Simulation in Nursing : Moving Forward Thailand 4.0 Sumolchat Teerawat Changpad Sumolchat Sumolchat 1
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. Sumolchat Sumolchat 2
Current 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) Sumolchat Sumolchat 3
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 Sumolchat Sumolchat 4
2. 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 The evolution of the new educator Sumolchat Sumolchat ( Clinical simulation in health care conference, 2010) 5
Today..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 Sumolchat Sumolchat 6
The future. Uses of simulation expanding in nursing education Teaching students differently by simulation Sumolchat Sumolchat 7
Why do nurse educators want to use simulation? Sumolchat Sumolchat 8
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) Sumolchat Sumolchat 9
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) Sumolchat Sumolchat 10
11 What is simulation? Sumolchat Sumolchat
Definition 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) Sumolchat Sumolchat 12
The Role of Simulation : A teaching strategy An evaluation tool Sumolchat Sumolchat 13
Using simulation to assess students performance Sumolchat Sumolchat (Teaching and learning in health science, 2012) 14
Simulation framework Sumolchat Sumolchat 15 ( Jeffries, 2012)
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 patientrelated 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). Sumolchat Sumolchat 16
Types 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) Sumolchat Sumolchat 17
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a 18 Level of simulators 1. Low fidelity simulators (Task-trainers) https://www.armstrongmedical.com/ind ex.cfm/go/product.detail/sec/2/ssec/11/ cat/21/fam/2073 http://www.gtsimulators.c om/ostomy-care-modelp/he-26130.htm https://www.squ.edu.om/portal s/57/images/den_img/skills%20l ab%20models/29.png.static and lack the realism or situational context
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a 19 2. Moderate fidelity simulators https://www.simulaids.com/prod/images/products/06/f1/3137302d4c4633363136t.jpg..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..
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a 20 3. High fidelity simulators 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...
Types of Simulation Description Advantages Disadvantages 21 Part-task trainers : injecta pads, breast and gyn/prostate models, eye/ear models, IV arms Simulated patients : standardized patient (trained actors), learner/learner, educator/learner Screen-based computer simulators : computer-assisted instruction (CAI), virtual reality excursions (VRE), Web-based programs Complex task trainers : virtual reality devices such as bronchoscocpy, laparoscopic surgery, haptic (touch cue) simulators such as pelvic exam Human Patient Simulators : Low-fidelity Moderate-fidelity High-fidelity Props, models, or mannequins used to practice skills and procedures Role-play patients for training, simulates assessment of history taking, physical exams, communication, and therapeutic psychiatric interventions Programs to train and assess clinical knowledge and decision making. High-fidelity visual, audio, touch cues with interfaces with computers 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 Reusable Allows for return demonstration of skills Large groups of learners Low to moderate cost No threat to patient safety Great tool for high communication skills Provides relatively consistent experience for all students No threat to patient safety Provides relatively consistent experience for all students Reusable No threat to patient safety Provides relatively consistent experience for all students Promotes realism Improves psychomotor skills No threat to patient safety High degree of realism and veracity Low educator/learner ratio (1:5) Active involvement of learner Task training Consistency Learner memorization Lower veracity Return demo without critical thinking Moderate to high cost with each use Limited learners Variable amount of critical thinking Moderate cost Moderate to high cost Limited learners 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 Sumolchat Sumolchat (Simulation-based medical education: an ethical imperative, 2003)
The virtual reality simulation http://simtalkblog.com/wp-content/uploads/2017/02/vr-istock- 636927696.jpg http://www.21stcentech.com/wp-content/uploads/2011/12/pulse.jpg Sumolchat Sumolchat https://encryptedtbn0.gstatic.com/images?q=tbn:and9gctivhxgiwmbjw6xw1w mcw7z0elaapigx_mc_hmat80bomealt7t http://healthysimulation.com/wp-content/uploads/2017/07/sub-buzz- 14640-1500056104-3-500x343.jpeg 22
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 Sumolchat Sumolchat 23
The 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 Sumolchat Sumolchat 24
Elements of simulation-based learning 25 A. Simulation Lab & equipment B. Staff C. Learners/participants D. Clinical Scenario E. Assessment tool Sumolchat Sumolchat
Simulation Lab & equipment : 1. Simulation room 2. Control room 3. Manikin 4. Debriefing room 5. Equipment Sumolchat Sumolchat 26
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Simulation room Control room 27 Equipment
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Control room Control room 28 Equipment
Manikins 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. Sumolchat Sumolchat 29
Nursing Anne Nursing Kelly 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. Sumolchat Sumolchat 30 Nursing Kid
http://laerdal.com/products/simulationtraining/emergency-care-trauma/megacode-kid/ SimBaby is a tethered high fidelity patient simulator. It is the advanced simulator for training in infant emergencies. 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. Sumolchat Sumolchat 31
http://laerdal.com/products/simulation-training/obstetrics-paediatrics/simmom/ 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 multiprofessional obstetric training of delivery management. Sumolchat Sumolchat 32
Simulation room Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Debriefing room Control room Equipements 33
Simulation room Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Equipment Control room Equipements 34
The operating information in a simulation exercise Sumolchat Sumolchat (Understanding simulation based learning, 2009) 35
Instructor Computer http://www.laerdal.com/images/l/adibaemm.jpg SimPad Sumolchat Sumolchat 36
Computer screen (SimMan) 37 Instructor monitor VS Patient moniter Sumolchat Sumolchat
How to show the EKG? Instructor monitor VS Patient moniter Sumolchat Sumolchat 38
How to show the LAB? Instructor monitor VS Patient moniter Sumolchat Sumolchat 39
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a 40 Integrating simulation in Nursing Practicum Pediatric Nursing
Adult & Elderly nursing Sumolchat Sumolchat 41
Leader course Sumolchat Sumolchat 42
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Leader course 43
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Leader course (CCTV) 44
Critical care program 45 Sumolchat Sumolchat
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Student Exchange program 46
Cardiac symposium (Pre-ICU program) Sumolchat Sumolchat 47
Su m ete o erae lch wra a awt t D act u hca an hnag gb npga ub pda ph d a Scenarios creating program 48
Advantages 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 Sumolchat Sumolchat 49
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) Sumolchat Sumolchat 50
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