Dr. Pam Jeffries, world-renowned simulation expert, conducted a webinar on the importance of realism in nursing simulation. Dr. Jeffries has made numerous contributions to the simulation community and advanced how we conduct nursing simulation. She collaborated with the National League for Nursing (NLN) to develop the NLN Jeffries Simulation Theory (2015). In 2024, Dr. Jeffries conducted a HealthySimulation.com webinar on the importance of realism in nursing simulation. This HealthySimulation.com article provides some highlighted excerpts from Dr. Jeffries from the recorded open-access CE webinar.
What is Realism in Nursing Simulation?
Dr. Jeffries: “A very important topic, I believe. You really can replicate a clinical experience. It represents that reality without the constraints of a real-life clinical simulation. And if you go back to the NLN Jeffries Simulation Model that started back in 2005 and then became a theory in 2015, real reality – fidelity – is one of those design features in simulation. And so it’s not only within the scenario but within the simulation center. So I think that’s why I feel very tied to that concept. The purpose of realism is to bridge that gap between classroom and clinical. That’s what we’re always trying to do to create new nurses, practitioners, whatever, to make sure they have a high-quality education, but they can transition to practice in a meaningful, very professional and efficient manner. But simulations help to bridge that gap between classroom and clinical, but providing reality within those clinical experiences does that. Also, having realistic scenarios in some centers helps facilitate that transfer of nursing skills to the clinical setting.”
View the HealthySimulation.com Webinar Developing Healthcare Simulation Centers to Create Realistic Clinical Scenarios to learn more!
“So a little bit about realism and fidelity. Years ago, I looked and studied students’ qualitative analysis looking at common findings and simulations with students, and then translating that simulation experience into the clinical. What I found were several gaps, and these were common findings, and I wanna share those with you. They’re more anecdotal than anything, but it was an ‘aha’ moment for me. So what I understood from many, many simulations where I developed, created, and immersed students, a lot of times, students do not understand pretend over the clinical setting very well. Educators need to be authentic when setting up the simulations. I think there’s nothing worse where you’ll say, just pretend to put your sterile gloves on. Just pretend to wash your hands. That pretend doesn’t carry over to the clinical very well. I’ve seen it done, I’ve seen it used, because some centers didn’t have enough supplies or equipment, so you have to pretend. And in the real clinical setting, do I just pretend, or do I really put the gloves on? What does that mean? So that’s a dilemma.”
Types of Realism in Clinical Simulation
Dr. Jeffries: So there’s evidence on realism and why is this important? There’s a belief that simulation experiences and the effectiveness will improve proportionally as the precision of the replication of the real world. In other words, the more real the simulation, the better outcomes that they can translate from simulation to practice. Under the assumption, we want a perfectly realistic simulation, right? We want realism. We want equipment that is either simulated real equipment or real equipment that you can adapt to the simulation world because that’s what they’re going to use in the real world.
Environmental or Physical Realism: If you’re in a critical care unit, it needs to look like a critical care units. And if you’re a community care setting and a COVID vaccination center, it needs to look like a community care center, right? Or ER, ED, OR, the equipment needs to be real. It needs to be realistic. Can you use it? It can be adapted to simulations that are like we have the fibrillators, but you’re not really giving off the high charge, but they’re adapted for that. The medication, the Pyxis, there’s a machine. We don’t want to just do a plastic drawer and say pretend this is the Pyxis or pretend this is how we’re going to scan medications with some false little thing. We need the realism so our students can translate that over to the real clinical setting.
Psychological Realism: Psychologically, that’s another part of realism. And this is where I love it when some ops people’s simulation operations. Even the psychological aspect of your caring for a burn patient, do you have the smells? Or you are bringing that psychological aspect and the sirens and the intense and the adrenaline flowing, that is that psychic effect.
Conceptual Realism: The conceptual realism is if I’m having a hypotensive crisis, my blood pressure is dropping, what should my pulse be doing? Should it be going up. So, conceptually and theoretically, that all needs to match. So you have got to make sure your scenarios are written correctly, appropriately, and conceptually, right? And the emotional is getting that psychological aspect, getting the adrenaline flowing. This is an emergency. You hear the alarms, the sirens that, the patient’s screaming with pain, whatever, ’cause that’s reality, right?
Some of those mannequins can’t provide the true realism. The cyanosis and seizures look a little chaotic at times. Right, and I think it’s a combination of orientation to say, hey, listen, this is what the mannequin can do presentation is trying to indicate to us in terms of what it means for clinical understanding. But also, there are these types of walkie-talkie headsets that you can put on with maybe one of your participants who is involved but is not the primary learner. And the cue could be given that then that particular individual, yes, the patient is now showing cyanosis and so that that individual could then say, I see that the patient is now showing cyanosis, right, in a way that everyone has agreed to that level of interjection So there are ways to kind of subtly bring these things in, but then I think it’s also about figuring out what are your learning objectives and what technologies and tools are available out there, right, so that we can increase that realism. And I just want to say that’s where it’s just like using something like the Pyxis, which is an actual medical device, will give us just the most realistic possible outcomes because it’s the real device that we potentially could be using in our clinical environments, right? And so that’s how we can kind of further kind of understand what are the learning objectives, what are the tools that are available out there and picking the right technologies to create
“So one’s equipment, of course. Real equipment replicates, you don’t wanna just false or fake or let’s do a shoebox to represent X. And I know during COVID, we were doing a lot of shoeboxes because we were having to do everything and clinical through simulations, but try to use as much real equipment as you can, whether it’s the IV pumps, whether it’s a Pyxis machine for the medication, whether it’s the real, or you can buy simulated syringes, but syringes and how you’re gonna fill an ampule and do all that. You gotta have that feel, that kinesthetic learning. All of that is very, very important. And simulators are more real life today than they ever were with you, Pulse, and you got all those facets that you already know about. And it’s a lot better than it used to be in replicating reality.”
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