Hot Topics in Nursing: How Simulation Saved Graduation

In March 2020, COVID-19 forced university students around the country to quarantine at home and learn online. That was a disaster for healthcare students who could no longer practice in clinics and earn the hours required to graduate. Faculty at the University of Colorado College of Nursing had to pivot. They expanded simulation training for students to practice with lifelike mannequins, virtual reality, task trainers, and other methods to complete their clinical rotations and earn their degrees.

About Our Expert

CON_FBowler_Expert Fara Bowler, DNP, APRN, CHSE

Dr. Bowler is the Director of the Clinical Education Center and Simulation for the University of Colorado College of Nursing. She speaks nationally on the use of simulation to promote quality and safety in care delivery.

Dr. Bowler along with colleagues at CU Nursing have been involved in a SAMSA grant focusing on the integration of SBIRT (Screening, brief intervention, and referral to treatment) into curricula incorporating high fidelity simulation. Recently, she was the section editor for AACN Advanced Critical Care on the topic of simulation.

She holds national certification as an Adult Nurse Practitioner with the AANP. Most recently, she achieved certification as a Certified Healthcare Simulation Educator with Society of Simulation in Healthcare.

As a result, CU Nursing was the first and only department on the Anschutz Medical Campus to return to in-person learning during the pandemic.

The high-quality simulation education was a success. The director of the Clinical Education Center and Simulation says the students graduated with the same state board exam pass rates as previous graduating classes. A study by the National Council State Board of Nursing also found simulation learning was equal, if not better, than learning in some clinical situations.

We spoke with Fara Bowler, DNP, APRN, CHSE, and Director of the Experiential Learning Team about the decision to expand simulation during the pandemic and their plans for the future.

Dr. Bowler, how were you able to make the transition to all-simulation training so quickly?

We were already using some virtual simulation in our education, so we are fortunate in that we already had it set up and were ready to go. We brought in additional adjunct faculty to help us teach, then expanded our licenses. The Colorado Board of Nursing says you can use 50% of clinical hours in a particular course for simulation. But during the pandemic, they issued an emergency rule that allowed us to use 100% well-designed, high-quality simulation.

How realistic are the simulation methods?

We use SimMan 3G mannequins which are easy to operate and designed for a fully immersive experience. There is a whole lifespan of mannequins from newborns to toddlers, adults, and females who can give birth. Their skin is interchangeable for diversity. The high-fidelity mannequins have a motherboard in their chests that connect to laptops in our control room. We are able to create scenarios where they complain about having chest pain, nausea, and other problems. They have heart sounds, lung sounds, bowel sounds, and respiratory rates. They can blink, sweat, and bleed to really interact with the students. While they can speak (with a microphone and speaker from the facilitator), they can’t move or reach out.

Each mannequin or patient has a name, employment history and full family background. So, within that, they have healthcare issues that come up and socio issues going on. We try to make it as complex as we can to meet the demands of the healthcare environment.

What other kinds of simulation training do you use?

There are multiple modalities and we use the modality of simulation to meet the objectives of learning. Mannequins are great for when you want a situational or psychological change. We also have virtual reality which is wonderful if the learners aren’t here in person. We can have them engage via the computer and they use the Oculus or the headset hardware. Then we can create the software in that scenario with different settings and different patients and the learner is able to engage in that virtual reality situation.

We also use standardized patients who are actors. They take on a character and act out the scenario and behave as someone would with whatever healthcare issue they have. We can do that via Zoom just like we would with a meeting or regular interaction or it can be face-to-face.

We also have what we call our task trainers. Those are small body parts so students can learn a specific task. For example, we have an arm to start an IV, or it may be a catheter into a pelvic model. We also have medication injection models. Those can be practiced with time and time again through what we call deliberate practice, where you continue to learn until you feel comfortable and confident.

Most of the modalities are done when a peer is watching a peer or faculty members guide the learning.

What sets your Clinical Education Center and Simulation apart from other university centers?

We use great combinations of simulation modalities in creative ways. Also, everyone who teaches in simulation is a practicing registered nurse and brings that clinical expertise to simulation to help transition students into practice.

We are also expanding our simulation services and engaging more students to use it. In October, we’re moving from a 5,000 square foot center to 13,000 square feet, plus a location at the Legacy Innovation Center in South Denver. In the future, we’ll also be expanding with our partnership to Fort Lewis College and developing a simulation center there.