1. Palatnik, AnneMarie RN, APN-BC, MSN

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This summer, my daughter participated in a softball tournament with 16 other teams, all in her age group, but displaying vastly different levels of playing ability. What makes the first-place team first and the last-place team last? Three things came to my mind: talent, a good coaching staff, and a lot of effective practice.

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But what makes practice effective? From the coach's perspective, three more things: teaching good fundamental skills, creating lifelike game situations that if executed effectively will make the difference between a win and a loss, and repetition. As a coach, when I plan practice, my goal is to create game-like situations to help the girls develop their critical-thinking skills and to teach them to take advantage of opportunities.


In 450 B.C., Confucius said, "Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand." This holds true whether you're coaching children on an athletic field or nurses in education programs. For nurses, simulated learning can be used as a teaching strategy and an evaluation tool. As a teaching strategy, simulation is innovative and experiential rather than instructional, with a greater emphasis on outcomes. Simulated learning is a great enhancement to the traditional classroom type of education, providing hands-on learning experiences.


Different types of simulation learning strategies are available:


* Computer-based simulation is an easily accessible way to gain knowledge and assist with critical-thinking skills, but lacks physical interaction with patients or experiential learning.


* Task trainers, such as the I.V. arms used to practice venipuncture, are good for practicing procedures and allow for frequent repetition.


* Human patient simulators offer high fidelity, interactive experiences that enhance critical thinking, decision making, and delegation. These devices facilitate knowledge integration. But they're costly and depend on the availability of an instructor or facilitator. Also, they provide limited realistic human interactions.


* Standardized patient actors offer more realism because they add emotional responses and interaction with you, the nurse. This enactment can enhance communication skills and interpersonal relationships. But because the patients are actors, they have no actual signs and symptoms to assess.



Ideally, an integrated model of several different simulation types provides the greatest learning opportunities for nurses.


As an assessment tool, simulation can be used to enhance or replace traditional assessment measures such as written exams or checklists. Simulation measures more than a nurse's knowledge base-it measures actual performance, and because it's standardized, the situations are consistent for all nurses being evaluated. But it does come with additional costs and valid and reliable evaluation tools to assess the simulated activity aren't readily available.


As you're thinking about how simulation is or can be used at your facility, read Chuck Fort's article about simulation education on page 22.


Coaching a great softball team really isn't that much different than coaching a winning nursing team. The real difference is that the wins in nursing are so much bigger and literally life-altering.


Until the next time: be healthy, be happy, and be great advocates for your patients!!


AnneMarie Palatnik, RN, APN-BC, MSN

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Director of Clinical Learning, Center for Learning, Virtua Health, Mount Laurel, N.J.




International Nursing Association for Clinical Simulation and Learning.


National Council of State Boards of Nursing.