Currently in all aspects of healthcare there is renewed focus on patient safety and quality indicators. Simulation-based training can help practitioners at all levels to reduce risk and improve the safety and quality of patient care. It is, however, most widely used in pre-registration programmes. You may feel this is only relevant to lecturers in the university but as this chapter will show simulation can be used and indeed is frequently used by mentors in practice. There is also increasing involvement of mentors in university simulation centres with the NMC seeing this as best practice.

First, don’t be daunted. Simulation is simply another tool in your repertoire of teaching and learning skills and although it may include technologically advanced tools, it doesn’t have to. The simulation process ‘allows interactive, and at times immersive, activity by recreating all or part of a clinical experience without exposing patients to the associated risks’ (Maran and Glavin, 2003 p. 22).

Students are required to respond to situations as they would in the clinical environment usually in real time, applying and integrating knowledge skills and critical thinking. Debriefing and feedback on performance is crucial to the process to ensure that learning is accompanied by assessment (usually informal) and reinforcement of good practice. Participants are active rather than passive receivers of information. This ‘learning by doing’ approach to learning is one that suits many nursing students.

Simulation is used in many disciplines, particularly when the reality may be dangerous, events are rare or errors are costly in human and/or financial terms. Obvious examples are the aviation industry, where sophisticated flight simulators are mandatory in the training of pilots to maintain their skills, the military and the nuclear power industry. Although the use of simulation and simulators has a relatively long history in medical and nursing education, it is only relatively recently that it has been recognized by the NMC as an essential component of nursing and midwifery programmes.

Students on nursing programmes need to learn practical clinical skills in order to become competent. Some of these psychomotor skills are technically advanced; in the wider context of patient care many involve high levels of cognition, critical thinking and communication skills. It would appear that the acquisition and development of competence in these skills is becoming more challenging as the complexity of healthcare increases and the context changes. As modes of healthcare delivery change there may be less and less opportunities for students to experience certain aspects of care or practise specific skills during their placements. Students gain experience in a variety of settings other than acute care. Whilst this is entirely appropriate, it means that students’ exposure to the hospital environment, where many clinical skills were traditionally honed, is reduced. Even in the hospital setting changing practices, for example, the increase in day case surgery, mean that students may not have the opportunity to practise certain skills, such as suture removal and injection techniques, as they once did. Mentors have many competing demands upon their time, whilst the NMC code of conduct requires all qualified nurses to support students, the needs of patients will by necessity take priority.

Against this background of an increasing patient safety and risk management agenda and reduced availability of clinical placements, the interest in and demand for simulation-based training has increased. Simulation is being recognized as a way of offering the opportunity to train multiprofessional groups of staff for real patient situations in a realistic context in a way that is risk free for patients and, if correctly facilitated, risk free for staff. Through simulation-based teaching, students are provided with the opportunity to rehearse skills, procedures and events not often used. They are also provided an opportunity to refine and develop skills used on a more frequent basis but which can not be rehearsed and practiced in the real environment for practical and/or ethical reasons.

In recent years many healthcare organizations have invested in sophisticated manikins and other equipment in order to provide simulation-based training to staff, which you may have used. The NMC has agreed that pre-registration nursing students can spend up to 300 hours of their 2300 hours of practice time in simulated environment but recommends that mentors should be involved.

There are many ways to provide simulation-based training. Sometimes simulation will involve highly sophisticated manikins, at other times it may involve actors or a mixture of both. Simulated learning can also take place in a virtual environment in the form of interactive computer-based learning packages. The key to all of these approaches is immersion. The scenario or patient situation created must be as realistic as possible in order that the participant becomes immersed in it and reacts and responds as if it were real. Simulation most often takes place in a university-based setting where students and practitioners come together to provide this experience with the support of the students’ lecturers. Whilst these facilities are often well equipped and provide access to staff who are experienced in simulation, it requires a high level of planning and co-ordination to get everyone in the same place at the same time.

Increasingly, simulation is taking place in the clinical environment, making use of a vacant space such as a side room or empty ward area or the organization’s own skills centre. The former have the advantage of creating a more realistic environment and an approach used by many mentors. In either setting the key to a successful learning experience is an enthusiastic, able and clinically credible facilitator.

The type of simulation chosen for any particular learning experience will be dictated by the learning outcomes and facilities available and so must be carefully thought through beforehand. The following sections provide some examples of simulated scenarios you may like to be involved in or could use in your workplace or in a skills/simulation centre.

Before you start to use simulation within your mentoring role, whether in the clinical area or in an educational establishment you must ensure that you have prepared both yourself and the learning environment.

The simulated learning environment needs to be as realistic as possible, so what is learnt and rehearsed is transferred easily into future practice. Within the clinical area it may be relatively easier to recreate a realistic environment as they will already be readily equipped with appropriate resources. Remember that empty wards and clinical areas are ideal venues for simulation as they can be quickly transformed into a realistic clinical environment.

Within a university simulation will require careful planning and sufficient resources to ‘mock up’ a convincing clinical setting. Planning will need to start early, so that equipment and supplies are available in good time.

On any manikin or human actor used within the simulation a range of recipes and procedures can be incorporated to mimic appropriate clinical situations or conditions such as bleeding, fake vomit, malaena, pus, etc. This practice is often referred to in literature and simulator user guides as ‘’moulage’. For access to tips and useful recipes for ‘moulage’ you can go to a number of websites, which include www.meti.com or www.laerdal.com.