Best Practices for Integrating Virtual Simulation into Nursing Curriculum
by Christi Doherty, DNP, MSN, RNC-OB, CNE, CHSE, CDP, Director, Nursing Research | August 10, 2021
Virtual simulation is a significant part of the nursing curriculum today and is a valuable educational tool. The interactive, immersive experiences in virtual simulations, like i-Human Patients by Kaplan, support the acquisition of clinical skills, developing clinical judgment, and strengthening decision-making abilities. Virtual simulation can enhance classroom or online instruction, provide clinical experiences in areas of limited access, or function as an adjunct or replacement for clinical hours. However, integrating virtual simulation into the nursing curriculum requires careful, deliberate consideration to optimize the student learning experience.
Virtual Simulation in the Classroom
Today, the demographics of nursing students are evolving. They are active learners and very technologically savvy, and that combination means we need to provide more interactive, immersive learning experiences for them. Bringing virtual simulations to the classroom, whether face-to-face or online, meets those learning needs.
Students can be assigned a simulation or case to complete individually, receiving immediate feedback on their actions. Then, they can repeat the simulation to reinforce their knowledge and build self-confidence in the material. In the flipped classroom, students can complete a virtual simulation case as a team, requiring collaboration and mutual decision-making abilities. The team experience allows students to learn from their peers, strengthen communication skills, and refine professional behaviors as they care for the virtual patient together.
Virtual Simulation to Augment Clinical Experiences
Obtaining clinical experiences for nursing students, particularly in specialty areas such as obstetrics, pediatrics, or mental health, can be challenging. Even if a nursing student gains access to one of these areas, often, they assume an observational role without direct patient care.
Virtual simulations allow the opportunity to care for high-risk patients or experience situations rarely open to students, such as Code Blue emergencies or disaster responses. Additionally, since the simulations are standardized, the faculty know that each student's learning experiences are consistent. Virtual simulations can also enhance manikin-based simulations and clinical skill task trainers, strengthening engagement and skill mastery.
Virtual Simulation as a Replacement for Clinical Hours
Whether from lack of clinical placements or for clinical makeup, virtual simulation can be used to replace clinical hours deficiencies. In 2014, the National Council of State Boards of Nursing (NCSBN) simulation study determined that substituting high-quality simulation experiences for up to 50% of traditional clinical hours produced comparable educational outcomes in nursing graduates (NCSBN, 2014). While each state has defined an acceptable percentage of hours to allow in nursing education programs, all agree that high-quality simulation experiences are critical. “High-quality” is accomplished by adhering to recognized best practices.
Virtual Simulation Best Practices
The International Association for Clinical Simulation and Learning (INACSL) developed the INACSL Standards of Best Practice: SimulationSM to provide evidence-based guidelines and best practice principles for implementing simulation into nursing education (INACSL, 2016). The standards are continuously revised, and the most current version reflects required elements for simulation design, outcomes and objectives, facilitation, debriefing, participant evaluation, professional integrity, interprofessional educations, and a simulation glossary. The criteria for simulation design are critical components of successful simulation experiences.
According to INACSL, the first step for simulation implementation is to perform a needs assessment (INACSL, 2016). A critical examination of the overall needs of the nursing program, including resources, will form the implementation plan and help identify target goals and outcomes. Often, nursing programs are aware of the issues that need to be solved, however, following a systematic process that includes input from various stakeholders is key to optimal simulation implementation.
The next step is to develop measurable objectives addressing the identified needs to meet the target goals. Virtual simulations often have objectives and competencies assigned to simulation cases. Faculty can build on these objectives, leveled for their curriculum needs, to support the desired outcomes.
Other INACSL (2016) criteria include selecting the appropriate modality for the simulation, providing a context for the experience, and using various types of fidelity to create realism. Carefully crafted virtual simulation cases provide faculty a relatively easy way to meet these elements. Virtual simulations have life-like avatars, conversational interviews, and electronic health records that depict authentic healthcare experiences.
INACSL emphasizes the importance of a pre-brief to share expectations with the students and a debrief to facilitate learning and provide feedback. Faculty can effectively incorporate pre-brief and debriefs; however, virtual simulations will offer detailed student reports that enable feedback. The reports allow students to review their individual strengths and weaknesses and provide faculty a cohort comparison to recognize students at-risk for not meeting learning objectives. INACSL criteria recommend providing resources to meet outcomes, and the simulation report supplies faculty with the necessary data.
Virtual simulations take careful planning to implement into nursing education, but the effort is worthwhile. Immersive, engaging virtual simulations, like i-Human Parients, have eased much of the implementation burden, and INACSL standards of best practice provide the framework.
Now, time to get started!
INACSL Standards Committee (2016, December). INACSL Standards of Best Practice: SimulationSM: Simulation. Clinical Simulation in Nursing. Volume 12, S5-S50. https://doi.org/10.1016/j.ecns.2016.10.001
National Council of State Boards of Nursing (NCSBN). (2014). Simulation Study. https://www.ncsbn.org/685.htm
Dr. Doherty is a skilled nursing researcher with published works on clinical judgment, communication, pharmacology, medical-surgical nursing, research design, and statistics. She was a professor of nursing at both the prelicensure and doctorate level. An experienced clinical nurse at the bedside for over 20 years and more recently a virtual simulation content designer, Dr. Doherty uses her vast experience to enhance nursing education at Kaplan.