Need to Finish Your Clinical Hours? We’ve Got a Simulation for That
June 10, 2020 / by Michelle Thompson
A nursing student enters the Emergency Department exam room to see her new patient, Charlie Snow, a 6 year old boy complaining of shortness of breath. Charlie is allergic to nuts and may have eaten a cookie that had nuts in it, explains Charlie’s aunt; the only adult relative accompanying Charlie to the Emergency Department.
“Please do something!” pleads Charlie’s aunt. Charlie is leaning forward in the stretcher, and is breathing loud and fast. What should the student nurse do, and in what order? Charlie’s appearance, work of breathing, and skin assessment (known as the pediatric assessment survey) is poor, and getting progressively worse.
While this may sound like a scenario a student could only experience in a clinical setting, this spring George Mason School of Nursing students gained experience with such scenarios virtually. With the COVID-19 pandemic, virtual reality and computer simulations have given Mason nursing faculty effective and proven ways to deliver required clinical experience—allowing students to graduate on time.
Dr. Helen Stacks is an assistant professor in the School of Nursing and the Division Director of the Simulation Center. When she learned that classes would move online and many clinicals were cancelled due to COVID-19, she sought technology-aided solutions for nursing students who would otherwise be in clinical placements, working with local school districts, or learning in the on-campus Simulation Center. To graduate on time this August, students in the Accelerated Bachelor of Science in Nursing (BSN) Program needed to complete required clinical hours. In response to the Executive Order declaring a State of Emergency in Virginia due to COVID-19, the Department of Health Professionals temporarily waived certain clinical hours requirements to increase the number of nursing personnel able to treat patients during the outbreak. Because the waiver is set to expire June 10, students scheduled to graduate beyond this date must meet the standard 500-hour clinical requirement.
Stacks stresses that a one-size fits all solution doesn’t exist for remote nursing education. “We evaluated the solutions required based on the needs of each individual program. For example, our Accelerated Nursing students needed more hours to sit for boards while our traditional BSN students are not as time-constrained to log their clinical hours. We are implementing technology based on the unique circumstances for each group.”
Simulation has long played an effective role in SoN teaching and the addition of virtual reality and computer-based simulations further enhances faculty’s ability to reinforce skills and knowledge. Stacks cites research, including the studies identified below, as evidence that computer simulations and virtual reality (VR) are proven to help students master clinical skills. In an evaluation of virtual simulation technology in an adult health nursing, 91% of participants indicated that the simulations were beneficial for learning. In a study of BSN students’ perceptions of learning with simulation, 75% of students found the simulations effective/realistic to enhance their learning. Virginia allows for up to 25% of clinical experience to take place as simulation and Stacks anticipates that this percentage may grow as data increasingly reveals the reliability and validity of simulation programs.
“Students not only learn from their own simulated experiences but from debriefing with the facilitator and other students on what happened during the encounter. They discuss reactions – what happened, why it happened – and their feelings. During the debrief, we separate fact from fiction and look at the assumptions behind our actions.” Similarly, the virtual simulation allows students a stop-action look at what is happening – and provides real-time feedback on the student’s actions, reactions, and underlying assumptions about the situation.
For example, simulation and VR can be used to successfully teach hands-on skills like inserting a nasal gastric tube. Students can watch a video and then perform the procedure on a virtual patient. The VR technology allows the student to complete the procedure followed by a comprehensive debrief with the faculty facilitator. Did the student explain the procedure to the patient, did he prep the equipment correctly, did she angle the tube correctly, did he help ease the patient’s anxiety?
Accelerated BSN student Kayla Thompson is completing her final coursework and is using computer simulations – like the example of the pediatric patient’s allergic reaction – to meet her remaining clinical requirements. “Overall the simulations are very realistic to what we might experience in the Sim Center or in a clinical. We follow the same steps we would complete patient-side – do the SBAR report (Situation-Background-Assessment-Recommendation), check vitals, and make an assessment to the provider who then issues orders. In the [pediatric] example, we had to determine whether to start oxygen before getting parental consent, as one example of the many intricacies we face with patients.”
Virtual and simulated experiences allow students to practice procedures repeatedly and evaluate their own actions. Stacks explains that students often want to focus on the tasks while the faculty facilitator can help students understand the “why” behind the task.
“The faculty have done a great job of providing hands-on training while we can’t be in schools, hospitals, and the classroom,” says Thompson. “The simulations are a great alternative and give us exposure to a wide variety of scenarios that play out in real life—we get practice in checking ABCs (Airway-Breathing-Circulation) and relaying information to the provider.” Areas of practice include pharmacology, medical-surgical, and critical care as well as specialties where patient-side experience may be harder to get such as maternity, pediatrics, and psychiatry.
Stacks sees virtual reality and virtual simulations as an important addition to students’ clinical experience and welcomes the opportunity to further incorporate facilitated simulations into the curriculum in a post-COVID 19 world. Stacks and SoN faculty are renovating a state-of-the-art simulation lab on the Mason Fairfax Campus which is scheduled to open in 2020.
 Wright, R. R., Tinnon, E. A., & Newton, R. H. (2018). Evaluation of vSim for Nursing in an Adult Health Nursing Course: A Multisite Pilot Study. CIN: Computers, Informatics, Nursing, 36(2), 84–89. https://doi-org.mutex.gmu.edu/10.1097/CIN.0000000000000388
 Foronda, C. L., Swoboda, S. M., Henry, M. N., Kamau, E., Sullivan, N., & Hudson, K. W. (2018). Student preferences and perceptions of learning from vSIM for Nursing™. Nurse Education in Practice, 33, 27–32. https://doi-org.mutex.gmu.edu/10.1016/j.nepr.2018.08.003