Time to unravel the conceptual confusion of authenticity and fidelity and their contribution to learning within simulation-based nurse education. A discussion paper.

High-fidelity patient simulation is a method of education increasingly utilised by educators of nursing to provide authentic learning experiences. Fidelity and authenticity, however, are not conceptually equivalent. Whilst fidelity is important when striving to replicate a life experience such as clinical practice, authenticity can be produced with low fidelity. A challenge for educators of undergraduate nursing is to ensure authentic representation of the clinical situation which is a core component for potential success. What is less clear is the relationship between fidelity and authenticity in the context of simulation based learning. Authenticity does not automatically follow fidelity and as a result, educators of nursing cannot assume that embracing the latest technology-based educational tools will in isolation provide a learning environment perceived authentic by the learner. As nursing education programmes increasingly adopt simulators that offer the possibility of representing authentic real world situations, there is an urgency to better articulate and understand the terms fidelity and authenticity. Without such understanding there is a real danger that simulation as a teaching and learning resource in nurse education will never reach its potential and be misunderstood, creating a potential barrier to learning. This paper examines current literature to promote discussion within nurse education, concluding that authenticity in the context of simulation-based learning is complex, relying on far more than engineered fidelity.

Bland AJ ，Topping A ，Tobbell J 《-》

The role of simulation in nurse education.

This descriptive survey evaluates the role of medium to high fidelity simulation in the preparation for clinical nursing practice, from the perception of third year undergraduate students. A questionnaire was distributed to 153 Adult Branch undergraduate nursing students from one Higher Education Institution. Quantitative data was collected through use of Likert scales, whilst a comment box permitted the compilation of qualitative remarks. A 60% (n=93) response rate was achieved. Findings indicate that simulation using high fidelity simulators is perceived to be a valuable method of learning, which should positively impact on the clinical effectiveness of nursing students approaching the transition to registered nurses. Furthermore participants believed that their experience with high fidelity simulators enhanced the safety of their practice. This study has strengthened the case for using high fidelity simulators as a means of assisting linkage of theory to practice. Whilst there are limitations to the realism of high fidelity simulators, the majority of subjects considered simulation an authentic learning experience. New knowledge from this research suggests that high fidelity simulators may contribute significantly to the preparation for nursing students' final key stage management assessment prior to entry to the Nursing and Midwifery Council (NMC) register. Although engagement with the high fidelity simulators can be anxiety provoking, this may precede perceived augmentation of learning, skill and confidence.

McCaughey CS ，Traynor MK 《-》

The educator inside the patient: students' insights into the use of high fidelity silicone patient simulation.

To explore undergraduate nursing students' experiences of High Fidelity Patient Silicone Simulation. Use of simulation as an educational tool is rapidly gaining popularity. Simulation provides a safe learning environment and helps overcome difficulties securing sufficient clinical placements. However, several limitations have been identified with this approach, particularly in relation to cost and authenticity. Exploratory qualitative methodology informed the development of knowledge in this under-researched area. Focus group interviews were conducted with 21 nursing students and first year graduates. Participants had experienced High Fidelity Patient Silicone Simulation during the program. This involved their lecturer simulating a patient by adopting mannerisms and behaviours of a person, based on a predeveloped character and using masks and appropriate clothing to establish the visual image of a simulated patient. Thematic analysis was undertaken to identify main areas of interest to participants. Two main themes are reported in this paper: 'realism of the character' and 'skills of the teacher'. Characters presented to students were viewed as realistic which enabled participants to engage with the character and take the process seriously. Knowledge and skill of the teacher was used to direct student learning experience and maximise learning benefits to be gained. High Fidelity Patient Silicone Simulation was perceived by student participants as a highly effective teaching tool. Participants found the experience positive and believe it impacted on the quality of learning experiences. Clinical experience is necessary for the development of safe and competent registered nurses. Simulation has been acknowledged as a useful adjunct to clinical experience, particularly when placements are limited. High Fidelity Patient Silicone Simulation may be used to promote realism, enhance student learning and contribute to an increase in clinical competence and confidence in nursing students.

Reid-Searl K ，Eaton A ，Vieth L ，Happell B ... -  《-》

The nature of reality represented in high fidelity human patient simulation: philosophical perspectives and implications for nursing education.

Simulation technology is increasingly being used in nursing education. Previously used primarily for teaching procedural, instrumental, or critical incident types of skills, simulation is now being applied to training related to more dynamic, complex, and interpersonal human contexts. While high fidelity human patient simulators have significantly increased in authenticity, human responses have greater complexity and are qualitatively different than current technology represents. This paper examines the texture of representation by simulation. Through a tracing of historical and contemporary philosophical perspectives on simulation, the nature and limits of the reality of human health responses represented by high fidelity human patient simulation (HF-HPS) are explored. Issues concerning nursing education are raised around the nature of reality represented in HF-HPS. Drawing on Waks, a framework for guiding pedagogical considerations around simulation in nursing education is presented for the ultimate purpose of promoting an educative experience with simulation.

Dunnington RM 《-》

Effectiveness of patient simulation in nursing education: meta-analysis.

The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms. To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis. This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis. We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity. These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods.

Shin S ，Park JH ，Kim JH 《-》