Practice simulation has grown exponentially over the past few years, and is considered a safe place to learn. It enables the consolidation of both theory and psycho-motor skills and allows students to progress or make mistakes safely. This type of learning is imperative to help student nurses become more confident with their clinical skills, and also help them gain confidence in dealing with difficult situations before they go into practice.
Simulation is therefore pivotal to practice learning. However, the learning experience is reliant on the fidelity of the equipment and the clinical competency of the facilitator teaching the session (Koukourikos et al, 2021).
Simulated practice learning placements have been adopted by many higher education institutions (HEIs) following the Nursing and Midwifery Council's (NMC) Simulated Practice Learning review, which recommends 600 hours of simulated practice learning amid a required 2300 total practice learning hours (NMC, 2023). The NMC recognises that simulated practice learning experiences have many benefits, including increasing learner confidence by generating exposure to skills that are encountered infrequently in clinical practice (NMC, 2023).
Resources
HEIs have in the main embraced simulated practice learning placements, and the benefits of learning in simulated environments are well recognised (Council of Deans and Anglia Ruskin University Research Team, 2024). All placements – including simulated practice learning – attract a tariff, which helps fund resource acquisition. However, the resources required to enable successful simulated practice learning cannot be underestimated. Students want and need field-specific clinical placement experiences, and HEIs must therefore try to make simulated placement components feel like any other placement. Negative experiences will likely impact on the way learners evaluate their experience of the whole programme, and quality simulated practice learning must therefore balance the competing needs of the NMC, HEIs and students.
Preparation
Excellent preparation, simulation and debrief processes have been seen to improve student performance (Dodson et al, 2023). Simulation educators can consequently play an important role in building student confidence. Likewise, dedicated simulation teams are valuable for sharing learning, peer observation, and staff upskilling while maintaining the highest standards of teaching.
Engaging students
The language used has a direct effect on the professionalism and participation of students undertaking simulated learning. Student nurses are expected to attend skills sessions within the simulation suite, yet in instances where that same simulation suite becomes a placement area, it is vital to alter the visual, auditory, speech and presentation of the environment. Student engagement in simulated placements increases significantly when language typical to the university environment such as ‘timetable, skills session and lecturer’ is changed to incorporate placement-specific terms such as ‘rota, shift and practice supervisor’. Introducing smells, sounds, roles and responsibilities equal to those of traditional clinical placements helps demonstrate value in the learning experience.
Involving service users
To offer diverse simulated learning opportunities, it is likewise necessary both to involve professionals with expertise, and to involve service users in sharing their knowledge and lived experiences in order to incorporate the patient perspective and increase relevance (Kuti and Houghton, 2019). Students express their gratitude for the support they receive on simulated placements, and appreciate the opportunity to work in small groups to problem-solve case studies that have been developed to simulate real-life experiences.
With smaller numbers per group per simulated placement, students develop a rapport and friendships with colleagues who they may never have spoken to before, helping their communication and confidence flourish throughout their time within simulated practice learning, while benefiting from the effective triangulation of practice supervisors, practice assessors and academic assessors.
Feedback and debriefing
Students report that multiple highfidelity experiences and planned activities throughout a typical day within a simulated practice placement can be intense, and can cause them to quickly feel drained. In comparison, students may only experience a high-intensity incident once during a 3-week clinical placement, on average. Therefore, it has been suggested that each hour in clinical practice should be evaluated against equivalent hours in practice simulation (Adamson and Prion, 2021).
During debriefs, students expect to feel able to share their thoughts and feelings, and gain reassurance and validation (Cambridge et al, 2023), and this process is also vital to simulation learning. Feedback from students when they start participating in simulations reveals perceptions that simulated practice placement merely prepares for or consolidates learning from adjacent clinical practice experiences. In contrast, upon completion of their simulated practice learning, students report that they feel more confident, educated and prepared to deal with the unpredictability of working in live clinical areas. In many instances, students have offered innovative solutions towards developing the simulated experiences further, and increasing immersion.