ADVANCING
YOUR PRACTICE
Get
a real-world education through simulation
By Charles W. Fort,
MSN, RN
Your patient, James, just
coded again. You begin CPR while you wait for the code
team to arrive. When help arrives, he's promptly and
appropriately managed according to advanced cardiac
life support (ACLS) guidelines and he's successfully
resuscitated.
This is the eighteenth
time James has coded today. That's because he's a human
patient simulator used to teach healthcare professionals
how to recognize and respond to medical emergencies.
Human patient simulators
are anatomically accurate manikins that are computer-controlled
to provide a realistic, real-time simulation of patient
conditions. You'll assess and treat these lifelike simulators
using real procedures and equipment, and they respond
to treatment the way a real patient might. In this article,
I'll review the different types of simulators available
and how they can help you improve your nursing practice.
What's simulation?
You had a lot of experience with one type of simulation
in nursing school when you discussed case studies and
engaged in role playing, using fictional examples based
on real patient scenarios to reinforce learning. But
case studies and role playing offer few opportunities
for hands-on experience.
Basic simulators, also
known as partial task trainers, include intubation heads,
I.V. insertion arms, and central venous access torsos.
You may have used them in school or in ACLS courses
to get hands-on experience by practicing a particular
skill. But partial task trainers aren't designed to
teach complex tasks that incorporate the whole patient
with associated environmental factors. That's where
human patient simulators come in.
Learning by doing
Human patient simulators help you learn by doing. Confucius
said, "I hear and I forget. I see and I remember.
I do and I understand." Research has shown that
nursing students retain knowledge learned during a simulation
longer than when the same skill is taught in a traditional
way.1
Patient simulators are
often used during orientation to objectively measure
competency in certain technical skills.2
A demonstration of a cardiopulmonary arrest scenario
can orient new nurses to how codes are run according
to facility policy. If a new nurse (or one transferring
to a different area of a facility) has trouble adapting
to a new department, simulation can help improve critical
thinking skills, nursing competencies, and confidence.
Simulation allows clinicians
to break down complex tasks into smaller components
so they can learn at their own rate. Important skills
such as hand hygiene, documentation, and communication
can be incorporated into every simulation.
Meet some simulator
types
The various types of human patient simulators available
are categorized by their capabilities and how they're
controlled. Basic models are full- or nearly full-bodied
static manikins that have features such as oral and
nasal airways that accept intubation, and can generate
cardiac dysrhythmias, including ventricular fibrillation
that responds to defibrillation. They have no electronic
feedback capability.
Intermediate models have
some feedback capability and can be programmed via computer
to provide specific clinical indicators, such as heart
rate, BP, oxygen saturation, and respiratory rate. These
can be assessed directly from the manikin or through
a patient monitor.
Advanced models react to
treatments and interventions such as oxygen administration,
medication administration, and needle chest decompression.
Scripted computerized scenarios change and adapt according
to the clinician's interventions Advanced simulators
provide the most clinical feedback because of features
like these:
- carbon dioxide exhalation
to assess quantitative end-tidal carbon dioxide
- air return with needle
chest decompression
- bloody fluid drainage
with chest tube insertion
- urine output with urinary
catheter insertion
- peripheral pulse palpation;
pulse intensity varies with BP.
Simulation sites:
Setting the stage
Simulation can be performed in the unit or a simulation
lab. Both options have pros and cons. In a simulation
lab, the human patient simulator and the whole clinical
"stage" can remain set up and ready for use,
and nurses can work with fewer distractions. On the
other hand, if the simulator is brought to the unit,
nurses can perform their normal roles where they're
most comfortable and use real patient-care equipment.
Working in the unit may reveal issues that might not
have come to light in the simulation lab. See Simulator
shortcomings for a discussion of potential
drawbacks to each training option.
A simulation is run by
a simulator facilitator or instructor who has the clinical
knowledge to guide the simulator through a realistic
scenario. Following a simulation, you receive immediate
feedback during a debriefing, which may be the single
most valuable aspect of simulation learning. At the
debriefing, you and the simulator facilitator or instructor
can discuss what went well and not so well. The opportunity
to detect and correct errors in performance helps you
sharpen your clinical skills without patient risk. After
the debriefing, you may go through the scenario again
to practice the "correct" way.
Pros and cons
Simulation has several advantages over traditional teaching
methods, such as lecture:
- Simulation lets the
nurse make mistakes, follow the mistakes to their
conclusion, and learn from the consequences without
harming the patient.3
- Simulation can decrease
feelings of anxiety and failure that some nurses experience
if they haven't yet mastered a skill.4
- Simulation lets the
new nurse develop a process of critical decision making
and improve self-confidence in a safe and controlled
environment.
- Simulation lets the
nurse practice clinical skills that are high risk
but are used infrequently.2
Simulation scenarios with
critical situations can help desensitize you to emergencies
and keep you from letting your anxiety get the better
of you. Even experienced nurses can benefit from practicing
how to intervene in rare but potentially lethal complications,
such as massive hemorrhage or shoulder dystocia.5
Future simulators
Soon, human patient simulators like James will have
new colleagues. Completely wireless models are now available,
so you can use them in any setting. For example, you
could stage an ED scenario by starting the simulator,
throwing it over your shoulder, and carrying it into
the ED, saying, "My buddy just got shot."
As computer technology
improves, so will the capacity of human patient simulators
to act and react more like real human beings—who
knows, one day you might find it hard to tell the difference!
Simulator
shortcomings
Even though human patient simulators provide opportunities
for hands-on learning, they can't replace the
experience you get by working with real patients
and interacting with colleagues.1 Human
patient simulators are expensive, costing from
$40,000 to $250,000 each, and they require someone
to operate them who has enough knowledge to ensure
that the simulated scenario is clinically accurate
and meets learning objectives. The simulator facilitator
or instructor has to be able to program and control
the human patient simulator, which requires training
and experience. Simulation can be labor intensive
and time consuming. Faculty need to be trained
in how to use the simulator, how to let the participant
make mistakes, and how to debrief properly, or
the educational session isn't as beneficial.
If the simulator
is used in a remote lab, it needs to duplicate
the clinical environment it represents. A simulation
lab requires dedicated facility space, which is
often a precious commodity in the hospital. Sometimes
the realism of the simulation isn't real enough,
and some nurses can't suspend their disbelief
enough to take the simulation seriously.
If the human patient
simulator is used in an actual clinical space,
the simulation has to be scheduled so it doesn't
interfere with actual patient care. With no simulation
lab, secure storage must be found for the simulator
and its related equipment. |
References
1. Childs JC, Sepples S. Clinical teaching by simulation:
lessons learned from a complex patient care scenario.
Nurs Educ Perspect. 2006; 27(3):154-158.
2. Ackerman AD, Kenny G, Walker C. Simulator programs
for new nurses orientation. J Nurses Staff Dev.
2007;23(3):136-139.
3. Hravnak M, Tuite P. Expanding acute care nurse practitioner
and clinical nurse education: invasive procedure training
and human simulation in critical care. AACN Clin
Issues. 2005;16:89-104.
4. Winslow S, Dunn P, Rowlands A. Establishment of a
hospital-based simulation skills laboratory. J Nurses
Staff Dev. 2005;21(2): 62-65.
5. Macedonia CR, Gherman RB, Satin AJ. Simulation laboratories
for training in obstetrics and gynecology. Obstet
Gynecol. 2003;102(2):388-392.
Source:
Nursing2009. November 2009.
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