Ask the Expert: Visioning of Simulation in Nursing Education

By: Dr. Pamela Jeffries

In her responses to the questions that follow, Dr. Pamela Jeffries shares her insights and leadership accomplishments in simulation in nursing education with NLNTEQ.

1. What are the significant milestones in your work as a leader in nursing?

My simulation work began when I was selected to serve as program director for the first NLN simulation research project in 2003. In this capacity, I was charged with recruiting a team to “study simulation research.” At that time there was very little work done on simulation. You would find anecdotal-type findings in the nursing literature, but rigor and detail were sparse, as were outcome-based findings.

For the NLN project, I worked with eight wonderful project coordinators from eight different institutions across the nation. It was an amazing journey! A significant milestone aligned with this work was the creation of a “simulation framework” grounded in theoretical foundations, which provided insight into how to design, implement, and evaluate simulations. The initial article on the framework was published in 2005 in the NLN research journal Nursing Education Perspectives. The first book on simulation, entitled Simulation in Nursing Education: From Conceptualization to Evaluation, followed in 2007. This book highlighted the work of the NLN project referenced earlier and published our findings from the study that began in 2003. A second edition of the book came out in 2012. Much had changed in the world of simulation since the book was first published. Working on the revision, it was amazing to see the explosion and growth of knowledge and the adaptation of simulations throughout the years.

Another significant milestone was the development of the NLN SIRC – the Simulation Innovation Resource Center website for simulation users and nurse educators. In developing the website, we recruited several experts to create online courses/modules on select topics relevant for the use of and implementation of simulations by faculty. These courses and other web resources are still available today and used all over the world.

In 2011–2013, I was fortunate to be an external consultant for the National Council of State Board of Nursing (NCSBN) multi-site simulation study exploring the amount and use of simulation for the substitution of real clinical time. This large national study provided evidence that nursing education can substitute clinical time with simulation without harming our students’ learning. Policy implications and best practices in guiding educators on what is needed to develop a simulation-based curriculum have risen from this research. I was proud to be involved with this national study and the dissemination of its findings. The overall project has added a significant contribution to the science of nursing education and provided needed data regarding the use of simulation to replace clinical hours. A comprehensive report the NCSBN published in August 2013 can be downloaded from the NCSBN.org website.

In 2015, another milestone within health care simulation was a partnership with the NLN and INACSL that led to the development of a midrange simulation theory. Through the assistance and support of nurse theorist Dr. Beth Rodgers and Dr. Katie Adamson, who conducted the literature review to support the development of the theory, the framework first published in 2005 became known as the NLN Jeffries Simulation Theory, a significant contribution for nursing education. A monograph from the NLN released to the nursing community in 2015 is widely cited as many graduate and doctoral students are now conducting research in the science of nursing education, particularly in the area of simulation.

2. What do you see as significant trends or gaps in in the use of simulation in nursing education, from your perspective as an expert in this are

Trends within simulation include the use of more virtual simulations, which allow us to access and implement the pedagogy of simulation anytime or anywhere, particularly in online courses/programs. Encouraging cost-effectiveness and scalability are other outcomes associated with using virtual simulations.

The trend today is to move toward more “realistic” simulators and encounters, so the fidelity of simulations has continually seen improvement. We are also seeing simulations moving from the academic arena into the practice arena. Hospitals and other health care organizations are frequently adopting the use of simulation in their orientation programs, team training, and for overall competency testing.

Another trend on the rise has to do with policies developed by regulatory boards and accrediting bodies. We have already seen in nursing where different state boards are adopting policies regarding the use and integration of a simulation-based curriculum for institutions within their respective states. I can appreciate that board regulators are using the research and evidence from the NCSBN study, conducted over a three-year period with 10 different schools, to explore the amount of simulation that can be incorporated as a substitute for real clinical time.

Gaps in the area still include lack of faculty development and assessment and evaluation of outcomes, particularly at level IV. We have to ask ourselves if we are making a difference in patient outcomes. The work and research in simulation has increased greatly, but we still have a lot of work and rigor to incorporate into the research.

3. What insights can you share related to the value of simulation best practices in nursing education for health care organizations now and in the future?

A major insight for leaders in any academic or health care organization is the importance of including faculty development and an evaluation plan when adopting a simulation-based curriculum or program. These two activities are often forgotten; however, once the manikins are purchased and the simulation center is built, academic or organizational leaders should ensure that both items receive adequate and substantial attention.

The value of simulation as evidenced by research is continually rising; and we have a lot more to explore. I believe simulation encounters need to be required prior to sending students into real clinical settings. I also believe the global community needs to be investigating the use of simulations in health care institutions and how health professionals can be trained in this matter before practicing in real-world global environments.

4. What advice do you have for nurse educators in the context of today’s health care and learning environments?

My advice to nurse educators in today’s health care environment is to learn pedagogy and evaluate/assess the outcomes associated with incorporating new activities and encounters in the student’s learning experience. Creating a data-based research project, where one obtains the data, analyzes it, and disseminates the findings, contributes greatly to the science of nursing education. Without evidence, our work is only anecdotal. Continuing to make a case for the value of simulation in our health professions training and education is critical. It is up to us to demonstrate and cite the value based on evidence.

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Pamela R. Jeffries, PhD, RN, FAAN, ANEF, Professor and Dean of George Washington University School of Nursing, is internationally known for her research and work in nursing education and simulation.  Throughout the academic community, she is well regarded for her scholarly contributions to the development of innovative teaching strategies, experiential learning techniques, new pedagogies and the delivery of content using technology.

Her accomplishments have been recognized through prestigious teaching and research awards and honors from a number of national and international organizations including NLN, AACN, Sigma Theta Tau International and the International Nursing Association of Clinical Simulations and Learning.

@GWnursing Dean and #nurse. Author of @NLN Jeffries Simulation Theory with expertise in #Simulation, #ClinicalEducation & #EmergingTechnology.