A Nursing Simulation Scenario is a clinical simulation event that replicates a nursing skill or situation to allow nursing students the opportunity to practice clinical judgment, critical thinking, effective communication, and safe patient care. A nursing simulation scenario incorporates multiple modalities that depend on the outcomes and objectives to be achieved and the equipment available. The purpose of these scenarios in nursing education is to provide skills in practice and real-life situations in a safe environment. The benefits of using nursing simulation scenarios in healthcare education are numerous. Common scenarios and available resources can help health simulation centers and their learners succeed. This HealthySimulation.com article will review the considerations when developing nursing simulation scenarios, and then be sure to check out our article on Free Nursing Simulation Scenarios!
Clinical simulation training has become a more common practice in nursing education. The number of undergraduate nursing programs has increased, which leads to more competition for clinical placements. In acute care settings, the number of nursing students and the clinical skills they are allowed to perform at the clinical site have been limited. Simulation that is purposefully integrated into a nursing curriculum transforms nursing education from theory to practical application.
With the transition to competency-based nursing education, many educators are open to explore how nursing simulation can benefit competency development. Clinical simulation can be one of the answers for the evaluation of competency. However, simulation is not the only option. Research, guidelines, and best practices for nursing education and simulation must be incorporated to achieve competency-based nursing education and simulation utilization.
National Council of State Boards of Nursing Simulation Study and Guidelines
The National Council of State Boards of Nursing (NCSBN) National Simulation Study (Hayden et al., 2014) found no statistical difference in clinical competency or comprehensive nursing knowledge in nursing students who had received simulation as part of their clinical experience when replaced with simulation at a rate of 25% or 50%. As a result, the NCSBN determined that nursing programs could substitute up to 50% of traditional clinical practice with simulation, provided trained simulation professionals used high-quality simulations.
However, specific caveats must be addressed to obtain the same results as the NCSBN Simulation Study. The NCSBN developed and published Simulation Guidelines for Prelicensure Nursing Programs and a Simulation Faculty Preparation Checklist (Alexander et al., 2015). The simulation program requires commitment from the school, the appropriate facilities to conduct the simulations, faculty and personnel to develop and conduct quality simulations, and policies and processes for the simulation-based experiences.
The NCSBN Simulation Faculty Preparation Checklist (Alexander et al., 2015) provides specific requirements that faculty must practice to conduct quality nursing simulations. One key component is that the simulation programs provide opportunities and support for faculty to participate in healthcare simulation professional development opportunities.
Healthcare Simulation Design Standard
The best place to start the development of a nursing simulation scenario is the INACSL Healthcare Simulation Standards, specifically the Simulation Design Standard. This standard provides an outline for the scenario development with specific criteria to obtain:
- Simulation-based experiences (SBE) should be designed in consultation with content experts and simulationists who are knowledgeable in best practices in simulation education, pedagogy, and practice.
- Perform a needs assessment to provide the foundational evidence of the need for a well-designed simulation-based experience.
- Construct measurable objectives that build upon the learner’s foundational knowledge (SMART Objectives).
- Build the simulation-based experience to align the modality with the objectives.
- Design a scenario, case, or activity to provide the context for the simulation-based experience.
- Use various types of fidelity to create the required perception of realism.
- Plan a learner-centered facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes.
- Create a prebriefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience.
- Create a debriefing or feedback session and / or a guided reflection exercise to follow the simulation-based experience.
- Develop a plan for evaluation of the learner and of the simulation-based experience.
- Pilot test simulation-based experiences before full implementation.
Steps in a Simulation Scenario Development
The simulation team needs to develop several components, which are required for all nursing simulation scenarios, to create and enact a simulation scenario.
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Prebrief: A prebrief is a summary of the simulation scenario given to participants before the start of the scenario. Instructions and preparatory information are given to participants to facilitate the achievement of simulation objectives.
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Expected Outcomes: In healthcare simulation education, expected outcomes are the results of the actions the clinical simulation participants take. More than one outcome can be determined, for example, short-term and long-term outcomes. Outcomes are integral to the process of simulation education. Once outcome measures have been determined, objectives can be created.
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Learning Objectives: The learning objectives of any given scenario are statements of what instructors intend or expect students to learn as a result of their instruction. The objectives are created based on the kind of knowledge and cognitive processes instructors seek to address through the use of simulation.
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Stages or Phases in the Scenario: Every simulation must have a start and an end, which guides the different phases that must be accomplished during the scenario. The stages or phases are defined as
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Simulation Scenario Environment and Setup: The scenario setup incorporates the type of room, supplies, and equipment needed; student, staff, and SP (if applicable) assignments; and facilitator notes. The modality selected should be appropriate to meet the identified outcomes and objectives.
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Debriefing: Debriefing is the period that follows an experiential learning activity, in this case, a nursing simulation scenario, when the learners and instructors reflect, review, and discuss the activity. Debriefing aims to improve individual and team clinical skills and judgment. A planned debriefing should be incorporated into all simulation activities.
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Maintain Psychological Safety: The Healthcare Simulation Dictionary (pg. ) defines psychological safety as “A feeling (explicit or implicit) within a simulation-based activity that participants are comfortable participating, speaking up, sharing thoughts, and asking for help as needed without concern for retribution or embarrassment”; and “The perception of members of the team that the team is safe for risk taking, and mistakes will be considered learning opportunities rather than there being embarrassment or punitive consequences” (Edmondson, 1999; Higgins et al., 2012). Nursing educators and facilitators should not cause preventable psychological harm to students. Research indicates that abuse of prelicensure nursing students in simulation is a problem. This includes bullying, incivility, verbal and emotional abuse (harsh criticism and demeaning language), and unrealistic expectations (Harder, 2023). This can hinder the student’s learning ability, decrease their confidence and self-efficacy, and create behaviors that prevent the student from speaking up in high-pressure situations, which directly impacts patient safety.
The Healthcare Simulationist Code of Ethics: An international workgroup developed the Healthcare Simulationists Code of Ethics to support quality and ethical healthcare simulation practice. The six core values are integrity, transparency, mutual respect, professionalism, accountability, and results orientation.
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Modalities Used in Nursing Simulation Scenarios
The simulation modality should be selected based on what is required to achieve the learning outcomes and objectives. A task trainer would be appropriate if the objective and outcome is to complete a successful intravenous (IV) insertion. However, if the objective and outcome are to recognize a patient’s deterioration that requires an IV insertion and medication administration, then a high-fidelity simulator would be appropriate. This is a list of modalities commonly used in nursing simulation scenarios:
- Task Trainers
- Static Manikins
- Low-, Mid- and High-Fidelity Manikins
- Standardized Patients / Participants
- Wearables or Overlays
- Role Playing
- Virtual Reality
- Augmented Reality
- Mixed Reality
- Screen-Based Simulations
- Case Studies
- Hybrid Simulations
- Simulated Equipment
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References:
- Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kesten, K. S.,. & Tillman, C. (2015). NCSBN simulation guidelines for prelicensure nursing programs. , 6(3), 39–42. Available at
- Harder, N. (2023). The silent epidemic: Addressing the abuse of prelicensure nursing students in simulation. Clinical Simulation in Nursing, 85, 101484.
- International Nursing Association for Clinical Simulation and Learning (INACSL) Healthcare Simulation Standards of Best Practice (2021). Available at
