Literature Review Chapter: Nursing What Effect Does Simulation Lab

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What Effect Does Simulation Lab have on the Confidence and Critical Thinking of Nursing Students as Licensed Practical Nurses?

Nursing graduates must have self-confidence and critical thinking capabilities in order to resolve multifaceted patient care issues. The use of human patient simulators to supplement teaching in schools of nursing is rising; however, further research is needed in order to validate the declaration that learning by way of simulation enhances critical thinking and self-confidence (Soucy, 2011). Nursing educators are increasingly utilizing technology to provide realistic educational experiences to prepare students to enter the workforce. Human patient simulation (HPS) is one type of technology that nursing educators are using with the belief that when students encounter a real-life experience after simulation, they will perform in a more self-confident manner (Lyles, 2009).

Literature reviewed in preparation for this study included many articles, theses, texts, and dissertations about simulation and self-efficacy. Specific areas of the literature explored include simulation, simulators, simulation as an educational strategy and supporting theoretical foundations, application in healthcare and nursing education, self-efficacy in education of healthcare providers, and the effect of simulation on self-efficacy.

Dependent Variable


Self-confidence is a very significant characteristic that adds to successful nursing practice. Nurses showing self-confidence put patients at ease, advocate for patients with more declaration, and are better able to grow solutions to patient care issues. Nurses who are able to radiate self-confidence augment patient comfort. Patients should feel as though those who are giving care are able to do so with accurateness and proficiency. There are characteristics connected with self-confidence. Nursing students with self-confidence believe in their capability to act in ways that benefit patients. In combination with the patient, nursing students set up a goal or patient outcome towards which both parties are willing to strive. This gives the student direction and can assist to increase self-confidence because the student can develop interventions to meet the objective. The student has a reason and direction. Nursing students have to also have self-awareness and have an inner locus of control. For instance, if a nurse is going to be effective they have to believe they can do it. They would start by setting a goal for the patient. This will help nursing students to control their own nervousness and ask for help if needed. Of course, nursing students gain knowledge and skills before self-confidence can develop. Nursing students ought to be in a compassionate environment and should be permitted to experience patient contact in skill-appropriate circumstances. "Nursing students without any prior clinical experience should not be placed in an emergency situation; instead, they should be allowed to care for a medically stable patient. Nursing students who develop self-confidence are able to advance effectively as practicing nurses" (Soucy, 2011).

Developing feelings of self-confidence can be attained in nursing education but it necessitates time and attention by nursing staff and a pledge by nursing students. When students feel contented with the cognitive and psychomotor facets of a patient situation, the feelings of self-confidence will appear; yet, students need faculty support and leadership along the gamut of learning in a nursing program. "For example, if students are participating in a learning activity involving a human patient simulator, the faculty member should require that students participate in a comprehensive, organized debriefing session after the activity. Organized debriefing sessions allow the faculty member to give feedback, answer questions, and praise the budding clinical competence demonstrated by the students" (Soucy, 2011).

Critical Thinking

Critical thinking is a multifaceted skill for students to achieve but a necessary function of successful nursing practice. Nurses take in a large amount of patient information and then make deductions, prioritize patient care needs, and ingeniously solve problems (Soucy, 2011). Practitioners in nursing who are critical thinker's value and hold fast to intellectual standards. Critical thinkers attempt to be apparent, precise, specific, rational, complete, noteworthy and fair when they listen, speak, read and write. Critical thinkers think intensely and broadly. Their thinking is sufficient for their planned purpose. Nurses want to get rid of immaterial, conflicting and irrational thoughts as they reason about client care. Nurses use language to plainly communicate in detail information that is important to nursing care. Nurses are not focused on the inconsequential or immaterial. "Nurses who are critical thinkers hold all their views and reasoning to these standards as well as, the claims of others such that the quality of nurse's thinking improves over time thus eliminating confusion and ambiguity in the presentation and understanding of thoughts and ideas" (Critical Thinking and Nursing, 2008).

Critical thinkers in nursing are skilful in using intellectual skills for sound reasoning. These skills have been defined as information collecting, focusing, remembering, organizing, evaluating, generating, putting together and appraising. The focus of classroom and clinical activities is to develop the nurse's appreciative of scholarly, academic work through the effectual use of intellectual capabilities and skills. As one comes across more and more multifaceted practice situations they will be required to think through and reason about nursing in larger depth and draw on deeper, more complicated comprehension of what it means to be a nurse in clinical practice. Nursing is never a shallow meaningless activity. All acts in nursing are extremely significant and require of the nurse to be mindfully engaged in the practice of nursing. "This is the challenge of nursing; critical, reflective practice based on the sound reasoning of intelligent minds committed to safe, effective client care. To accomplish this goal, students will be required to reason about nursing by reading, writing, listening and speaking critically" (Critical Thinking and Nursing, 2008).

Independent Variable

Simulators and Simulation

References in the literature often refer to simulators and simulation, and while similar, there are differences that should be clarified. "A simulator refers to a physical object of the task to be replicated while simulation refers to applications of a simulator for education" (Cooper & Taqueti, 2004). While simulation has been used in several businesses such as the military, aviation, and nuclear power, the aviation model is most closely associated with healthcare simulation. "Early in aeronautical simulation use, researchers were concerned about the transfer of learning from the simulator to actual situations. It was found that the degree of fidelity (psychological, physiological, and operational realism) of the simulator was related to the amount of learning transferred" (Lyles, 2009).

In the healthcare arena, Gaba (2004) notes patient simulators, referred to as mannequin-based simulators, were developed. Other terms found in the literature for a mannequin-based simulator includes hands-on-simulator, realistic simulator, integrated simulator, and high-fidelity simulator. The simulators in use today have evolved from basic skills simulation to high-fidelity treatment interventions. "The first computer controlled mannequin for patient simulation was Sim One, built in the mid-1960's to train anesthesia residents in the skill of intubation. While expensive and perhaps too far ahead of the technology, Sim One did not achieve acceptance" (Cooper & Taqueti, 2004). "Later in the 1980's several different patient simulators were developed for investigating performance in anesthesia. In 1996, METI introduced the Human Patient Simulator (HPS), representing the highest performance potential of a patient simulator on the market" (Rodgers, 2007). While simulators are not all highly technical in nature, Yaeger et al. (2004) classify fidelity into three categories: low, medium, and high fidelity. The definitions are stated below:

Low fidelity simulators are focused on single skills and permit learners to practice in isolation. Medium fidelity simulators provide a more realistic representation but lack sufficient cues for the learner to be fully immersed in the situation. High fidelity simulators provide adequate cues to allow for full immersion and respond treatment interventions (p.328).

Simulation as a Teaching Method

Simulation can be utilized to teach theory, evaluation, technology, pharmacology, and skills. The prominence in simulation is frequently on the application and incorporation of knowledge, skills, and critical thinking. "Unlike a classroom setting or a paper-and-pencil test, simulation allows learners to function in an environment that is as close as possible to an actual clinical situation and provides them an opportunity to think on their feet. Simulation has been successfully used as a teaching strategy in both clinical and formal education" (Rauen, 2012).

Learning more multifaceted skills by way of simulation became possible as technology advanced. For instance, interactive simulators linked to hemodynamic monitors permit learners to master working with the monitor, which displays patients' data without being attached to an actual patient. "Intra-aortic balloon pump simulators connect to the pump, allowing the display of electrocardiographic and pressure waveforms on the screen. Nurses can learn timing, troubleshooting alarms, and the general mechanics and function of the pump without risk to a patient" (Rauen, 2012).

The most recent technology integrates computer-based simulators that support CD-ROM applications. Learners progress through a clinical situation by answering questions and choosing therapies. These applications necessitate learners to examine the data and make a choice. "Interactive computerized cardiopulmonary resuscitation or Advanced Cardiac Life Support simulators allow learners to practice psychomotor skills and receive feedback on the learners' performance" (Rauen, 2012).

Simulation is an outstanding teaching strategy for… [END OF PREVIEW]

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Nursing What Effect Does Simulation Lab.  (2012, June 16).  Retrieved May 26, 2019, from

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