Question

3. Describe the use of patient simulators in clinical nursing staff education.Consider the cost and upkeep of the equipment for simulators and faculty training and education, and the need for technical support of the equipment.

Answer 1

Simulation is an example of an interactive teaching learning method in nursing education.Simulation is the imitation of certain tasks, relationships, phenomena, equipment, behaviors and cognitive activities that occur in real life.

Nursing education involves practice oriented curriculum in which emphasis is placed on both theoretical knowledge and psychomotor skills.In skill based education,where learning through practice occupies a central role ,it is important to to ensure the integration of theoretical knowledge into practice.In nursing education, simulations represent an innovative teaching method that stimulates a number of senses at the same time among learners.The simulation method allows students or nursing staffs to repeatedly practice their clinical skills until they develop a sense of proficiency; to learn at their own pace; and to freely make mistakes.. Nursing staffs who take part in education programs involving simulations perform less medical mistakes in clinical settings, and are able to better develop their critical thinking and clinical decision-making skills. For these reasons, were commend that simulations, which represent an interactive learning method, are rendered more common in institutions providing nursing education.

Equipments, techniques and cost of simulation

It is important that facilities ensure provision of adaptable, realistic simulation mdels including both part task and full body simulators.Knowledge of the various simulation models available and their appropriate use is important to ensure their full potential.

Role-Playing

Fidelity to the real clinical situation helps students to react as they would in a real-life scenario.Role playing involves asking learners to act out an event or situation. Although it is helpful to conduct role playing in a realistic setting, elaborate, mock set-ups or other props are not necessary. Hence the cost of this type of simulation can be relatively low. The objective in creating any simulation experience is achieving fidelity, i.e., a close replication of the real-life, human situation . Fidelity to the real clinical situation helps students to react as they would in a real-life scenario. Despite its relatively low fidelity, role-playing can reap substantial benefits, especially in the realms of team training and/or change in attitudes.

Standardized Patients

Also known as simulated patients, or actors, these live simulators can be utilized in teaching students to conduct a physical assessment, take a patient history, communicate bad news, practice a psychiatric intervention, and even perform a pelvic or prostate exam. The use of standardized patients has been found to help students gain self-awareness of their communication and clinical strengths and weaknesses, their reactions to stressful situations, and also their biases . A well-trained standardized patient with a good script is very effective at suspending disbelief in the scenario and creating a valuable learning simulation. Disadvantages of teaching using standardized patients can include recurring cost and scheduling of the actors .

Partial Task Trainers

Partial task trainers are designed to replicate a part of a system or process. The learning objectives associated with partial task trainers are often task specific. Examples include intubation mannequins; IV arms; and machines involved in processes, such as surgery, resuscitation, or emergency scenarios. Advantages of these simulators include product sustainability, standardization, portability, and skill specificity. Disadvantages include lower level of ability to suspend disbelief in a simulation scenario due to the single task purpose of the trainer.

Complex Task Trainers

Haptic systems allow a learner to perceive tactile and other stimuli to the senses through a complex, computer-generated environment. These virtual-reality scenarios offer an opportunity for the learner to practice skills, including surgical skills, bronchoscopy, and intravenous and central line catheterization via computer-based training. These sophisticated systems are sometimes housed in a partial task trainer to lend greater fidelity to the partial task trainer educational experience . Sensors placed within the partial task trainer can detect pressure and presence during learner activities, such as pelvic exams and surgical procedures . These high fidelity trainers lend an added dimension to simulations, but also increase the simulator cost.

Integrated Simulators (Human Patient Simulators)

Integrated simulators are whole body mannequins (adult, child, or infant) that are capable of responding to certain medications, chest compressions, needle decompression, chest tube placement, and other physiologic interventions and subsequent responses. Integrated simulators, also known as human patient simulators (HPS), help suspend disbelief during a simulation due to the integrated computer technology housed in the mannequin that allows the mannequin to respond in real time to specific care interventions and treatments. What makes these integrated simulators so appealing to health professions educators is their ability to contribute high degrees of realism (fidelity) to the simulation scenario. Fidelity can range from low to high with cost rising as the fidelity increases. Although these integrated systems are generally whole body mannequin simulators, the integrated computer technology is sometimes built into the partial task trainers.

Full Mission Simulation

A full mission simulation brings the learner into a complex situation or task that usually involves a team. Full mission training is limited only by the simulation resources available to the educator. The scenario typically begins with a pre-brief, is followed by the execution of the task, and concludes with the instructor leading a review of the event in a debrief session, as described below . One example of a full mission simulation would be an emergency scenario carried out in a replicated emergency room. A more sophisticated example of a full mission simulation would be rehearsing complex or rare surgical cases with a full operating room team in a simulated operating room that incorporates high fidelity, complex task trainers and/or human patient simulators.

Debriefing

The formal, reflective stage in the simulation learning process is the “debrief.” Debriefing follows the actual simulation and serves to help learners clarify and integrate the simulation experience with previous knowledge. When debriefing is skillfully facilitated with a positive attitude and constructive criticism, learning is reinforced and the learner advances to transference, the next and final step in the simulation learning pyramid described below . Transference is the ability of the learner to incorporate the lessons learned from simulation and debriefing and apply them to real world situations. This is the ultimate goal of simulation.

evaluation

The cost of incorporating simulation tools into the educational experience can range from a small to a considerable expense. To make effective and convincing use of these practices and techniques, the educator must assess the learning needs and environment of the institution where it will be used. Evaluating the appropriate use of simulation according to a performance pyramid in which the base reflects factual or didactic knowledge and higher levels of the pyramid move upward into higher levels of skill competency. If the learner is required to show or demonstrate a skill, simulation will likely be an appropriate learning tool during the skill phase development.

Other criteria for evaluating the potential benefit of simulation in the education program include the degree of necessary skill sustainment in a high risk, low volume clinical setting and a desire to minimize or decrease potential risk or threat of injury to the patient or learner. The overarching questions that must be assessed are: (a) who are the learners? and (b) what do they need to know? The answer to these questions may be found by asking learners, supervisors, instructors, risk managers, and patient safety experts, and by reviewing the literature .

in conclusion, Simulation enables healthcare professionals to hone the clinical skills that are needed to provide safe care without harming patients as they develop these skills. As educators and as practitioners of healthcare, we have an obligation to actively engage in learning the pedagogy related to simulation-enhanced learning.