Simulation Training for New Emergency Nurses “SimMan” Margaret M Miller FNP,BC

Introduction The Emergency Department (ED) is one of the areas that is the forefront of Nursing. Since the ED is both fascinating and challenging for the new nurse, a comprehensive orientation with high technology is warranted for success. The use of Simulation in the orientation process will set standards and guidelines for various kinds of learning and assessments

Objectives Compare simulation technology to traditional learning models Identify potential advantages and disadvantages of simulation as a teaching strategy Evaluate how simulation help the new nurse transcend to the ED

The Role of Simulation as a Trend in Nursing Education A teaching Strategy An evaluation tool Can be use to provide a more experiential learning opportunity Provides increase use of learning technology It is more outcome based Provides more evidence-base education

Rationale for Incorporating the SimMan in Orientation Program To promote better preparation of the new ED nurse To simulate a patient safety environment To support innovative teaching strategies To have a better prepare nurse for the Preceptors To create complicated patients presenting to the ED, and implementation of Emergency Care

Types of Simulation Screen-based/PC-based simulation Virtual Patients Partial task trainers Human patient simulator Standardized patients Integrated models

Definition Wikipedia, the free encyclopedia defines Simulation as the imitation of some real thing Simulation is widely used for educational purposes. Such as Aviation, Military, Medical and Transportation. A good example of this was seen recently when the pilot landed the plane in the Hudson River. A situation that was practice by simulation for a long time and was eventually put to use which save over 100 lives

Simulation In the Healthcare systems simulators are increasingly being developed and deployed to teach therapeutic and diagnostic procedures There are human simulators for every patient we care for from birthing to the neonatal to the adult One of the amazing features of simulation is the see the real life reaction of the mannequins

Type of Models Active models: Attempt to reproduce living anatomy or physiology such as palpations, electrocardiography and auscultation Interactive models: Responds to interactions taken by a user. This has the advantage of allowing a student to make judgments or errors. The process of iterative learning through assessment, evaluation, decision making and error correction

Types of Models Computer Simulators: Simulators have been proposed as an ideal tool for assessment of student for clinical skills

Simulation

Simulation

Wooden mechanical horse during WW1

What Is a SimMan Human simulator Computer controlled manikin that displays physiologic data, such as heart rate, blood pressure, respirator rate and prerecorded sounds. Supports clinical decision making activities Preset scenarios available and the ability to generate scenarios

SimMan Computer driven It provides highly realistic training experience: To master decision making Patient care skills Simulate team work

Features of the SimMan Interactive manikin that responds physiologically to interventions Examples are: Defibrillation Airway system: Its anatomically realistic airways systems allows practice of all types of difficult airway management Difference in heart sounds and breath sounds

SimMan Allow practice of IV insertions Life threatening emergencies can be simulation through the injections of drugs and fluids Improvement in patient’s safety and outcomes Decrease in errors Best standards use for care and training

SimMan in Education Helps health the providers to “think on their feet” Provides feedback as they practice Ability to witness how quickly a patient can become unstable Realize how important the application of their assessment skills and response time can improve a patient’s outcome

SimMan in Education The ability to recognize deviations from expected baselines Refocusing for skilled nurses in their assessment techniques

Advantages Offers opportunities to practice rare and critical events Can be manipulated Allows for updates of new medications and new calibrations Scenarios can be reproduced Offers opportunities to make and learn from mistakes

Advantages The use of simulation saves lives and money by reducing medical errors, training time Allows for the nurse to practice on a variety of patients Each patient can present with a different case history and unique symptoms Responds to user action with appropriate physiological responses

Advantages The system is able to generate detail evaluation after each session which helps with feed back and the debriefing process

Limitations/Disadvantages Not real Limited realistic human interaction Students may not take it seriously It is costly Must have trained educators Must maintain trained technical support

Summary We can conclude that simulation training for the new ED nurse will increase both productivity and creativity It will create patient safety It will increased and build on the new nurse confidence And will help with nurse retention and decrease in nursing turnover

References Donohue, A J., Durbin, DR., Nadel, FM., Stryjewski, GR., Kost, SI., Nadkami, VM. (2010). Perception of realism during mock resuscitations by pediatric house staff: The impact of simulated physical features (1) 16 – 20 Hoyt, RE., Sutton, M., Yoshihashi, A., Practical Guide for the Healthcare Professional 3rd edition, 2009

References MCGonigle, D., Mastrian, K., (200). Nursing Informatics and the foundation of Knowledge Ruesseler, M., Weinlich, M., Muller, MP., Byhahn, C., Marzi, I., Walcher, F. (2010). Simulation training improves ability to manage medical emergencies. Emergency J. (10) 734 -8.

References Sutton, RM., Niles, D., Meaney, PA., Aplenc, R. (2010) “Booster” training: Evaluation of instructor led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during stimulated cardiac arrest. http://www.ncbi.nln.nih.gov/pubmed/20605336

References Thomas, F., Carpenter, J., Rhoades, C., Holleran, R., Snow, G. (2010). The usefulness of design of experimentation in defining the effect difficult airway factors and training have on simulation oral tracheal intubation success rate in novice intubators. Academy of Emergency Medicine (4) 460 - 3

References Weidman, EK., Bell, G., Walsh, D., Small, S., Edelson, P. (2010). Assessing the impact of immersive simulation on clinical performance during actual in hospital cardiac arrest with CPR sensing technology: A randomized feasibility study. http://www.ncbi.nlm.nih.gov/pubmed/20724057