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School of Nursing presents remote simulation learning at Indiana conference

The Boise State University School of Nursing simulation team recently presented an innovative distance learning technique for simulations at the  SimGHOSTS conference in Fort Wayne, Indiana.

A simulation scenario allows students to assume the nursing role and care for patients in a realistic setting. Simulations involve patients who may be mannikins or hired actors mimicking specific medical concerns, and students are able to assess the patient, provide care, and make clinical decisions. Then, faculty are able to observe and provide feedback on student performance. Simulation has been part of nursing education for decades, but it has grown and developed in exciting new ways over the past two decades. Simulation provides students with a low-risk but highly realistic environment to practice critical thinking skills. Traditionally, most simulation has been done in-person. Last year, COVID-19 response measures moved universities online around the world, and the Boise State simulation team came together to deliver online simulations as close to reality as possible.

The team developed several methods that might sound familiar to anyone who’s played a video game before. These included screen-based simulations where students are presented with a scenario and select actions from a menu, watching recorded simulation scenarios and then discussing with a faculty member, or a choose-your-own-adventure-style recorded simulation where students select what happens next and then receive feedback on their choices. Kelley Connor, associate professor and director of simulated learning and research, studies the applications of technology in nursing education. “Game-based learning options allow students to make decisions and see the outcomes of those decisions. They can also re-do the simulation multiple times to explore what happens when different decisions are made.” Says Connor. However, these multiple-choice-style simulations aren’t truly reflective of clinical experiences. “A problem with screen-based simulation is that the choices students have to select from have been created for them. Students know the answer is in front of them, they just have to find it.”

In order to create a remote simulation experience that is closer to the real thing, the Boise State simulation team has developed what they call ‘puppet’ simulations, where students tune in to a live simulation from home. Students take on the role of the nurse and they give instructions to a staff or faculty member acting in their place. Simulations are held in small mock-hospital rooms, and only one to two masked individuals are permitted in the room to allow for physical distancing. Students must make decisions and give their ‘puppet’ instructions to carry out, such as asking questions about medical history or examining a wound dressing. They are making all of the same decisions and having all of the same conversations they would have if they were really in the room with their patient.

Image is divided into four quarters. Quarter one: a nurse taking a mannequin's blood pressure, with the blood pressure value displayed for the viewer in the upper right corner. Quarter 2: A nurse applies personal protective equipment from a cart in a hospital hallway. Quarter 3: A nurse takes notes in a notebook and sits across a table from a patient in a consultation room. Quarter 4: A nurse adjusts bedding for a mannequin patient.
Students can tune in to several observation cameras for a variety of scenarios, including recording vital signs (top left), using personal protective equipment (top right), consulting with irritable or manic patients (bottom left) and assisting patients with medication (bottom right).

“I would receive an instruction to wash my hands when I entered the room, and the student would make small talk with the patient in the meantime.” Says Angela George, simulation operations specialist and more recently, remote simulation puppet. “It’s good practice to ask a patient permission before touching them, and tell them what you need to do so they understand. You don’t get that sort of interaction in a video game, and it’s an important part of providing effective care.”

As always, students are required to complete technical skills laboratory classes, where they learn how to insert IV lines, dress wounds, and other necessary nursing skills. These classes are held in large classrooms with increased air flow and space for physical distancing in accordance with Boise State COVID-19 guidelines. Currently, simulations are being held in-person on Boise State campus. However, the simulation team is prepared to bring back online simulations and live distance simulations as a regular part of coursework if necessary.