Student nurses’ perceptions of the impact of a simulated clinical environment on their clinical learning experience

Maureen Crowley MN, RGN, RNT. School of Health, Nursing & Midwifery, UWS, SCOTLAND

Background Nurse training moved into higher education and provided students with equitable exposure to theory and practice. However, changes in healthcare provision and increasing numbers of pre-registration students resulted in less opportunity for the acquisition of clinical skills in practice placements (Scholes et al. 2004). Simulated clinical environments, using low/medium fidelity simulators have been introduced to address this – a move supported by the NMC (2007). Research has established that simulation helps in the acquisition and transfer of skills to practice in the short term. Research is needed to establish how simulation works from a holistic perspective and how it influences their development over time.

Study Aim To explore the nature of student nurses experience of learning within a simulated clinical environment, in relation to the development of clinical skills within the psychomotor, cognitive and affective domains and the impact this has on the transfer of skills to practice. Design A purposive sample of 12 student nurses interviewed over two years, from entry into branch to registration.

Preliminary Findings Analysis is ongoing, but initial findings are generally encouraging and despite some initial discomfort, the majority of the participants value simulation. Many had no previous experience of being in a clinical ward area so they reported feeling more confident going into practicum. Concerns include the fear of looking ‘silly’ in front of staff and wanting to fit in so simulation prepared them. They knew what to expect and got a ‘head start’ – “I feel shaped and ready to go out” Simulation would appear to take learning from the realms of imagination to the realms of reality and participants valued the ‘guilt free’ aspect – “you can do it wrong and get a second chance” Learning in simulated environments seems to suit the preferred learning styles of many of the participants – “you can read all you want in a book, but doing it makes it so much easier” and “…but if you’re in a clinical skills lab it keeps your attention” However, one recurring theme evident throughout the data is that of engagement. Many comment on how communication is difficult and some feel inhibited when in the simulated environment – “you start fumbling instead of focusing and you end up getting lost somehow” and another participants commented “I am terrified walking into the sim room…I would literally freeze…I feel silly with other students watching me, I hate it”. Those participants able to fully engage with the technology appear to get the most benefit. Further exploration into the concept of student engagement within clinical simulation is currently underway.

References Nursing and Midwifery Council (2007) Simulation & Practice Learning Project. NMC Scholes J, Freeman M, Gray M, Robinson D, Mathews-Smith G, Miller C (2004) Evaluation o f Nursing Education Partnerships. DoH

From this…

…To this

It’s good to have time to make mistakes

Right, what’s happening? What are we going to do?

I’m glad we did this in college

Real people are easier to talk to

I am confident I can do this

Research Questions 1. How does learning through simulation facilitate individual student

learning and influence preparation for practice? 2. To what extent does simulation support the development and

transfer of the student’s clinical skill proficiency in the cognitive, psychomotor and affective domains?

3. What factors facilitate or inhibit student engagement with the simulated learning experience

4. How do student’s transfer skills gained in the simulation setting to the practice setting?