Why do you think that simulation is the best way to teach nurses in the current health care system?
Simulation involves using mannequins, standaradized patients, the virtual world  and/or hybrids e.g linking one or more of approaches together to recreate care settings  where patients  may access nurses. These settings may be in the community e.g nursing homes, hospices  or hospital e.g intensive care, surgical, and medical areas and cover patients from neonates, to infants, teenagers, adults and the elderly. Nursing students do not receive enough practice as real patinets may not want to let  nursing students care for them under supervision or they need the skills of a licenced nurse. As a result when they qualify many  feel underconfident and may not perform  to the best of their ability . Many  newly qualified nurses feel disheartened  as they feel they cannot deliver safe, evidenced based care and need more support. Simulation techniques allow educators to work with under and post graduate leaners to rehearse both their practical skills and those elements such as communication, leadership and teamwork in many diferent care environments  in a safe manner. Learners  can repeat  the experiences as often as required to gain both confidence and competence. This translates that when they work and care for real patients  and  their families they act as advocates providing holistic care to the highest degree.

What is innovative simulation in nursing?
Nursing is the only profession with patients  24/7 and so can extend the boundaries of integrating  the simulation education approach. INACSL one of the major organisations in simulation healthcare  education  were the first in the world to publish evidenced based standards on how to deliever simuation and this group was formed and  is led by nurses .

When the idea of simulated practice in nursing began?
If you look back into history  there are early accounts from Egypt and  China for healthcare  simulation . More recent  was in France in the early 18th Century Madame Du Coudray a pioneering midwife built an early obstertric simulator and as a result of working in community settings reduced neonate  and maternal mortality by teaching prominent  womren in  villages to safely  deliver babies and deal with complications for example breech, . In adult nursing Mrs Chase a life sized adult mannequin was first reported in 1911 in USA being used for undergraduate  nurses and many universities across the world have used such tools. If I reflect on my own nurse training in the 1980s we practised on each other and role eplayed so this is f simulation . Nursing and midwifery have a history of innovation and creating activities to improve patient care. The interactive mannequins that are used today such as the ones here in Navarra have  been used since  the late 1990s  initially by medicine with a surge in the mid  2000s from 2008 onwards for nursing  . 

Do you think that simulation is a good method of teaching at the University?
Learners often find it hard to translate what  is being taught in university and translating  this into clinical practice, simulation education provides the bridge between theory and  practice  in  a safe way. After the simulated event, the debrief allows learners to focus on what they did well  and why they performed as they did and what they are struggling with . This affords the  educators the opportunity to support learners  so that they can  grow  and as they move towards the goal of being a licenced nurse  who provides safe care .

What is the PNCI?
PNCI stands for Programme for Nursing Curriulum Integration and is a set of evidence  based simulation case studies with tools to support faculty  to fast track simulation based education into any undergraduate  nursing curriculum. This tool  was devloped by nurses from the USA and UK and provides a complete package to support educators  to become simulation  facilitators  so that they can support learners. The case studies cover  medical, surgical , mental health  and  learning disability nursing from the cradle  to the grave  in community and hospital  settings . CAE Healthcare supported pioneering simulation nurses to produce this package and it is used in countries all over the world.

What has been the experience of simulated practice over the years?
This has been variable, healthcare  regulators  are beginning to suggest using  simulation education  to replace some of the contact hours with patients. As an example in the UK , the regulator in 2007 stated that  up to 300 of the 2300 hours of direct patient  care can be replaced by a simulated practice environment tif an institution chooses.  In the USA , many nursing regulators are allowing simulation to replace a percentage of hours .

I believe  as we move forward in the next 25 – 30 years simulation based education and assesment will be the norm in nursing and other healthcare professions  as it is for pilots across the world today .

What did you think of the Center for Simulation in Nursing at the University of Navarra?
I have been fortunate to vist many simualtion centres across the world and the Centre for Simulation in Nursing at the uNiversity of Navarra has been extremy well desogned to focus on   nursing in all its guises.  It Is not just about the rooms and  the equipment although they are amazing, I have been incredibly impressed by the nursing team who will be leading this ventuire as their enthusiasm and commitemnet  is what will make this centre a world  class centre for nursing education.

What do you think of the current situation of nursing in the world?
I am biased, as I am a nurse, I think we are leading the way. When you look at the literature or attend conferences about simulation education and/or education, many nurses in academia and clinical practice are implementing simulation in creative ways with the same goal enhancing patient safety and quality.  Nursing still needs to go further and this is one of the reasons that I have stayed in simulation-based education, as we need to keep pushing the envelope.