What is Simulation? Simulation is essentially an imitation of what is real. Gaba (2007) defined simulation as a technique which replaces or amplifies real experiences with guided experiences. These situations replicate substantial aspects of the real world in an interactive fashion. A simulator is the device used for simulation. Is the use of simulation new in teaching nursing one may ask…the simple answer would be ‘NO.’ Traditionally in teaching nurses, simulation has always been used. Examples of these would be the practice of demonstrating skills in a lab and having students return the demonstration; the many role plays that are used to concretize concepts; using case studies and problem-based scenarios are all forms of simulated learning. However, many senior nurses may well remember practicing giving an injection on oranges…and of course on patients hospitalised to be cared for. ‘Am I in the muscle?’
Nursing is both a science and an art which requires both the theoretical knowledge and clinical expertise. Jamaica has consistently educated nurses who are highly sought after around the world with many nurses migrating to North America. The challenges that have arisen for some years now are the expansions of nursing programmes and the large numbers of students being admitted since nursing is being taught in the university settings. At the University of Technology, Jamaica, where I teach, for example, there is usually 100 students accepted in year one on the Kingston campus and another 50 at the Montego Bay campus. At the same time the University of the West Indies School of Nursing would be accepting even more than 100 students on their Kingston campus, with additional numbers at their Western campus and at franchised institutions in some of the Community Colleges in Kingston and other parishes; Northern Caribbean University also accepts very large numbers of students. Are you getting the picture? With so many students to be trained and all of them using the same clinical facilities, the overcrowding is inevitable. This results in students not being able to get ample clinical practice for the skills that they need. This is also occurring in a setting where so many nurses are migrating to other countries. In 2015, the Nurses Association President, Mrs. Janet Farr, raised the alarm that migration and resignation of specialist nurses from the public health system in 2014 resulted in extreme shortages and contributed to an increase in workload (Porter, 2015). This trend has continued steadily and in 2016, Minister of Health Christopher Tufton was reported as saying that migration of nurses has creating a health care crisis (The Jamaica Observer, 2016).
The use of patients to teach and practice within the clinical setting will always be relevant in nursing and cannot be fully replaced. However, patient safety must be paramount. Patient safety is a major reason to use simulation in teaching nursing or any other health discipline for that matter. McGaghie, Issenburg, Cohen, Barsuk and Wayne (2011), reported that for the field of medicine a growing body of evidence supports improved patient care practices and better patient outcomes when clinical skills are acquired in medical simulation laboratory settings.
Other reasons, in addition to the changes in the clinical environment outlined above; are to facilitate deliberate practice and assessment; team training; research, improved technology as well as being more effective; facilitates immediate feedback; allows deliberate practice; curriculum integration; outcome measurement; skill acquisition and maintenance; transfer to practice among others. Simulation is also fun while learning! You can “kill” the patient without suffering terrible consequences (Gaba, 2007; McGaghie, Issenburg, Petrusa and Ross, 2010).
How much is the simulation technologies used to teach nursing in Jamaica. The three major universities have a variety of simulators used to assist nursing students to learn. At UTech there are a mix of regular mannequins, medium fidelity simulators and high fidelity simulators. The simulators can be programmed to replicate many human responses such as crying, groaning, coughing; students can take vital signs, pass naso-gastric tubes, pass urinary catheters, set up intravenous lines; simulators can display illnesses such as asthma, heart failure etc. These abilities can allow the students to practice and become proficient in a safe place. The big BUT is do the institutions have all the human and material resources needed to fully utilize these simulators? Are there dedicated simulation labs that would replicate a hospital setting? These are challenges that the institutions face. Much more resources need to be put into this…more staff is needed and to be trained in simulation; more space is needed to create the proper environment and the nursing curriculum importantly must be revised to reflect the changes in teaching methodologies.
Examples of the simulators available in the simulation learning environment in Jamaica are:
Medium Fidelity Simulators
High Fidelity Simulators Including a Pregnant Woman, SimMan & an ICU SimMan
Norman (2012) sums up at that time what the literature indicated on simulation in nursing education; the simulation learning environment proves that knowledge, skills, safety, communication and confidence is improved, however, there is a gap in literature on transfer of these outcomes to the clinical setting. In Jamaica, the simulation learning environment is still taking ‘baby steps’ and therefore will not yield the type of results that is seen in some countries. In addition the research is sparse and must be undertaken so that evidence can be used to support the use of simulation technologies to teach nursing in Jamaica. I fully support the use of simulation technologies to teach nursing in HEIs in Jamaica!
Gaba, D.M. (2007) The future vision of simulation in healthcare. Simul Health c, 2, 126-135.
Porter, R. (2015). Public health sector lost 200 nurses last year- NAJ. The Jamaica Observer. http://www.jamaicaobserver.com/news/Public-health-sector-lost-200-nurses-last-year—NAJ_19219817
McGaghie, W.C., Issenburg, S. B., Cohen, E. R., Barsuk, J.H., & Wayne, D.B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, vol. 86 (6), pp. 1-6.
McGaghie, W.C., Issenburg, S. B., Petrusa, E.R, & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education; 44: 50-63
Migration of nurses creating health care crisis – Tufton. (2016, January 26). The Jamaica Observer. http://www.jamaicaobserver.com/news/Migration-of-nurses-creating-health-crisis—Tufton
Norman, J. (2012). Systematic review of the literature on nursing education. The ABNF Journal; Spring 2012: pp. 24-28.
By: Keron Jones-Fraser