NR522 High Fidelity Simulation Chamberlain College of Nursing Instructor Marjorie McDonough Kim C. Gomez Spring B 2015

Introduction
The use of high-fidelity simulators in nursing education has been around for a long time. Simulation is the art of science and the recreating of a scenario in to a setting that is not real is one that has been an important aspect of nursing for decades. Although the manikin Resusci Anne was introduced to modern nurses practicing cardio-pulmonary resuscitation (CPR), the Mr. Chase doll was initially used in 1911 for nurses to practice their skills (Burns, O’Donnell, & Artman, 2010). Computers and technology have become instrumental in the delivery of nursing education. The use of high fidelity simulators, promotes problem solving, critical thinking and communication skills development (Stokowski, 2013). As high fidelity simulation is emerging to address the 21st century, clinical education in nursing must be aligned with the current trends without compromising patient safety and curriculum. This technology of simulation will foster learning as a catalyst into the new era of learning and critical thinking needed for the evolving profession of nursing. Some debate has been raised over replacing clinical hours with high fidelity simulation. Passive learning occurs through passive teaching methods such as dictated lectures. Active learning strategies such as high fidelity simulators are usually more effective and can largely affect new graduate nurses when entering the profession. Impact
According to Stokowski (2013), given the choice some students prefer to practice on a patient who cannot be harmed where a level of comfort is achieved in preparation for real life patients. Simulation promotes critical thinking, problem solving and communication skills which are tools needed to provide safe and competent patient care. One study revealed that nearly 65% of new nurses lacked skills needed to make appropriate clinical decisions when failed video-taped patient care scenarios Baracki & Handberg, 2010). This further proves and confirms for some that experimental learning is most effective process to teach clinical skills. Further advancements in technological media again have raised the bar for the limits in simulation education. Such innovations as virtual worlds and computer simulators are building gaps between nursing theory and nursing practice. Here, then, lies the future of nursing. State Board of Nursing Regulations/Illinois
The boards of nursing that comprise the NCSBN of which Illinois is included performed a national landmark study of 10 pre-licensure programs across the US in 2011. This study included three phases. Illinois did not have a nursing program represented in this study. This research initiative explored the role and outcomes of simulation in pre-licensure clinical nursing education. Details and results of the study can be found at the National Councils State Boards of Nursing’s (NCSBN) website. Illinois supports and follows recommendations related to replacing clinical hours with simulation hours and protect the public’s health and welfare by assuring that safe and competent nursing care is provided by licensed nurse. The mission is achieved by outlining standards for safe nursing care and issuing licenses to practice nursing. Two key questions were how much simulation should be used and what are the best practices (NCSBN, n.d. 2015). Effect on Learning Needs of Students
Students reach competence by practice and rehearsing or creating an environment that is now widely done by using high-fidelity simulators (Burns, O’Donnell, & Artram, 2010). The use of low-moderate-high fidelity simulators may facilitate learning and further enhance hands on learning. The degree of similarity between a virtual world and the real world is the higher the fidelity, the richer the experience which in some cases can be taken too far. As mentioned before, passive learning has been the way students learn in traditional lecture setting. The current trend of high-fidelity simulation promotes students to learn more actively while putting in place the nursing process. Students can become proficient in a less stressful environment, the system is controllable, predictable and can be reproduced (Illinois Nurse, 2011). Debriefing is an opportunity to point out trials, errors and reflection and where feedback is usually given. This occurs after the use of simulation and is facilitator led. Debriefing makes way for effective and successful continuation of simulation in nursing education (Alexander, 2014).
Writer’s Position on Use of High-Fidelity Simulation in Nursing Education This writer strongly feels that the use of simulation in nursing programs is and can be a resourceful tool. Whether some like it or not technology is all around us. The writer also strongly feels that most programs will use some form of simulation whether it be through fidelity, games or virtual scenarios. Deciding to use the advances can be beneficial or hindering. Problem solving and critical skills are pillars of nursing and are necessary to deliver safe, effective and knowledgeable care. The above skills are needed in real life. There is a level of preparedness that occurs with simulation. The writer supports the notion that many professional nursing affiliations endorse simulation as an innovative instructional method that complements curriculum and enhances clinical experiences for nursing students (CCC, 2015). Nursing education must not solely rely on simulation but rather additives to overcome and succeed. As a future educator, this writer would definitely utilize the use of simulators in the instructional setting and clinical skills lab.

Conclusion Simulation use is now at the frontline in nursing education. There are still kinks to be flattened in this area but overall simulation has been a surefire win. Knowledge, problem solving and critical skills will erupt from its use. Research will continue to offer recommendations as well as outlining strengths, weaknesses and areas needing improvement for this positive instructional method. Findings of the simulation study were able to provide credible evidence that simulation can be effectively substituted for clinical hours or experience in core nursing courses. This landmark simulation study further noted that with the appropriate dedication, structure, resources, excellent student outcomes can be achieved in pre-licensure nursing programs (Alexander, 2014).

References
Alexander, M. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in pre-licensure nursing education. Journal of Nursing Regulation, 5(2).
Brewer, E. (2011). Successful techniques for using human patient simulation in nursing education. Journal of Nursing Scholarship, 43(3). Burns, H., O’Donnell, J., & Artman, J. (2010). Clinical simulation in nursing: High fidelity simulation in teaching problem solving to first year nursing students: A novel use of the nursing process. Nurse Education Today, 6(3).
Handberg, A. & Baracki, K. (2010). Leader to leader. Retrieved from www.ncsbn.org