SIMULATION

INTRODUCTION

Simulations are useful teaching strategy for illustrating a complex and

changing situation.They are less complex than the situtations they represent.In a
simulation the learner acts the simulation reacts, the the learner learns from this
feedback.Examples of simulations are car and flight simulators,monopoly,mock elections
etc.Note that in each cases the game involves rule and the students must make the
decision.

Simulation modelling has been used in a wide range of physical and social
sciences and engineering fields, ranging from nuclear fusion to economic forecast to
space shuttle design. For different types of situations and systems, different types of
models are used. In classifying simulations, there are important distinctions among the
types of models that are being simulated, and among the types of program structures that
are used to carry out the simulation.

MEANING OF SIMULATION

A simulation is something that represents something else it isn't the real

thing. At times you might perform a simulation as practice for real life, such as a flight
simulation thats used to train pilots.
 DEFINITION OF SIMULATION

Simulation is a technique the enable adult learners to obtain skills, competencies,

knowledge or behavior by becoming involved in situations that are similar to those in
real life (R Sudha).

Role play in which the process of teaching is displayed artificially and an effort is
made to practice some important skills of communication through this technique (K P
Neeraja).

Simulation may be defined as a role playing in which the process of teaching is

enacted artificially and an effort is made to practice some important skill of
communication through this(clement I)

PURPOSES OF SIMULATION
Encouraging the team work
When working in teams, as occurred in this study, students learn to
realy on one another as fellow team members and to collaborate with one another.
simulation is one of the more important components of the experience. Reflection
during debriefing allows the student to critically think through the lived experience.
Although simulated experience will never be exactly the same as patient care, it allows
the student to experience a critical event before they are responsible for one in a
working environment.
Knowledge and skill development

Simulation is designed to imitate the clinical environment and provides

the opportunity for the student to demonstrate knowledge and skills learned within their
education program as well as the opportunity to practice decision making and critical
thinking . Several studies have demonstrated that simulation training allows the training
agenda to be determined by the needs of the students and not the patients; that it is a safe
learning environment to practice rare and critical events and that it provides objective
feedback to students. Several studies have found simulation to be an effective way to
increase clinical competence, to build confidence in skills in a supportive environment
and providing repetitive practice which can help speed acquisition of skills, enhance
technical, behavioral and social skills and provide reflective learning through debriefing
feedback interviewing and physical examination skills.

Preventing medication errors

Errors are often due to confusion caused by similar drug names. Another
factor is lack of understanding by patients about their medications, including the
risks and side effects of medications and what to do if side effects occur.
Medication errors directly related to nursing practice usually involve
inappropriate medication dosage, overlooked allergies, giving the wrong drug,
and incorrect administration site. All these errors are impacted by environmental
distractions, miscommunication, and drug labeling problems. Medication
administration is a vital aspect of nursing practice and a critical component of
nursing education curricula. Faculty in schools of nursing are concerned with
teaching students about safe medication administration. Educating students
about safe administration of medications is multifaceted and involves instruction
about actions and uses of medications, safe dosage, side effects, and nursing
implications.
Promoting effective communication
Patient care scenarios using the human patient simulator
provide an opportune way to teach students to effectively use a
standardized communication method and to allow them to practice this
technique. With minimal effort in simulation, requiring practitioners at all levels
to develop and refine their communication techniques to be more effective.
 Ideally, students representing various health care disciplines can work together in
patient care simulations, practicing communication techniques that are
representative of the actual health care setting

Nursing education programmes

University and community college nursing education programs use patient
simulators with a variety of learners. Patient simulators are used to teach basic
assessment and psychomotor skills with beginning students, evolving to complex
clinical scenarios as students advance in the curriculum.4, Graduate nursing
programs utilize the patient simulator to teach advanced practice skills and
concepts in nurse practitioner and nurse anesthesia programs.It is used by
clinicians to teach new procedures, to validate competencies, and to transition
new graduates into the clinical practice. The patient simulator can be used in
research concerning best practice for patient care and education. It has potential
for use in masters and doctoral-level education programs to train future faculty
members.
Promoting continuing education

The patient simulator can be incorporated into a variety of continuing

education programs, departing from the traditional lecture format to provide a
experiential learning experience for participants. Physical assessment classes, nurse
anesthesia updates (e.g., airway management), advanced cardiac life support (ACLS)
certification, critical care courses, and nurse refresher programs can be conducted
using patient simulators. Nurse refresher courses typically consist of didactic and
clinical components to prepare nurses to return to practice after an extended absence.
Using patient simulators, these nurses can practice assessment and psychomotor
skills before entering the clinical area. This helps promote self-confidence in the
nurse refresher students as they resume hands-on care in a setting that does not
endanger a live patient.

OBJECTIVES OF SIMULATION

Develop highly complex cognitive skills

Simulation helps to develop cognitive skills,which helps to decision making in
client setting area.By using these skills helps to solve the problem of the patient
effectively through assuming this simulation role.
Impact on learners values and beliefs
Consider the learners social values and beliefs for the application of this
simulation.It means we should not hurt the learners religious values.
Improves self confidence
Through this simulation the learners will get the thorough knowledge about the
situation.so they engage in effective participation,which will promote the self
confidence.
Induces feelings of empathy
It means experience of understanding another persons condition from their
perspective.you place yourself in their shoes and feel what they are feeling.

VALUES OF SIMULATION
Simulation ensures safe nursing practice by nursing students through bridging the
gap between theory and practice: In the simulated environment of the
fundamental lab, students learn safe practice of learned theory under the
guidance of the teacher.
Simulation is an effective techniqe to learn psychomotor skills: In the simulated
environment of the fundamentals lab ,by the use of mannequins and other
equipments students learn psychomotor skills essential for giving nursing care in
the clinical situation.
 Simulation helps the students to develop critical thinking abilities and problem
solving skills: Simulation is the most effective way for developing problem
solving skills. The acquisition of problem solving skills will in turn help students
to apply the nursing process by gathering and analysing data, identifying the
problem, setting priorities, selecting and modifying interventions and evaluation
outcomes.
Simulation not only helps the students to learn the decisions making process but
also provides feedback regarding the consequences of the decision made:
students learn decision making process by making decisions rather than simply
grasping the relation theory.They also get the feedback regarding the
consequences of the decision from the teacher and classmates.In this way,
students become aware of their ability to make effective decisions.
Simulation, especially the role play enables students to empathise with the real
life situation: By means of empathy, students place themselves in other position,
this will help to understand others feelings and to interact effectively by
employing appropriate communication styles suitable to the situation. As
interaction is taking place in a simulated environment ,students get an
immediate feedback regarding their way of interaction and communication
style.
By way of simulation teacher can easily inculate proer attitude among nursing
students;Proper attitude is essential for good nursing practice.Simulation helps
students to recognise the need of proper attitude in giving comprehensive nursing
care and helps them to cultivate a positive attitude esential for a successful
nursing career.
Simulation can also be used to evaluate students:Questions in the simulated form
are very useful in assessing the knowledge related to the practical aspects of a
subject. Here the teacher identifies that whether she achieved the goal or not.
 CHARACTERISTICS OF SIMULATION
This techniques requires a very systematic planning in advance. Whatever is to
go on during the training process is decided well in advance. Right time planning
ensures attainment of desired goals.So that confusion among the topics to
resolved.
Proper involvement of the student in the training program of this technique
guarantees its success.Because it will promotes students interest thereby the
effective implementation of simulation takes place.The students perceived the
condition as their own problems ,it helps to promotes feeling of participation.
Feed back plays an important role in simulated teaching. The drawbacks noted in
teaching are pointed out and appropriate suggestions are given. The feed back is
positive and is of constructive type .If it is negative they can go for revision.
The supervisor helps in creating proper environment for the smooth functioning
of this technique. By giving a really good demonstration , he ensure that the
learner follows it in its true spirit and thus come out successful in achieving the
desired goals.
The learners are made to face minor really good, Gradually they are accustomed
serious type of problems. All this makes there in learning really good. Later those
learners are ready to face any type of challenges.Which will helps in decision
making skills in a crisis situation and resolve the problem in easy manner.
It is based on system approach. That is full control of the supervisors when this
scheme of learning ease in progress.Which helps to organize the dsimulation ina
systematic manner.Then naturaly everybodys effort is the attainment of goals.
The training is provided in artificial situation so there is no risk for real
situations.The students will understand the topic very well and they engage in
active participation. There is a proper adjustment of time factor in accordance
with the ifficulty in learning . Keeping the objectives in view, time can be
inctreased or decreased as situation demands.
 TYPES OF SIMULATION

1. Low-fidelity Simualtion

Low-fidelity has been defined as simulations that are static and lack realism .
Examples of low- fidelity would be what are referred to as task trainers
technology such as a prosthetic arm that can be used to learn how to administer
intramuscular injections or take blood pressure readings or a prosthetic abdomen
which can be used for students to demonstrate how they perform a wound dressing
change.

2. Moderate Fidelity Simulatiom

Moderate Fidelity Simulatiom increases the realism through the use of a prosthetic
device or unit to mimic reality. An illustration of a moderate-fidelity device would
be a lung and heart chest torso that has the capacity to produce both normal and
abnormal heart and lung sounds upon auscultation with a special stethoscope.

3. High Fidelity Simualtion

High Fidelity Simualtion includes computerized mannequins that are operated by a

technologist from another location to produce audible sounds and to alter and
manage physiological changes within the mannequins such as altering the heart
rate, respirations, chest sounds, and saturation of oxygen as a few examples. The
scenarios offer students a chance to practice inter-professional teamwork principles
which are widely encouraged as a method to improve patient care and safety .
STEPS OF SIMULATION

Assignment on roles

The student teacher assigned the role of teachers,students and

observers,respectively. Every pupil teacher has to play all the three rules one
after another.It is done on rotation basis.

Deciding the skills to be practiced

This stage skill to be practiced through simulated techniques is desireded

and then planning and preparation for it.The topic for each training is selected
according to his interest and intelligence.

Preparation of work schedule

In order to run the programme of practice successfully the details of the

work schedule are prepared.At the stage it is desided who will teach first and
who will observe the lesson.It is also decided how everyone turn by turn will be
teaching and how everyone turn by turn observing the lesson.

Determining the technique of observation

The teacher decided the procedure of observing the lesson.How

different type of data is to be observed and how are these to be recorded.The
procedure for the interpretation of the data is also decided through discussion at
this stage.

Organising the first practice lesson

The first practice lesson is started and its observation are recorded for
judging the teaching behaviour.This is followed by discussion leading to
feedback and suggestion for the improvement of the lesson.
 Alteration or procedure

The whole procedure is changed ath this stage.There is change of

teacher change of observer,change of teaching skills and also change in the topic
to be taught.Every student teacher is given an opportunity to play the role of a
teacher student and observer.

ACTIVITIES IN SIMULATION

Role playing

In role playing the role assumed is one in which the actor portrays either a
fictitious role or an actual role,but perform that role in an artificial environment.

Sociodrama

Sociodrama is a powerful teaching strategy that combines a case study

approach with traditional role-play methodology to illustrate critical issues in end-of-life
care. Building on principles of adult learning and communication skills, the sociodrama
method enables the skilled facilitator to draw on the learner's past experiences as
resources for teaching and reflective practice.

Gaming

It can be used as a motivator for learner.Games can be used during a

learning experience to stimulate discussion,especially when the game relates to players
interactions.At the end of a learning experience,games can be used to provide an
oppurtunity to apply knowledge.

ADVANTAGES OF SIMULATION

Simulation offers opportunities to practice rare and critical events in a

safecontrolled environment, affording unlimited practice without risk to patients

 .Simulation simplifies the complexity of real life to a level that can be handled by
the beginners.In the simulated environment of fundamental lab,first students learn
how to deal with patients.Eventhough the environment of fundamentals lab, is
controlled,it issome what similar to a hospilal ward.The studentts to get
acquainted easily with the real life situation during their clinical posting.
Simulation is highly student centered because of its very interesting and

motivating nature,effectiveness in teaching slow learners as well as fast learners

and all type of students.
Simulation always facilitates peer learning which is considered as an excellent
way of learning .Various roles played by the students in simulation such as
participants ,discussions members and observers provide them an opportunity to
learn.
Simulation offers excellent opportunity to learn from mistakes ,especially from
those which are deterimental to the nursing if commited in the real life
situation.For those who are belived in the proveb "to error is human but but
repeating is foolish".Simulation is an excellent method of learning .Through
simulation students aiso become aware of possible ways and chances of
committing mistakes so that they can avoid mistakes by taking class.
Teacher can easily make the students understand the concepts of interpersonal
relationship,assertive communication style etc.As simulation provides a realistic
experience,students can easily these concepts in the clinics

Simulation fosters critical thinking skills and problem solving skills.Through

simulation teacher can be provided a controlled environment in which students
can test different solutions arising out of a critical thinking skills until a suitable
solutions is reached .This will enable them tosolve problem, especially in the
clinical situation.
DISADVANTAGES OF SIMULATION

Equipment fidelity.
Fidelity is the degree to which the simulator itself replicates
reality. A major limitation of simulation is the fidelity; no matter how high the
fidelity is, it is not real. It is often impossible to imitate actual physiological signs
or symptoms. For example, it is impossible to display crackles in the lung, when
such a symptom would be important to the scenario. In addition to the need for
high equipment fidelity, simulation requires psychological fidelity. This reflects
the degree to which the trainee perceives the simulation to be a believable
representation of the reality it is duplicating. Students may not take it seriously,
since mistakes or errors have no real consequences on patient safety. Along with
equipment and psychological fidelity, simulation requires environmental fidelity
that is, the realism of the environment in which the simulation takes place. For
example, emotional stress does not exist in mannequins and standardized patients
are not really sick.
Cost
It is expensive in terms of money and energy.Eventhough the induction
of computers in education reduced the cost ofpreparing stimulations,still
simulations especially the commercially prepared ones are very expensive

Time
Lack of faculty time and training in simulation instruction. Effective use of
technology in education depends on faculty readiness to operate the tools for
maximum educational impact. It is important to recognize the need for faculty
training in the specific demands which simulation-based teaching imposes.
Number of students
 Access to the simulator is limited and dependent on the availability of
instructors and operators. Simulation also limits the number of students that can
be taught at any one time.
Negative transfer.
Negative transfer occurs if the student learns something incorrectly
due to imperfect simulation. This most commonly occurs because the instructor
fails to make