Human Patient Simulation

1. Human Patient Simulation Carol Jean Luppi, BSN, RN Nursing Simulation Center

2. What is Human Patient Simulation? • The use of manikins to reproduce clinical scenarios for the purpose of education, evaluation, or research.

3. Simulation Technology History and Precedents • Flight simulators for pilots and astronauts. • Military training exercises. • Management training for business executives. • Technical operations for nuclear power plants.

5. Increased Use of Simulation • Need to address nursing shortage and increase enrollment in nursing programs. • Complexity of health care requiring exposure to very infrequent events. • Cost has decreased. • Increasing acceptance of the modality. • Increasing awareness of the need to address patient safety. • Proven track record of enhancing clinical practice.

6. Simulation Options • Skill / Task Trainers • Computer Simulation • Manikin-Based Simulation

7. Skill / Task Trainers • Useful for introducing or practicing psychomotor skills. • Lack situational context. • Varied levels of sophistication.

8. Computer-Based Simulation • Use of software to simulate a subject or situation on a computer screen. • i.e. 2 dimensional product. • Varied levels of sophistication. • Evidence-based. • Includes a debriefing analysis and a review of their actions. • Universal access.

10. Manikin-Based Simulation • Varied levels of sophistication. • Manikin Task Trainers • Resusci-Anne / VitalSim  • High-fidelity, computerized manikins with human functions. e.g. breathe, talk, blink

11. High Fidelity Human Patient Simulators • Outward appearance of reality. • May be enhanced by simulation specialists with props and make-up. • Cosmetic fidelity • Respond realistically to interventions. • Controlled by computer software programs individualized by simulation specialists. • Response fidelity

12. High Fidelity Human Patient Simulators • Response Fidelity • Patient speaks to the participant. • Able to perform interventions with realistic response. • IV insertion with blood return. • Chest tube insertion. • Endotracheal Intubation. • Physiologic responses. • Patient’s chest rises. • Patient has pulses, breath sounds, bowel sounds. • Hemodynamic parameters display on typical monitor screens.

13. Help me, I’m having chest pain.

14. Full-Scale Human Patient Simulation • Environment supports the clinical situation. • Location is adapted to appear as realistic as possible. • Patient Room • OR • ED • Participants are provided a brief description of a carefully created scenario/clinical situation and asked to respond.

15. Full-Scale Human Patient Simulation • Manikin functions and hemodynamic monitor displays are controlled by the manikin’s computer software. • Requires electrical power. • Requires compressed air to initiate manikin responses. e.g. pulses, chest rise, breath sounds.

16. Computer Control Area • Control area should be hidden from participants. • Sight • Soundproof • Can be accomplished from the bathroom of a typical hospital room. • Formal simulation suites have a control room with a one way mirror.

18. How can we use Full-Scale Simulation? • Crisis Management • Team Training • Interdisciplinary Training • Risk Management • Error Analysis and Avoidance • Basic Patient Care

19. How can we use Full-Scale Simulation? • Reproduce almost any physiologic event. • Myocardial Infarction • Hemorrhage • Cardiac Arrest • Asthma • Pneumonia • Trauma

23. Debriefing • Most powerful use of simulation includes a debriefing session immediately after the simulated event. • Facilitated by trained simulation specialists. • Participants self-assess and provide peer assessment. • Provides opportunity for reflective learning. • May include observers as well as participants.

24. Large Debriefing Session

25. Individual Debriefing

26. Full-Scale Human Patient Simulation • Facilitator may utilize taping of the scenario in the subsequent discussion and debriefing. • To initiate discussion. • To validate participant’s memory of the event during discussion. • Requires some degree of audio-visual support. • Handheld camcorder to theater-quality cameras and microphones.

27. Taping of Scenarios • Requires participant permission. • May be used for training of individuals that are not present at the simulation event. • Challenging technical issues regarding effective reproduction without theater quality equipment.

28. Debriefing • Great potential. • Origins in military and aviation. • Pre-battle and Post-battle debriefing • Cockpit Resource Management • Must be confidential for participants to fully disclose. • May also be psychologically traumatic for certain participants or when facilitated by untrained individuals.

30. Full-Scale Simulation Advantages • Realistic Experiential Learning • Emotional Learning • Positive emotional state when learning influences retention and activation. • Contrast to PTSD. • Inert v. activated knowledge. • Recalled when similar emotions are invoked. • Tends to be indelible. • Positive stress and emotion “anchors” knowledge.

31. Full-Scale Simulation Advantages • Promotes self-reflection. • Improves confidence. • Encourages further development of clinical judgment skills. • High level participant satisfaction

32. Participant Reactions • “Adding to the curriculum would be invaluable…The discussion session afterward is one of the most valuable parts…” • “It should be part of every nurse’s education.” • “I’m much more comfortable with the thought of being in a maternal resuscitation now…I’d never seen it before.”

33. Full-Scale Simulation Advantages • Allows training regarding infrequent and common events. • Complements clinical education. • Provides a safe environment for training regarding high-acuity events.

34. Human Simulation Training • Allows practice with no patient harm.

35. Questions? email: cluppi@partners.org