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H I G H - F I D E L I T Y PAT I E N T S I M U L AT I O N
H i g h - F i d e l i t y Pa t i e n t S i m u l a t i o n i n N u r s i n g E d u c a t i o n :
An Integrative Review
A M Y W E AV E R
IGH-FIDELITY PATIENT SIMULATION (HFPS)
the use of realistic, simulated patients and clinical environments in the education of health care professionals is more visible
in nursing education than ever before (Jeffries, 2009; Nehring & Lashley,
2010). This presents a challenge to nursing faculty: can they justify the
investment of time and money necessary to train faculty in the use of
HFPS and incorporate the technology into their curricula? To answer
that question, it is necessary to examine the effect of HFPS on nursing
students.
HFPS provides opportunities for interactive learning that can be
used in any nursing course. It can also be used as reinforcement for traditional classroom lessons and as an adjunct to laboratory sessions.
Because competition among nursing programs for clinical sites can limit
students time in clinical rotations, HFPS has also been used as a supplement to those rotations (McCallum, 2007; Nehring, 2008). In a landmark
study, the National League for Nursing (NLN) conducted a four-phase,
national, multisite, multimethod project to design and implement models for simulation use in nursing education (Jeffries & Rizzolo, 2006).
Several tools were developed and tested in this study. Its publication
resulted in the development of a simulation model and a much-needed
upsurge of interest in the use of HFPS in nursing education.
But does the evidence support HFPS as an alternative to clinical
experience with real patients? This integrative review evaluates the findings of recently published research.
Simulation
makes for an ideal learning environment for nursing students: it mirrors
the clinical setting and mimics patients responses in a controlled setting, without the risk of students harming patients. Unpredictable
patient conditions can be included, as can the patients responses to
students interventions.The theory is that HFPS can encourage students
to push the limits of their abilities so that they can better learn what to
do in a real clinical situation. Also, HFPS allows for the repetitive teaching of skills and concepts in a variety of clinical situations (Nehring, Ellis,
& Lashley, 2001) and can be useful for students in need of remediation.
It can also provide a learning opportunity for conditions that students
may rarely encounter in a clinical setting.
HFPS can be used across the nursing curriculum. In beginning
courses, for example, it can be used to teach fundamental assessment
skills by demonstrating abnormal physical findings (Nehring et al.,
2001). In medical-surgical nursing courses, it can be used to teach students about drug and IV fluid administration. The complexity of the
RESEARCH
A B S T R AC T
An integrative review was undertaken to analyze studies published since 1998 on the use of high-fidelity patient simulation (HFPS)
in undergraduate nursing education. This review found that HFPS benefits nursing students in terms of knowledge, value, realism, and learner satisfaction; findings were mixed in the areas of student confidence, knowledge transfer, and stress. Further research in these and other areas will determine
whether its increased use is warranted.
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INCLUSION AND EXCLUS ION CRITERIA A priori inclusion criteria for the search included HFPS in nursing education and quantitative
studies. Initially, only articles involving baccalaureate nursing programs
were included in the search, but later articles on associate degree and
diploma programs were included. The concepts of confidence and knowledge as they related to HFPS were used for the initial screening of the
literature. After initial review and analysis of the articles, it became clear
that several other concepts were worth examining: value, realism, stress,
and knowledge transfer. All articles were reviewed again to determine
whether they addressed these concepts. A concept that emerged in the
new search was learner satisfaction.
Excluded were articles on HFPS used for the education, training, or
orientation of nurses rather than nursing students, as were those limited
to live patient simulation, computer simulation, and low-fidelity simulation; conference proceedings; and articles on the use of HFPS in graduate-level nursing education. No specific criteria were set for sample size.
High-fidelity patient simulation refers to predeveloped patient scenarios utilizing computerized manikins that respond to intervention by
providing instant feedback. Since fidelity refers to the realism of the simulation, high-fidelity patient simulation is currently the highest level of
realism offered with patient simulation. Low-fidelity patient simulation
refers to individual manikin parts that are used simply as task trainers
to teach students specific psychomotor skills. Medium (or intermediate)-fidelity patient simulation uses manikins that can be somewhat
computerized; these offer opportunities to practice specific psychomotor skills but lack the complexity and realism of patient scenarios.
TERMINOLOGY
The term patient simulation has been used
throughout the nursing literature with a variety of meanings. In earlier
literature, patient simulation referred to anything from people acting the
role of an ill patient to computer software simulation to low- and medium-fidelity simulators. Most recently, the term has been used interchangeably with high-fidelity patient simulation. Another term used interchangeably with high-fidelity patient simulation is human patient simulation; many of the studies in this review used this last term.
It is interesting to note that although all of the studies in this review
utilized HFPS, many of the studies did not use the term high-fidelity
patient simulation, or another simulation term was used in the title. One
study referred to intermediate-fidelity simulation in the title (Alinier,
Hunt, Gordon, & Harwood, 2006), but the researchers description of
the study suggests that HFPS was used. For the purpose of this review,
patient simulation refers to high-fidelity patient simulation conducted
using realistic scenarios with a high-fidelity manikin.
Results and Review Process The search using the term patient
3 8 N u r s i n g E d u c a t i o n Pe r s p e c t i v e s
H I G H - F I D E L I T Y PAT I E N T S I M U L AT I O N
Discussion
H I G H - F I D E L I T Y PAT I E N T S I M U L AT I O N
January / February Vo l . 3 2 N o . 1 3 9
H I G H - F I D E L I T Y PAT I E N T S I M U L AT I O N
environment, nursing students must be educated with the most realistic technologies available. HFPS might just change the face of nursing education. NLN
Smith, S., & Roehrs, C. (2009). High-fidelity simulation: Factors correlated with nursing student satisfaction and self-confidence. Nursing Education
Perspectives, 30(2), 74-78.
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