SIM lab - Do you like it?

[AOx1]

I am a nurse educator and our school is considering the use of simulators such as SIM man and would like your opinions.

1. What are your thoughts on the use of simulations?
2. Do you gain anything from them?
3. What makes them helpful or not helpful?
4. Do you have any recommendations for improving simulation experiences?

Thank you for your time!

[chevyv, BSN, RN]

I had my first SIM experience a few months ago and was very disappointed. It feels so unrealistic to me (and most of my fellow students). There was a general consesus at the end of the semester that it is not as helpful as they had hoped. But, the one thing everyone agreed on is the computer program that was finally installed. We all had to work a little on it before the SIM experience and we all learned so much. I think the computer part is related to the company that puts out the SIM. This program takes you through scenarios where you click on things you would do for your patient (these are actual people looking patients,that groan and talk to the staff). You know right away if what your doing is working. If your patient doesn't make it, you will know why and what you need to do differently next time. You can go through the same scenarios until your comfortable, working at your own pace. It was 100 times better than spending the amount on the actual SIM man. At this point, my opinion is not to hop on the wagon just because everyone seems to be doing it. It's not as wonderful as what some make it out to be. Of course, this is just my opinion. I hope it helps.

[sissyboo]

I'm not a big fan of "sim-man" labs.

1. My school had a wierd schedule for time doing SIM applications. They tried to make it so that the situation related to class, but considering it took three to four weeks to get everyone through each scenario, the testing was already over for that. I do believe any education is good, even if it is not "on schedule"--but that did not give everyone the same benefit.

2. I gained a little less than nothing.

3. What I did find helpful was hearing abnormal heart and lung sounds and having to differentiate between the two (we were still working on abnormal assessment at the time).

4. If you're going to do them, I advise enforcing that sim man is an actual patient. More times than not, people in my groups were quickly drawing up the meds and pushing them with no regard to the dosage or how fast to push it. I would also try to make the scenarios useful to each particular group getting a rotation (changing scenarios would also allow for fewer relays of info; the next group will not know what they're doing in the activity)

[AOx1]

One thing I have been told is that the scenarios aren't helpful because they are too "clean" (ex- no blood return when starting an IV, etc) and that the situations themselves aren't realistic. Has this been the case in your experience?

One thing I had considered incorporating into class was a *brief* demo or simulation relevent to the topic (ex- first semester students could listen to lung sounds and identify normal vs. abnormal, second semester students could list possible interventions) in order to make lecture more interesting. I always hated sitting in a four hour lecture and being "read to" from the text. I have tried to use youtube videos, games, demonstrations, and standard patient scenarios (in pharm for example, a community member comes to class and students assess him/her for common med side effects).

[NoviceRN10]

I really havn't thought much of the SIM experience I have had so far. I'd much rather work with real patients. It's just weird pretening he's real and trying to treat him as such. I looked at it as a lost day of clinical at the hospital and I'd rather have been at the hospital!

[smk1, LPN]

I thought SIM was great for when we did code situations. I really felt like I got a good experience and when I saw my first real code in a hospital it was very similar. Nothing beats real patient care, but it is nice to be able to run fluids and feel a "pulse" and hear breath sounds to practice on. Labor and delivery labs were good too.

[chevyv, BSN, RN]

For us, the SIM instructor wanted to trip us up as a way to learn, rather than proceed with a scenario, which is a huge reason none of us liked it. It was a two day (3hr class), day 1 prep (paper due, computer part done). The next day we walked in and had a patient experiencing cardiac pain. The IV was not needless (although we had never been taught with needles), the IV fluid was wrong as was the rate. Also, O2 was set wrong and not in nostrils. There were so many of these little things that were set up that it made it an awful experience. Were we learning about cardiac or ?? People take out their O2, but normally an employee will be precepted to the hospital IV's. I talked with the lab nurse who told me the SIM instructor just didn't ask her to make the IV needleless and she proceeded to do that. It seemed as though it was done in a rather haphazard way. It's a shame actually, because it should be a good experience.

If you proceed with the SIM man, remember that a student is here to learn. Too many little things wrong really detract from the bigger picture that your trying to teach. I have to stand by my earlier post that I don't feel its worth the $$

[Salamanda NP, MSN, APRN, NP]

I like our SIM lab. I think it's a great resource, and I was relieved to have Ms. Sim (what we call her) to practice everything on. We are able to use the lab ourselves anytime during the week, and it has helped many of us feel much more comfortable with procedures. (I know I am glad my first attempt at inserting a foley was on Ms. SIM and not a human being.)

[frez]

I did not feel that stan as our sim man was called was a benificial experiance. As others said I had a hard time talking to stan I knew he wan't real and the stress of preparation and fear of looking stupid hindered any learning that could of happened. the voices that were supposed to come from the sim man came from the ceiling and I found myself talking to the seiling when responding. lol

Plus nothing was ever in stock so you had to pretend everything including b/ps and temps. If it was more realistic maybe but in my mind I still knew it was a fake person. I did not mind practicing skills on the dummys or sim man that did help but the scenerios were uinbelievable and not really helpful in the end. I would of rather had more experiance in clinicals. Then again its just my opinion

frez

[ccstudent]

I am in my third semester and I have had sims each semester. There is hospital room with one way glass and everything. I must say two things. This semester(3) we did a cardio sim day and it was the best sims yet. It was difficult enough to challenge the students and I felt good about the experience afterward. The other thing is not so postive. I had the WORST experience in sims 2 semester. Everything that went wrong did , and I got very upset at the inconsitant instruction and unrealistic atmosphere. I was much more stressed then I had ever been at clinicals. I was reacted more so then I would have liked and I belive that the high stress that was happening at school and at home got to me. I mention this because I feel that I was looked at differently by faculty and the saying that "what happens in sims stays in sims" is really hard for the instructors to actually manage to do. I say this, but know that I have loved all of them, and I think that it is human to do so. Just a reminder that sims is very stressful and to be video taped and watched is something that will bother some students more then others, and try not to judge, sometimes its just a bad day.

[AOx1]

ccstudent, I think your advice is valuable not just in sim lab but throughout a student's experience: I wish we would see more of a climate of respect in nursing education. As faculty, we need to realize that students are human and have bad days and external pressures that may interfere with performance. I know I want the same when I make mistakes (thank goodness the students I had the first semester I taught were gracious!) I always try to talk to my students when they are having a bad day at clinicals to ensure they realize that this will happen when you are in practice and it's OK! I think sometimes there is such a climate of "We must be perfect, you must never make a mistake or you'll fail" which makes me sad because I've tried so hard to create a safe place for the students to learn and grow, and then someone fills their head with just the opposite- that if you fail you're an idiot and a bad nurse. One of my students was actually told by a physician that she was an idiot because she didn't know the normal blood pressure range of a neonate. I pulled the physician aside and congratulated her on the fact that although she was apparently born knowing everything, the rest of us aren't that lucky and have to learn it the old fashioned way. I ended up sending a letter to the house officer in charge of the physician expressing my displeasure. And this was at a TEACHING hospital. Very sad. Needless to say, the student and I discussed this at length until I was certain she understood that asking questions makes you a good future nurse, not an idiot.

[Music in My Heart]

I just finished my first semester in an accelerated program. After about 100 hours of hospital time and 2/3 through med-surg 1 I spent two days at the sim lab.

I loved my sim experience. It was valuable to have the scenarios playing out in real time and having to make clinical decisions on the fly without an instructor or nurse backing me up. In this controlled setting I was able to encounter a number of complications that I've yet to see in my hospital clinical setting.

The feedback that I've heard from most of my classmates has been similarly positive.

That said, it does feel a little weird talking to the dummy and trying to manipulate it. It certainly lacks some of the feedback that I get with real patients (particularly as regards skin color, temp, etc). However, once I set aside the "weirdness" of it, I found it very helpful.