Challenges in High Fidelity Simulation: Risk Sensitization and Outcome Measurement.

AbstractAs the use of high fidelity simulation (HFS) in nursing education increases, evidence of its impact on learner self-confidence continues to grow. However, evidence to demonstrate an actual, positive influence on learner competence remains inconsistent. This lack of clear evidence supporting increased clinical competence challenges faculty seeking effective teaching strategies related to HFS. The purpose of this article is to discuss two key challenges in the integration and use of HFS in nursing curricula. The authors review the use of HFS in nursing education and provide a critical discussion of two challenges to incorporating HFS into the nursing curricula: the dangers of risk sensitization and the need for a standardized framework. They conclude that simulation experiences that encompass the element of longitudinal care and patient response, along with further research identifying best practices are needed to provide a sound basis for supporting the use of HFS in nursing education.Citation: Onello, R., Regan, M., (July 11, 2013) "Challenges in High Fidelity Simulation: Risk Sensitization and Outcome Measurement" OJIN: The Online Journal of Issues in Nursing Vol. 18 No. 3.DOI: 10.3912/OJIN.Voll8No03PPT01Keywords: high fidelity simulation, undergraduate nursing education, nurse competency, clinical judgment, clinical reasoning, risk, simulation design, learning outcomes, simulation design, simulation frameworkUndergraduate nursing programs are looking for evidence that will support the use of high fidelity simulation (HFS) and guide best practices in the use of simulation to improve learner outcomes. The purpose of this article is to discuss two key challenges in the integration and use of HFS in nursing curricula. The first challenge is related to the potential for sensitizing students to risk events that may impact the learners' overall nursing competence. The phenomenon of sensitizing students to risk is based on a common use of HFS involving simulations focusing primarily on emergency situations, thus reinforcing reactive rather than proactive (anticipatory) skill sets. Risk sensitization is problematic because it can limit students' ability to take in and process information, for example in situations where a patient's condition is in the very early stages of deterioration. The second challenge is the lack of a standardized approach to measuring and evaluating competence outcomes among nursing students. In this article, we will describe the use of HFS in nursing education and address the challenges of risk sensitization and the lack of a standardized approach to measuring and evaluating competence outcomes. We will recommend that simulation experiences include both acute and longitudinal care, and that educators conduct additional research to fully understand the best practices in using HFS in educational settings.Use of High Fidelity Simulation in Nursing EducationHFS goes beyond the sophistication of basic simulators by including aspects of realism related to the physical and psychological learning environment (Rogers, 20071. HFS seeks to address the cognitive, affective, and psychomotor domains of active learning (Bastable, 20081. For the purpose of this article, HFS is defined as a replicated clinical experience using a computer-driven, full-bodied simulator with physiologic responses to interventions. Common, computerdriven simulators used for HFS include Laerdal's Sim Man® and METI's iStan®. These simulations occur in a realistic context that emulates an actual clinical scenario and incorporates visual, tactile, and auditory cues. The learner is engaged in deliberate practice to meet cognitive, affective, and psychomotor objectives (Cannon-Diehl. 2009: McGaghie, Issenberg. Petrusa, &Scalese, 20101.The integration of HFS into nursing education has increased in recent years and is now used to augment clinical practice hours. This practice of augmenting clinical practice hours with simulation is actively promoted by the American Association of Colleges of Nursing (AACN) and its associated Commission on Collegiate Nursing Education (CCNE). …