Clinical Outcomes from Human Patient Simulation Paula Garvey BSN, RN-BC No planner or presenter has any conflict of interest in the content to be discussed. This presentation received in-kind assistance from METI in the form of a simulator to use for demonstration purposes. The educational content was not influenced in any way by this in-kind assistance.

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Objectives Explore the benefits of HPS as a teaching modality for acute care nurses. Examine benefits and challenges to implementing simulation as a teaching modality in a hospital-based nursing education department. Demonstrate the care of a patient utilizing the HPS.

Current Trends Due to high patient acuity, patients on traditional med-surg floors are as critically ill as some ICU patients. Nurses are expected to have a strong foundation of knowledge –Physical assessment skills –Technical skills –Critical thinking skills

Benefits of Human Patient Simulation Allows the adult learner a degree of self- directed learning. Gives realism to a education scenario allowing the learner to become engaged. The learner gains skills in a safe, non- threatening environment. Classroom theory is put into practice.

Benefits of Human Patient Simulation Teaching of non-technical skills such as collaboration, leadership, communication, & professionalism. Provides a standardized framework for managing a patient’s condition. Outcomes evaluation and research. Improved quality of care and safety of patients. Gains a foundation for critical thinking & clinical judgment.

SIMULATION Analyze/Synthesize/Evaluate Clinical Judgments Critical Thinking Clinical Reasoning Current to new knowledge; Recall facts; Organize; Apply; Re-Evaluate Take action based upon processed information; Evaluate © OSUMC 2007

Simulation Design Approach Goal of simulation Type of simulation learning model Development of scenario Prebriefing & Debriefing

Goal of High Fidelity Simulation Prepare staff to make sound judgments, complex problem solving, and think critically Progression to a higher level of competency and proficiency Putting theory into practice

Simulation Learning Models Self-Directed-Learning model: The learner is given brief instructions and to manage the patient as indicated by the signs and symptoms without any instructor input. Self-Directed-Learning model with facilitated debriefing: The learner is instructed as above but encouraged to collaborate and make team decisions. Debriefing is to occur immediately following the scenario. Instructor-Modeled learning: The learner observes the instructor assess and manage the patient, verbalize their findings along with rationale and are allowed to ask the instructor questions for approximately 5 minutes. Then the learner repeats the scenario individually while being videotaped.

Prebriefing & Debriefing Prepares participants for simulation scenario, sets ground rules, stresses confidentiality and creation of a non-threatening environment. Allows participants to reflect on the facts, thoughts, impressions, and reactions to the situation. Need to provide a supportive climate in order to ensure successful debriefing process. Participants need to be able to share their experiences in a frank and honest manner. The most important aspect of simulation education and crucial to the learning process.

Patient Care Management Management of Chest Pain Management of Respiratory Distress Management of Cardiac Arrest Management of Sepsis Management of EKG dysrhythmias

Courses Applicable for Simulation Failure to Rescue- When is It Time to Worry ACLS Code-Blue Readiness Staff communication and collaboration ECG Class New Equipment Central Nursing Orientation Sentinel Events Annual competencies Hospital-specific practices and protocols Verification of general nursing skills

Facilitator Evaluation Benefits: –Some participants seem to lose even the most basic of skills when placed in a “high-pressure” situation. –Excellent method to evaluate the most basic competencies –Method to locate those staff who might be having clinical difficulty, which isn’t evident using traditional teaching methods –Differences in comprehension and application from didactic to hands-on environment –Decrease in system-wide Code Blue numbers –Increase in system-wide Code Blue “survival to discharge” numbers Challenges: –Do not have our own simulation lab! –Unrealistic environment in our training center with a mid-fidelity simulator

Learner Evaluation Benefits: –More comfortable with equipment and assessment skills –Felt like they had been in a “real” code situation –Increased the understanding and comfort level of participants in a cardiac arrest situation –Take class multiple times and “learn something new each time” –“This class should be mandatory for every nurse” Challenges: –Simulation loses benefit when the environment is not realistic –Difficult to overcome that it is a mannequin –Felt “disorganized” due to the “usual” co-workers are not present –Confusion when nurse is taken out of his/her usual role

Questions Paula Garvey:

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