Nursing studies

Simulation gives students a short-cut to confidence

A training room using actors and manikins to simulate emergencies requiring clinical decisions is succeeding in instilling confidence in nursing students

A training room using actors and manikins to simulate emergencies requiring clinical decisions is succeeding in instilling confidence in nursing students


Deputy chief nursing officer at NHS England Hilary Garratt officially opens the
simulation suite, cutting a ribbon held by adult nursing student Kimberley Lowe (left)
and midwifery student Ceara Watson. Picture: University of Chester

As a nursing student, trying to gain real life experience of managing a critical incident without jeopardising patient safety was once unachievable.

But a new simulation suite at Chester University is enabling health and social care students to practise their skills while avoiding compromising patients’ well-being.

‘We wanted to provide immersive environments that support students to develop their skills and competences, so they feel confident to take on their role as soon as they walk into their first job,’ explains senior lecturer Stewart Rickels, the university’s faculty co-ordinator for simulation.

A patient’s journey

Opened in June by England's deputy chief nursing officer Hilary Garratt, the suite has two defined areas designed to simulate a patient’s journey, starting with being seen at home then moving through to hospital admission and eventual discharge.

Ms Garratt says: ‘This simulation suite provides student nurses and midwives with excellent opportunities to learn safely in environments that represent the whole life course and the reality of multidisciplinary working.’

The suite includes a one-bedroom flat, a community clinic and an acute clinical setting – complete with triage assessment – plus a seven-bed general ward, children’s and maternity wards, and a relatives’ room.

There is even a room with placebo drugs in the right bottles, so learners can practise a drugs round. ‘These are things that students don’t always get lots of experience of on placement, but as soon as they have their registration they’re expected to undertake these activities,’ says Mr Rickels, whose background is in emergency nursing and risk governance.

Outside comfort zone

Having a fully functioning community setting, including the patient’s home, reflects how care is becoming much more integrated, says Mr Rickels. ‘We have far greater provision of some acute care in the community environment,’ he says.

‘Our students need to understand how to nurse here and manage discharge. I hope it means they feel more prepared to apply for jobs in the community.’

Managing risk is key to the experience. ‘It’s completely safe because there aren’t real patients at the other end of what students are doing,’ says Mr Rickels. ‘They can learn through errors. But we’re also pushing them outside their comfort zone, because the student doesn’t have their mentor with them. If there is an emergency they have to take clinical decisions themselves, working collaboratively with their colleagues.’

Actors bring unpredictability

To ensure the students’ experience is as realistic as possible, Mr Rickels has worked with an acting coach in preparing actors to play different characters, who may be patients or relatives.

These include a patient with learning difficulties, a young patient with asthma, someone approaching the end of their life, and one with dementia. Relatives include some who don’t always agree, enabling students to manage challenging circumstances.

‘Using actors gives us unpredictability in a fluctuating healthcare environment, which can change shift by shift, or even minute by minute,’ explains Mr Rickels ‘It’s crucial they don’t break character, even for a moment, otherwise it gives the learner the option to think this isn’t real.’


One of the manikins in the simulation suite. Picture: University of Chester

Involving groups of between seven and nine nursing students, each simulation lasts up to an hour and a half and is followed by a debriefing session. ‘I can’t emphasise the importance of this enough, because that’s where the learning actually takes place,’ he says.

Among those who have taken part in the experience is third-year adult nursing student Kimberley Lowe. After coming on shift and having a handover, she was allocated a patient – in this case a manikin – whose partner was played by an actor. During the scenario, her patient had a cardiac arrest.

‘I had to deal with it’

‘If you’re on placement and there is a critical incident, other staff will naturally take over,’ says Ms Lowe. ‘You can watch what happens, but you can’t do much else because it’s obviously not safe. But in this case I had to deal with it, coordinating the rest of the team. It helped me to develop leadership skills, keeping my eyes on the overall picture.’

She also valued the opportunity to work in a multidisciplinary way, including seeking support from a social worker when safeguarding issues were raised during her simulation.

‘Again, if this happened on a placement, you might be able to observe or take notes but you wouldn’t be able to lead on it,’ says Ms Lowe. ‘But here I had to follow through to make sure the person was safe.’

‘You realise you have the skills’

She admits that she initially felt wary of critical care nursing, but this experience has significantly boosted her professional confidence. ‘When you’re managing what happens, you begin to realise that you do have the knowledge and skills to cope,’ says Ms Lowe.

‘As a third-year you have that panic that you’re really close to the end of your course and it’s easy to feel you don’t know anything. But now if that situation happens when I’m on a ward, I have the confidence to think that I know what I’m doing.

‘Simulated experience gives you that exposure – even if it’s something that hasn’t happened yet in your practice.’


Students in the simulation suite. Picture: University of Chester


Lynne Pearce is a health journalist

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