Transcript Human Patient Simulation

Human Patient Simulation
Carol Jean Luppi, BSN, RN
Nursing Simulation Center
What is
Human Patient Simulation?
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The use of manikins to reproduce
clinical scenarios for the purpose of
education, evaluation, or research.
Simulation Technology
History and Precedents
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Flight simulators for pilots and
astronauts.
Military training exercises.
Management training for business
executives.
Technical operations for nuclear power
plants.
Increased Use of Simulation
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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
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Skill / Task Trainers
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Computer Simulation
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Manikin-Based Simulation
Skill / Task Trainers
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Useful for introducing or practicing
psychomotor skills.
Lack situational context.
Varied levels of sophistication.
Computer-Based Simulation
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Use of software to simulate a subject or
situation on a computer screen.
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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
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Varied levels of
sophistication.
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Manikin Task Trainers
Resusci-Anne /
VitalSim 
High-fidelity,
computerized manikins
with human functions.
e.g. breathe, talk, blink
High Fidelity
Human Patient Simulators
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Outward appearance of reality.
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May be enhanced by simulation specialists
with props and make-up.
Cosmetic fidelity
Respond realistically to interventions.
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Controlled by computer software programs
individualized by simulation specialists.
Response fidelity
High Fidelity
Human Patient Simulators
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Response Fidelity
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Patient speaks to the participant.
Able to perform interventions with realistic response.
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IV insertion with blood return.
Chest tube insertion.
Endotracheal Intubation.
Physiologic responses.
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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
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Environment supports the clinical situation.
 Location is adapted to appear as realistic as
possible.
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Patient Room
OR
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Participants are provided a brief description of a
carefully created scenario/clinical situation and
asked to respond.
Full-Scale
Human Patient Simulation
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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
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Control area should be hidden from
participants.
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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?
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Crisis Management
Team Training
Interdisciplinary Training
Risk Management
Error Analysis and Avoidance
Basic Patient Care
How can we use
Full-Scale Simulation?
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Reproduce almost any physiologic event.
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Myocardial Infarction
Hemorrhage
Cardiac Arrest
Asthma
Pneumonia
Trauma
Debriefing
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Most powerful use of simulation includes a
debriefing session immediately after the
simulated event.
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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
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Facilitator may utilize taping of the scenario in
the subsequent discussion and debriefing.
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To initiate discussion.
To validate participant’s memory of the event during
discussion.
Requires some degree of audio-visual support.
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Handheld camcorder to theater-quality cameras and
microphones.
Taping of Scenarios
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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
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Great potential.
Origins in military and aviation.
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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
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Realistic Experiential Learning
Emotional Learning
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Positive emotional state when learning influences
retention and activation.
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Contrast to PTSD.
Inert v. activated knowledge.
Recalled when similar emotions are invoked.
Tends to be indelible.
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Positive stress and emotion “anchors” knowledge.
Full-Scale Simulation
Advantages
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Promotes self-reflection.
Improves confidence.
Encourages further development of
clinical judgment skills.
High level participant satisfaction
Participant Reactions
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“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
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Allows training regarding
infrequent and common
events.
Complements clinical
education.
Provides a safe
environment for training
regarding high-acuity
events.
Human Simulation Training
Allows practice
with no patient
harm.
Questions?
email: [email protected]