Lessons for Life: Simulation Labs Enhance Nursing Education Through Fail-Safe Learning
To those unfamiliar with the College of Health and Human Services, the third floor looks like many others in an academic building on UNC Charlotte’s campus. However, behind many of the card-swipe-access doors stand Learning Resource Center classrooms, where simulation labs are transforming the learning process for students and faculty, especially in the School of Nursing.
Traditionally, nursing has used an apprenticeship model, where making and subsequently learning from a mistake may be at the disadvantage of a patient and the learner. Simulation labs challenge this dynamic by placing students into safe environments where they perform supervised clinical simulations, made realistic through the use of technology.
The Learning Resource Center offers several simulation labs, including the Marilyn Greene Smith Living Learning Laboratory, which is designed and furnished like an apartment so students can gain skills in the care of clients in the home setting. There is also the Maternity/Pediatric Resource Lab, which features a high-fidelity patient simulator called a manikin, baby and toddler manikins, and fully equipped infant cribs and bassinets.
Other labs such as the Clinical Simulation Lab and the Nursing Skills Lab feature a variety of models and culturally diverse manikins, as well as fully equipped health-care technology to simulate clinical environments.
“The simulation labs are amazing,” said nursing student Devin Yates. “They allow us to practice our skills on a seemingly live simulator before real patients. We can develop our skills and work out any challenges we may have before getting to a human.”
Scenarios Created
Learning Resource Director Colette Townsend-Chambers underscores Yates’ point about skills development. “Simulation allows us to create a scenario for students to embed themselves in; they take what they have been given on paper and bring it to life,” said Townsend-Chambers, a registered nurse (RN) and lecturer. “We want our students to be prepared and marketable in the workforce. Simulation is the part of the process to get them ready.”
Nursing students participating in this environment are required to have a nurses’ aide certificate, which requires 50 hours of patient contact. Students formally begin simulation experiences in the first semester of their senior year but receive an orientation in their first semester of nursing school and a day of simulation in their sophomore year.
For many students, the step from learning to application is a significant one. “Through the use of the simulation labs I gained comfort and skills pertaining to direct patient care,” said Shieka Pharr, a recent graduate of the RN program. “The greatest dilemma many new grads encounter is when to act. What I learned as a student and new graduate is that there is book knowledge and then there are skills.”
Working together, future nurses find the labs to be an arena for both self-discovery and teamwork, according to Yates. “Having served in the military and training in many medical areas, I was able to help my clinical group learn to start an IV. Over my time serving I started hundreds of IVs, so my skills are polished. I used those skills to help my class.”
Expanding Simulation Use
Townsend-Chambers said the curriculum will soon integrate simulation into nursing students’ junior year.
“We feel it’s important that simulation is integrated into every cohort,” she said. “Whether it’s a patient with heart disease or a pregnant woman giving birth, the students get to go through the paces before they’re out on the real floor.”
Simulations start with a scenario and objectives from an instructor; then, students create a nursing plan and carry out simulations. Students must think immediately and apply information they’ve learned in increasingly rich simulated environments, rather than simply regurgitating memorized information.
Making manikin “patients” look realistic helps with the process. “We apply makeup and recreate body fluids to stimulate how injuries look and feel,” said Townsend-Chambers. “It’s been a process of learning different tricks on how to make things look ‘real’ in order to increase the fidelity and suspend their (the students’) disbelief.”
The Learning Resource Center also aims to create diverse scenarios. Instructors incorporate other health-care professionals such as social workers or LGBT patients.
“With diversity challenges coming out, we need to utilize simulation much more than we currently are to prepare our students to be not only competent but culturally sensitive as well in their care for all clients,” Townsend-Chambers said.
Planning for the Future
The College of Health and Human Services (CHHS) is currently completing a strategic assessment involving all simulation resources for each of the four academic units and the college as a whole. Improving the capacity to document student performance within a variety of simulations using video assessments will be a key element in upgrading existing simulation capability. According to Lanny Inabnit, an instructor in the respiratory therapy program, video assessments and debriefs can be powerful teaching tools.
“Students are using the real equipment they’ll use in a critical-care unit. We can really simulate any lung mechanic and then troubleshoot it,” said Inabnit. “The biggest thing with simulation is that it allows students the capability to learn and fail; they can reset after a mistake and not cause real-world damage or danger.”
Another part of the strategy for expanding simulation at the college level is to integrate emerging technology, such as telepresence, room-scale virtual reality, wearable fitness sensors and augmented reality. Integrating new technology will prepare students for workplaces that in the near future will feature a rapidly changing technical environment that could include video consults with clients and fellow professionals or 3-D printing of casts and other medical equipment.
The challenge for the college is to build a network of technological resources and to bring that content into the classroom, in addition to helping faculty see the functionality between the equipment and curriculum.
Council Meets on Campus
During the last academic year, the North Carolina Nurses Association Simulation Council held its biannual meeting at UNC Charlotte. Council members discussed current standards for conducting simulations to increase and enhance students’ clinical learning. They also talked about the promotion of formal education for simulation educators.
“We had about 550 people tour the lab last year,” said Townsend-Chambers, talking about council members and others. “These are experts from the field, and we were fortunate to have them come from all over the state to our school. They were really excited about our manikins and the space we have.”
The council also discussed the promotion of inter-professional simulation, an area in which CHHS wants to lead.
“We’re starting to collaborate more with other departments. In the clinical setting, it won’t just be nurses working with nurses; there are social workers, respiratory experts, physicians, X-ray techs and many other field professionals for nurses to learn to work among,” said Townsend-Chambers.
An Edge for Students
In education today, simulation is an essential tool to help the School of Nursing fulfill many goals — to prepare students for a changing demographic population, serve as part of the solution in health care and serve as experts in the evidence-based practice of nursing science.
In 2016, the school acquired seven new high-fidelity manikins, or patient simulators. Such use of the technology has not gone unnoticed. The School of Nursing was named a 2016 Center of Excellence in Nursing Education, recognizing the school’s innovations, commitment and sustainability of excellence.
CHHS’s commitment to simulation helped earn the school the excellence award and provides students an edge, said Pharr, the recent RN graduate. “I would encourage all students to take advantage of the simulation labs and explore their skill sets while the opportunity presents itself; this will make the transition to practice much easier.”
And health care is all the better for it.
by: Tayler Green and Wills Citty
Tayler Green (’17) was a communications intern in the College of Health and Human Services in spring 2017. Wills Citty is the director of communications for the college and for the Cato College of Education.