When COVID-19 lockdowns prevented learners attending universities, alternatives to simulation-based education (SBE) had to be found to deliver emergency remote teaching. At Northumbria University, the use of an online platform enabled scenarios to be embedded in a virtual ward, with learners guided through patient assessment stages that would have been explored ordinarily in small groups during high-fidelity simulation.
Simulation bridges nursing practice and theory, and is recognised as a pedagogy that enables authentic learning about situations that may occur in the practice environment. It has been defined as ‘a technique that … allow[s] persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing or to gain understanding of systems or human actions’ (Lioce, 2020:44). Within nursing, it enables students to practise core skills such as communication, SBAR handover (situation, background, assessment, recommendation) and ABCDE assessment (airway, breathing, circulation, disability and exposure). SBE allows for the exploration of unusual cases or never events that learners are unlikely to encounter in the practice environment, enhancing readiness to practise.
The Nursing and Midwifery Council (NMC) acknowledged the benefits of SBE for students during the implementation of COVID emergency and recovery standards. In recognition of the challenges associated with practice placement during the pandemic, pre-registration nurses in all fields were able to demonstrate up to a maximum of 300 hours of simulated learning across the duration of their programme (NMC, 2022). The NMC is currently considering post-Brexit changes to pre-registration standards, which include the increased use of SBE (Ford, 2021). The NMC continues to review draft proposals to increase flexible use of simulated learning for nurses only. This shows confidence that simulation can enhance practice knowledge and fulfils the four purposes of simulations to facilitate patient safety, as outlined by the Society for Simulation in Healthcare (2021): education, assessment, research and health system integration.
During the first lockdown, in March 2020, group simulation sessions were cancelled, and alternative approaches were sought to provide emergency remote teaching. At Northumbria University, we modified an online scenario-based learning (SBL) platform we had previously designed using the Articulate Storyline software package.
The online ward recreated simulation using SBL principles, and enabled review of case studies and multiple characters, such as patients, family members and interprofessional staff. The stages of ABCDE assessment, SBAR handover and care planning were integrated into the online platform, with supplementary information, eg a glossary of terms and NICE guidelines, to promote depth of learning and enable students to plan effective interprofessional care. Although students were unable to attend simulation in person during the pandemic, the online alternative addressed the key learning points.
It was possible to use an online ward to subsidise simulation, which was a valuable online educational solution for learners unable to attend simulation in person during periods of lockdown. Current evidence suggests virtual simulation improves student learning outcomes, however, as a relatively new concept, more evidence is needed to inform this evolving approach (Foronda et al, 2020). In the longer term, the effectiveness of an online simulation ward needs to be evaluated to enable integration into health and social care programmes as an educational pedagogy based on the principles of SBE and SBL.
Simulation in nurse training is being increasingly acknowledged as a rich and authentic pedagogy, and there is a need for learning technologies to evolve to provide virtual platforms for students to continue learning throughout and beyond the pandemic.