work experiences addressing resource management, communication, patient safety, pain management, evidence-based care, emergency responses, end-of-life care, and critical thinking, among other knowledge and skill competencies. The residency program was implemented at six medical centers in 2002, with 259 nursing residents being enrolled under the guidance of assigned, individual preceptors and resident facilitators within each institution.12

Individualized Training

Research shows that not everyone learns the same way. While many individuals learn well through reading, some learn better through auditory mechanisms, such as lectures. Others learn better through approaches that allow them to use their motor skills. Teaching adult learners therefore requires different styles of education and training or supplements to lecture-style continuing education (Lazear, 1991), and nursing staff can benefit from being helped to learn individually, rather than as group learners, at a pace suited to their particular learning styles. CD-ROM-based and individualized text-based programs can be used to provide this individualized learning (Rauen, 2001). Peer support groups also are helpful to NAs in nursing homes in internalizing new knowledge (CMS, 2000).


Simulation is the use of an artificially created, “practice” event or situation constructed to resemble an actual event or situation that an individual is likely to encounter and that requires critical decision making and/or physical skills. Simulation exercises often emphasize the application and integration of knowledge, skills, and critical thinking (Rauen, 2001). Simulation training allows workers to practice dealing with error-inducing situations without jeopardy to themselves or patients and to receive feedback on both individual and team performance (Helmreich, 2000). Use of simulation training has been cited by 23 percent of employers reporting to the ASTD education and training benchmarking service (Thompson et al., 2002).

In nursing, simulations of clinical practice using varying degrees of technological sophistication can be used to teach clinical assessment skills, nursing procedures, and use of technology. Body-part simulators allow the practice of such skills as inserting catheters and tracheostomy care and suctioning. Computers have greatly aided the use of simulation as an education


Personal communication, A. Rhome, American Association of Colleges of Nursing, June 11, 2003.

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