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Human Patient Human Patient SimulationSimulation
Carol Jean Luppi, BSN, RNNursing Simulation Center
What is Human Patient
Simulation? The use of manikins to reproduce
clinical scenarios for the purpose of education, evaluation, or research.
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.
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.
Simulation Options Skill / Task Trainers
Computer Simulation
Manikin-Based Simulation
Skill / Task Trainers Useful for introducing or practicing
psychomotor skills. Lack situational context. Varied levels of sophistication.
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.
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
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
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.
Help me, I’m having chest pain.
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.
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.
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.
How can we use Full-Scale Simulation?
Crisis Management Team Training Interdisciplinary Training Risk Management Error Analysis and Avoidance Basic Patient Care
How can we use Full-Scale Simulation?
Reproduce almost any physiologic event. Myocardial Infarction Hemorrhage Cardiac Arrest Asthma Pneumonia Trauma
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.
Large Debriefing Session
Individual Debriefing
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.
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.
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.
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.
Full-Scale Simulation Advantages
Promotes self-reflection. Improves confidence. Encourages further
development of clinical judgment skills.
High level participant satisfaction
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.”
Full-Scale Simulation Advantages
Allows training regarding infrequent and common events.
Complements clinical education.
Provides a safe environment for training regarding high-acuity events.
Human Simulation Human Simulation TrainingTraining
Allows practice with no patient harm.
