Introduction

Teaching methods are the broader techniques used to help students achieve
learning outcomes, while activities are the different ways of implementing these
methods. Teaching methods vary in their approach, some are more
student-centered while others are more instructor centered.In this,Simulation is
Students acting out roles or improvising scripts, in a realistic and problematic
social or interpersonal situation. Students playing out, either in person, or virtually,
a hypothetical social situation that abstracts key elements from reality and
laboratory method is a method in which students were focus on their learning
process through application, observation and reflection
Simulation
Meaning
Simulation is the basis of sensitivity training, sociodrama, role-playing and
psychodrama. It is not actual teaching. Certain underlying skills to teaching can be
modified, described and practised like any other skill. It is assumed that through
role perception the psychological appreciation of the classroom problems will grow
and develop in the student-teacher as a basis for handling the problems in the class.
Definition
❖ Simulation is a method whereby an artificial or hypothetical experience is
created that engages the learner in an activity that reflects real-life conditions
but without risk-taking consequences of actual situations.
-Rystedt and Lindstrom (2001)
❖ Simulations have been defined as an operating representation of central
features of reality as an attempt to give appearance and/or to give the effect
of something else.

-Barton (1970)-

❖ Simulation is the artificial representation of a complex real-world case with

sufficient fidelity to facilitate learning through immersion, reflection,
feedback, and practice without the risks inherent in a similar real-life
experience.
❖ Role-playing/Simulation in which the process of teaching is displayed
artificially and an effort is made to practice some important skills of
communication through this technique. The pupil-teacher and the students

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 simulate the particular role of a person or actual life situation. The whole
programme becomes a training in Role perception and Role Playing."
-K.P Neeraja-
Principles of Simulation
Simulated patient experiences must be comprised of certain components in order to
be successful teaching tools and include the following:
1. Clear stated objectives: Prepare and disseminate clearly prepared
objectives to student for engaging in simulation experience.
2. Actual patient care experience: Students are required to prepare for a
clinical simulation experience in the same manner as they would prepare for
an actual patient care experience. Steps include in simulation experiences
comprise the actual simulation experience, debriefing, and evaluation. This
should show actual care experiences.
3. Proper orientation of proceedings/scenario: An orientation to both the
simulation technology and the environment is required.
4. Use of problem-solving and critical reasoning: The simulation must
challenge the student to use problem solving and critical reasoning skills to
assess the situation and determine the correct interventions.
5. Role of educator must be as a facilitator: The educator assumes the role of
facilitator, providing cues when necessary, but is not an active participant in
the simulation.
6. Simulation should be Collaborative approach between educator and
simulator: The educator and the student should participate in an active
debriefing. Facilitated by the educator, the debriefing should challenge the
student to think critically about his/her practice and clinical judgment.
7. Feedback and Evaluation of stimulatory session: Feedback and
evaluation regarding student performance is important one. Each simulation
session should include overall experience by both the educator and student.
Characteristics of Simulated Teaching
● Can be used in research work
● It can be used for rehearsal before going to classroom teaching
● Effective for practice of teaching skills by the pupil teacher
● Effective feedback can be provided
● It is a very convenient method.

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Purposes of Simulation
➢ To learn and practice decision-making skills and to develop human
interaction abilities in a controlled and safe setting.
➢ To gain cognitive, affective, and psychomotor skills in nursing.
➢ To apply theory into practice in a controlled setting.
Application of Simulation in Teacher Training
Crruikshank (1968) has developed a teacher training system which includes:
➔ The participant is introduced into the situation (i.e., if he is a new teacher in
a school)
➔ The participant is provided with information and opportunities to solve the
problems (for beginning teacher)
➔ The participant is exposed to a variety of potential solutions to a particular
problem.
➔ The participant is given the opportunity of observing the results of his
chosen line of action.
➔ The participant is introduced to the situation by film strips.
➔ The participant is also given the materials, e.g. the rules, regulations,
curriculum hand- book and record cards, to familiarize to the topic.
➔ The participant is presented with role playing situations, written and
responds to incident as a response sheet.
➔ The participant then identifies the factors influencing the problem, locates
the relevant information, suggests appropriate alternative course of action,
communicates and implements a decision.
➔ Small group discussions.
Simulators
It is deliberately designed to omit certain parts of the real operational situations.
Simulators are designed for procedures:\
● For adjusting electronic representation of motor skills.
● Identification of targets.
● Emergence signals.
● Conceptual tasks involving reasoning.
● Team functions.
The Procedure of Simulation
1. Selecting the Role Players: A small group of 4 or 5 student teachers is selected.
They are assigned different letters in an alphabetic order. The role assignments are

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rotated within the group to give chance to everyone. Every member of the group
gets an opportunity to be the actor and the observer.
2. Selecting and Discussing Skills: The skills to be practiced are discussed and the
topics that fit in the skill are suggested. One topic each is selected by the group
members for exercise.
3. Planning: It has to be decided who starts the conversation, who will top the
interaction and when .
4. Deciding the Procedure of Evaluation: How to record the interaction and how to
present it to actor has to be decided so that a proper feedback on his performance
could be given.
5. Provided Practical Lesson: The role plavers should be provided reinforcements
on their performance to give them training for playing their part well.
Activities in Simulation
Role Playing: The role, false or actual is performed in an artificial
environment. This may give the pupil, an understanding of a situation or
relationship among real life participants of a social process. He will gain
some perceptions of the actions, attitudes and insight of persons or
situations.
Socio-drama: It seeks to utilize role-playing as a means of finding out the
solution to a problem situation assigned to the role-players. The problem
may be false or based on real life situation, and the actor is required to find
out an acceptable solution of the situation.
Gaming: The situations involve outcomes affected by decisions made by one
or more decisions. These are designed in a manner which enables chance to
affect the outcome.
Stages of simulation
1. Pre-brief/Brief
2. Scenario
3. Debriefing
a) Reaction
b) Analysis
c) Summery

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 1. Brief/Pre-brief

Briefing is a foundational part of the simulation experience that helps to prepare

and orient learners to the simulation experience. It promotes experiential learning.
The pre- brief also introduces learners to the concept of simulation, orients them to
the simulation environment, equipment, and embedded participants. The facilitator
discloses learning objectives of the simulation scenario, establishing a fiction
contract (expectation setting for performance) with learners, providing logistic
details about the session, and pledging to respect the learners. It allows for
confidentiality and create psychologically safe environment for the learners which
will enable to optimize their experience in the simulation lab.
2. Scenario
A scenario is an outline or model of the simulated sequence of events that can be
used for an exercise or to support scenario based training. It can be written as a
narrative or depicted by an event timeline. Simulation scenarios are designed to
assess, educate, and help learners to self-identify gaps in their understanding of
material or application of knowledge. It provides the context for the simulation
based on actual or potential situations and includes the objectives, target
population, description and progress of the situation, actions expected from the
students.
3. Debriefing
"Debriefing is the heart and soul of simulation based training"

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Post-event debriefings in healthcare are defined as an after-event discussion
regarding performance and thought processes of the team during the scenario to
promote reflective learning and improve clinical performance.

It is a facilitated or a guided reflection in the cycle of experiential learning.

Debriefing should be based on the pre-set learning outcomes. 80% of learning take
place in this phase. It should allow for progression through the identified phases of
debrief-reaction, analysis and summary. A psychologically safe environment must
be established in debriefing stage. It allows people to share and reflect their
feelings, assumptions and opinions. This further helps in discussing difficult topics.
Debriefing consist of three phases

● Reaction phase: in this the facilitator will ask regarding the emotions or
reaction of participants when he/she is in the simulation scenarios.
● Analysis phase: in this phase, the facilitator will engage the group in
discussion regarding the particular scenarios by asking open-ended questions
like what happened/why did it happened.
● Summary phase: in this phase, the facilitator will ask the participants
regarding the take-home message means regarding their new learning, what

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 they learned from the o particular scenarios and the application of the
learning experience to the future encounter

Goals of the Debrief

* To enable the participants to become aware of their reactions during a crisis

* To help them develop tools for evaluating and analyzing their reactions
* To effect a positive change in their behavior.
Advantages of Debriefing
* Clarify learning points
* Introduce key issues to participants for further dialogue
* Insight into strategies and processes that lead to good results, not just results
themselves
* Participants can begin to develop their own evaluative skills for future critical
events

Types of Simulation
In a whole aspect(according to B.T Basavanthappa)
1. Written simulation.
2. Audio visual simulation.
3. Live stimulated simulation

Written simulation: Individual uses either paper and pencil latent image format.
The Purposes includes Problem solving, Decision making, To evaluate student's
ability to apply the skill.
Audiovisual simulations: An entire simulation can be placed on videotape.
Management vignettes can be dramatized and filmed. Questions can be posed for
the viewers right on the screen, and the alternative outcomes, dependents on which
approaches to a solution are chosen, can be all taped.

Live stimulated simulations: Lincoln, Layton and Holdmen (1978) described

their experiences with simulated patients. The patients were healthy people, usually
students, who were trained in the role they were to play. Simulated patient used
their own history as much as possible but memorized and added the elements of the
history that had been created for the simulation. Nursing students found the

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experience to be beneficial. They would be much more relax and confident when
meeting their first real patient.
The different instruments, equipments and simulated patients used are
● Video recording: can be used to help students develop physical examination
skill in much the same way as for interviewing skills.
● Simulation devices: These devices include those for cardiac auscultation,
breast examination, prostate palpation, pelvic examination and laryngeal
examination.
● Simulated patients: These can also be used very much the same way as for
history taking, with the similar advantages.
1. Model simulation.
2. Oral simulation.
3. Written simulation.
4. Computerized simulation.
5. Simulated patients.

The other types are briefly described as follows:

❖ Part task trainer

Part task trainers, also known as low-tech or static task trainers, are designed to
replicate only a part of the body or portion of the task.The learning objectives
associated with partial task trainers are often task specific. Used to teach:
➔ mostly procedure
➔ basic psychomotor skills
➔ Anatomy of human body

Example:
➢ Teaching of injection technique to arm by using Orange or Banana
➢ Using Mannequin for teaching Neonatal Resuscitation
➢ Plastic "IV Arm"

❖ Standardized patient
A simulated patient, standardized patient or sample patient (SP) (also known as a
patient instructor), in health care, is an individual who is trained to act as a real
patient in order to simulate a set of symptoms or problems. Simulated patients have

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been successfully used in medical education, nursing education, evaluation, and
research.
Used for:
➔ Physical assessment skills
➔ History taking
➔ Teaching Communication skills
➔ Teaching clinical skills
➔ Interaction with psychiatric client
➔ Clinical examination
Example:
Teach the student how to collect history from psychiatric patient.
❖ Screened based computer simulator
This include computer application for simulation
Use:
➔ Model various aspect of human physiology
➔ Model of specific task or environment
➔ Making clinical decision
➔ Observe the result in action
Example:
Computer-assisted instruction programs or Web-based programs.
❖ Complex task trainer
Complex task trainers involve:
➔ Heptic systems: This type of technology is particularly useful in learning
environments where the faculty cannot clearly see where the student is
assessing the patient. Haptic systems allow a learner to perceive tactile and
other stimuli to the senses through a complex, computer-generated
environment.
➔ Virtual reality: These virtual-reality scenarios offer an opportunity for the
learner to practice skills via computer-based training, including
● Surgical skills
● Bronchoscopy
● IntravenousCentral line catheterization

❖ Integrated Simulators (Human patient simulator)

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Integrated simulators, also known as human patient simulators (HPS), combine
computer technology and part- or whole-body mannequins to provide a more
realistic learning experience. Integrated computer technology
housed in the mannequin that allows the mannequin to respond in real time to
specific care interventions and treatments for example:
➔ Medications
➔ Chest compressions
➔ Needle decompression
Chest tube placement, and other physiologic interventions and subsequent
responses.
These interactive mannequins are capable of realistic physiologic responses,
including Respiration, pulses, heart sounds, breath sounds, urinary output, and
pupil reaction.
Why simulation is Important
Integrated simulators contribute high degrees of realism (fidelity) to the simulation
scenario. Additionally, the more advanced models can communicate with the
student, responding to questions posed by the learner in real time during the
simulation exercise
Points to remember while preparing simulations:
The simulation should:
1. Initiate the problem in a realistic manner, it should contain the elements a nurse
would encounter in the real situation.
2. Reflect problem solving process by requiring a series of sequential
interdependent decisions.
3. Enable the learner to obtain the necessary. information and/or feedback related
to a previous decision as input to the next step.
4.The consequences of errors should be built into the situation, and learners should
not be able to reverse wrong decisions, rather they should deal with the
complications or delays that result from such errors
5. The simulation should accommodate alternative, solutions if these are possible
in real life.
Advantages of Simulation in Teacher - Education
1. Simulation establishes a setting where theory and practice can be combined.
2. Simulation requires the teacher to be active participants in the process.

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3. No risk involved. The decisions are made and carried out without physical or
psychological harm to children or school as a result of practice-teaching.
4. Controlled teaching assignments are possible. Student teacher obtain
experiences which are realistic and thus they become critical.
5. Simulation is a teaching device that motivates and involves students. It changes
teacher behaviour. Introduces novelty in the whole learning process. Level of
freshness and novelty is maintained throughout the learning session.
6. Students are not expected to identify the group time and follow it. Every student
is expected to have experiences, which are different from the usual laboratory type
experiences common to all.
7. Stimulates the students for the acquisition of purposeful activities and they feel
keenly interested in role-playing, socio-drama and gaming activities.
8. Removal of student-teacher polarization. Simulations are self-monitoring.
Participants recognize their aim progress by various feedback methods. Students
are involved in decision-making. They observe their own evaluation of these
consequences, which influence their future actions. Personal tensions in the
teaching situation are likely to be reduced by the process of self-monitoring.
The teacher's role may be as interpreter of the simulation and as a guide, but he
doesn't have to pose as an expert or as a judge.
9. Simulation as a universal behavioural mode.
10. Gains related to relevance and learning.
11. Decision-making skills into action. It develops various skills in children in
increasing difficulty order.
12. Role awareness - The individual when he plays the role of others becomes
conscious of that role.
13. An interdisciplinary view It provides an integrated view as well as a vehicle for
free interdisciplinary communication.
14. Dynamic framework.
15. Bridging the gap to reality - Simulation works to bridge the gap between unreal
and real. Students enact real situations and learning becomes more interesting and
lively than purely theoretical.
16. Gestalt communication: It is holistic in nature. It permits the learner a greater
flexibility in addressing facets of complexity.

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Values of Simulation Techniques
➢ Enables the learner to learn directly from experience.
➢ Promotes a high level of critical thinking.
➢ Develops in the students an understanding of the decision-making process.
➢ Enables the individual to empathise with the real-life situation.
➢ Provides feedback to the learners on the con- sequences of actions and
decisions made.
➢ Motivates the students by making real life situations exciting and interesting.
➢ Enables teachers and learners to assess the realism of the situation by
uncovering misconceptions.
Limitations in Simulation Technique
1. Simulation cannot be made in all subjects of the curriculum.
2. Simulation cannot be conveniently used in case of small children because
mechanism is too difficult for them to follow.
3. It requires a lot of preparation on the part of teachers, very few teachers are
prepared to take up the extra work which is required to make use of the technique
as a success.
4. Learning is a serious activity which is highly individualized and needs
concentration on the part of the learner. Simulation reduces the seriousness of
learning.
5. Minimum of feedback sequence to choose.
6. Time consuming.
7. Difficulty in using an analytic approach.
8. Need for many simulators.

Role of the Teacher in Simulation

1. Planning: Planning begins with choosing or developing and appropriate

simulation that will meet course objectives. Assign some reading for the students
to do before class. Textbooks or library resources should be pointed out to students
so that they can prepare for the simulation. Teacher is responsible for preparing the
environment, it includes arrangements of chairs and tables, ventilations, and
lighting.

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2. Facilitating: Teacher should function as a facilitator during the actual process of
the simulation. After introducing the activity you may take a backseat and talk
relatively little. You must coach students who are
trying to find their way through a sticky problem and encourage creative thinking
and act as an information Resource. Take notes during the class so that in later
discussion you can refer back to specific strengths and weaknesses of the process.

3. Debriefing: Your role is the final discussion or debriefing session. Immediately

following the simulation when the information is fresh in everyone's mind. You
should briefly summarize what has taken place. Self-analysis can help students
gain insight into why they made certain decisions or took a specific course of
action. In simulations where emotions have run high, ventilation of feelings should
be part of the debriefing.

At the end of the discussion period you should point out how principles and
concepts have been applied and how the experience ties into the learning objectives

Application of principle and concept of simulation

Type Example Fidelity Typical use

Simulation Manikins Low Demonstrative practice
Oral simulation Problem based Low Case discussion
Written simulation Paper and pen Very Teach knowledge
latent image low assessment
Simulated patient Trained actor Very Teach interpersonal
roleplay high skills

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 Laboratory Method

Laboratory method of teaching utilizes a problem-solving approach to learning. It

offers students the opportunities for supervised, individualized, and direct
experience in the testing and application of previously learned theory and
principles and in the refinement of specific skills or complex abilities.
It can be defined as planned learning activity dealing with original data in the
solution of problems.

In laboratory method, both teacher and students have definite responsibilities for
the effective use of the method. It provides well-planned and supervised
experiences and converts principles of nursing into active problem-solving nursing
practice.

Objectives of Laboratory Method

1. To provide first-hand experience with materials or facts in solving the problems
related to anatomy, physiology, microbiology, and nutritional laboratory.
2. To provide experience with actual solution such as nursing foundation
laboratories.
3. To help students in gaining skills in manipulation and practicing nursing
techniques in the laboratory.
4. It helps students to acquire a scientific attitude towards problem-solving.

Shulman and Tamir, in the Second Handbook of Research on Teaching, listed

five types of objectives that may be achieved through the use of the laboratory in
science classes:

1. Skills - manipulative, inquiry, investigative, organizational, communicative

2. Concepts for example, hypothesis, theoretical model, taxonomic category

3. Cognitive abilities -critical thinking, problem solving, application, analysis,

synthesis.

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4. Understanding of the nature of science -scientific enterprise, scientists and
how they work, existence of a multiplicity of scientific methods, interrelationships
between science and technology and among the various disciplines of science

5. Attitudes for example, curiosity, interest, risk taking, objectivity, precision,

confidence, perseverance, satisfaction, responsibility, consensus, collaboration, and
liking science.

Technics of the Laboratory Method

There are three phases of laboratory method.
Preparation
1. It requires establishment of objectives and plan of work,
2. It motivates the student by presenting problem together with effective method
for its solution.
3. Teacher prepares the plan with cooperation of the student considering objectives
not wasting time.
4. Teachers allow time for maximum use of laboratory work.
Work period
1. It refers to that period when demonstration, experimentation or practice for a
skill in a nursing procedure.
2. To ensure an effective work period there must be adequate equipment and
facilities including basic tools.
3. There must be adequate supply of specimens and materials.
4. There should be sufficient space, light and ventilation.

Teacher should plan the entire class for learning activities, extra-work should be
assigned to those who finish, but it should not be special work, but to get more
knowledge in the same work,
Evaluation/Culminating activities
Group discussion, individual reports of findings, written report of principles
learned is the evaluation tool, which gives more opportunities to the student in
mastering knowledge and to put into practice.

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Values of Laboratory Method
Laboratory method helps:
● The student to master the subject.
● To participation of student with his suggestion while planned demonstration
by the teacher helps to learn the procedure accurately.
● To provides concrete and first hand knowledge of factual materials.
● To make provision for purposeful student activity.
● In training in scientific method and develop scientific attitude.
● To development of laboratory techniques in handling laboratory things.
● Provision of concrete materials which help in imaginary experiences
Correct Method of Teaching in a Laboratory

Taking up practical classes is hectic. A sincere guide walks around to supervise

his/her students. Therefore, most of the lime is spent standing and this is absolutely
strenuous.
Point 1 Self Preparation
You should know everything about what you are going to teach your students. You
must know the details of the experiment. Revise the techniques of the lab so that
you make your students learn the correct way right from the beginning. You should
be well prepared to answer their questions and clarify their doubts. A good start is
always needed to begin an experiment.
Point 2 Right Explanation
The worth of a teacher is always weighed by students. Knowing everything is not
enough. So what are the effective teaching strategies in a lab? You should be
capable of sharing your knowledge with your students. You must be able to make
them understand each and every scientific cause behind the observations. Your
students will be curious to know and so you have to be efficient enough to reply
them confidently.
Point 3 Starting Experiments
There are different ways to start with. The best is to explain the process orally
once, explaining the methods as written in the protocol. You should ask your
students to follow the protocol before handing the instruments. This way they will
learn the correct procedures for performing the experiment. You can also
schematically explain the process.

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Point 4 Handling Instruments
This is one of the most important aspect to be considered while performing an
experiment. Mishandling of instruments might lead to accidents and breakage of
expensive lab supplies. Show them how to hold the test tubes, light burners or
handle any instrument. Your students should follow you and should not try
anything spontaneously if they are ignorant about it.
Point 4 Explaining Observations
Once the experiment is over, you are supposed to explain your students the reasons
behind the observations. Explain them the inference in details, so that no doubt
remains in their mind. Relate the observation with the text they have learned in
their theory classes.
Point 5 Writing Reports
There are different ways to write lab reports. You should teach your student the
sequence for writing a lab report format. The typical structure of a thesis or lab
reports begins with the aim of the experiment, the requisition and then the detailed
explanation of the process, methods techniques and the precautions required. At
last, the observation along with a good conclusion is cited. Diagrams, flow charts,
formulas, schematic paths, etc. are important part of the report.
Point 6 Lab Safety
You should know the safety guidelines and lab safety symbols before teaching your
students. You should explain them the precautions needed for the experiment. Your
students should know how to operate safety devices like oxygen cylinders, masks,
gloves, headbands, etc. This way mishaps are avoided. Last but not the least, if you
have taken up teaching as your profession, then you must work on this line, 'a
teacher should be a friend, philosopher and a guide'.
Asking and Answering Questions
Asking questions

Establishing contact with students as they work involves learn names and using
them in conversations with students. Asking questions means you can watch out
for students who look like they're coping well but are really putting on a show. You
will discover your own best way to interrupt, but here are some suggested
questions:
➔ You seem to be getting on well?
➔ Where have you got to? Are you stuck?

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 ➔ This looks good. What are you going to do next?
➔ Why do you think that happened?
➔ Have you finished? What are you going to do next?
➔ What sort of thing did you take notes on?
➔ Have you thought about how you will write up this
➔ project/experiment?
➔ What have you got out of today? Has it been worthwhile?
➔ Other people have said such-and-such. Do you agree?
➔ How do you think this fits in with the rest of the course?

Answering questions
No matter how long you teach or how thoroughly you prepare, there will always be
questions that take you by surprise or you don't know the answer right then.
Remain calm, honest, and try one of these approaches for responding:
➔ The student can be encouraged to find out the answer (especially when it is
their responsibility). Where do you think you could go to find an answer to
that question?
➔ You can go and find the answer. Can I think about that and come back to
you?
➔ You and the student can explore together. Why don't you try looking in that
book and I'll try this one.
Managing Laboratory Sections
Labs are sometimes offered in conjunction with large lecture courses so that
students may acquire technical skills and apply concepts and theories presented in
lecture. Labs, however, are often "stand-alone" classes with no connection to a
parent course. Even where they are related to another course, they often have their
own agenda that may not be related to the lecture. This hands-on experience
encourages students to develop a spirit of inquiry and allows them to live for a
semester as practicing scientists. It may sound trite, but you really do have an
opportunity
to help students develop some appreciation of the mysterious scientific method.
Evaluating What You have Done.
As the lab section draws to a close, you'll want to assess your success as well as
that of your students in the lab. As in most situations, evaluations can be conducted
both formally and informally.

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Advantages of Laboratory Method
1. With this method students learn to master the subject.
2. Students learn to work under the guidance of teacher and learn the procedures
accurately.
3. First-hand information is provided to the students.
4. It is an excellent method in which students learn first the concrete and then the
abstract learning.
Disadvantages of Laboratory Method
1. Laboratory method can be waste of time, if there is no planning and there is a
lack of direction by the teacher.
2. Lack of budget may make it difficult for the teacher to arrange all the materials
required for laboratory method.
Conclusion
In clinical nursing the use of the laboratory method and simulation becomes
procedure for providing students with well- planned, supervised experiences in
translating principles of nursing into active, problem-solving for nursing problems.
Theses methods serves as the foundation for building in those combinations of
teaching methods best suited for establishing a structural framework to bridge the
gap between the theoretical study of nursing and the study of patients. Therefore,
the following methods of teaching can be viewed both in terms of their singular
uses or their integral contribution to the total methods.
Research evidences
About the journal: Clinical Simulation in Nursing,Volume 91,June 2024
(Clinical Simulation in Nursing is an international, peer reviewed journal published online
monthly. Clinical Simulation in Nursing is the official journal of the International Nursing
Association for Clinical Simulation & Learning (INACSL) and reflects its mission to advance the
science of healthcare simulation.)

Innovation and Restructuring of Laboratory and Clinical Simulation in

Undergraduate Nursing Programs During the COVID-19 Pandemic: An
Integrative Review

Authors: Shehnaaz Mohamed , Tawny Lowe , Melody Blanco , Sumayya Ansar ,

Kim Leighton , Jessie Johnson (University of Calgary in Qatar, PO Box 23133,

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Doha, Qatar) Medical Education Department, Itqan Clinical Simulation &
Innovation Center, Hamad Medical Corporation, PO Box 3050, Doha, Qatar

Abstract

Background

The COVID-19 pandemic forced nursing education institutions to abruptly shift

away from traditional in-person learning and find alternative approaches to fulfill
program requirements. This integrative review explores the various innovative and
restructured simulation strategies used by undergraduate nursing programs for lab
and clinical courses in response to the pandemic.

Methods

Whittemore and Knafl's (2005) five-step framework guided this review. A

systematic search of six academic databases and quality appraisal using the Mixed
Methods Appraisal Tool yielded 10 studies for the review.

Results

Strategies identified primarily employed virtual simulation methods using avatars

or real people. Additional approaches included flipcharts and simulation-based
flipped classrooms. Key themes pertaining to language and culture, immersion,
facilitation and skills emerged.

Conclusion

Virtual simulation was a valuable tool during the pandemic.Additionally, further

research into the effectiveness of virtual simulation as a replacement for in-person
nursing clinical and lab experiences is warranted.

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Effectiveness of clinical simulation on nursing student’s improving critical
care knowledge: A pretest-posttest study
Filomeno E. Renzi, E. Insa-Calderón

Registered Nurse, Policlinico Umberto I - Sapienza University of Rome, Italy;

Registered Nurse, Research Scholar, Department of Public Health and Infectious
Diseases, Sapienza University of Rome, Italy

Aim. To evaluate the effectiveness of Human Patient Simulation method, as an

additional method to theoretical lectures, on improving critical care knowledge of
third course nursing students compared to only theoretical lectures. It was
hypothesised that, the greater cognitive abilities used and trained around a specific
subject, more strengthening of the subject contents is done by the students.
Methods. A non-experimental pretest-post test study was carried out with a
questionnaire created ad hoc. specifically for this study. Pretest questionnaire was
administered after students received five weeks of theoretical lectures on critical
care subjects. Post test was administered after students performed the theoretical
classes and the simulation based learning activity on critical care subjects.
Results. 60 nursing students of the Campus Docent Sant Joan de Déu, attending to
critical care subjects, were enrolled in the study. The statistical analyses performed
showed a significance of the intervention in the post-test: p value 0.01 and the
students improved on average by 1 point after the intervention, passing from 11.94
in the pre-test to 12.94 in the post-test. Results of this study suggest that use of
Human Patient Simulation method of zone two made a positive difference in
nursing students’ ability to answer questions about critical care when there was
need to apply their cognitives abilities.
Conclusion. We evidenced that is crucial to direct cognitive resources
appropriately toward each section of the simulation activity. Choosing the quantity
and the kind of cognitive abilities that will be used by a specific group of students
in a simulation activity, facilitators can upgrade the student knowledges and avoid
impaired learning

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