The training of nursing professionals has been a dynamic and continuous process because of the impact of technological developments. The current argument is that nursing training should be based on comprehensive teaching in line with technological developments to move past the traditionalist understanding of, and contradiction between, learner and educator (Alexander et al., 2015). Besides, nursing training is about developing new opportunities to produce and offer knowledge, ethically educating students while delivering the learning content. Thus, it is important for the teacher to integrate and deliver the educational content in collaboration and partnership with the student. Technology has initiated a broader educational context and a learning process that supports the integration of a learner in the teaching-learning process (Rodrigues et al., 2016). The teacher is no longer the sole creator and disseminator of knowledge because a student can play an active role in the learning process. Although many changes have occurred in nursing education due to social, economic, and political factors, technological innovation has created new dynamics in the field such as the introduction of simulation or game-based learning in training various courses, including hand hygiene compliance.
Developments in the technology used in learning have initiated new learning strategies and tools used to deliver content. Nurse educators are using a variety of innovative technologies to support students to develop target skills and knowledge that they can use in practice. One of the developments includes the use of simulations or gaming strategies that support the teaching and learning process using a simulated scenario. Simulation refers to an instructional setup where the teacher defines a new “world” for the students to engage and interact with while developing knowledge (Alexander et al., 2015). The simulated reality plays a significant role in the learning process because it presents scenarios, which are close to reality. The parameters of the simulated “world” are highly controlled, but they mimic reality. Therefore, the learning process that transpires in the simulated world can be easily transferred into the real world of nursing practice. Learners experience the simulated reality and create critical meaning that they can easily transfer into the real world. According to Klipfel et al. (2014), simulation supports student-centred and constructivist teaching and learning because it allows the learners have greater control over the learning process as they create their meaning of the content that they can easily use in practice.
Computer-based games and game-based learning, including simulation, have become important in the modern nursing education setting to train new and experienced professionals to develop the necessary knowledge to provide quality and safe care. They train in a low-risk environment and develop skills that are transferred in practice to care for patients (Klipfel et al., 2014). The primary reason for the growing interest in the use of technology in teaching and learning is because it makes the process exciting and enhances the possibility of understanding the content. There are two factors behind the continued growth in the use of technology in the teaching-learning process (Cheng et al., 2015). The first aspect is that simulated learning is highly engaging and motivating, which is particularly missing in the conventional approaches to learning, such as in lectures. The second factor is that computer games integrate various aspects of learning, including simulation and artificial intelligence that provides diverse channels for content delivery (Alexander et al., 2015). The current nursing education has various channels through which game-based learning is implemented to improve the learning process and create a greater understanding of content.
Current Use of Simulation/Gaming Strategies
Nurses can use educational innovations such as simulation to improve the learning environment and enhance the level of understanding of specific content. Various organizations within and outside the healthcare sector have adopted the use of simulation in the teaching and learning process. One of the organizations revealed in research to have considerable use of the strategies in teaching and learning is the University of British Columbia. In this institution, simulation is used in teaching various subjects and educating different professionals, including nurses. The university uses simulation mostly in training postgraduate medical education students and nurses (both in undergraduate and continuing professional development). Qayumi et al. (2014) conducted a study in the institution that revealed the rate of simulation use in the institution. The results revealed that although simulation has not achieved a high level of integration in the institution, it plays a crucial role in training medical and nursing professionals. The current use of simulation in the institution reveals the role of the teaching approach in creating exceptional possibilities in hands-on, team-based training with the opportunity to improve safety and quality care outcomes. The recent years have witnessed an increase in the integration of simulation into the medical and nursing curricular activities.
Another organization that uses simulation in its training for nurses is the Johns Hopkins School of Nursing. The organization plays a significant role in bridging the gap between training and clinical practice by developing competent professionals to provide quality care to patients. Johns Hopkins School of Nursing Clinical Simulation Center supports the use of technology on the training of medical professionals, including nurses. The institution trains nursing students in a way that they can effectively integrate their knowledge into practice. It challenges the barrier in transferring classroom knowledge into practice by simulating the learning process (The Johns Hopkins School of Nursing, 2019). The organization includes simulation in the nursing curriculum as an approach to teaching that creates an interactive learning environment. It also develops a practice-based education to provide the nurse trainers with the chance to meet the educational needs of nursing students. Simulation is used in various areas, such as in training learners to apply best practices in quality and safety of care, as well as developing problem-solving and critical thinking skills.
The Benefits of Simulation in Organizational Settings
Educational organizations in healthcare aim at improving the quality and safety of care given to a variety of patient populations. Therefore, the use of educational innovations such as simulation plays a significant role in enhancing the level of understanding of the educational content and improves the target skills. Previous studies have proven the effectiveness and impact of educational innovation in nursing education and practice (Klipfel et al., 2014). Therefore, the University of British Columbia and the Johns Hopkins School of Nursing have benefited after implementing simulation approaches in their teaching context to train nurses and other medical professionals. They are using simulation-based education to provide the chance for nursing students to develop and rehearse skills in a risk-free setting and later use the knowledge in practice (Cheng et al., 2015). When training, the nurses will have a chance to learn and practice in a simulated environment before using the skills in practice. The organizations have proven that simulation works to improve nursing training.
The organizations have proven that simulation works in training experienced and skilled nurses to work on establishing safe and quality care to their patients. They develop skills that are bridging the gap between learning and practice. Simulation is more beneficial compared to other instructional strategies, such as lecturing and discussions, because it can simulate the real practice before moving on to work in healthcare settings. Qayumi et al. (2014) concluded that nurse educators could work with students as though they are working with real patients. They can test knowledge development and work on weakness to improve safety and quality care outcomes. Further evidence from research shows that simulation is superior to the traditional approaches because the process enhances the role of a nurse educator and also makes the student an active participant in the training process (Klipfel et al., 2014). Technology-enhanced simulation has been revealed to have considerable benefits to the organizations that have implemented the approach such as improving the development of knowledge and skills that affect patient and organizational outcomes when the nurses are working in the real-life workplaces.
The Role of Simulation in Changing the Faculty
Simulation continues to play an essential role in the way nurse educators are training nurses to become competent in their profession. Collaboration and partnership are some of the changes that have taken place due to the continued use of technology in education. Although the nurse educator has the necessary knowledge to educate the students using simulation to develop hand hygiene skills and compliance, collaboration with other professionals is necessary for positive results. Information technology in nursing education plays a vital role in enabling educators to receive information and feedback from peers in the same profession (Cheng et al., 2015). The feedback is evaluated by collecting data from peers and students regarding the impact of technology in nursing education. Simulation enables nurse educators to work collaboratively and in partnerships to create the knowledge that is delivered to their students (Klipfel et al., 2014). They have the opportunity to discuss and ensure that the content is the most effective to train skilled and knowledgeable nurses to improve the safety and quality of care in practice.
Preparation for the Nurse Educator to use Simulation
The nurse educator will play an important role in implementing technology in education settings. Notably, the use of simulation differs from the traditional teaching approaches where the trainer delivered information to primarily passive learners, such as the lecturing method. Conversely, simulation and other technology tools have created a more active class of learners, allowing them to become co-creators of knowledge. Therefore, the nurse educator should be prepared to teach in a student-centered environment, engaging the learner in the whole learning process, including the creation and delivery of knowledge (Sittner et al., 2015). Nursing trainers should understand concepts such as student-centered and constructionist learning because they play an important role in the implementation of technology-supported teaching and learning. They should learn about the ways they can include students in the teaching and learning process because they no longer have a monopoly over education. Students have become active participants in the teaching and learning process (Cheng et al., 2015). Nurse educators should learn about the new role of the teacher and student to use simulation effectively.
The nurse educator working in an innovative educational setting should be trained to use different kinds of technologies, including simulation and gaming strategies. Training and development of nurse trainers should assume a new approach from the traditional nurses who used lecturing and other passive teaching methods. They should be trained using the technological tools that they are most likely to use when teaching their students. The nurse educator should be prepared to identify and implement the technology when teaching nursing students to ensure that they benefit from the innovative context and improve their nursing practice outcomes (Sittner et al., 2015). Educators should also learn about the requirements for the innovative tools that they could use in training their students. They should understand the kind of technology that is critical in implementing simulation-supported learning. In some cases, the nurse educator will implement the lesson plan that will use the technology. Therefore, they should know the kind of technology to acquire and use.
A Framework for a Nursing Course
Hand Hygiene Compliance
The course supports the development of hand hygiene skills and compliance among nurses to support safe and quality care and reduce negative outcomes such as high incidences of hospital-acquired infections. The students will understand the situations where they should exercise hand hygiene to control hospital-acquired infections. Those setups should include instances before and after having physical contact with a patient (such as when taking a patient’s blood pressure), before the performance of an invasive procedure such as surgery, before and after using medical equipment or tool. In addition, the process should also entail before serving or preparing food in a clinical environment, before and after collecting blood or any other specimen, before giving drugs, after coming into contact with any body’s fluid such as blood, before and after wound dressing, and before and after using gloves.
A simulated learning environment will be used to train nurses about hand hygiene, which is one of the most effective ways of preventing adverse medical outcomes such as hospital-acquired infections. Since the nurses have already learned about the need for hand hygiene, the simulated environment will develop the skills to help them to implement the knowledge in practice. The simulation modality that will be used in the course is the Virtual Patients Simulation, which is a computer-based interactive technology that mimics the actual patient care environment (Sittner et al., 2015). In the modality, nursing students mimic the role of the health care provider to support effective care and make beneficial decisions regarding their interaction with patients. In this case, the students will learn about hand hygiene and use knowledge when interacting with virtual patients. The process is important to test compliance with hand hygiene to protect patients from hospital-acquired infections.
Evaluation is critical to collect data to show whether the implemented change is achieving the objective. For example, the implementation of hand hygiene training in a simulated environment aims at training nursing students with some of the principles and skills in hand hygiene practice in health care practice. Therefore, the evaluation will test whether the students have developed the target skills and improved their level of compliance (Alexander et al., 2015). The information for the evaluation will be an assessment of the level of understanding of the hand hygiene skills and compliance. An assessment will reveal the level of understanding of hand hygiene practice. For example, the nurse educator will evaluate the process to determine whether the students have understood the target skills. The process is important for the overall success of the entire simulation project to support the course and the faculty.
Another critical source of data for the evaluation process is using feedback from nurse educator peers about the progress of the training program in achieving its objectives. The nurse should use the knowledge from peers to evaluate the simulation-training program. Sittner et al. (2015) reveal that simulation supports collaborating learning, where the nurse educator works with peers to develop the content for the training program. The peers will not only help in the implementation but also in the evaluation of the training program to ensure that the objectives are met. The nurse educator will work with peers in the faculty to create the assessment to test the level of development of target skills. Curriculum integration will be an important part of the nursing faculty that will affect all nurse trainers and students.
Evidence-based information should inform the evaluation process. For example, the faculty should determine whether the simulation approach is achieving the faculty’s teaching and learning objectives. It is necessary to compare the effectiveness of the technology as opposed to the traditional learning approaches. Educational peers should observe the variability between the simulation environment and the technological setting to determine the most useful in developing hand hygiene skills and compliance (Sittner et al., 2015). The information will be used in the future to implement training courses and programs at the institution. It is also essential to determine the necessary changes in the training programs because different kinds of simulated environments are available, which the institution or faculty can implement (Alexander et al., 2015). Hence, to make such decisions, it is significant to establish the outcomes achieved by the current program by collecting and analyzing data for evaluation purpose.
Advantages of using Simulation in Nursing Education
Various benefits are likely to be drawn from using an educational innovation, such as simulation or gaming strategies, in teaching hand hygiene to nursing students. Simulation and other technologies in nursing education are engaging and motivating to students. They enable the learner to engage directly with the learning material and create customized content. Therefore, they improve their chances of understanding the relevant skills and competencies by drawing meaning from the teaching and learning process (Stocker, Burmester, & Allen, 2014). Simulation is the most suitable method for teaching complicated and extensive practical issues when they cannot be solved using traditional approaches. The model enables educators and students to comprehend such problems and apply knowledge in practice.
Another advantage of using simulation is the potential to gain long-term knowledge of the target content. Unlike other information delivery methods that are less engaging, such as lecturing, simulation or gaming technologies enable the student to learn and retain information because of learning through practice. Besides, the teaching model is usually flexible and can change the systematic system variables, depending on the needs of the situation. Educators and teachers can use the solution that suits their needs among different educational models (Stocker, Burmester, & Allen, 2014). Besides, in simulated environments, students perform experiments with the model with the system remaining intact. Therefore, many students can use the system to develop different skills. It is worth noting that acquiring knowledge in a less risky environment also minimizes the risk in real life systems.
Disadvantages of Using Simulation in Nursing Education
Regardless of the advantages of simulation or gaming strategies in training nurses, some disadvantages are evident, which might affect the effectiveness and positive impact of the innovative teaching methods. One of the drawbacks in integrating the simulation technology into the curriculum is the capital. Investing in any technology in education is a costlier activity compared to the use of more traditional approaches such as lecturing or discussions. The faculty implementing the new technology should spend on the computerized systems that create the simulated experience (Stocker, Burmester, & Allen, 2014). The investment also requires additional resources, including books, boards, and other resources used in the traditional classroom. Besides, the faculty will invest in the time to set up an effective simulation model. The initiative is not as direct as the classroom settings that do not use technology. It is a comprehensive decision that takes time to gather and analyze necessary information (based on the model) regarding the conditions and constraints surrounding the use of technology.
Another drawback is that simulation does not always generate optimal solutions in the learning process. Technology in education poses the risk of distraction. People use technology for various reasons besides education, such as entertainment and communication. Hence, in the process of learning the learners can be distracted even in a formal educational setting (Stocker, Burmester, & Allen, 2014). For example, students can use gaming strategies for entertainment, which might distract them from the educational goals of the technology.
Impact of Simulation on Student Outcomes
Nurse educators should implement an organized and systematic strategy for the use of technology in nursing education. Such strategic incorporation of simulation into the nursing curriculum has significant benefits to students. Simulation provides nursing students with alternative methods to learn and develop particular skills and competencies such as hand hygiene compliance. The approach helps them to customize the learning process to their individual needs. For example, students who face challenges understanding theoretical information have the opportunity to use simulation to mimic the real-life experience to understand specific content better (Stocker, Burmester, & Allen, 2014). Simulation is making it possible for healthcare educators to achieve learning outcomes by engaging their students in the learning process. In turn, students are motivated to learn when they are an important part of the teaching and learning process. However, they should begin with a clear purpose of the program and anticipated learning outcomes, and hence, match their learning objectives to the simulated approach.
Future Integration of Simulation
Important lessons are evident in implementing a nursing education course using innovative technology. The course has allowed the personal development of a nurse educator, including learning new approaches to teaching that can enhance understanding. For example, educational innovation has provided alternative methods of delivering informative content to nursing students (Alexander et al., 2015). Simulation is one of the innovative ways to support effective teaching in nursing, which educators should use to train students and develop skills in various subjects. Educators should understand the current simulation technology, related standards, and best practice to implement simulation in the teaching and learning context. They can use information from the National Council of State Boards of Nursing (NCSBN) that includes the outcome of comprehensive research on the implementation of simulation in the place of traditional learning settings (Alexander et al., 2015). The organization concludes that quality simulation experiences are effective in promoting clinical learning and practice. Acquiring the right simulation technology and using the available simulation and learning standards will enable nursing education organizations to implement and successfully use simulation to support nursing education.
As it s evident from the discussion and analysis of various settings, nurse educators have accepted and supported the use of educational innovation in training and developing skilled nurses who can provide health services to diverse patient populations. Besides, some organizations, such as the University of British Columbia and the Johns Hopkins School of Nursing, have already implemented and used simulation in training different medical professionals, including nurses. Information from the organizations that are using simulation in training nurses indicates that technology is effective in supporting the teaching and learning process. Therefore, it can be adopted in other institutions to train nurses and develop skills and competencies, such as hand hygiene, to prevent hospital-acquired infections. Simulation transforms the way nursing education is delivered, although it has some advantages and disadvantages that nurse educators should understand. In essence, simulation process is improving nursing education and can be implemented successfully to train new and experienced nurses in a low-risk environment before the professionals can apply the knowledge in real practice.
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