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.

Questions?

email: cluppi@partners.org