Simulation is an excellent tool that can be used to display one’s understanding of learned concepts. Simulation can be used to train participants for a variety of situations including emergency events, end of life care, interprofessional collaboration, and more. Instructors look forward to seeing their learners participate in a simulation scenario and display transference of knowledge. However, some instructors have anxiety about the behavior and knowledge that their learners will show in a simulated event but hope for the best.
Many participants often look to simulation time as a stressful period of time for them when they are put on display in a fishbowl and unable to perform up to their own standards. Why does this occur? Did they not understand what was taught? This occurs due to what this author calls the “Sim Brain Phenomenon.” Sim Brain occurs as a result of stage fright (they are being watched and filmed), a fear of judgement (they seem to think that simulation is for a grade, when it is not or that their actions are being looked at for nefarious means), and/or the inability to consult a reliable resource when they are unsure of their interventions.
There are some tools that can be used to alleviate the Sim Brain Phenomenon and ensure a meaningful learning experience for all. One of these tools would be the STAR corner: when a participant is using the STAR corner they will state that they need a STAR moment or they need to use the STAR corner. When they request a STAR moment the sim is paused for up to 60 seconds so they can collect themselves in the STAR corner. STAR means Stop, Think, Actively Reflect, and Respond to the situation at hand. While in the STAR corner, the participant may consider the root cause of the situation, if they need to call for help, or even if they need to call the doctor; once a decision has been reached or the 60 seconds is up they will resume the simulation session. The STAR corners that have been used by this author have had a star drawn or created for them; all learners and facilitators know of it and its purpose and has been utilized with much success.
Another method that can be used to combat the Sim Brain Phenomenon would be to have the clinical instructors serve as charge nurses. The clinical instructors would serve as a simulated charge nurse so they would not give out the answers but rather prompt the participants to help them come to a good decision. One may also use a participant as a charge nurse, but they would have to be instructed not to complete the scenario for the other learner but help them in demonstrating the best practice for this situation. Learners can also serve as resource nurses, but they will have to be assigned a task when they are called in and once that task is finished they leave, if they are seen to be loitering in the room or interfering in the simulation they will be called to “assist another patient in a different room.”
These methods have been found to assist participants who become overwhelmed or lack the confidence to actively participant in simulation scenarios to the best of their abilities. It is important to educate the participants about proper use of these tools so that it does not disrupt the learning experience or disrupt the achievement of the learning objectives. The instructions about the use of the tools should be included in simulation orientation.
Storytelling is the oldest form of education; storytelling has been used to communicate critical information about safety, recipes, teach lessons, remove bad habits, and explain events. In our various cultures we hear stories from our family members, in school, and at work. It is part of our oral tradition and how history is shared. I remember hearing stories as a child that explained why we have certain practices and why humans have internal ethical struggles. The lessons from these stories stuck with me in a way that made me evaluate my choices carefully when making a critical decision. When these tools are used to teach nursing students they can have a wondrous effect.
Storytelling and mental modeling often go hand in hand; when people are told of a situation or told a story, they will work out the process of that situation within their brains to see how the situation resolved or could have resolved if other steps were taken. The individual may go through different algorithms to work out the most correct path for the situation. This is a clear demonstration of critical thinking and may help with improving clinical reasoning in nurses.
Research shows that storytelling is a method of learning that can be transferred; students remember the “war stories” that their nursing instructors have told them about their clinical experiences. I can remember being told a story by an instructor about a congestive heart failure patient that she had that was receiving fluid and developed wet lungs and frothy pink sputum. She was so vivid in the way that she was describing the sputum that I never forgot to correlate strict intake and output with congestive heart failure patients. As a nursing educator myself, I have told stories of patient care that aligned with what I was teaching to the students to the students didactically and have later gotten a phone call or email from a student saying that they saw a similar case in clinical or in their practice and remembered what I told them.
Storytelling is an excellent method of instruction and provides auditory and visual stimulation to learners in a manner that connects to the concepts being taught to the students. And they provide an opportunity for reflection and transference. Telling a story in the right context that links to the concepts being taught may help the individual visualize the situation in their mind and then practice the concept/skill.
How are you using storytelling in your instructional practices?
“Stories are a communal currency of humanity.” —Tahir Shah, in Arabian Nights
Nursing education is done a little differently at Linfield College. We pride ourselves on creating innovative methods in which aspiring nurses can learn and grow into strong and competent professionals. One of the many ways in which that is done is through our simulation program. Our simulation program is run out of our experiential learning center (or ELC); it includes low, mid, and high-fidelity simulations. With these simulations, our students go in one by one to care for the patients individually for ten to fifteen minutes at a time with each student picking up where the other one left off. They plan the care together using what’s called a mega brain and prioritize the patient’s needs within the plan prior to the start of care for the patient. We have not witnessed this method being used at many facilities.
The students have the option of continuing care as the previous student or changing the plan; they are all the same nurse so if they are in the middle of a task then they are able to continue with that task without starting the steps over again, which saves time and enables them to carry out the task. In the past, we had found that having each student start over took away from the simulation experience and that the students were more focused on the task instead of the patient. This brought about the solution of one mind nursing. The students have found this to be extremely helpful and have verbalized how this increases the realism of the clinical simulation by having them think like a nurse, especially with the situation of end of shift or hand-off. In this situation the students have to consider what is the best option if they receive hand-off in the middle of a nursing task. This is one of the aspects that increases realism.
Another method of increasing realism comes from the use of alumni. We use alumni as family members during the simulation (we have a manikin or a standardized patient as an actor). During the simulation, the alumni act as though they are the family members dealing with that situation. After the simulation is complete, they help with debriefing after we walk through the case and ask high-level critical thinking questions to stimulate reflection, retention, and transference. They tie in clinical examples of how it relates to their clinical practice and emphasize why the clinical reasoning and actions based on clinical judgement are so important. The students enjoy having the alumni because they have shared their experience and have gone through what they have experienced and have become successful after it. The alumni serve as additional mentors and role models in this way, offering advice and further insight into the role of nurses. With this addition to our clinical simulation program, we have created a more realistic and enjoyable experience for our students.
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