E-learning covers all computer-based simulation, from a video explaining how to use a device to a complex virtual scenario where students interact with patients and other providers.
9. Combined simulations blend two or more types for more realism and let students practice several skills at once. For example, securing a suture pad to a standardized patient lets a student suture a wound while getting consent and explaining the procedure.

Sample Scenarios by Course

The American Nurses Association recommends that faculty coordinate which courses use which scenarios, so students repeat key skills deliberately instead of stumbling into a new simulation in every class. Some common examples:

Maternal health: Students perform newborn assessments on a simulator or appropriately sized doll and learn to care for a laboring patient, including high-risk situations like hemorrhage.

Leadership courses: Role-playing ethical dilemmas or nurse-to-nurse bullying gives students strategies for handling them.

Pediatrics: Students practice infant assessment, with standardized patients acting as parents or guardians, including scenarios like a guardian who refuses vaccination.

Mental health nursing: Standardized patients lower student anxiety and build communication skills through listening and responding to questions.

Medical-surgical I and II: Students practice recognizing stroke in an older patient admitted for another condition, such as surgery.

Multiple courses: Patient handoffs, handwashing, and medication safety show up across classes because those skills need repetition.

Preparing for Simulation

Both faculty and students prepare. Faculty set up the scenario to meet the learning objectives; students prepare during prebriefing by gathering information, asking questions, and forming a plan.

Faculty

Faculty design scenarios that help students hit the objectives and build the skills they need. They should be trained in simulation and debriefing, per the National Council of State Boards of Nursing simulation guidelines and the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards for Designing Simulation. Other INACSL standards:

• Create a case scenario that gives the simulation context.
• Open with a prebriefing and close with a debriefing or feedback session.
• Provide preparation materials that help students meet the objectives.
• Match the approach to the participant's knowledge, skills, and experience.
• Build a clear starting point showing the patient's initial state, structured activities for engagement, and an endpoint, usually when the learning outcomes are met.

Students

Students prepare during prebriefing, and the type of simulation shapes how. Common steps:

• Review key skills like surgical technique or IV insertion.
• Prepare a plan of care and questions for the patient or guardian.
• Listen during the prebriefing.
• Talk through your approach with classmates.
• Research the patient's condition.

What to Expect

Effective simulation runs in three phases, and both faculty and students need to engage with all three.

Prebriefing tells students what to expect, setting up the scenario, outcomes, and objectives. The instructor sets ground rules and makes clear that mistakes are fine; you'll work through them in the debriefing.

Simulation opens with a clear starting point and context. The activities are built around the participants and their level, designed to teach skills and rehearse what they'd do in a real clinical situation. It ends when the objectives are met.

Debriefing follows immediately. Students get feedback, discuss mistakes and how to improve, and reflect on their performance, folding what they learned into what they already knew.

Pros and Cons

Simulation gives students a safe place to practice as much as they need without risking patients. It also has limits: it's expensive, it can't fully replicate a real clinical situation, and a poorly designed scenario can teach the wrong thing.

Pros

• No harm to patients
• Real-time feedback
• A safe environment
• Less dependence on clinical sites
• Repeatable until the student masters the skill

Cons

• Can be costly
• Can't replicate every element of a clinical situation
• Requires faculty trained in simulation
• Poor design can teach incorrect information