Clinical Outcomes from Human Patient Simulation

1. Clinical Outcomes from Human Patient Simulation Paula Garvey BSN, RN-BC No planner or presenter has any conflict of interest in the content to bediscussed. This presentation received in-kind assistance from METI in the form of a simulator to use for demonstration purposes. The educational content was not influenced in any way by this in-kind assistance.

2. Please place cell phones and pagers on vibrate

3. Objectives • Explore the benefits of HPS as a teaching modality for acute care nurses. • Examine benefits and challenges to implementing simulation as a teaching modality in a hospital-based nursing education department. • Demonstrate the care of a patient utilizing the HPS.

4. Current Trends • Due to high patient acuity, patients on traditional med-surg floors are as critically ill as some ICU patients. • Nurses are expected to have a strong foundation of knowledge • Physical assessment skills • Technical skills • Critical thinking skills

5. Benefits of Human Patient Simulation • Allows the adult learner a degree of self-directed learning. • Gives realism to a education scenario allowing the learner to become engaged. • The learner gains skills in a safe, non-threatening environment. • Classroom theory is put into practice.

6. Benefits of Human Patient Simulation • Teaching of non-technical skills such as collaboration, leadership, communication, & professionalism. • Provides a standardized framework for managing a patient’s condition. • Outcomes evaluation and research. • Improved quality of care and safety of patients. • Gains a foundation for critical thinking & clinical judgment.

7. Take action based upon processed information; Evaluate Clinical Judgments SIMULATION Critical Thinking Clinical Reasoning Analyze/Synthesize/Evaluate Current to new knowledge; Recall facts; Organize; Apply; Re-Evaluate © OSUMC 2007

8. Simulation Design Approach • Goal of simulation • Type of simulation learning model • Development of scenario • Prebriefing & Debriefing

9. Goal of High Fidelity Simulation • Prepare staff to make sound judgments, complex problem solving, and think critically • Progression to a higher level of competency and proficiency • Putting theory into practice

10. Simulation Learning Models • Self-Directed-Learning model: The learner is given brief instructions and to manage the patient as indicated by the signs and symptoms without any instructor input. • Self-Directed-Learning model with facilitated debriefing:The learner is instructed as above but encouraged to collaborate and make team decisions. Debriefing is to occur immediately following the scenario. • Instructor-Modeled learning: The learner observes the instructor assess and manage the patient, verbalize their findings along with rationale and are allowed to ask the instructor questions for approximately 5 minutes. Then the learner repeats the scenario individually while being videotaped.

11. Prebriefing & Debriefing • Prepares participants for simulation scenario, sets ground rules, stresses confidentiality and creation of a non-threatening environment. • Allows participants to reflect on the facts, thoughts, impressions, and reactions to the situation. • Need to provide a supportive climate in order to ensure successful debriefing process. • Participants need to be able to share their experiences in a frank and honest manner. • The most important aspect of simulation education and crucial to the learning process.

12. Patient Care Management • Management of Chest Pain • Management of Respiratory Distress • Management of Cardiac Arrest • Management of Sepsis • Management of EKG dysrhythmias

14. Failure to Rescue-When is It Time to Worry ACLS Code-Blue Readiness Staff communication and collaboration ECG Class New Equipment Central Nursing Orientation Sentinel Events Annual competencies Hospital-specific practices and protocols Verification of general nursing skills Courses Applicable for Simulation

16. Facilitator Evaluation Benefits: • Some participants seem to lose even the most basic of skills when placed in a “high-pressure” situation. • Excellent method to evaluate the most basic competencies • Method to locate those staff who might be having clinical difficulty, which isn’t evident using traditional teaching methods • Differences in comprehension and application from didactic to hands-on environment • Decrease in system-wide Code Blue numbers • Increase in system-wide Code Blue “survival to discharge” numbers Challenges: • Do not have our own simulation lab! • Unrealistic environment in our training center with a mid-fidelity simulator

17. Learner Evaluation Benefits: • More comfortable with equipment and assessment skills • Felt like they had been in a “real” code situation • Increased the understanding and comfort level of participants in a cardiac arrest situation • Take class multiple times and “learn something new each time” • “This class should be mandatory for every nurse” Challenges: • Simulation loses benefit when the environment is not realistic • Difficult to overcome that it is a mannequin • Felt “disorganized” due to the “usual” co-workers are not present • Confusion when nurse is taken out of his/her usual role

18. Questions Paula Garvey: paula.garvey@osumc.edu

19. References • Beyea, S. C., Von Reyn, L. K., & Slattery, M. J. (2007). A nurse residency program for competency development using human patient simulation. Journal for Nurses in Staff Development, 23, 77-82. • Bush, M. C., Jankouskas, T. S., Sinz, E. H., Rudy, S., Henry, J., & Murray, W. B. (2007). A method for designing symmetrical simulation scenarios for evaluation of behavioral skills. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(2), 102-109. • Day, L. (2007). Simulation and the teaching and learning of practice in critical care units. American Journal of Critical Care, 16, 504-507. • Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(2), 115-125. • Glavin, R. J. (2007). Simulation: An agenda for the 21st century. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(2), 83-85. • Jankouskas, T., Bush, M. C., Murray, B., Rudy, S., Henry, J., & Dyer, A. M. et al. (2007). Crisis resource management: Evaluating outcomes of a multidisciplinary team. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(2), 96-101. • Landry, M., Oberleitner, M. G., Landry, H., & Borazjani, J. G. (2006). Education and practice collaboration. Journal for Nurses in Staff Development, 22, 163-169. • LeFlore, J. L., Anderson, M., Michael, J. L., Engle, W. D., & Anderson, J. (2007). Comparison of self-directed learning versus instructor-modeled learning during a simulated clinical experience. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(3), 170-177. • Paparella, S. F., Mariani, B. A., Layton, K., & Carpenter, A. M. (2004). Patient safety simulation. Journal for Nurses in Staff Development, 20, 247-252. • Rudolph, J. W., Simon, R., & Raemer, D. B. (2007). Which reality matters? Questions on the path to high engagement in healthcare simulation. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(3), 161-163. • Winslow, S., Dunn, P., & Rowlands, A. (2005). Establishment of a hospital-based simulation skills laboratory. Journal for Nurses in Staff Development, 21, 62-65.