Skills and simulation education: a key part of the nursing curriculum and on-going skill maintenance??

* Skill acquisition is an integral part of the development of any practitioner, and both student and postgraduate nurses need every opportunity to master and gain confidence with key practical skills in a safe learning environment before being exposed to 'real' patients.

Practical, clinical skills lie at the heart of nurses' professional practice. With nursing programmes spending increased time studying subjects such as psychology, sociology, health policy, pharmacology and physiology, many students now spend less time on acquiring the psychomotor / practical skills essential for safe nursing practice.

As a result, many student and practicing nurses working in clinical practice have concerns about their ability to perform well in difficult or life-threatening situations. This is now being recognised by some of the nursing and paramedic education providers and District Health Boards around the country by the provision and access to dedicated skills and simulation centers that provide space, equipment and the motivation for new and innovative learning opportunities.

Using computer based simulation manikins, enough elements of reality can be recreated to allow the acquisition of skills that are transferable back to the clinical environment and the potential of such systems for teaching and training nurses and paramedics is enormous. During simulated education sessions, other nursing care issues can be incorporated such as communication, assessment, team dynamics, crisis management and decision-making. This is particularly relevant with multi-disciplinary simulation sessions where doctors, nurses and technicians participate together to mimic the reality of the clinical situation.

Learning a skill or optimizing critical decision-making in a crisis is not achieved simply through observation and apprenticeship, but through a structured and systematic approach, which allows repeat practice in a safe environment. To do this, skill acquisition and on-going skill maintenance needs to be valued and allocated sufficient time for development within the curriculum and considered a key aspect of the in-service educational culture.

The recently developed Waikato Skills and Simulation Centre is a result of this thinking and is the cooperative effort and commitment of the Waikato District Health Board and the Waikato Clinical School--a branch of University of Auckland, Faculty of Medical and Health Sciences.

Denise Bregmen, CNLE for ICU at Waikato Hospital, says that the feedback she gets from her staff who have undertaken simulation education at the new centre has confirmed her view that there has been a long-standing need for such a facility.

Colleen Vandy who facilitates the new graduate nursing programme at Waikato enthusiastically echoes this view. "The WDHB have committed to providing graduate nurses a twelve month education program with a very strong clinical focus related to their practice. Exposure to skills and simulation training ensures that all new graduates can be guaranteed exposure to certain situations that they may not otherwise see during their placements. This enables them to enhance and refine their physical assessment and treatment skills and significantly accelerate their integration into practice".

Some of these issues will be explored at an upcoming skills and simulation conference at Waikato in April 2004.

* Rob Sinclair, Coordinator Waikato Skills and Simulation Centre