ANA\C The Nursing Voice Summer 2019

anacalifornia.org  .  19 What is Simulation? Simulation is a situational learning process to practice skills and reasoning in a safe environment. Simulation is a technique, not a technology, to replace or strengthen real experiences with guided experiences to evoke real world situations in an interactive manner (Gaba, 2004). The aviation and military have used simulation to train their personnel in both skills and safety-related behaviors for many years (Aebersold, 2016). In a practical setting, simulation is used to predict future systematic actions to determine and influence that behavior. The first step in developing a simulation exercise is determin- ing the overall purpose and goals of the training, as well as to consider the desired methodology or technique of simulation. Modeling a simulated situation solves real-world problems efficiently and safely. The process of debriefing which is the crucial step of the simulation provides an important step and valuable insights to navigate complex systems. Nursing simulations have become increasingly more sophisti- cated and generally consists of: Theoretical Knowledge: the preparation of work (self-study or a classroom lecture); Simulation: simulated patient scenarios with learning objectives and the desired outcomes; Debriefing Session: students review their own performance and consider how nursing theory is applied and synthesized to nursing practice with the instructor providing feedback. The National Council of State Boards of Nursing (NCSBN) simulation study is over a few years old. There are continued discussions and concerns on whether simulation hours can replace clinical placements in nursing education. As a result of the study some state boards of nursing have started to incorporate these recommendations into their nursing school guidelines. Some state nursing boards have not been successful in sup- porting academics to shift clinical hours to non-direct care or simulation up to 50%. Some state boards have not offered recommended guidelines to implement simulation up to 50% to reflect adoption of the NCSBN guidelines. The National League of Nursing (NLN) is a significant contributor to educa- tional research with simulation. The NLN published a visionary statement endorsing the NCSBN study and provided strong recommendations to deans, directors, and chairs of nursing program, and to faculty on how to best support and incorpo- rate simulation into the prelicensure curriculum (NLN, 2015). Although the study reported that up to 50% of clinical time in simulation can provide the same and in some cases stronger clinical performance than that in traditional clinical place- ments (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014), there still remain concerns about the ability of simu- lation to be a comparable alternative to traditional clinical practice experiences and hours. Simulation has become a significant part of the prelicensure curriculum. Nursing schools are faced with a growing shortage of clinical placements (American Colleges of Nursing, 2017) as well as restrictions on the activities in which nursing students can engage in. Simulation can provide an effective alternative to clinical training. Simulation can be viewed as another approach to teaching. Instead of asking the question can we replace nursing clinical experiences, we should be asking why we should replace some of the clinical experiences with simulation to benefit the student’s ability to synthesize their theoretical knowledge into clinical reasoning. Simulation when done poorly or poorly integrated into the curriculum, will not be any better than the clinical approach. It requires a thoughtful approach to safeguard the success of both students and faculty which includes curricular mapping and integration. Currently, the nursing education clinical practice with 8–10 students is managed by one clinical instructor to provide direct care to 1–2 patients in an acute setting (Tanner, 2006). Clinical practice can be limited for students when looking at the current clinical practice trends in the hospital, the shift in healthcare delivery models, and the availability of patients in this setting. Often, the clinical instructor must substitute the lack of available practice to provide direct care with obser- vation of students performing their psychomotor skills and Nursing Practice Corner Let’s Go All the Way, Simulation! In a practical setting, simulation is used to predict future systematic actions to determine and influence that behavior. Alice Martanegara DNP, RN