The role of simulation labs in refining nursing skills and competencies

For trainee nurses at the start of their careers, the simulation lab experiences offered by nursing schools are a crucial part of becoming a competent practitioner. During these practical lessons, students are given hands-on instructions to help them understand more about the equipment used in hospitals and to prepare them for meeting real patients in the near future. Lab simulations are not places where students are expected to be perfect, instead, they provide an environment that is both safe and supportive to support the learning of future nurses.

Instructors will guide the class through a range of increasingly complex scenarios, encouraging them to seek out the best patient care scenarios and put them into practice. There will usually be a progression in the learning curve of each simulation. To match the students’ educational level, the simulations become progressively more challenging as the curriculum moves on. Lab learning has significantly enhanced nurse training and is now part of both traditional and online nurse training programs. In the past, students who wanted to transition into nursing as a second career might have struggled to fit their studying around their existing work and home commitments. This is because the standard Bachelor of Science in Nursing (BSN) degree can take around four years to complete. Today, the Accelerated Bachelor of Science in Nursing (ABSN) program is designed to offer a solution.

The ABSN program is specifically for people seeking to transition into nursing who have a bachelor of science degree in an unrelated field. Available through reputable institutions such as Elmhurst University, this fast-tracked course blends clinical residencies with on-campus residencies and online learning. For graduates who are considering the benefits of an ABSN vs BSN and want to start their medical career sooner rather than later, the Elmhurst program is likely to be a convenient choice.

Learning what to expect on a real hospital ward

Simulations are useful whichever route a nurse takes into the profession, because patient situations are all different. At work, practitioners meet new people every day with different personalities, cultures and backgrounds. This means nurses need to adapt the approach they take to providing care, while working towards the same positive outcomes for each patient. In the earliest stages of a nursing degree, a simulation is likely to focus on the key concepts of healthcare. Students will be taught the basics about patient safety, communicating with other professionals and medical assessments. As the weeks go on, the scenarios will develop to include more challenging events, a pregnant woman in distress, a suspected heart attack and even people with injuries created through fake blood could be set up to test out the trainees.

Each session in the lab will last for around an hour, students will be tasked with identifying the problem, responding appropriately, prioritizing what needs to be done and managing their feelings. However, the majority of each lab lesson is spent after the practical events have unfolded. This will involve a group discussion and will often include individual meetings with the instructor, so each person can receive individual feedback on their performance. Although the learning environment is designed to be realistic and trainees are asked to demonstrate their current level of competency, there are no consequences if they struggle with the task. Instructors will simply observe how well each person does in terms of bringing together their medical knowledge and their clinical reasoning in a practice situation. Once the event is over, they can provide targeted guidance.

What is a simulation lab?

Simulation labs are rooms within a college or other educational setting. They have been built to resemble a realistic hospital room. The idea is to create an immersive experience for student nurses, as well as clinicians who are earning further certification. Often the furniture and equipment are changed around to mimic different parts of a medical facility, from labor units to emergency rooms and pediatric intensive care units. In larger simulation centers, there could be several rooms set up to look like hospital departments, as well as patient assessment rooms and surgical simulators.For a well-rounded educational experience, consider integrating a game room within the simulation center, providing a space for students to relax and unwind, fostering a balanced approach to learning and recreation.

Along with an array of medical equipment and hospital beds, simulation labs have manikins that act as patients. Although some manikins are basic, others are more advanced and will exhibit certain behaviors, in addition to having responsive pupils and an audible heartbeat. When the instructor wants an idea of their student’s progress from a patient’s perspective, they may even bring in an actor to play the role of the patient.

How is the simulation managed?

Simulations will almost always begin with a pre-briefing session in which the students will be given some background regarding the situation and information on the patient they will be treating. Instructors will usually take the time to run through the standards they will be expecting of the team, as a reminder. Once that’s over, the session will move on to the scenario. Here, the case study that was mentioned earlier will unfold with the help of a simulator manikin, or real actors if the learning outcomes require a more interactive patient. During the scenario, students will take on a specific role and will remain in this role while they respond to the situation. Often other learners who are part of the same cohort group will listen and observe the action through a video link or a one-way mirror.

Once the scenario has played out, there will be a debriefing period. In addition to receiving the instructor’s feedback, students will also think about their performance. They will consider what their strengths were and what they might work on for next time. Self-reflection is a crucial skill in healthcare. In this instance, it helps people to modify their behavior and, as a result, become better at what they do.

How does experience in the simulation lab benefit nursing students? 

In eight separate studies, nursing simulations were found to offer ‘statistically significant improvement in skill performance, knowledge acquisition, clinical performance, self-confidence, critical thinking skills, and communication skills…’ for the students involved, compared to other forms of teaching. There are many reasons why trainee nurses respond so well.

New nurses learn about their strengths

Before a simulation begins, nurses are given learning materials and have the chance to read more about the scenario they are about to experience. This can help them to build their confidence when the time comes. However, each student learns differently and reacts differently, both in the lab and in a real-life situation. This means some will have reached their learning objective in about 10 minutes and others will take more time.

Although this can be stressful, it helps the instructors adjust a scenario to suit each individual student’s needs. The process of practicing, repeating and reflecting leads to learning, and this is true of finding and filling the gaps in a student’s knowledge. In addition, the lab will cover unusual and uncommon medical scenarios, giving nurses the chance to practice proficiencies that might otherwise be overlooked.

Self-reflection is encouraged

All working nurses are encouraged to develop their self-reflection skills as a way of managing the daily challenges of working in healthcare. Hectic days, shifts during which things have gone wrong and unexpected situations can all put pressure on nurses. During professional development, they are taught to process their feelings sooner, rather than later. This allows them to let go of any negative emotions and be refreshed for the upcoming shift. Simulations nurture this skill because, after the debrief at the end of each session, students are encouraged to talk about their feelings. In fact, the ability to reflect on what went well and what could be improved is a key component of the experience. It helps nurses to understand more about their clinical approach and why they acted in the way they did.

Students get to practice their medical skills in a safe space

In the simulator lab, student nurses have a chance to practice their medical aptitudes, as well as their critical thinking, bedside manner and psychomotor skills. Unlike on a ward, when they are dealing with real patients, the lab is a controlled environment in which there is a limit to what can go wrong. As a result, students can practice their competencies in a more relaxed way, and within reason, try out new things that they may have read about. Whatever the result of their efforts, they never have to fear hurting or endangering a patient.

In the simulation lab, forgetting to set up a particular test, misdiagnosing a condition or failing to insert an IV properly is a simple part of the learning curve students must experience. On the ward, in a clinical rotation, using equipment such as feeding tubes and catheters is stressful. Nurses want to get it right, but at the same time, with little experience in performing the task, they can be fearful of hurting the patient. That’s why the lab is an ideal learning opportunity, as students can practice the procedure and correct their mistakes before performing it on a real patient.

Becoming familiar with a clinical setting builds confidence

Even after learning about healthcare and reading about medicine, entering award for the first time can be an intimidating experience. Labs can take away some of the stress involved by allowing students to practice in a managed way and slowly build their confidence. Eventually, they will begin to feel more at home in the lab and comfortable when dealing with the patient simulator. They will be ready to make a potentially life-saving decision within a few seconds because they are sure it is the right thing to do. Once they encounter similar situations in a real clinical setting, they will be better equipped to maintain their composure and make the right choices.

Trainee nurses can learn problem-solving skills 

In a real-world situation, nurses think creatively in order to solve problems and achieve the best outcomes for their patients. They often need to know the right questions to ask when people are presenting with certain symptoms, consider a wide range of options and use their knowledge to improve the patient’s health. However, in the earliest stages of their training, when students are still learning the basics of healthcare, problem-solving at this level is a challenge.

Students are aware that making a mistake when dealing with a real patient can cause harm, but they know they are free to ask questions, think through possibilities and offer suggestions in the lab. That is not to say they won’t feel stressed by the scenario or be forced into thinking quickly, but there will also be opportunities to be creative when it comes to looking for a solution. In the lab, students are expected to look for every possible outcome and solution, as this prepares them for doing so when a patient needs their help.

Communicating with a team of people becomes second nature

Good communication skills allow nurses to collaborate with diverse teams of professionals. This is also an important element in patient-centered care, as nurses who can interact with the people on the ward through active listening form better relationships, which can lead to improved health outcomes. Effective communication can also reduce the risk of medical errors and encourage a smooth workflow in the facility because everyone understands what is expected of them.

In a simulation, students are encouraged to practice communicating with a team made up of different medical professionals. Each trainee will play the part of a nurse, a clinician or another member of the hospital staff, and sometimes even the patient. This gives everyone involved hands-on experience of managing interactions in an immersive, but ultimately safe environment. Instructors will observe how trainees manage communication with the patient and their colleagues, then provide advice for the future.

Simulations have a direct link to theory work

Nurses who are entering a simulation for the first time will have already gained a good general knowledge of healthcare and learned important skills during their class-based education. To maximize the benefit of lab learning, tutors will align the scenarios that students experience in the lab with the skills they are currently working on. For example, if the simulation is set up in a cardiac ward and a patient has heart problems, the coursework students complete beforehand will focus on coronary care. As a result, the trainees can apply the knowledge they have very recently acquired to the clinical situation.

By applying their knowledge to a patient care simulation and eventually a clinical rotation, nurses become better prepared for a professional role upon graduation.

Students are taught to give and receive feedback

Every lab experience is managed and observed by the trainee’s tutor or instructor. This person will be responsible for preparing the class by setting the scene and explaining what may happen. Once the simulation is underway, they can even control the reactions of the manikin, depending on how advanced the equipment is. Once the simulation has run its course, the instructor leads a debriefing session. This is when each trainee will be asked to offer insight and give feedback to the group. To ensure the session’s learning objectives are met, the instructor will guide the conversation.

By embedding the idea of giving and receiving feedback into nurse training, simulation lab work prepares students for the same experience on a ward. From nurse leaders to graduates who are in their first professional healthcare job, giving feedback in a constructive way is useful in peer review situations and mentorship programs. In addition, it can be highly motivating and encourage the recipient to work towards a set goal; however, done harshly or poorly, providing feedback can have the opposite effect and negatively impact the recipient. Training in the lab teaches students how to connect and show empathy, both of which are fundamental to providing constructive feedback.

Trainees are better prepared for their time on clinical rotations 

Once they begin a clinical rotation, nurses will need to respond when there is an emergency and think on their feet if the ward is busy. From assisting in patient assessments to communicating, accurate note taking and prioritizing tasks, there are many skills to master. These can all be strengthened through simulation lab work and repetition also builds up a student’s confidence.

Through each mistake and triumph in a simulation, students learn how to cope and improve their practice. From something as basic as recognizing the sound of healthy lungs, to identifying the symptoms of a rare disease, their competence is developed and enhanced in every scenario. By refining their skills in a controlled setting, nurses are more confident in using them again in a clinical environment and they will be better prepared to reassure patients.

Simulations are a buffer between learning textbook definitions of patient care and working on a real ward. They enable students to put their knowledge into practice but also to experience the more nuanced, unusual and chaotic aspects of healthcare.

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