Authenticity in simulated action:

Nursing students learning insertion techniques for intravenous canulation

Helen Melander
Department of Education, Uppsala University

Within nursing and medical education, the practicing of skills in simulated environments is widely spread, relying on the assumption that the simulated actions are approximately the same as actions in authentic situations. In focus for this presentation is how nursing students at a Swedish university hospital’s clinical training center learn a seemingly trivial but one of the most common invasive procedures performed in hospitals: the insertion of a peripheral venous catheter (PVC, i.e. a small, flexible tube that is placed into a peripheral vein in order to administer medication or fluids). The study is based on micro-analyses of video recordings of a training session that was organized such that each student first inserted PVCs into a paper tissue, and then into two different models: one tablet and one mannequin arm. The students were also allowed to perform a venous canulation on a fellow participant under supervision. The analysis involves tracing one of the student’s actions as she practices inserting a PVC on the different devices and on a fellow student, as well as when her body is transformed into a work site for other students. More specifically, the analysis considers how the body – mannequin and real – figures into the fine-grained organization of practices of learning and how the participants in various ways orient to authenticity as an aspect of the training episodes. The analysis addresses the emergent properties of objects and bodies and pays specific attention to the ways in which verbal as well as bodily conduct is reflexively produced in a material environment (e.g. Goodwin, 2000).

Following the unfolding organization of action as one student progresses through the training episodes, makes it possible to discern how the activity changes as different contextual configurations (Goodwin, 2000) are brought into play. Depending on whether they are practicing on objects or bodies, authenticity is oriented to in various ways. The models simulate the human body, but the results of the study also show that the human body is transformed into a mannequin of sorts and where focus is on the learning student rather than the student as patient. The results of the study do not question the relevance of simulations but the detailed analyses contribute to a deeper understanding of interaction and learning in simulated environments.