Use of simulations for clinical training during the pandemic

Use of simulations for clinical training during the pandemic

Last March when it became obvious that we were facing an unprecedented pandemic, schools correctly removed pre-licensed students from clinical training sites. This move was essential to both ensure student safety and to preserve limited personal protective equipment (PPE) for those on the frontlines. As the world grappled to find answers to this novel and deadly virus, nursing students remained sidelined for the remainder of the spring 2020 term as well as throughout most of the summer. Students only began to return to onsite clinical training this past fall, but many were once again pulled out when local numbers of cases spiked once more.  

Protecting the safety of our students, while at the same time ensuring rigorous training for a desperately needed workforce has posed unique and pressing challenges for educators and regulators alike. Most state boards of nursing have opted for some type of relaxation of direct patient contact hours (see for a current list). Supervised remote live videoconferencing, distance learning, and the use of simulations have all been expanded.

As educators, we grapple with how best to deploy simulation, what types of simulation are most effective, and of course, within budget. When approaching these issues, think about two questions; what are the learning outcomes we need to achieve, and what is the simplest way to achieve them? With this thought process in mind, we can begin to aggregate outcomes into various buckets, with associated technologies to support each.

Certainly, nurses need a high degree of manual dexterity and technical skills to safely place an intravenous line, draw blood, listen and interpret heart sounds as some examples. Such physical acumen will not be gained through interactions with an avatar. Fortunately, most nursing schools have a variety of low and high-fidelity mannequins to learn and practice these skills in an in-person simulation environment. Low fidelity, and low cost, models allow students to learn anatomy and practice basic skills such as injections. High fidelity mannequins can reproduce physiologic functions and respond to therapeutic interventions in a safe and controlled environment. Computer programming allows the student to interface with both normal and rare conditions such that experiences can be broad and comprehensive. All of the interactions between students and mannequins can be recorded for training purposes, without fear of patient privacy issues. 

Nursing is about far more than technical skills, with many essential non-technical skills such as communication, teamwork, critical thinking, and cultural awareness. The use of role-playing, virtual simulation, and instructor-operated avatars has enabled deep and realistic experiential learning in these areas, all done at a distance. Students can be “placed” in a wide array of environments, interact with patients and patient families over the course of months and conduct difficult interviews through virtual simulation. Decision-making can be assessed and cultivated, interprofessional teamwork can be developed and nurtured through technology-assisted learning. Students can and do experience that increases in heart rate and sweaty palms as they grapple with well-designed scenarios.

Over the past several years the use of both in-person and virtual simulation has been gaining traction in nurse education as many areas have been challenged with a shortage of qualified faculty and access to clinical training sites. Simulation offers the advantages of a safe environment where students can make mistakes, the opportunity to present students with disease states that they may not come into contact with naturally in clinical settings, and exposure to different cultures, neighborhoods, and communities, where students must act appropriately and professionally. The pandemic has forced greater use of simulation. We should all take this opportunity to learn from this past year and continue to expand and improve the use of simulation in nurse education.