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Newly qualified specialist nurses report great transfer value between simulations and clinical practice.

Students in specialist nursing learn a lot from realistic simulations

Research indicates that students need to find the simulations believable to gain any real benefits.

Simulation is an educational method for creating realistic situations that can be practiced. In medical simulation, students get to practice procedures, communication, and collaboration. When they use manikins, or dolls, they are confident they will not harm the patients.

This method of learning is used both at educational institutions and hospitals. 

At the University of Agder, a dedicated simulation centre has been built for this purpose, where students can practice on patient simulators. These look like humans and have features such as speech, sweat, tears, and lung and heart functions.

“The government wants to use simulations more in the nursing education. Since it's difficult to secure enough and relevant clinical placements for all students, simulations can offer an alternative learning environment,” says Hege Kristin Aslaksen Kaldheim.

She is the first to have completed a doctorate in surgical nursing at the University of Agder. 

Use simulation in education

Kaldheim has conducted interviews with students and newly qualified specialist nurses. She has also organised many simulations as the person in charge of simulations in the training of surgical nurses at Lovisenberg Diaconal University College.

There are many different medical patient simulators. Many look very lifelike and have human-like features, while others are simple dolls, like this one.

“I'm interested in how students learn through simulations. It's useful to look at how those who use simulations best can plan and organise them to ensure good learning outcomes,” says Kaldheim. 

Today, she actively uses simulations in the education of student nurses at master's and bachelor's levels at the University of Agder.

Commonly used, little researched

“Simulations allow students to take more responsibility, such as handling emergency situations, and do more than they are allowed to do in a clinical setting. It's important to customise the exercises to ensure the students can experience a sense of mastery, and it's good for them to learn through activities with other students,” the researcher says.

Simulation has long been an established way of practicing in the nursing profession, but not much research has been done on it. 

Operasjonssykepleiere utøver pleie til pasienter med livstruende sykdom eller skade. Å øve på simuleringer, ofte dukker, gir studentene tro på at de også mestrer akutte kliniske situasjoner, viser forskningen til Hege Kristin Aslaksen Kaldheim.
Operating room nurses provide care to patients with life-threatening illness or injury. Practicing simulations, often dolls, gives students confidence that they can also master acute clinical situations, according to the research of Hege Kristin Aslaksen Kaldheim.

There has been limited research on how participants learn, and even less on so-called interprofessional simulation. This is a simulation where several specialists simulate together, such as simulations with both anaesthetic and surgical nursing students. 

It has been unclear how much competence is transferred from simulation exercises to everyday work.

In her doctoral thesis, Kaldheim interviewed newly qualified specialist nurses who reported a significant transfer value.

“They recalled simulations from training when they encountered similar situations in the real world. They felt better prepared to handle such situations. They also wanted more simulation in their studies to become even better and more prepared,” says Kaldheim.

Positive stress

It is crucial that a simulation is as realistic as possible.

“It's also important that the simulation is well organised and that the students experience positive stress,” says Kaldheim.

Positive stress means that students get to experience the responsibility they will have in their future role as nurses. This provides both learning and a sense of mastery.

Kaldheim says it is important for leaders to recognise how crucial it is for learning to have simulations of high quality. In her research, she discovered important prerequisites for obtaining high quality.

“The participants must feel that the simulation is realistic, and that they are well-prepared and confident in the learning situation. Both participating in the simulation and observing fellow students are important,” she says.

Kaldheim found through interviews that the competence of each individual profession is essential in simulations. The planning and implementation are best achieved when the simulation planners also have expertise in the scenario being simulated.

An addition to practice

Today, the amount of clinical practice required for specialist nursing students during their training is determined by law. This is challenged by the increasing demand for nurses. 

Kaldheim concludes that simulations are good, as long as they are well implemented. However, there is still little research on the impact of replacing clinical practice with simulations.

And therefore, simulation cannot simply replace practice. But it can serve as a good addition.

“Good simulations require competent professionals who know how to conduct simulations, and resources to ensure proper implementation,” says Kaldheim.


Kaldheim et al. Professional competence development through interprofessional simulation-based learning assists perioperative nurses in postgraduation acute clinical practice situations: A qualitative studyThe Journal of Clinical Nursing, vol. 32, 2022. DOI: 10.1111/jocn.16377

Kaldheim, H.K.A. Interprofessional simulation-based learning used to prepare perioperative nursing students for acute situationsDoctoral dissertation at the University of Agder, 2023. 


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