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

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

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

11. Simulation

12. Simulation

13. Wooden mechanical horse during WW1

14. 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

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

16. 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

17. 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

18. 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

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

20. 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

21. 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

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

23. 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

24. 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

25. 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

26. 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)

27. 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.

28. 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)

29. 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.