The role of technology in different framing of scenario-based simulation in nursing education and the impact on design for learning

Scenarios for simulation in nurse education are often designed around specialized technological equipment such as full-sized programmable manikins in order to achieve a high level of fidelity and credibility. The scripted scenarios are performed or played out by students as part of their training in order to acquire proficiency in specific techniques, e.g. measuring blood pressure, catherization or administering CPR. In addition to the scenario the learning designs often include rounds of evaluation in order to integrate theory in what is conceived as simulation of praxis and to provide opportunities for reflection on action. In such designs technology withdraws into the background as part of an evaluation of how realistic the scenario is deemed. The emphasis is on evaluation of the performance.
In this paper we would first like to offer an analysis of the above approach as evaluative as we have observed simulation unfold in a training facility in a Danish school for nurse education. We would like to suggest an alternative explorative approach to the design and execution of scenarios for simulation training. Unlike the evaluative approach an explorative approach places little emphasis on the fidelity of the simulation and much more on the simulations ability to support guided discovery for the student.
Secondly we would like to discuss the impact a change in design approach will have on the overall purpose of simulation training. Learning goals of scenarios remain embedded in the acquisition of technical proficiency however the purpose of the simulation shifts from emulation of real conditions to providing a secure environment for students to explore different courses of action and develop their skills. Rather than evaluating the fidelity of the scenario this learning design makes it a point - that the scenario is not real. Time-outs where the student steps out of character and back-stage communication in between performances are considered part of the design. These pauses are not only opportunities for reflection but can be used to discuss alternative courses of action with peers, recall information, and provide guidance in prioritizing and relevant criteria for professional judgment. In such a design technology plays an active role in the exploration and reflection on the students’ skill progression. The emphasis is on an education of attention wherein the students’ sensitivity and criteria of relevance are developed in tandem with her skill as reflection in action. Finally we consider concrete changes in the role technology plays in the two designs.
Keywords: Simulation-based learning, technology, nurse education, design for learning.