Technology is advancing at a fast pace. Since the 1980s, technology has penetrated every sector of the human economy. Manufacturing, Education, Travel, Real Estate and Transportation are just some examples that may come to mind. Among the sectors of the global economy that have been heavily penetrated by technology is Medicine and Healthcare. The medical field, in its entirety, has been undergoing major shifts as more and more of it becomes exposed to technological advancement. The areas of surgery, diagnosis and the human genome have been particularly influenced by advancing technology. The world of Nursing has not been spared by this penetration. Advances made in robotics and automation, for instance, has brought to question the need for nurses. This exposure to technological advancement in Nursing is mostly a good thing.
Among the ways in which technology has been evident in the world of Nursing is in the introduction of games, simulations and virtual worlds into the training and practice of Nursing as a field. A number of studies and surveys have shown that the continued introduction of new technology into the Nursing arena has resulted in an overall improvement of patient satisfaction and reduction in clinical errors. Additionally, the near-elimination of paperwork and drudgery that automatically follows the introduction of technology has resulted in nurses and doctors being freed up to focus on what ultimately matters the most-their patients.
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A game is an objective-based competitive activity guided by a set of rules. In a game, some actions that one takes will be rewarded, while others will be penalized. Nursing Education games are set up in such a manner that lessons learnt and positive actions taken are rewarded by accolades. Conversely, mistakes and negative actions are punished. Games are mainly fabricated tools which consist of conflict and predetermined objectives. They also have to be governed by a set of rules. Trainees of nursing education usually have different learning styles. Gaming and other strategies that tend towards experiential learning make for a dynamic learning experiment (Blakely et al., 2009).
Simulations are virtual imitations of otherwise real scenarios. Trainees interact with the simulated environment to implement the acquired knowledge and practical skills that they have learned, to real problems (Garcia-Carbonell & Watts, 2012). In Nursing Education, a few simulations are often conducted complete with training mannequins and dummies. The mannequins are programmed to mimic situations that may actually happen in the course of clinical practice. Trainees will assess the mannequin, take the vital signs and make decisions just like they would in a live situation.
Simulations allow one to learn through mistakes without bearing any lasting negative consequences. The mannequins are live patients. There are also screen-based simulations that do not require a physical presence like that required for mannequins. On these screens the trainees are able to respond to simulated scenarios and patients in real-time using required tools and procedures. Generally, simulations are dynamic tools whose aim is to represent the fidelity, accuracy and validity of real-life scenarios.
Virtual reality is a simulated environment that is interacted with using special electronic equipment and sensors. The subject behaves in the same way as they would in the same environment, were it real. Games, simulations and virtual worlds have the advantage of being able to provide for much more complex situations than would happen in real-life. Thus, the trainees achieve a state of readiness and experience that would otherwise be very time-consuming and costly to attain.
A good topic in Nursing Education that is ripe for technological intervention is Care Delivery in Nursing Informatics. A good number of technological innovations have already made their way into the delivery of nursing care for patients. However, like many other fields, it would further benefit from the intervention of Virtual Reality, Games and Simulations. The best target audience to introduce these technological tools to would be student nurses. These are nurses in training who are likely still young adults with a vastly more frequent exposure to emerging technology, compared to their older counterparts. Additionally, student nurses are also more likely to be malleable and accepting of new exploratory ideas that may or may not work.
A suitable tool for nursing students to consider for their frequent use during training is some combination of games and simulations. Simulated games work perfectly because they focus on both cognitive knowledge and affective knowledge. Content games focus on cognitive knowledge while Process games focus on affective knowledge. Games provide set objectives with small rewards along the way until the final goal is attained. Good moves are rewarded while negative actions are punished. This provides a sense of what happens in the real world for nurses. In the hospital ward, a bad move could result in death or permanent injury. A good action often results in recovery and good health. Games are well suited for training in Nursing Education. They reward and reinforce good actions and punish the bad, while keeping a desired outcome well in the sights of the trainee nurse.
Simulations are effective for immersing the trainees into what a real life scenario would look like. They allow trainees to objectively participate in risky activities and procedures within a safe environment. This is without the hazardous consequences to themselves or the patients that are typical of mistakes made in a hospital ward. Simulation games trigger and nurture problem-solving ability while providing important information required for the nursing students to have. They feel the pressures and emotions that come with dealing with real patients.
In simulations, the nursing students can learn all the important lessons about wards and patient care without suffering the dire consequences of making mistakes associated with the learning process. A combination of simulations and games would be ideal for achieving the goals for which the nursing profession aims. Studies also indicate that simulations combined with traditional clinical experiences produces better nurses than using traditional experience alone (Smith et al, 2016). Games maintain the objectives in a reward and punishment system while simulations maintain the experiences at a level as close to reality as possible.
The Patient Care topic in the Nursing Informatics field that is suggested here would be structured in such a way that both theory and practice are well covered. The course would be designed in such a way as to allow for a healthy balance of both theory and the practical aspects of Nursing Informatics. The course commences with a few units covering basic Nursing and Medical Theory. After this it would progress to a few simulation gaming exercises to keep the trainees rapt. Afterwards the course proceeds further into some more Theory work and actual clinical experience. Next would be some final Theory work, before doing another round of Simulation Gaming. This round of simulation gaming would signal the end of the course. The trainees would be free to join the nursing working force henceforth, in real hospitals and wards.
The advantages of a simulated game delivery method in Nursing Education revolve around the motivation and enthusiasm for learning that these games produce. Simulated games have been seen to cause a rise in the performance, engagement and learning motivation amongst trainees. Simultaneously, simulation games reduce the stresses, monotony and anxiety that are associated with traditional classroom tutoring. Trainees in Nursing Education often report feeling apprehensive before getting into a ward with patients for the first time. Simulations can help correct such unwanted instances (Khalaila, 2014). Simulations teach important skills like time management, task prioritizing, communication, teamwork, decision-making and leadership skills.
Simulation games are also advantageous in the sense that when carried out as a team, they allow for collaborative effort and the sharing of outcomes and experiences (Robertson, 2009). Nursing is a team sport and experiences like this will definitely add to the quality of nurses that are churned out by any institution that undertakes these simulations.
Simulation games allow for trainees to experiment in valid and authentic situations without risk to themselves or the patients in a clinical sense. The game immerses the trainee nursing student into a fabricated scenario that they will likely encounter in real life. They may apply knowledge, skills or previous experience here, for which there are no lasing or harmful consequences in real life. The feedback is prompt and the consequences neither negative nor long-lasting.
Another major advantage of simulation games is that they are adaptive to the trainee’s pace of learning. Depending on the trainee’s learning ability, they can be hastened or slowed down. The nursing student will not advance to the next level until they have mastered and earned accolades in the previous level. These same simulations may also be customized to facilitate individualized learning. Also, simulations can be repeated as often as necessary for as long as it takes the trainee to grasp the lessons therein. These repetitions happen at zero to minimal cost.
The disadvantages associated with a simulated game approach in Nursing Education training revolve around the whole concept being relatively new. As such, most of the application of Simulated Games to the teaching of Nursing Education has been haphazard and uncoordinated. Additionally, the participating trainee gamers must be well curtailed against the extreme natural reactions associated with gaming. This calls for extra supervision in terms of a trainer, tutor or supervisor.
Another demerit is that it is quite likely that most participants of the simulation game may focus on the game itself without paying attention to the feedback and debriefing segments which complete the whole learning experience. This therefore makes it almost imperative to have a tutor or instructor to ensure the expedition of the training by simulated gaming.
A disadvantage that is often directed towards training by simulated games is that simulations often provide an incomplete clinical experience for the nursing education trainees. The claim is that simulated gaming is devoid of any psychological and emotional aspects that are immensely helpful in dealing with patients. A big percentage of time in Nursing Education is spent covering the human and psychological aspects of patient care. Therefore, for simulation gaming to fail to cover these aspects screams trouble for a lot of people. This disadvantage is in line with the general claim that simulations do not always completely replicate real-life situations.
In conclusion, a major criticism that simulated gaming faces is that some simulators are very expensive to acquire. This usually requires the acquiring institutions to dedicate significant resources towards training through simulated gaming. The simulation systems also usually require constant updates, monitoring and specialized staff to operate.
The future of Nursing Education looks bright. Nursing Education is strongly influenced by changing technological innovations. With the influx of more efficient and effective technological methods, the Nursing Education training will only keep improving in form and reach. The pace of information transmission and adoption requires new innovative methods of instruction (De Oliveira et al., 2014). Therefore adoption of gaming and simulation is necessarily a positive thing.
References
Blakely, G., Skirton, H., Cooper, S., Allum, P., & Nelmes, P. (2009). Educational gaming in the health sciences: systematic review. Journal of Advanced Nursing , 65 (2), 259-269.
Curl, E. D., Smith, S., Chisholm, L. A., McGee, L. A., & Das, K. (2016). Effectiveness of integrated simulation and clinical experiences compared to traditional clinical experiences for nursing students. Nursing education perspectives , 37 (2), 72-77.
De Oliveira, S. N., do Prado, M. L., & Kempfer, S. S. (2014). Use of simulations in nursing education: an integrative review. REME , 18 (2), 496-504.
García-Carbonell, A., Andreu-Andrés, M. A., & Watts, F. (2014). Simulation and Gaming as the future’s language of language learning and acquisition of professional competences. Back to the future of gaming , 214-228.
Khalaila, R. (2014). Simulation in nursing education: an evaluation of students' outcomes at their first clinical practice combined with simulations. Nurse education today , 34 (2), 252-258.
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th Ed.). Burlington, MA: Jones and Bartlett Learning, LLC.
Robertson, B., Schumacher, L., Gosman, G., Kanfer, R., Kelley, M., & DeVita, M. (2009). Simulation-based crisis team training for multidisciplinary obstetric providers. Simulation in Healthcare , 4 (2), 77-83.
