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Overview of Simulation

Overview of Simulation. Hsing-Mei Chen, PhD, RN Assistant Professor, Department of Nursing, College of Medicine National Cheng kung University, Taiwan. Education Achievement in 21th Century. Simon Cooper, PhD, RN. A transition from training to education for higher level of decision making

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Overview of Simulation

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  1. Overview of Simulation Hsing-Mei Chen, PhD, RN Assistant Professor, Department of Nursing, College of Medicine National Cheng kung University, Taiwan

  2. Education Achievement in 21th Century Simon Cooper, PhD, RN A transition from training to education for higher level of decision making Surface to deep thinking Independent thinker Multi-professional links (inter-professional education) Evidence based practice

  3. Original of Simulation • 16th century, mannequins (referred to as “phantoms”) were developed to teach obstetrical skills and reduce high maternal and infant mortality rates. • Airline industry training: pilot and flight crews • Anesthesia education • First simulator in health education in 1960s • Resusci Anne • Harvey for cardiology training (Simul Healthcare 2006;1: 252–256)

  4. Havey for cardiology training

  5. Current Situation Pamela R. Jeffries DNS, RN, FAAN • A movement toward making simulations a part of the clinical practicum, either as a clinical substitute or as an adjunct. • Movement arises out of need for: • More clinical sites • More nurse educators • New clinical practice models to prepare 21st century graduates in high-tech, complex environments

  6. Reflection from my teaching I am truly a good and responsible teacher! A quantity of handouts for each topic Video watching Cases or examples for important concepts Discussion

  7. However http://www.bing.com/images/search?q=in+the+class&FORM=HDRSC2#view=detail&id=344FFE8DAF824B1B087E93E92003ED3B328A9FCD&selectedIndex=86

  8. My critical care nursing class • Around 40-60 students in a class • Problem with student clinical practicum • Each critical care unit can allow 1 student/ 5 beds Good transition time • Look for alternative way to solve the problem with student placement.

  9. Teaching Strategies Traditional lectures Low fidelity simulation for lectures and quizzes Videos Homework Examines Self-directed learning

  10. Becoming a Nurse

  11. How to promote the student’s motivation and interest in learning? • Different styles • Visual • Visual / verbal • Physical • Auditory

  12. Hsun Tzu (ca. 310-237 BC), Confucian philosopher and author of on learning https://tw.search.yahoo.com/search?p=%E8%8D%80%E5%AD%90&fr=yfp&ei=utf-8&v=0 What I hear I forget What I see I remember What I do I understand

  13. Definition of Simulation-1 Jeffries, P. R. (2005). A frame work for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103. Activities that mimic the reality of a clinical environment and are designed to demonstrate procedures, decision-making, and critical thinking through techniques such as role playing and the use of devises such as interactive videos or mannequins.

  14. Definition of Simulation-2 Jeffries, P. R. (2005). A frame work for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103. A simulation may be very detailed and closely simulate reality, or it can be a grouping of components that are combined to provide some semblance of reality.

  15. Simulation Tools / Approaches http://healthcare.kyst.com.tw/products_detail.php?bgid=26&bid=47&gid=973 Ziv, A., Wolpe, P. R., Small, S. D., & Glick, D. (2006). Simulation-based medical education: An ethical imperative. Simulation in Healthcare, 1(4), 252–256. Low-tech simulators Simulated/standardized patients Screen-based computer simulators Complex task trainers Realistic patient simulators

  16. Five Areas of Simulation • Objectives • Planning • Fidelity • Complexity • Cues • Debriefing. Jeffries, P. R. (2005).

  17. Fidelity of Simulation Goldsworthy, S., & Graham, L. (2013). Simulation Simplified. A practical handbook for nurse education. USA: Wolters Kluwer. • Low fidelity • Injection pads, IN cannulation device • Moderate fidelity • Human simulators without chests or vocal sounds • High fidelity --> Realism • Human simulator (mannequin or manikin) run with a computerized program, a chest, and vocal sounds.

  18. Realism-1 • Ensuring that equipment and the surrounding environment is similar to the practice environment • Using ‘props’ to aid a sense of realism to the manikin e.g. patient pajamas, wigs, dressings, moulage for wounds • Using resources that the student would encounter in the clinical environment, e.g. intravenous lines, dressings, catheter bags, patient identification bracelets Edgecombe et al., 2013

  19. Triage 25 y/o, Abdominal pain after drinking 10 db, murmur 1 20 y/o, hyperventilation after a big fight OHCA 5 0 db, can’t talk

  20. Realism-2 • Ensuring that all paperwork, forms and patient charts are similar to the clinical environment • Utilizing evidence-based practice to inform realism e.g. date all intravenous lines, use appropriate dressings and dressing techniques. Edgecombe et al., 2013

  21. Use Simulators

  22. Use Standardized Patients

  23. Use Others • EKG Games • Dr. Simon Copper in MonashUniversity, Australia

  24. Innovation Adoption for Simulation Issenberg, S. B. (2006). The scope of simulation-based healthcare education. Simulation in Healthcare, 1(4), 203–208. Stage 1: Awareness Stage 2: Interest Stage 3: Evaluation Stage 4: Trial Stage 5: Adoption

  25. A Bunch of Resources for Simulation • National League for Nursing • http://sirc.nln.org/ • Monash University • Dr. Simon Cooper • http://www.med.monash.edu.au/nursing/staff/simon-cooper.html • http://first2actweb.com/index.php/first2actweb/ • http://www.freebookez.com/sample-nurse-simulation-scenarios/ • http://cms.montgomerycollege.edu/nursingsims/

  26. Effective use of Simulation Curricular institutionalization Effective simulation-based healthcare education Training resources Trained educators Issenberg, S. B. (2006) = X X

  27. Training Resources Issenberg, S. B. (2006) Simulators, task trainers, standardized patients, and computer software. Physical space and equipment (eg, monitors, beds, cameras, microphones, recording and playback equipment). Curriculum, outcome measures, learning strategies, and curriculum management system.

  28. Features of Simulations-1 Issenberg, S. B. (2006) • Feedback • The most important feature of simulation-based education to promote effective learning. • Repetitive practice • The intent is skill improvement, not idle repetition • Range of difficulty level • beginning with basics, advancing to progressively higher difficulty levels based on objective measurements.

  29. Features of Simulations-2 Issenberg, S. B. (2006) • Multiple learning strategies • Including instructor-centered formats, small group tutorials, independent study… etc. • Clinical variation • Should represent a wide variety of patient problems • Controlled environment • Learners can make, detect, and correct patient care errors without negative consequences.

  30. Features of Simulations-3 Issenberg, S. B. (2006) • Individualized learning • Active learners • Defined outcomes/ benchmarks • Goals should have tangible, objective measures that document learner progress. • Simulator validity/realism • simulation and the behavior it provokes come close to, but never exactly duplicate, clinical challenges that happen in genuine patient care contexts.

  31. Why use Simulation-Based Medical Education Ziv et al. (2006). Best standards of care and training Error management and patient safety Patient autonomy Social justice and resource allocation

  32. Examples of Simulation in Nursing Physical assessment Symptom care Commutation skill Discharge planning Nurse students vs. nurses

  33. Case Scenario for Chest Pain-1 Mr. Lee is admitted due to symptoms suggestive of unstable angina including chest pain, dizziness, and cold sweating. He complains that he is still not feeling well and finds his urine output has decreased since last night.

  34. Case Scenario for Chest Pain-2 • Learning objectives • Perform a focused assessment based on Mr. Lee’s complaint or change in his status. • Recognize normal and abnormal assessment findings. • Prioritize interventions based on findings and assessments.

  35. Case Scenario for Chest Pain-3 • Debriefing • Did you predict the development of shortness of breathing? • Did you provide appropriate care of the symptoms? • Are you capable of explaining the pathophysiological mechanisms of ileus? • Were you satisfied with your ability to work through the simulation?

  36. ACLS (Goldsworthy & Graham, 2013)

  37. Role of Faculty in Simulation (Goldsworthy & Graham, 2013) • Design the curriculum • Set up a topic and objectives • Develop 3 or 4 learning outcomes • Timing • Sequencing of learning • Unfold the case scenario • Case summary • Starting state • Make up

  38. Role of Faculty in Simulation (Goldsworthy & Graham, 2013) • Assessing the student’s knowledge, skill, and judgment • Facilitating the debriefing • Be sensitive to the learner’s emotional well-being • Program the simulator • Care for the equipment • Simulation technologists

  39. Student Preparation for Simulation Edgecombe, K., Seaton, P., Monahan, K., Meyer, S., LePage, S., & Erlam, G. (2013). Clinical simulation in nursing: A literature review and guidelines for practice, retrieved from http://akoaotearoa.ac.nz/communities/collaboration-clinical-simulation-leading-way • Pre-learning packages / short videos • Well-identified learning objectives • Overview of the simulation • Description of how the simulators work • Clinical scenarios linked with references to review • Evaluation methods • Reinforcing the professional student behaviors expected in the scenario (Goldsworthy & Graham, 2013)

  40. Learning Outcomes (Goldsworthy & Graham, 2013) Performance related Contextual Standard or criterion based Specific or general (satisfaction, confidence, critical thinking…)

  41. Key points (Goldsworthy & Graham, 2013) Make the environment as realistic as possible using screens, curtains, posters, or equipment Match learning outcomes with appropriate simulator and equipment Select faculty with relevant clinical expertise

  42. Key points (Goldsworthy & Graham, 2013) Clear outcomes and expectations Is the evaluation for: Student feedback? Facilitator feedback? Simulation design? Use the most appropriate measurement tool for the intended evaluation. Deliver all evaluations in a caring, constructive, and positive manner.

  43. The Future Inter-professional education (IPE) Hybrid Scenario National International

  44. Discussion What do you think about simulation? What do you think that students should learn from simulation?

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