The introduction of high fidelity simulation learning into a pre-registration nursing course : the lived experience of nurse academics

Abstract

The aim of this study was to uncover the lived experiences of nurse academics when introducing, adopting and implementing a high fidelity simulation program in a school of nursing and midwifery at a large multi campus Australian University. In recent times, in Australia and internationally, high fidelity simulation has been introduced as a teaching and learning strategy in health care education. This innovative strategy has been increasingly adopted into nursing programs in an attempt to address the many challenges facing nursing education and the health care system. Nurse academics are being challenged to prepare pre-registration nurses to enter a workforce with increasing complexities such as higher patient acuity, rapid changes in technology within the workplace, advancements in nursing and scientific knowledge, increasingly complex care management roles and a limited number of clinical placements for a growing number of pre-registration nursing students. Simulation learning has been proposed to address some of these challenges by offering pre-registration nursing students opportunities to improve their clinical competence and workplace readiness in a safe learning environment. However, the adoption and incorporation of simulation learning into nursing programs has been varied and many institutions struggle to maximise the capabilities of high fidelity simulation and successfully integrate simulation learning into their curriculum. A hermeneutic phenomenological approach was chosen as a method to provide a voice for the nurse academics involved in the adoption of the simulation program. This was a staged study with a convenience sample of ten academics in stage one and five academics in stage two. Ten face-to-face semi structured interviews were undertaken within the first three months of implementation of the program. Follow up interviews for stage two were conducted three years after full implementation across the pre-registration program. The findings from the study highlighted three major themes with subthemes and minor themes. The first major theme illuminated the fundamental essence of being in the world of imposed change with sub themes of feeling disconnected and feeling underprepared. The participants felt a distinct lack of connection with the high fidelity simulation program due to lack of consultation from management and an absence of a guiding philosophy. They also experienced anxiety with feelings of being underprepared to effectively implement a high fidelity session. The second theme to emerge was being in the world of implementing a new program with subthemes such as encountering communication and collaboration challenges, a sense of a struggle and feeling engaged. The participants voiced feelings of enthusiasm and engagement with the program however; they also experienced frustration with the lack of collaboration and communication between team members. There was a sense of struggle for the participants because of lack of technological readiness and lack of technical support to assist with successful implementation of a high fidelity session. In addition, the participants voiced concern with large student numbers and feelings of isolation when facilitating the sessions. A high fidelity simulation program, three years on: a fractured journey became the third theme. This depicts the journey that the participants experienced over the three years of program implementation. Whilst searching for meaning on this fractured journey, the dominant dialogue related to obstacles or barriers and lack of congruence in the engagement and uptake of this new program. The first sub theme to emerge was encountering obstacles with minor themes: a diverse workforce and academic staff buy in. The second subtheme was technological investment versus human investment: a lack of congruence. The implications from these findings offers nurse academics and senior nursing academic management an insight into the experiences and barriers involved when adopting an innovative program such as high fidelity simulation into a preregistration nursing program in Australia. It serves to promote an awareness of the importance of infrastructure and resources to enable successful integration into curriculum.

Date of Award	2015
Original language	English