Using simulations in nursing education to optimize learning outcomes

It's not just about practicing a lot, but also about practicing correctly. This is shown by new research from the University of Agder.

The government wants to use simulations more in the nursing education. Since it is difficult to secure enough and relevant clinical placements for all students, simulations can offer an alternative learning environment."

Hege Kristin Aslaksen Kaldheim

She is the first to have completed a doctorate in surgical nursing at the University of Agder. Kaldheim has conducted interviews with students and newly qualified specialist nurses and has also organized many simulations as the person in charge of simulations in the training of surgical nurses at Lovisenberg Diaconal University College.

"I am interested in how students learn through simulations. It is useful to look at how those who use simulations best can plan and organize them to ensure good learning outcomes," says Kaldheim.

Today, she actively uses simulations in the education of student nurses at master's and bachelor's levels at UiA.

Simulation is an educational method for creating realistic situations that can be practiced. It is used by both educational institutions and hospitals. At the University of Agder, a dedicated simulation centre has been built for this purpose, where students can practice on patient simulators. These look like humans and have features such as speech, sweat, tears, and lung and heart functions.

Commonly used, little researched

"Simulations allow students to take more responsibility, such as handling emergency situations, and do more than they are allowed to do in a clinical setting. It is important to customise the exercises to ensure the students can experience a sense of mastery, and it is good for them to learn through activities with other students," says Kaldheim.

Simulation has long been an established way of practicing in the nursing profession, but not much research has been done on it. There has been limited research on how participants learn, and even less on so-called interprofessional simulation. This is a simulation where several specialists simulate together, such as simulations with both anaesthetic and surgical nursing students. It has been unclear how much competence is transferred from simulation exercises to everyday work.

In her doctoral thesis, Kaldheim interviewed newly qualified specialist nurses who reported a significant transfer value.

"They recalled simulations from training when they encountered similar situations in the real world. They felt better prepared to handle such situations. They also wanted more simulation in their studies to become even better and more prepared," says Kaldheim.

It is crucial that a simulation is as realistic as possible.

"It is also important that the simulation is well organised and that the students experience positive stress," says Kaldheim.

Positive stress means that students get to experience the responsibility they will have in their future role as nurses. This provides both learning and a sense of mastery.

Kaldheim says it is important for leaders to recognise how crucial it is for learning to have simulations of good quality. In her doctoral work, she discovered important prerequisites for obtaining high quality.

"The participants must feel that the simulation is realistic, and that they are well-prepared and confident in the learning situation. Both participating in the simulation and observing fellow students are important," says Kaldheim.

Kaldheim found through interviews that the competence of each individual profession is essential in simulations. The planning and implementation are best achieved when the simulation planners also have expertise in the scenario being simulated.

An addition to practice

Today, the amount of clinical practice required for specialist nursing students during their training is determined by law. This is challenged by the increasing demand for nurses. Kaldheim concludes that simulations are good, as long as they are well implemented. However, there is still little research on the impact of replacing clinical practice with simulations.

And therefore, simulation cannot simply replace practice. But it can serve as a good addition.

"Good simulations require competent professionals who know how to conduct simulations, and resources to ensure proper implementation," says Kaldheim.