1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 4 Using Simulation to Teach Nurses

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Simulators Initially low-technology mannequins, task trainers Now proliferation of high-fidelity patient simulators Full-sized computerized mannequins with realistic programmed responses –Assessment data in real time –Programmed signs, symptoms –Response to nursing actions

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Capabilities of Patient Simulators High fidelity = highly realistic –Programmed to display signs and symptoms, respond to actions Listen to preprogrammed heart, lung, bowel sounds Assess pulses at anatomically correct sites Visualize respirations, pupil responses Observe displays of physiologic parameters (can change in planned trajectory or via operator control)

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Capabilities of Patient Simulators (cont.) High fidelity = highly realistic –Possible simulator preprogramming to speak, respond Participation in scenario just as in an actual setting –Actions can be recorded for reflection, debriefing –Debriefing considered most powerful component –Peer observation for collaborative dialogue, problem- solving

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Most simulators today are primarily task trainers.

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Today, patient simulators are considered high-fidelity simulators that are computerized with realistic, programmed responses.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Simulation and Health Care Quality IOM report, promotion of simulation training to prevent, mitigate errors Administrators: growing awareness of simulation role in increasing safety and quality of health care and reducing financial risk Simulation only effective if designed and delivered appropriately

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Simulation and Health Care Quality (cont.) New graduate = novice nurse at best Need for nurses entering practice with a “higher level of knowledge” Issues faced: –Rapid changes in technology and impact on patient care –Staff shortages, rapid turnover, use of traveling nurses –Needed mentoring –Patient acuity, fast-paced environment

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Simulation and Health Care Quality (cont.) Call for changes in nursing education –Student focused on patient’s experience via unfolding cases, that is, simulation scenarios –Development and implementation of effective clinical simulation exercises –Addition of competency assessments

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Benefits of Simulation Close instructor observation: multiple teaching moments, possible coaching to correct fallacies Exposure to rare events where competency critical but rarely possible Greater uniformity in student experience Allowance for student to experience full impact of decisions

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Benefits of Simulation (cont.) Team practice for collaboration, communication skills Adaptable level of difficulty (simple to advanced) Development of critical thinking, decision-making based on scenario; competency evaluation

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would be considered the most important component associated with patient simulators? A. Realistic nature of scenario B. Ability to debrief on completion C. Collaborative problem-solving D. Ability of simulator to speak

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Although realism, collaborative problem-solving, and ability of the simulator to speak or respond are important components, the ability to debrief is considered the most powerful component. Debriefing can –Produce insightful reflection of events –Help students analyze, explain reasoning behind actions –Facilitate exploration of alternative approaches

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Disadvantages of Simulation Initial, ongoing costs Number of students working at one time Student-faculty involvement Possible student anxiety, feeling “put on the spot” Student perception of artificiality to setting Confidence leading to taking on tasks beyond level of expertise Need for well-trained faculty; expert debriefers

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Simulation for Practice Settings Test new procedures before bringing to bedside Training for advanced skills New nurse orientation; transitioning new graduates Proficiency development in critical-care settings Development of critical thinking skills for specialty areas, “in situ” training Ongoing nursing staff development

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Research on Simulation Outcomes Recommendations for effective learning with simulators (see Box 4.1) Perceived satisfaction, decreased anxiety, increased confidence Learning outcomes: –Increase in clinical skills –Gains in knowledge, critical thinking, perceived clinical confidence Need for reliable and valid instruments to measure outcomes

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Regulatory Trends Certifying, licensing boards look to simulation to validate initial, ongoing competency Possible reluctance until validity, reliability of assessment methods assured Examples of use: –Neonatal Resuscitation Program –Disaster, terrorism response/treatment training

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A majority of certifying agencies are using simulation as a way to validate ongoing competency of their health professionals.

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Although it is likely that many certifying agencies will look to simulation as a way to validate initial and ongoing competencies, the use is not widespread. –Validity and reliability of assessment methods must be assured before it becomes an accepted tool.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Simulation in Continuing Education Traditional methods under scrutiny Acknowledgment of simulations to improve effectiveness of continuing education Development of simulation centers

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Developing a Simulation Center AHA steps for acquisition of simulators –Assessment of simulators currently available –Outline of clear purpose, specific objectives –Multiyear business plan –Assessment of human resources

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Developing a Simulation Center (cont.) AHA steps for acquisition of simulators –Space allocation –Budget plan (capital expenses, maintenance, repair and replacement, ongoing software upgrades) –Plans for revenue generation –Faculty training plan

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The first step in developing a simulation center is to determine the amount of space needed.

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. The first step in developing a simulation center is to conduct an assessment of the simulators currently available within the institution and the region.

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation