Date post: | 13-Jan-2015 |
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MS.J.JAYANTHI.,MSc(N).,LECTURER IN PAEDIATRIC
NURSINGGRACIOUS COLLEGE OF
NURSING
“SIMULATION REALITY INTO REAL WORLD Simulation in some form has probably been used as a teaching strategy in nursing education since the first nurse tried to teach the first nursing student how to do a task properly.
Tell me, and I will forget.
Show me, and I may
remember. Involve me,
and I will understand.” - Confucius, 450 BC
MEANING‘ Simulator (noun): any device or
system thatreproduces the conditions of a situation
for thepurposes of research or training’ (Collins,
2005)
DEFINITION
Simulation:
“… as a strategy – not a technology – to
mirror, anticipate, or amplify real situations
with guided experiences in a fully interactive
way.”
Simulator:
“…replicates a task environment with sufficient
realism to serve a desired purpose”
TRENDS IN NURSING EDUCATIONProviding more experimental learning
opportunity than instruction
Increased use of learning technology
More emphasis on outcome-based then
process-based education
More evidence-based education strategies
and curriculum
USESLearning by doingImproved quality of instructionThe simulation program enables multiple
training opportunitiesDebriefing is an important part of the
learning experience
DEBRIEFING Debriefing is a process of receiving an
explanation of a study or investigation after participation is complete.
Debriefing (post-experience analysis) is thought to be one of the most important features of simulation based medical education. Simulation can lead to an experience that is emotional and thought provoking –experiential learning. (Think of how you feel when you poorly execute the resuscitation of the manikin in a simulation session.) Debriefing plays a role in the reflection and analysis of that experiential learning.
THE ROLE OF SIMULATION
Abstract The 1975 experiment demonstrated that when
learning occurs in a realistic environment related to work, learning is retained and reproduced. Therefore, the more realistic the environment is to the learner’s own area of work, the more successful the learning will be. This was one of the first reported occasions when it was seen that by learning in a realistic environment enhanced the educational experience. Simulation allows the creation of realistic simulations to allow greater retention of what is learned Learning using simulators . (harvey).
SIMULATION FIDELITYA “system that presents a fully interactive
patient and an appropriate clinical work environment.
The degree to which a simulation and/or a simulation device accurately reproduces clinical and/or human parameters; in Realism.
High fidelity Maximum interaction of learner in an environment that closely resembles reality. Scenarios using mannequins, actors and/or props in a structured, intentional and well-directed production can provide a high fidelity learning experience.
Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR.
Equipment/Physical
FidelityFidelity
EQUIPMENT/PHYSICAL
Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR.
Equipment
Task
FidelityFidelity
EQUIPMENT
TASK
Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR.
Equipment
Task
Environmental
FidelityFidelity
EQUIPMENT
TASK
ENVIRONMENTAL
Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR.
Equipment
Environmental
Psychological
Task
FidelityFidelity
EQUIPMENT
TASKENVIRONMENTAL
PSYCHOLOGICAL
TYPES OF SIMULATIONComputer-based clinical simulations
Task-specific simulatorsVirtual realityFull-bodied manikin-basedStandardized patientsHuman cadavers
COMPUTER BASED SIMULATION
Screen-based or PC-based simulations are
human computer interactions that allow
students to experience a variety of medical
skills and procedures. This is best used with
entry-level students.
CONT……StrengthsEasy, flexible and unlimited access Useful for knowledge acquisition and critical
thinkingAccommodating to individual pace of learningGood for lower/entry level studentsRelatively low costLimitationsNo physical interactivityLow fidelityNo experiential learning
TASK SPECIFIC SIMULATION Task specific models are designed to teach
a specific task, procedure, or anatomic region. They often resemble anatomic sections of the body, This allows concurrent teaching of a large class, broken down into small groups, to increase the hands-on time for each trainee.
TASK SPECIFIC SIMULATION Task trainers are mechanical parts of the
anatomy that simulate an individual skill.
Strengths Low cost Good for procedural practiceLimitations Low fidelity
Virtual reality Virtual reality (VR), sometimes
referred to as immersive multimedia, is a computer simulated environment that can simulate physical presence in places in the real world or imagined worlds. Virtual reality could recreate sensory experiences, including visual, taste, sight, smell, sound, touch, etc.
VIRTUAL REALITYStrengthsEasy access Economic for teaching multidisciplinary careAccommodating to individual pace of learningGood for lower level of studentsLimitationsLimited physical interactivityLow fidelityLimited experiential learning
FULL-BODIED MANNIKIN-BASED Manikin-based simulations use high fidelity
simulators, manikins that breathe, with breath sounds, heart tones, and palpable pulses. In addition, the manikin has a monitor that can display EKG, pulse oximeter, blood pressure , arterial wave forms, pulmonary artery wave forms, anesthetic gases, etc. Procedures can be performed on the simulators such as bag-mask ventilation, intubation, defibrillation, chest tube placement, cricothyrotomy and others.
FULL-BODIED MANNIKIN-BASED
The highest fidelity simulation.
"Drug administration can be simulated, and
with the use of the drug recognition unit,
the simulator will respond physiologically.
CONT…..StrengthsHigh fidelityInteractive experience Using emotional and sensory componentsGood for critical thinking, decision-making and
delegationLimitationsCostlyLimited access Dependent on availability of human
instructors/operators Limited realistic human interactions
STANDADISED PATIENT In health care , a Simulated Patient,
Standardized Patient, Sample Patient and Patient Instructor is an individual trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated Patients have been successfully used in the education and evaluation of nurses, nurse practitioners, physicians & surgeons, physician assisstant ,and basic, applied and transitional medical research.
STANDADISED PATIENT
StrengthsHigher realism in the interpersonal and
emotional responsesGood for communication skills and
interpersonal relationships trainingGood for evaluation LimitationsSigns do not match symptomsInversed power dynamic
HUMAN CADAVER A corpse, also called a cadaver in
medical literary and legal usage or when intended for dissection, is a dead human body.
LEARNING THEORY IN PATIENT SIMULATIONThere is no “Simulation Learning TheoryBut, simulation can benefit from broader
learning theories
EXPERIMENTAL LEARNING THEORY
Dominant learning theory in simulation
David Kolb – Chief proponentBased on Kurt Lewin’s Experiential Learning Cycle
Concrete Experience
Testing implication of
concepts in new situation
Observation and Reflection
Formation of abstractconcepts and
generalizations
Concrete Experience
Observation and Reflection
Formation of abstractconcepts and
generalizations
Testing implication ofconcepts in new situation
EXPERIMENTAL LEARNING CYCLE
ADULT LEARNING THEORYAdults have an intrinsic need to knowAdults have self-responsibilityAdults have a lifetime of experiencesAdults have an innate readiness to learnAdults have a life-centered orientation to
learningAdults have internal motivators
PRINCIPLES OF SELECTIONShould be driven by the educational goal/objective
Should match the level of the student
The higher the realism, the more effective it is in engaging the student
POTENTIAL ADVANTAGES OF SIMULATION Reduces training variability and increases
standardizationGuarantees experience for every students Student-centered learningAllows independent critical-thinking and
decision-making, and delegationAllows Immediate feedback Allows
deliberative practiceAlso uses the concept of experiential learning
LIMITATIONS OF SIMULATION OVER ACTUAL CLINICAL EXPIERENCENot realLimited realistic human interaction
Students may not take it seriously
No/incomplete physiological symptoms
VISION FOR FUTURE
Class → Simulation → Clinical→ Real world
Integrated into mainstream healthcare education
SIMULATION AS A TEACHING STRATERGY:CHALLENGES
Initial capital expendituresHigh financial costFaculty developmentOngoing faculty/administrative/technical support
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