ADVICE FROM 3 EXPERTS ON USING SIM TO BUILD CLINICAL JUDGMENT
HOW SIMULATION OFFERS ADVANTAGES OVER REAL-WORLD CLINICALS
Bipolar disorder is not widespread in the general population. It affects — at most — about 6% of the general population. But because some 50%-90% of people with serious mental illness like bipolar disorder have one or more chronic medical illnesses, it’s likely your students will regularly encounter clients with these types of mental health ailments when in practice.1, 2
What are the chances, though, that your students will work with a client exhibiting bipolar disorder during their clinicals? And what about all the other life-threatening scenarios they will face? How can students gain the necessary experience to feel confident in handling the wildly fluctuating circumstances of real-life nursing?
We talked to 3 of the nursing profession’s most-respected simulation experts to get some advice:
- Beth Phillips, PhD, RN, CNE, Strategic Nursing Advisor for ATI/Ascend Learning and Associate Professor Emeritus at Duke University School of Nursing. Her previous positions at Duke were as Associate Professor and Director of the Institute for Educational Excellence.
- Suzan Kardong-Edgren, PhD, RN, ANEF, CHSE, FSSH, FAAN. consultant on the landmark National Council of Nursing National Simulation Study that determined that up to 50% of traditional clinical could be replaced with high quality simulation. She currently is immediate past president of the International Nursing Association for Clinical Simulation and a Senior Fellow at the Center for Medical Simulation.
- Christine l. Heid, PhD, RN, CNE, CHSE, ATI Consultant. Dr. Heid is a Certified Healthcare Simulation Educator and 2017 member of the INACSL Learning Fellowship Program.
Their advice will help you navigate the opportunities of using simulation with your students.
THE DIFFICULTIES OF DELIVERING NURSING CLINICAL EXPERIENCE
According to a May 2023 report by the American Association of Colleges of Nursing (AACN), the number of students in entry-level baccalaureate nursing programs decreased by 1.4% in 2022, ending a 20-year period of enrollment growth in programs designed to prepare new registered nurses (RNs). The organization also recorded declines in master’s and PhD programs.
Among reasons cited for the decline in enrollments is an insufficient number of clinical sites, clinical preceptors, and budget constraints. Simulation, then, has become the go-to solution for many nursing programs to replace on-site clinical experience.
Included among the computer-based simulation activities that NCSBN studied for that report was ATI's Real Life Clinical Reasoning Scenarios.
SIMULATION’S ADVANTAGES TO PROVIDER-BASED CLINICAL EXPERIENCES
“When we send students to clinical, we are really at the mercy of the patients that are there,” said Duke’s Dr. Phillips. “But, with simulation and virtual environments, we can create and provide consistent experiences for students.”
For those who believe screen-based simulation can’t deliver the emotional impact of real-life clinical, Dr. Phillips advised setting aside such concerns. “I’ve personally experienced, in virtual environments, feeling nervous that my patient was going to crump on me or was going to stop breathing,” she said. “I’ve seen in my previous work that when students saw a patient wasn’t doing well, they had a visceral reaction to it, even though it was on a computer screen.
“So, I know that we can learn in a simulated type of environment. I know that it can affect students’ processes and how they make decisions later on in their careers.”
Besides giving students authentic emotional experiences, simulation tools — such as ATI's Real Life Clinical Reasoning, Swift River Simulations, and Engage Series — can develop students’ critical thinking, clinical decision-making, and clinical judgment skills.
Dr. Heid explained that “Students become deeply engaged in the realistic client scenarios. The scenarios offer challenging situations in which students must make crucial healthcare decisions.”
She added, “If they make the wrong decision? They can significantly impact client outcomes.”
More specifically, screen-based simulations such as those from ATI provide 2 key advantages:
1) BUILD + MEASURE CLINICAL DECISION-MAKING SKILLS
Using simulations, students will:
- Deepen their learning as they choose different options along the scenarios’ “branching-logic” decision points, redoing each scenario and making different choices to learn which leads to the best outcomes
- Develop stronger critical thinking, clinical decision-making, and clinical judgment via deeper engagement
Educators who employ simulations in their lessons will:
- Measure students’ clinical decision-making ability alongside competencies from QSEN, NCLEX Client Need Categories, and relevant body functions.
2) GAIN EXPERIENCE IN REAL-LIFE CLINICAL SITUATIONS
The solutions offer:
- Credible scenarios that provide experience with clinical situations nurses face in real life without the need for live clinical presence or any risk to client safety
- Exposure to situations students will see every day, as well as less common situations that traditional clinical rotations often miss
- A consistent clinical experience, ensuring students encounter the same sets of clients and scenarios
- The opportunity to practice as often as students want so they remediate and hone their skills with clients who exhibit pain, confusion, and anger, fostering an emotional connection in students to each situation.
CLINICAL SITUATIONS IN WHICH SIMULATION IS HUGELY IMPACTFUL
Dr. Phillips pointed out the importance of students gaining first-hand experience with life-threatening situations in risk-free environments. She mentioned pre-eclampsia and postpartum hemorrhage as some especially dangerous situations with which students need to be familiar.“We can’t guarantee they’re going to see maternal clients with these illnesses during clinicals,” she explained. “We hope they don’t, because it means the mom is really, really sick. However, that would be something we would want them to experience.”
Simulation tools such as Real Life and the Engage Series incorporate a wide variety of scenarios to provide that knowledge. Both pre-eclampsia and postpartum hemorrhage, for example, are among the scenarios in Real Life's RN Maternal-Newborn module. And both Real Life and Engage offer modules on the mental health illnesses mentioned at the beginning of this article, such as bipolar disorder, schizophrenia spectrum disorders, and psychosis. (Review the newest Engage Series' modules for more details: Mental Health, Adult Medical-Surgical, Community & Public Health, and Fundamentals. And check out additional Real Life modules on RN Medical-Surgical, PN Adult Medical Surgical, and RN Nursing Care of Children.)
THE IMPORTANCE OF SCENARIOS IN YOUR SIMULATION LESSONS
An important aspect to consider when choosing simulation tools is the scenarios they depict. Researchers stress that good scenario design is more important than the technology or method of the simulation. A good sim requires:
- Clear learning objectives
- Problem-solving components
- Student support
- Fidelity appropriate for the learning objectives
- Structured debriefing.
ATI's simulation solutions fulfill those suggestions with lesson plans and learning activities.
ATI Consultant Dr. Heid said, “To build their clinical judgment skills, students need experience in making decisions — including wrong decisions. Every experience adds to their knowledge and understanding of the impact of their actions.”
She added, “It’s so important to give them the opportunity to practice, practice, and practice some more. When they enter the real world of nursing? They’ll be prepared to think on their feet and deliver the compassionate, safe nursing their patients need.”
Learn more about how to implement simulation inside and outside your classroom. Read “3 lesson plans for using screen-based simulation.”
SOURCES:
1Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2007;64(5):543–552. doi:10.1001/archpsyc.64.5.543
2Gold KJ, Kilbourne AM, Valenstein M. Primary care of patients with serious mental illness: Your chance to make a difference. J Fam Pract. 2008;57:515-525.