Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review

Nurse Educ Today. 2016 Jan;36:281-6. doi: 10.1016/j.nedt.2015.08.005. Epub 2015 Aug 19.


Objective: This integrative review identified, critically appraised and synthesised the existing evidence on the barriers and enablers to using high-fidelity human patient simulator manikins (HPSMs) in undergraduate nursing education.

Background: In nursing education, specifically at the undergraduate level, a range of low to high-fidelity simulations have been used as teaching aids. However, nursing educators encounter challenges when introducing new teaching methods or technology, despite the prevalence of high-fidelity HPSMs in nursing education.

Design: An integrative review adapted a systematic approach.

Data source: Medline, CINAHL plus, ERIC, PsychINFO, EMBASE, SCOPUS, Science Direct, Cochrane database, Joanna Brigge Institute, ProQuest, California Simulation Alliance, Simulation Innovative Recourses Center and the search engine Google Scholar were searched. Keywords were selected and specific inclusion/exclusion criteria were applied.

Inclusion criteria: The review included all research designs for papers published between 2000 and 2015 that identified the barriers and enablers to using high-fidelity HPSMs in undergraduate nursing education.

Review methods: Studies were appraised using the Critical Appraisal Skills Programme criteria. Thematic analysis was undertaken and emergent themes were extracted.

Results: Twenty-one studies were included in the review. These studies adopted quasi-experimental, prospective non-experimental and descriptive designs. Ten barriers were identified, including "lack of time," "fear of technology" and "workload issues." Seven enablers were identified, including "faculty training," "administrative support" and a "dedicated simulation coordinator."

Conclusion: Barriers to simulation relate specifically to the complex technologies inherent in high-fidelity HPSMs approaches. Strategic approaches that support up-skilling and provide dedicated technological support may overcome these barriers.

Keywords: Educator nurse and integrative review; Faculty nurse; Human patient simulator; Manikin; Nursing students; Patient simulation.

Publication types

  • Review

MeSH terms

  • Education, Nursing / methods*
  • Manikins*
  • Patient Simulation*