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Simulation in Nursing :

Moving Forward Thailand 4.0

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Now….there is currently a

widespread movement to use

simulations of all types in

medical education as a

teaching-strategy and/or as an evaluation mechanism.

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dCurrent state of clinical nursing education

Education : Higher education paradigm shift from teaching to learning

paradigms

More emphasis on outcome-based then process-based education

More evidence-based education strategies and curriculum

Graduates: Errors correlated to new graduates inability to make clinical

decisions

New graduates do not meet their expectation for clinical judgment

as identified by employment in clinical agencies

Critical thinking and reflective skills of the practitioner are

correlated with quality of patient care

( Clinical simulation in health care conference, 2010)

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d Changing in nursing education

1. Faculty skills sets changing and required :

Changes in teaching student-centered approach

High technology must include technology into clinical and

classroom teaching

Must be creative, innovative keep student engaged

High quality, real skills, high expectation of students

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d2. Need for better prepared students exiting

nursing programs :

A gap exists between the academic preparation of

nursing students and the needs of clinical agency

Clinical education is not currently working using only the

traditional models we have used for decades

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The evolution of the new educator

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dToday………..nurse educators : Facilitators of learning

Innovative, creative

Technology-savvy or willing to learn

Focus : student-centered learning

Providing students with real-world experiences and

examples

Knowledge workers, creators, and designers

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dThe future…. Uses of simulation expanding in nursing education

Teaching students differently by simulation

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Why do nurse

educators want to use simulation ?

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9 We need simulations because …….

• Decreasing number of clinical sites for

practice

• Nurse educator shortage

• Decision-making/problem-solving skills

needed

• Cost-effective clinical education needed

• Gap between education and practice

• Increasing patient safety**

• New model of education needed ( e.g.

technology and diagnostic reasoning

skills)

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d

Simulation in nursing : Simulated practice learning has been used as an

adjunct to clinical skills gained in practice settings

for a number of years.

The increased use of simulation has been aided by

some of the technological advances mentioned

above and to some extent has been driven by

policy change.

The use of simulation in health care education is

gaining popularity and is becoming a foundation for

many undergraduate nursing programs.

(Nurse Education Today, 2011)

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dWhat is simulation?

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dDefinition of terms Simulation: “… as a strategy – not a technology – to mirror,

anticipate, or amplify real situations with guided experiences in a fully

interactive way.” (http://www.ahrq.gov) Simulation : “…is a technique to replace or amplify real-patient

experiences with guided experiences, artificially contrived, that evokes or

replicates substantial aspects of the real world in a fully interactive

manner…..” (Society for Simulation in Healthcare, 2009)

Clinical simulation : “…is an attempt to replicate some or

nearly all of the essential aspects of a clinical situation so that the

situation may be more readily understood and managed when it

occurs for real in clinical practice….” ( Morton,1995)

Simulator: “…replicates a task environment with sufficient

realism to serve a desired purpose” (http://www.ahrq.gov)

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dThe Role of Simulation :

A teaching strategy

An evaluation tool

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(Teaching and learning in health science, 2012)

Using simulation to assess students’ performance

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dSimulation framework

( Jeffries, 2012)

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Simulation has the potential to improve education

outcomes :

In health, a meta-analysis of studies relating to health professions

education concludes that “In comparison with no intervention,

technology-enhanced simulation training in health professions

education is consistently associated with large effects for outcomes of

knowledge, skills, and behaviors and moderate effects for patient-

related outcomes.” (Cook et al., 2011, p. 978).

In medical education, simulators help novice surgeons develop their

skills, retain knowledge, and reduce procedure times and error levels

for laparoscopic surgery (Al-Kadi & Donnon, 2013).

In nursing, simulation experiences may enhance knowledge gains

(Gates, Parr & Hughen, 2012; Shinnick, Woo & Evangelista, 2012;

Weaver, 2011), decrease medication errors (Shearer, 2013), be

equivalent to traditional clinical experiences promoting student

acquisition of fundamental knowledge (Hayden et al. 2014; Schlairet &

Pollock 2010), and increase self-confidence (Leavett-Jones, Lapkin,

Hoffman, Arthur & Roche, 2011) and efficacy (Dunn, Osborne & Link,

2014).

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dTypes of simulation

1. Part-task trainers

2. Simulated patients

3. Screen-based computer simulators

4. Complex task trainers

5. Human patient simulators

( Medical education, 2012)

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dLevel of simulators

1. Low – fidelity simulators (Task-trainers)

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….static and lack the realism or situational context…

https://www.armstrongmedical.com/index.cfm/go/product.detail/sec/2/ssec/11/cat/21/fam/2073

http://www.gtsimulators.com/Ostomy-Care-Model-p/he-26130.htm

https://www.squ.edu.om/Portals/57/Images/den_img/skills%20lab%20models/29.png

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d2. Moderate – fidelity simulators

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…..more resemblance of reality with such features as pulse, heart sounds, and breathing sounds but without the ability to talk and they lack chest or eye movement…..

https://www.simulaids.com/prod/images/products/06/F1/3137302D4C4633363136t.jpg

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d3. High – fidelity simulators

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……combine part or whole body manikins to carry the intervention with computers that drive the manikins to produce physical signs and feed physiological signs to monitors…... Sum

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Types of Simulation Description Advantages Disadvantages

Part-task trainers :

injecta pads, breast and

gyn/prostate models, eye/ear models, IV arms

Props, models, or mannequins used

to practice skills and procedures

No threat to patient safety

Reusable

Allows for return demonstration of

skills

Large groups of learners

Low to moderate cost

Task training

Consistency

Learner – memorization

Lower veracity

Return demo without critical

thinking

Simulated patients :

standardized patient (trained

actors), learner/learner,

educator/learner

Role-play patients for training,

simulates assessment of history

taking, physical exams,

communication, and therapeutic

psychiatric interventions

No threat to patient safety

Great tool for high communication

skills

Provides relatively consistent

experience for all students

Moderate to high cost with each

use

Limited learners

Screen-based computer

simulators :

computer-assisted instruction

(CAI), virtual reality excursions

(VRE), Web-based programs

Programs to train and assess

clinical knowledge and decision

making.

No threat to patient safety

Provides relatively consistent

experience for all students

Reusable

Variable amount of critical

thinking

Moderate cost

Complex task trainers :

virtual reality devices such as

bronchoscocpy, laparoscopic

surgery, haptic (touch cue)

simulators such as pelvic

exam

High-fidelity visual, audio, touch

cues with interfaces with computers

No threat to patient safety

Provides relatively consistent

experience for all students

Promotes realism

Improves psychomotor skills

Moderate to high cost

Limited learners

Human Patient Simulators : Low-fidelity

Moderate-fidelity

High-fidelity

Full-length human mannequins

Simulated anatomy and physiology

Computer-driven scenarios that

responds as programmed

Computer-driven physiologically

based that responds in real time to

interventions

No threat to patient safety

High degree of realism and veracity

Low educator/learner ratio (1:5)

Active involvement of learner

High cost (startup and ongoing

cost)

Maintenance

Resource intensive: monetary

and faculty

Limited learners

High staffing ratio

No validation of transfer of

learning to clinical setting

Learner’s disbelieving attitude

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(Simulation-based medical education: an ethical imperative, 2003) Sum

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22 The virtual reality simulation

http://www.21stcentech.com/wp-content/uploads/2011/12/pulse.jpg

http://simtalkblog.com/wp-content/uploads/2017/02/VR-iStock-636927696.jpg

https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcTIVhXgiWmbjW6XW1wmcW7z0ElaaPIGX_MC_HMAt80BomeAlt7T

http://healthysimulation.com/wp-content/uploads/2017/07/sub-buzz-14640-1500056104-3-500x343.jpeg

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Selecting type of simulation to use

Should be driven by the educational goal/objective

Should match the level of the student

The higher the realism, the more effective it is in

engaging the student

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dThe stage of simulation implementation:

1. Choose or write a scenario

2. Obtain and set up equipment

3. Determine the student roles

4. Offer pre-briefing activities

5. Implement the simulation

6. Facilitate a debriefing discussion

7. Evaluate

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dElements of simulation-based learning A. Simulation Lab & equipment B. Staff C. Learners/participants D. Clinical Scenario E. Assessment tool

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dSimulation Lab & equipment :

1. Simulation room

2. Control room

3. Manikin

4. Debriefing room

5. Equipment

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Control room

Simulation room

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Control room

Control room

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SimMan is a full body simulator that represents an average-size adult

patient. As a high fidelity manikin. SimMan can teach core skills in airway,

breathing, cardiac, and circulation. He comes equipped with a patient

monitor that displays vitals, labs, and radiology.

Manikins

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Nursing Anne, Kelly and Kid

are specifically designed to assist

students in learning how to

properly care for a wide range of common in-hospital conditions.

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Nursing Anne

Nursing Kelly

Nursing Kid

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Megacode Kid is a tethered

moderate fidelity patient simulator. It

is able to provide repetitive practice

skills training and communication training on a pediatric patient.

SimBaby is a tethered high fidelity

patient simulator. It is the advanced

simulator for training in infant

emergencies.

http://laerdal.com/products/simulation-training/emergency-care-trauma/megacode-kid/ Sum

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SimMom is considered a tethered high fidelity patient

simulator. It is an advanced full body birthing patient simulator

with accurate anatomy and functionality to facilitate multi-professional obstetric training of delivery management.

http://laerdal.com/products/simulation-training/obstetrics-paediatrics/simmom/

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Control room

Equipements Simulation room Debriefing room

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Control room

Equipements Simulation room

Equipment

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dThe operating information in a simulation exercise

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(Understanding simulation –based learning, 2009) Sumolc

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Instructor Computer SimPad

http://www.laerdal.com/images/L/ADIBAEMM.jpg

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Computer screen (SimMan) 37

Instructor monitor VS Patient moniter

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Instructor monitor VS Patient moniter

How to show the EKG ?

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Instructor monitor VS Patient moniter

How to show the LAB ?

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dIntegrating simulation in Nursing Practicum

Pediatric Nursing

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d Adult & Elderly nursing

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d Leader course

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d Leader course

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Leader course (CCTV)

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Critical care program 45

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Student Exchange program 46

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Cardiac symposium (Pre-ICU program) 47

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Scenarios creating program 48

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dAdvantages of Simulation over actual clinical

experience :

Reduces training variability and increases standardization

Is more accurate reflective learning especially with HPS

Is student-centered learning

Allows independent critical-thinking and decision-making,

and delegation

Allows Immediate feedback

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Limitations of Simulation Compared to actual

clinical experience :

Not real

Limited realistic human interaction

Students may not take it seriously

No/incomplete physiological symptoms

(Practicing medicine without risk: students’ and educators’ responses to high-fidelity patient simulation., 2010)

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