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The goal of this page for you to learn about the future of Nursing. As our iPhones get upgrades so does the world of medicine. We chose this particular topic not only to present but get familiar with new technologies. It is vital for us professionals to always stay ungraded!
Please explore the innovation in areas such as Voice-Activated  Communications (green color), Game and Simulation Technologies (blue), Virtual Reality (purple) and Mobile Devices (red).
Please find the questions for the assignment in the comment area at the bottom of the page.

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Use of mannequins in various colleges for simulations to perform assessments, run cardiac codes, etc
To learn more:

https://magazine.nursing.jhu.edu/2011/07/virtual-reality/

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Electronic simulation technology to complete BLS and ACLS.

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The implementation of mobile technology allows nurses to spend more time at the bedside to care for their patients. Epic, an Electronic Health Record system, has a mobile app for nurses to quickly access their patient list, conduct barcode validation, and perform clinical documentation all at the bedside. The following links show that mobile apps can be a powerful tool to help nurses safely care for their patients.

https://www.epic.com/epic/post/epic-rover-prevents-med-errors-nationwide

https://appadvice.com/app/epic-rover/583359867

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Voice -Activated Communications                CHECK OUT THIS, ON VOCERA!!

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Voice -Activated Communications                CHECK OUT THIS, ON VOCERA!!

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The Vocera platform can connect healthcare professionals securely to the information about their patients in real time. This is just a taste of what vocera can do for a hospital system. Evidence suggests that information technologies can promote nursing practice and patient satisfaction and quality of care
(Warshawski, Itzhaki, & Barnoy, January 2019).
https://embed.vidyard.com/share/w7947daLzbPS3FonApyfry?

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Bring Care Together with the Vocera Platform

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In a single hospital unit or across an entire health system, the Vocera Platform helps you bring care together to unify care teams, priorities, and information around the patient.

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Article focusing on simulation based learning and the absolute necessity to include in nursing schools on all levels. Online Journal of Issues in Nursing

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Michelle Aebersold, PhD, RN, CHSE, FAAN

Simulation, once the domain of those faculty who enjoyed the technical aspects of using computerized mannequins, has now moved to center stage in nursing education. Nursing programs realize that they can no longer afford to consider simulation as merely an 'add-on.' Simulation today includes role play, standardized patients, virtual simulation, and computerized mannequins. It is now imperative to integrate simulation throughout the entire curriculum. Today, simulation allows students to learn skills; develop clinical reasoning abilities; and to become competent in caring for patients/families in a safe environment. The variety of simulation-based learning options can offer a way to replace traditional, and often hard to find, clinical experiences. In this article, the author describes the background, theoretical basis, and current uses of simulation; reports on simulation effectiveness in nursing; shares educational strategies to enhance effectiveness; and considers simulation methods and feedback and debriefing strategies. The conclusion addresses simulation evaluation, and the future of simulation in nursing education.

Citation: Aebersold, M., (April 3, 2018) "Simulation-Based Learning: No Longer a Novelty in Undergraduate Education" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2.

DOI: 10.3912/OJIN.Vol23No02PPT39

Key Words: undergraduate education, simulation, virtual reality, simulation standards, mannequins, patient safety, NCLEX, NCSBN, research, fidelity

...simulation-based learning has matured as an educational strategy and research about this area has increased. Simulation in undergraduate (UG) education has become one of the new policy areas to which leaders in both nursing education and practice will want to pay careful attention. As the nursing shortage increases, the number of faculty available to educate new nurses decreases. The number and availability of clinical sites is diminishing ( American Colleges of Nursing, 2017), and we will need to rely increasingly on simulation to fill the gaps. The good news is that simulation-based learning has matured as an educational strategy and research about this area has increased. However, there remains much work to be done.

In this article, I will briefly discuss the background of simulation; address the theoretical basis, and the current uses of simulation; report on simulation effectiveness in nursing; and share educational strategies to enhance simulation effectiveness. I will discuss simulation methods, including feedback and debriefing strategies; consider simulation evaluation; and share my insights on the future of simulation opportunities for undergraduate nursing education.

[Simulation] is not defined by a technology but rather an educational approach grounded in learning theories. Simulation-based education is an educational or training method that is used to "replace or amplify real experience with guided experiences" ( Gaba, 2004b, p.i2). It is not defined by a technology but rather an educational approach grounded in learning theories. Simulation is meant to replicate aspects of the real world in an interactive manner that allows learners to be immersed in the learning environment ( Gaba, 2004b; Jeffries, 2012). Aviation and the military have used simulation to train pilots and personnel in both skills and safety-related behaviors (e.g., communication and teamwork), for many years ( Aebersold, 2016). Historically, simulation in nursing has been used primarily in undergraduate (UG) education to teach nursing skills.

The first mannequin was a life-size doll named Mrs. Chase. She was built in 1911 by a doll maker, Martha Jenkins Chase, to train nurses to dress, turn, and transfer patients ( Weir, 2012). Some early 'sim labs' were called demonstration rooms, the skills laboratory, or the nursing laboratory ( Nickerson & Pollard, 2010). Nursing students would practice on mannequins, such as Mrs. Chase, or on each other by using various training devices to learn to administer injections, insert a nasogastric tube, and other basic nursing skills.

In the 1990s there was a significant change in the world of educational simulation, a change that impacted the nursing skills laboratories. Companies, such as Laerdal™ and Medical Education Technologies, Inc. (METI), developed affordable, high fidelity simulators based on the earlier pioneering work of David Gaba and others ( Gaba, 2004a). METI was bought out by CAE™ which is now a major producer of high fidelity simulators, along with Gaumard Medical™, and Laerdal™. Subsequently, nursing education has moved from a traditional skills laboratory into the world of high fidelity simulation (HFS).

...although a sophisticated, computerized mannequin can produce a high fidelity simulation, so also can an actor who is playing a role. Many think of high fidelity simulation as highly sophisticated, computerized mannequins that can mimic the body's physiology. However, it is important to recognize today that, although a sophisticated, computerized mannequin can produce a high fidelity simulation, so also can an actor who is playing a role. Fidelity refers to realism or the ability to replicate the real 'thing' that the simulator or actor is representing. Therefore, high fidelity simulation can be done with a high fidelity simulator (i.e., a computerized mannequin) or a live person. There are a variety of simulators available, as well as several different simulation methods. The most common methods utilize computerized mannequins, role-play, standardized or simulated patients, and virtual simulations. There is now a Healthcare Simulation Dictionary, which includes all commonly used terms in simulation (Loprieato et al., 2016).

Since the 1990s there has been a tremendous amount of knowledge and research in the area of simulation-based learning. Some very important, landmark studies have been completed. Simulation has become a cornerstone of UG nursing education. It is important to understand benefits and policy implications of this shift.

Simulation-based experiences (SBEs) most often occur in a simulation laboratory setting in which the UG students come for a defined period of time and engage in activities specifically designed around a set of learning objectives. These activities are developed into simulation scenarios. The scenario contains the learning objective, the patient information (e.g., background, current condition, medications, and other relevant information), actor scripts as needed, information for the high fidelity simulator, a timeline for the unfolding of the scenario, cues needed by the facilitator to help the action flow along, and other essential information to ensure that the simulation-based learning education experience is successful.

Simulation-based education is a learner-centered approach, grounded in learning theories based on constructivism. Several educational learning theories and conceptual models guide development of SBEs. Some of the more popular ones are described below. Simulation-based education is a learner-centered approach, grounded in learning theories based on constructivism. As such, learners create their own reality and truth. To support this type of learning, activities include discussion, self-reflection, and questioning so that learners can engage actively in the learning process ( Kriz, 2010).

One popular learning theory often used to guide and develop SBEs is Kolb's Experiential Learning Theory (ELT) ( Kolb, 1984). This theory has four steps (concrete experience, reflective observation, abstract conceptualization, and active experimentation). These steps form a continuous cycle. As applied in SBEs, concrete experimentation occurs initially when learners or students engage in a simulation scenario, such as caring for a simulated patient (i.e., a high fidelity mannequin) who is experiencing a stroke. After the scenario ends, students engage in reflective observation as they debrief and reflect on their performance during the simulation and identify any gaps. The next step is abstract conceptualization. During this step, or phase, the facilitator of the SBE helps learners create or adapt their mental model to incorporate what they have learned. This is where learning occurs and where knowledge can transfer into practice when the next opportunity arises. The process in which learners put newly gained mental models into practice is referred to as the active experimentation step ( Zigmont, Kappus, & Sudikoff, 2011).

An additional theory is the NLN/Jefferies Simulation Theory ( Jeffries, Rodgers, & Adamson, 2015). This theory evolved from the NLN/Jeffries Framework ( Jeffries, 2012). It includes context, background, and simulation design characteristics. These elements lead into the simulation experience itself, which includes a dynamic interaction between the facilitator and the learner through the use of appropriate educational strategies. Outcomes occur in three areas: the system, the patient, and the participant. Adamson ( 2015) conducted a systematic literature review that included 153 articles; findings from this review supported the major components of the NLN/Jeffries ( 2015) framework.

...faculty have integrated simulation into many different undergraduate courses. A review of current literature demonstrates that faculty have integrated simulation into a many different undergraduate courses. This section will describe how simulation has already been integrated into a number of nursing programs via undergraduate course content that includes mental health, end-of-life care, mass causality situations, anatomy, and intradisciplinary and interdisciplinary communication (virtual simulation).

Mental Health
In the mental health undergraduate curriculum, use of standardized or simulated patients (SPs) (trained actors) has been found to reduce student anxiety and develop interview and therapeutic communication skills, thus increasing student confidence prior to the clinical experience ( Doolen et al., 2014). Another use of simulation in mental health nursing is to involve students in 'voice-hearing' simulations, to give them an opportunity to appreciate what it is like to live as a patient with auditory hallucinations, and to help them understand the behavioral risks associated with these conditions ( Orr, Kellehear, Armari, Pearson, & Holmes, 2013).

End-of-Life Care
Simulation at the UG level also helps students learn to provide appropriate end-of-life (EOL) care for patients and families. Students receive didactic information in class ( Allchin, 2006), yet seldom have an opportunity to care for dying patients during clinical rotations. Through simulation, however, students are exposed to EOL in several ways.

Students agreed that this type of multi-patient simulation experience improved their ability to prioritize patient needs, resolve conflicts, and track multiple responsibilities. One UG EOL simulation experience centered on an elderly patient with lung cancer that had metastasized to the liver and bone. This patient was admitted for palliative care ( Fabro et al., 2014). After students participated in this scenario, caring for the patient and family with the goal of managing the patient's pain and the family's grief, they completed a qualitative questionnaire about their experience. Students described their experiences as awkward and uncomfortable, and with feelings of sadness and helplessness. However, they also learned about what a 'good death' can look like, and how difficult it can be to administer medications and assess vital signs while the family is crying. Students went on to say that they gained new knowledge and hoped they would remember this experience when they cared for similar patients in the future.

Another multisite study about EOL care considered knowledge, self-confidence, and communication skills among baccalaureate, associate degree, and accelerated baccalaureate degree pre-licensure students. The setting for this simulation was a hospice setting. The 336 students who participated in the simulation demonstrated a significant increase in knowledge, self-confidence, and perceived communication skills ( Fluharty et al., 2012).

Mass Causality and Multi-Patient Situations
Simulation has also been used in disaster training for UG nursing students. Collaborating with a local health center to participate in a mass causality event can provide an opportunity for nursing students to experience the role of triage and also for teamwork with other care providers. Austin et al. ( 2014) found that senior nursing students, under the guidance of pediatric nursing faculty, were able to successfully participate in a community-wide, mass-causality event that increased their understanding of the disaster response process, role clarity, and teamwork. Additionally, Horsley et al. (2014) have developed a multi-patient simulation to prepare students to care for multiple patients at a time on an inpatient unit. Students agreed that this type of multi-patient simulation experience improved their ability to prioritize patient needs, resolve conflicts, and track multiple responsibilities.

Anatomical simulation is another area of virtual reality that continues to grow. Anatomical simulation is another area of virtual reality that continues to grow. Some schools are investing in virtual anatomy tables that allow students to visualize patient anatomy by 'virtually dissecting' patients ( Choi, 2013). Future technology in this area will include immersive virtual reality and augmented reality. Immersive virtual reality is currently represented by two major companies, Oculus, which makes the Oculus Rift, and HTC, which makes the Vive. Websites for the Oculucs Rift, HTC, Vive, and other Virtual Resources (VRs) are presented in Table 1.

These resources use head-mounted displays to immerse the wearer into a three-dimensional, virtual world that completely visually isolates them from the physical world. The devices can be used for skills training (e.g., practice to insert a small bore feeding tube or perform a sterile procedure). Augmented reality enables a virtual object or image to be projected into the room or onto an object, such as a simulator. Microsoft® has developed the HoloLens, which is the current product in this market. This is very new technology and currently is at the 'proof of concept' testing stage.
Table 1. Virtual Resources
Intra and Interdisciplinary Communication (Virtual Simulation)
Many educational institutions have developed islands into spaces where faculty can engage in virtual simulations. Virtual simulations are a small but growing part of UG simulation experiences. Some virtual products currently in use include: Second Life® (Linden Labs); vSim® for Nursing (Laerdal); and Shadow Health™. Second Life®is a three-dimensional virtual world built by Linden Labs that enables people to visit as avatars. This is done by downloading a free computer program, creating a free account, selecting an avatar, and traveling to various 'open' spaces called islands. Many educational institutions have developed islands into spaces where faculty can engage in virtual simulations ( Aebersold, Tschannen, Stephens, Anderson, & Lei, 2012).

A systematic review of studies published on the experience of using Second Life® in UG education found that although positive learning can occur, Second Life® is an emerging technology; further research is needed to enable this platform to become a common teaching strategy ( Irwin & Coutts, 2015). Virtual simulations using Second Life® have been an acceptable method for teaching students from different professional backgrounds to work together as a team to deliver difficult news to patients. Caylor, Aebersold, Lapham, and Carlson ( 2015) studied 21 students from nursing, pharmacy, and medicine who participated in a multi-professional simulation in which they had to disclose to a 'virtual patient avatar' that a medication error had occurred. Students rated the experience as realistic, effective, and a convenient platform for learning.

Early research has shown that students view these experiences positively... For comparison vSim® and Shadow Health™ are both commercial products that contain pre-built cases and activities. vSim® is a computer simulation that allows students to care for patients with a variety of healthcare needs. This product includes scenarios for students taking courses in medical-surgical concepts, maternal-child health, gerontology, fundamentals, health assessment, and pharmacology. Because this technology is very new, there are few published studies evaluating its use. However, some UG programs are counting simulation technologies, such as vSim, as part of clinical replacement hours (personal communication, B. Cambridge, September, 2016). Early research has shown that students view these experiences positively and recommend their use ( Foronda et al., 2016). Another study found that the addition of vSim in a fundamentals nursing course increased student knowledge significantly when compared with that of other students who received only the usual course content ( Gu et al., 2017).

Another commercial, virtual-simulation experience is CliniSpace™, an online, virtual, clinical environment developed with Unity, an open-source game design platform. CliniSpace™ has developed a game-like environment where nurse and physician avatars can interact and deliver care in patient care units. Foronda et al. ( 2014) used this virtual world to pilot a simulation with UG students to determine whether simulations focused on handoffs would improve their skills. After a series of two simulations, significant improvement was noted in student scores on the Identify, Situation, Background, Assessment and Recommendation (ISBAR) rating sheet, thus supporting the ISBAR process as a safe process for transferring patient information in clinical handoffs.

Nehring and Lashley ( 2009) published their 40-year review of simulation, finding that simulation was used in nursing education in many forms, including standardized patients, computerized instruction, and mid- and high-fidelity simulators (HFSs). They predicted that the use of simulation would grow in nursing education; yet they cautioned that standards needed to be developed to ensure that quality education would be associated with its use.

Simulation-based education today has matured to the point where we have good evidence to demonstrate effectiveness. Simulation-based education today has matured to the point where we have good evidence to demonstrate effectiveness. A recently published 'review of reviews' found seven review articles on HFS in the last ten years that focused on UG nursing education and HFS ( Doolen et al., 2016). Of the five integrative reviews, three validated simulation as an effective teaching-learning strategy in pre-licensure nursing education. Behaviors addressed in these reviews included medication safety, handwashing, communication related to safety, knowledge acquisition, and knowledge transfer. Also noted in these reviews, however, were a lack of randomized studies, few valid and reliable measurement tools, and overuse of 'confidence' as an evaluation measure. To date, both the topic of pre-briefing and that of debriefing have not been studied sufficiently in nursing.

Another review by Cant and Cooper ( 2017) found that simulation has become a well-accepted method of learning by students, a method which enables them to reconcile theory with practice. Study outcomes demonstrated the positive impact of simulation on knowledge acquisition, psychomotor skills, self-efficacy, satisfaction, confidence, and critical thinking skills.

For students who had either 25% or 50% of their hours replaced with simulation, there was no difference in NCLEX pass rates or end of program educational outcomes... The most significant research to date to influence nursing education at the pre-licensure level was a two-part study conducted by the National Council of State Boards of Nursing (NCSBN). The first part was a randomized, controlled trial looking at the effectiveness of simulation in UG nursing; the second part was a survey study of the new graduates and their managers during their first six months of employment ( Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). This study measured the effect of simulation as a replacement of clinical hours for either 25% or 50% of each school's total clinical hours. The control group could have no more than 10% of student clinical hours replaced by simulation. For students who had either 25% or 50% of their hours replaced with simulation, there was no difference in NCLEX pass rates or end of program educational outcomes when compared with students who had more clinical time. Students also perceived that simulation enabled their learning needs to be met; that they could perform well on tests; that they could synthesize content they had learned; and that they did well in all subject areas (pediatrics, maternal child, mental health, medical-surgical, and community health).

...results demonstrated that clinical hours can be effectively replacement by simulation. Phase two of the study ( Hayden et al., 2014) followed students into their first jobs. In this phase, managers were asked to rate the new graduates readiness for practice and overall global competency. That there were no differences between the three groups was important, because these results demonstrated that clinical hours can be effectively replacement by simulation. It also identified best practice methods for conducting those simulations.

After completion of the study, the NCSBN convened a panel of experts in simulation who put forth a set of guidelines ( Hayden, et al., 2014). These guidelines were based on the study ( Hayden et al., 2014); International Nursing Association for Clinical Simulation and Learning (INACSL); Standards of Best Practice: SimulationSM; and current knowledge of best practice from the study ( Hayden et al., 2014). As a result of the study, some state boards of nursing have started to incorporate these recommendations into nursing school guidelines.

As these state boards begin making decisions about how many clinical hours can be replaced, some boards that offered no guidelines in the past have started moving to implement a 25% or 50% replacement with the adoption of NCSBN guidelines. The National League of Nursing (NLN) has also been a significant contributor to the educational and research efforts with simulation. The NLN has published a visionary statement endorsing the study and making some very strong recommendations to deans, directors, and chairs of nursing programs, and to faculty on how best to support and incorporate simulation into UG programs ( NLN, 2015).

...simulation done poorly, or poorly integrated into the curriculum, will not be any better than the traditional clinical approach. Simulation has become a significant part of the UG curriculum. It is a theory-based, effective teaching method with a growing body of research evidence support. With nursing schools facing a growing shortage of clinical placements ( American Colleges of Nursing, 2017), as well as restrictions on the activities in which nursing students can engage, simulation provides an effective alternative to clinical training. One might argue that simulation can be more effective than the 'see one, do one, teach one' model that has often been the mainstay of the clinical teaching model. However, simulation done poorly, or poorly integrated into the curriculum, will not be any better than the traditional clinical approach. Teaching via simulation must be done as carefully as any other new teaching method. It requires a careful, thoughtful approach to ensure success for both students and faculty. The paragraphs below describe a few strategies for such careful and thoughtful approaches.

Curricular Mapping and Integration
To begin, it helps to think about using a curriculum development strategy. Examples of these include the Six-Step Curriculum Development Process for healthcare education ( Thomas, Kern, Hughes, & Chen, 2016) which starts with a needs assessment and ends with evaluation and feedback. You can also find other excellent resources at the National League of Nursing-Simulation Innovation Resource Center (NLN-SIRC), including a faculty toolkit that contains curriculum integration information and links to helpful resources ( NLN, n.d.). These resources promote simulation not just as something to add to a course, but as a strategy to integrate throughout the entire curriculum.

...it is important to create a curricular map of the concepts and high-level learning... To gain the most value from simulations, it is important to create a curricular map of the concepts and high-level learning occurring in each simulation for each course. This ensures that you are not focusing on the same topics in each simulation (e.g., simulations in pediatrics, maternal health, and community health that all focus around the death of a newborn). Unless each one will teach something novel, or the goal is to ensure scaffolding of learning in a particular area, you are likely repeating something without purpose due to a lack of awareness about what others are doing. A better way to approach this is to meet with key faculty from different courses to explore what is done, or might be done, in simulation, and then determine how student needs can be best met overall. However, there may still be skills or concepts (e.g., patient handoffs or medication safety) which merit repeating in many simulations because they are key skills.

Simulation Outcomes
...it is critical to establish ground rules during the pre-brief period so that students understand expectations. Simulation allows students to practice caring for 'patients' in ways that they cannot in the hospital or other settings. Faculty are encouraged to leverage this freedom to give students experiences that they may not get in ordinary clinical settings. For example, faculty can have students play the role of the nurse (not student nurse). Students need to practice the role of the bedside nurse, to include making decisions, calling other healthcare providers, documenting without a co-signer, and administering medications independently. This experience offers students the opportunity to evaluate how well they can perform, while remaining within a safety net. To do this, it is critical to establish ground rules during the pre-brief period so that students understand expectations. They need to know it is okay to make mistakes, and that those mistakes will be discussed during debriefing, giving them the opportunity to learn from the mistakes and consider ways to improve.

Simulation can be incorporated into the curriculum as a way to support student achievement of knowledge, skills, and attitudes (KSA) and competencies needed to attain the overall program goals set forth by the school curricular plan. These goals also link curriculum planning to program accreditation; the National Council Licensure Examination (NCLEX) test outcomes; the Quality and Safety in Nursing Education (QSEN) competencies; The Joint Commission Safety Goals; and other areas. Simulation can be included in either formative or summative assessment methods, as long as faculty are clear with students regarding the goals of a given simulation experience. Developing curricular maps with the simulation scenario, major content, and concept threads is the best way to track what you are doing in simulation. Table 2 offers some specific ideas for incorporation of simulation into the curriculum.
Table 2. Simulation Ideas for Undergraduate Nursing Education

Pediatrics

Create a simulation for students to practice infant assessment in a clinic setting.

Create a challenge when parents state they do not want their child to receive vaccinations.

Add a cultural dilemma or language barrier.

Pediatrics

Asthma

Patient handoff/Transitions of care

Nurse Role(s)

Create an unfolding set of simulations where a school age child has an acute exacerbation of asthma at school. The school nurse follows her asthma action plan, calls EMS and the child goes to the ED. There is a handoff to the inpatient unit or an observation unit where the child receives care.

Maternal Health

Students need to understand the care of the laboring mom, so it would be important to learn to care for a mom in labor. For simulation centers that do have access to a birthing simulator there are options such as:

Mama Natalie® by Laerdal (less than $1000)

Parto Pants™ (Pronto) another low cost solution; worn by a student or SP.

Both allow for normal or complicated deliveries.

Newborn assessment can be done using a newborn simulator or even a doll that is appropriately sized.

Maternal Health

Managing obstetrical emergencies

Post-partum hemorrhage

Teamwork

Communication

Situational awareness

Conducting a simulation on post-partum hemorrhage is essential in the maternal health curriculum. This simulation can be found in most vendor-offered packaged curriculums or other free resources. This teaches students to recognize and manage an area with a high rate of mortality as well as many other important skills.

Medical-Surgical

Cardiac

Respiratory

Sepsis

Stroke

Acute MI

Patient handoff

Medication Management

Multiple patient management

Communication

Critical Thinking

The importance of simulation at the medical-surgical level is focus on:

developing student clinical judgment and skills

determining how to prioritize assessments

gathering data

making decisions

implementing interventions correctly

reflecting about what they are doing

The content is less important. This is not the time to load content that does not seem to fit elsewhere. This is an opportunity to think about key patients for whom it would be great if every student had an opportunity to provide care.

Medical-Surgical or Advanced Medical-Surgical

Focus on a case to assist students to recognize signs of a stroke in a patient who is in the hospital for another problem, such as an elderly man who had a hip replacement and has a history of atrial fibrillation and sleep apnea.

This will teach students to recognize a stroke and learn how to react in a crisis. This type of simulation generally requires a high-fidelity mannequin.

Leadership

Impaired nurse

Nurse-to-nurse bullying

Root Cause Analysis for a Sentinel Event or medication error

In leadership courses, simulation can be used to address topics nurses face on the unit. There are articles and resources available to assist in developing simulation on these topics. Students find it beneficial to learn how to deal with nurse-to-nurse bullying and they need opportunities to role-play these types of strategies.

There are many simulation methods from which to choose... The key is selecting the technology or method that provides for active engagement with the learner. There are many simulation methods from which to choose, as evidenced by the review of types of simulation used in various areas. The challenge for faculty and simulation educators is choosing the most appropriate methods. In the Simulation Model for Improving Learner and Health Outcomes (SMILHO), Aebersold and Titler ( 2014) address this challenge. The key is selecting the technology or method that provides for active engagement with the learner. This links back to the theoretical models upon which simulation is based. If the goal of the simulation is to practice therapeutic communication skills, then using a standardized simulation patient (SP) will be the 'best' option. Another option would be to use a mannequin and provide the voice for the mannequin through a microphone placed near the mannequin's head with the faculty providing the voice. You do not need a sophisticated computerized (i.e., high-fidelity) mannequin. Rather you can use any mannequin; by adding clothes, a wig, and glasses, one can simulate a person.

Standardized or simulated patients can also be effective to play family members in simulations that include role play (e.g., a mom of an infant coming for a well-baby checkup). Students could then interview mom to provide a history for baby. A simulation patient can create tension around immunizations for baby when parents are unwilling to have their child vaccinated. Although students could play this role, younger students often lack the life experiences for effective role play unless they have some background in the specific area or perhaps have been students in the performing arts.

If students are practicing a specific skill, such an intravenous or Foley catheter insertion, you only need a task trainer or a 'body part' (e.g., an arm or torso). These allow students to practice the skill and do not tie up mannequins or increase 'wear and tear' on expensive equipment. It is best to use mid-fidelity or mid-level mannequins for mid-level students practicing basic scenarios. Although these mannequins often lack more sophisticated features (e.g., chest movement, pupillary response), they can produce vital signs such as lung and heart sounds. They can be used successfully to run many simulations, such as identifying changes in lung sounds during early congestive heart failure or performing a priority assessment. They are also great for multiple patient simulations that may be run in a skills laboratory along with SPs.

... a newer style of debriefing and feedback is emerging that is showing promising results. It is important to note that in simulation experiences, goals and objectives will likely be different from goals in the clinical area. Simulation is intense and there may only be 2 to 4 learning objectives for a short focused simulation. Learning in simulation occurs primarily during debriefing ( Cheng et al., 2014; Shinnick, Woo, Horwich, & Steadman, 2011) thus it is important that all debriefing facilitators are trained and use a debriefing framework ( Cheng et al., 2014). Most faculty are familiar with common debriefing frameworks; however, a newer style of debriefing and feedback is emerging that is showing promising results. This newer method is based on the deliberate practice work of Anders Ericsson ( 2004). Deliberate practice and feedback, using a pause and discuss approach, provides instant feedback to learners about a skill they are learning and then they 'rewind' and practice that skill again ( Eppich et al., 2015). This can be very effective for certain types of simulations, such as cardiopulmonary resuscitation training, where repetition with feedback is important ( Hunt et al., 2015).

The concept of debriefing is one of the most studied areas in the field of simulation. Faculty must keep informed about current literature and research. They should receive training about debriefing and practice their skills. It is important for faculty to receive feedback from other facilitators, and also students or learners, when possible. There are excellent tools available to help in this regard, such as the Debriefing Assessment for Simulation in Healthcare ( Center for Medical Simulation, n.d.) which offers both faculty and student debriefing versions to provide feedback to the debriefer. Other tools, such as the Simulation Effectiveness Tool (SET), can evaluate student perceptions of the effectiveness of simulation. This tool has been recently modified (SET-M) and has demonstrated good psychometric properties (Leighton et al., 2015).

... measurement of learning outcomes and transfer of knowledge and behaviors is expected, although still not consistent. Research about the effectiveness of simulation has grown from earlier stages, in which learner self-confidence was the only measure, to the present day where measurement of learning outcomes and transfer of knowledge and behaviors is expected, although still not consistent. The most commonly used evaluation framework in simulation is the Kirkpatrick model of training effectiveness ( Kirkpatrick, 1994). This evaluation framework includes four evaluation levels: reaction (satisfaction with the training); learning (increase in knowledge and skills); behavior (the participant performs differently); and results (change is noted). Applying this framework to simulation training provides an effective way to measure how well simulation-based education has improved learner knowledge, skills, and ability to transfer knowledge and behavior to the practice site.

As with all research, it is important to use tools with established validity and reliability and ensure good rater training. Fey, Gloe, and Mariani ( 2015) published a helpful rubric for assessing simulation-research articles. In addition, the 2016 International Nursing Association for Clinical Simulation and Learning (INACSL) Standards for Best Practice: SimulationSM provides evidence-based standards for developing, facilitating, and measuring the effectiveness of simulation-based education ( INACSL Board of Directors, n.d.). Information about the standards can be found on the INACSL website.

Simulation can provide students with opportunities they would not get in the clinical area. Simulation is a safe way for students to learn: they can practice until they achieve skill competency; and they learn how to reflect upon what went wrong; how to self-correct; and how to accept feedback. Clinical sites are often scarce and students may only 'shadow' another person; these clinical learning experiences can be less than optimal. Simulation can provide students with opportunities they would not get in the clinical area.

However, simulation is a different way to facilitate learning. It is not clinical teaching and it is not classroom teaching. To do it well, faculty need to learn to effectively design, facilitate, and debrief simulation-based experiences to meet objectives for learning experiences. Use of virtual simulations needs to become part of the overall simulation program. Although virtual and augmented reality are still in early stages, this option will grow quickly now that the technology is becoming available and affordable. Quality of devices will provide opportunities to train students in skills that required physical trainers in the past, thus opening new opportunities for schools to re-allocate space resources.

Simulation has become a large part of the undergraduate curriculum. It has grown from something that happens in the simulation laboratory by a few faculty who enjoy 'playing around' with technology to an evidence-based, effective learning technology. Use of simulation offers a safe space where students can learn skills they need to be comfortable and competent before entering the clinical site. Although simulation requires a significant financial investment to purchase simulators and provide dedicated space and personnel, there are many advantages to incorporating more simulation into the UG curriculum.

Michelle Aebersold, PhD, RN, CHSE, FAAN
Email: mabersol@umich.edu

Michelle Aebersold, a Certified Healthcare Simulation Educator, is a Clinical Associate Professor and Director for Simulation and Educational Innovation at the University of Michigan School of Nursing (Ann Arbor, MI). Previously she served as Nurse Manager for the Neuro Intensive Care Unit, Neuro Acute Care Area, and the Stroke Unit at Michigan Medicine. Her scholarship is focused on advancing the science of learning as applied in simulation, with the goal of aligning clinician and student nursing practice behaviors with research evidence to improve health outcomes of populations. Her interest in healthcare simulation arose both from her love of video games and from her knowledge about how simulations in other educational areas can help people learn. She publishes extensively, most prominently in the area of virtual simulation. She is also actively involved in the development of simulation standards and in guiding future research efforts related to simulation-based learning.

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© 2018 OJIN: The Online Journal of Issues in Nursing

Article published April 4, 2018

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Simulation-Based Learning: No Longer a Novelty in Undergraduate Education

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Michelle Aebersold, PhD, RN, CHSE, FAAN Simulation, once the domain of those faculty who enjoyed the technical aspects of using computerized mannequins, has now moved to center stage in nursing education. Nursing programs realize that they can no longer afford to consider simulation as merely an 'add-on.'

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Uses of VR devices in for Bedside Procedures

Article by Dr. Hirt shows efficacy of VR to reduce anxiety, pain and discomfort in patients while performing procedures such as suturing laceration, bone marrow aspiration, wart destruction, etc

To learn more:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138477/

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As we continue forward in the twenty-first century, technology continues to evolve to simplify and make our lives more convenient.  Technology has evolved to allow us to access the world through the Internet—initially from a home computer with a dial-up modem to now having the ability to access the Internet through our fingertips on our smartphones and tablets.  It has evolved from playing 8-bit video games on a TV monitor and console to immersing oneself in the video game via a virtual reality console and playing with other virtual reality gamers in real time.  We are now able to turn on lights, adjust the thermostat, play music, and control other creature comforts with our voices instead of having to get up and adjust things manually.  As the world is adapting to the continuous evolution of technology, so is healthcare.  From paper charting to electronic charting, from taking manual blood pressures to using machines that can cycle blood pressures continuously to every 5 minutes to 15 minutes or whichever interval desired, the technology at our fingertips is catching up to the technology at hand.

Precise, clear, quick and secure communication is necessary in today's healthcare. Taking the best possible care of patients today requires collaboration of a multi-multi-disciplinary team. This team needs the ability to communicate securely but safely, and Vocera makes this possible with the touch of just one button, or sometimes with just your voice, keeping your hands free for the many healthcare related tasks necessary to provide the best care. Secure communication that is instant is vital to the fast paced, patient-centered healthcare industry.
Virtual reality is used in a patient's care to alleviate the pain and suffering. It is also widely utilized in academics to create a real time environment for student's practice. Simulation is quickly becoming the forefront of medical education. Being utilized in medical and nursing schools, simulation is a quick, easy way for students to work through scenarios prior to real-life patient care. Gaming technology is being utilized in education as well. As an alternative to traditional in class setting, hospitals are incorporating e-learnings with use of games to achieve annual competencies.

After reviewing the different types of technology available in healthcare, which technology do you feel is most beneficial for the future of nursing or practical in nursing and why?

Does new technological advancements diminish the use of nurses?

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A Vocera badge, which can be answered by just your voice helps save valuable time. You can quickly communicate with just the right person at the right time. You can also quickly communicate with a group that has a specific job function, such as the Code Stemi Team, all at once. Vocera makes reliable, instant and secure communication possible throughout the entire hospital system and often with just your voice or touching just one button. Communication systems was the only eHealth domain found to be applicable to the themes of nurse-patient relationship, autonomy for the nurses in their role, and patients' functional status (Rouleau, et al., April 2017). https://embed.vidyard.com/share/BF7vQ-4ynlH34POLD5n9dg?

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Vocera Helps Care Teams Save Lives In emergency situations, every second counts. Vocera ensures critical information reaches the right person at the right time, saving valuable time and precious lives.

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vSim for Nursing

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Seventy percent (70%) of medical errors made have been attributed to communication breakdown according the the Joint Commission.  Mobile devices allow healthcare workers to collaborate and communicate with each other more quickly and easily. Improvement in communication results in improved quality of patient care and increased patient satisfaction, leading hospitals to invest in mobile technology.

https://www.mobihealthnews.com/content/zebra-technologies-study-predicts-jump-mobile-adoption-2022

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VR gear to fully carry out nursing tasks/scenarios play outs for educational purposes

To learn more:

http://nursingeducation.lww.com/blog.entry.html/2017/03/15/nursing_in_a_virtual-UctW.html

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Use of high-tech mannequins are the future of medical schools, nursing schools, and military combat medic training. The mannequins being used are not just plastic but breathe, bleed, and talk.

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Use of Virtual Nurse:Use of “Angel”, a patient-focused virtual care nurse, it  communicates with patient to gather information for medical providers, fill gaps in care and improve outcomes in chronically ill patients. 

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Use of Virtual Nurse:Use of “Angel”, a patient-focused virtual care nurse, it  communicates with patient to gather information for medical providers, fill gaps in care and improve outcomes in chronically ill patients. 

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Applying AI to healthcare to care, not to replace the human touch, but to augment and magnify the way we care. The world's first healthcare voice AI nurse.

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Simulation Center at Mayo Clinic Florida

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Simulation Center at Mayo Clinic Florida

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Within the simulation center at Mayo Clinic Florida there are multiple skill labs for medical staff, nurses and doctors practice patient care scenarios prior to delivering that skill with a real-life patient.

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Florida Facilities

The J. Wayne and Delores Barr Weaver Simulation Center at Mayo Clinic's campus in Jacksonville, Florida, provides team and individual skills training for Mayo physicians, residents, students, nurses and allied health professionals and for learners from other organizations. The Society for Simulation in Healthcare-accredited center comprises approximately 9,500 square feet of multidisciplinary simulation training space, complemented by an additional 2,500-square-foot expansion of the center's Procedural Skills Lab.

Procedural Skills Lab

The simulation center staff assists in procuring and presenting materials to support or modify scenarios to meet specific training needs. In addition, the simulation center offers basic and extensive faculty development courses.

Standardized Patient Program

The center incorporates the use of standardized patients - actors trained to portray roles of patients, family members, or others - allowing learners to practice communication skills, physical examination, delivery of bad news and other exercises. Through vigorous and innovative training, standardized patients play a vital role in real-life portrayal of healthcare-based scenarios. The standardized patient interacts with learners in a safe environment that does not put actual patients at risk.

Training rooms

The J. Wayne and Delores Barr Weaver Simulation Center offers learners several unique training environments. The simulation rooms are replicas with the same, look, and feel of current clinical space to ensure realistic learning experiences. All rooms are fully integrated with our audio-visual system, one-way viewing mirrors, vital-sign monitors, 50-inch monitors for projection of learning aides, and contain fully functioning medical gas supply and lighting.

Rooms include:

Task training room

Clinical exam rooms

Operating suite

Emergency room, medical-surgical room and intensive care unit suite

Debriefing and conference rooms

Simulation equipment

Equipment includes, but is not limited to:

Analgesia pump (patient-controlled)

Anatomage virtual dissection table

Arjo Huntleigh patient mobility devices

Baxter infusion pumps

Blue phantom A-line/PICC/IV line trainers

Blue phantom paracentesis and throacentesis trainers

Blue phantom ultrasound central line trainers

CAE virtual ultrasound trainer

Code Blue crash cart

Colonoscopy trainer and gastrointestinal cart with scopes

Draeger Apollo Anesthesia Machine

ECMO simulator

Endoscopy-colonoscopy virtual reality trainer

Gaumard IV/A-line training arm

Gaumard pelvic trainers

Gaumard Victoria birthing simulator with Baby Tory

Glidescopes

GYN pelvic trainer

Harvey - The Cardiopulmonary Patient Simulator

Kangaroo enteral feeding pump

Laerdal SimMan 3G mannequins

Laerdal SimBaby

Lap Mentor laparoscopic virtual reality trainer

Laparoscopic box trainers (FLS)

Lumbar puncture trainer

Michigan Lung

Mimic da Vinci robotic virtual reality trainer

Multiple airway trainers

Olympus endoscope tower

Philips Sparq ultrasound

Philips Lumify ultrasound

Scout vital signs monitor

Siemens Mini C-arm

Simbionix Pacerman

SonoSite M-Turbo ultrasound

SonoSite X-Port ultrasound

Suture boards and suturing materials

Ventilators (I-Servo and Philips V-60)

Vimedix virtual ultrasound trainer

Zoll defibrillator

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Mayo Clinic College of Medicine & Science

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The J. Wayne and Delores Barr Weaver Simulation Center at Mayo Clinic's campus in Jacksonville, Florida, provides team and individual skills training for Mayo physicians, residents, students, nurses and allied health professionals and for learners from other organizations.

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Carlyne - Mobile devices research,  References Page,  Contribution to Summary of Padlet and Questions, FlipGrid Recording, Initial Discussion Board Post
Denny - Voice-Activated communication research, Summary of Padlet, Reference Page
Elena - Virtual Reality research, Questions, Answering Padlet/Discussion Board, Formatting of Flipgrid
Matt - Game and Simulation research, Answering Padlet/Discussion Board

The agreement of this team is to collaborate and work on each task together.

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Attached is the link for the FlipGrid video. If the link does not work, please utilize this direct link to the video: https://flipgrid.com/c95c3617