using the human patient simulator in nursing education sarah j. clark, rn-c, msn davidson county...

Using the Human Using the Human Patient Simulator in Patient Simulator in Nursing EducationNursing Education

Sarah J. Clark, RN-C, MSNSarah J. Clark, RN-C, MSN

Davidson County Community CollegeDavidson County Community College

Where do student nurses learn?Where do student nurses learn?

ClassroomClassroom• Content is introducedContent is introduced• Concepts are exploredConcepts are explored

LabLab• Skills are taughtSkills are taught• Discrete hands on practiceDiscrete hands on practice

ClinicalClinical• Classroom concepts and clinical skills Classroom concepts and clinical skills

are applied to patient care situations are applied to patient care situations

So, what is simulation?So, what is simulation?

Representing certain key Representing certain key characteristics or behaviors of a characteristics or behaviors of a selected physical or abstract systemselected physical or abstract system

Modeling of natural or human Modeling of natural or human systems in order to gain insight into systems in order to gain insight into their functiontheir function

Simulation can be used to show the Simulation can be used to show the eventual real effects of alternative eventual real effects of alternative conditions and courses of actionconditions and courses of action

Simulation in nursing educationSimulation in nursing education

Low techLow tech• Skills mannequinsSkills mannequins• Inject a padsInject a pads

High techHigh tech• Human patient simulatorHuman patient simulator

Human patient simulatorHuman patient simulator

Human Patient SimulatorsHuman Patient Simulators

AdultAdult ChildChild Laboring patientLaboring patient NewbornNewborn BabyBaby


AssessmentAssessment• BreathesBreathes• VocalizesVocalizes• Vital signsVital signs• PulsesPulses• Breath soundsBreath sounds• Heart soundsHeart sounds• Bowel soundsBowel sounds• EKG rhythmEKG rhythm


InterventionsInterventions• IV insertion and careIV insertion and care• IM injectionsIM injections• NG insertion and careNG insertion and care• Urinary catheter insertion and careUrinary catheter insertion and care• Oxygen administrationOxygen administration• Medication administrationMedication administration• IntubationIntubation• Chest decompressionChest decompression


Pre-program Pre-program • Program scenarioProgram scenario• Program responses to interventionsProgram responses to interventions

Run “on the fly”Run “on the fly”• Operator runs the scenarioOperator runs the scenario• Original assessment findings are setOriginal assessment findings are set• Responses are programmed in real timeResponses are programmed in real time

Any Questions?Any Questions?

Simulation and the North Carolina Simulation and the North Carolina Board of NursingBoard of Nursing

NCBON will accept simulation in lieu NCBON will accept simulation in lieu of clinical with direct patient careof clinical with direct patient care

Alternative for clinical experiences Alternative for clinical experiences with limited opportunities for patient with limited opportunities for patient carecare• PediatricsPediatrics• Mental health Mental health • MaternityMaternity

Why simulate in nursing?Why simulate in nursing?

Ensure experience with Ensure experience with conceptsconcepts demonstrated in patient situations demonstrated in patient situations • Post op carePost op care• Respiratory distressRespiratory distress• Chest painChest pain• Hip fractureHip fracture• Vaginal deliveryVaginal delivery


RemediationRemediation• Medication errorsMedication errors• FallsFalls• Failure to rescueFailure to rescue• Make mistakes in a risk free Make mistakes in a risk free

environmentenvironment


RemediationRemediation TeachingTeaching

• Scenario that teaches application of Scenario that teaches application of classroom contentclassroom content

Assess patient for specific risk factors Assess patient for specific risk factors Assess patient and implement appropriate Assess patient and implement appropriate

nursing interventionsnursing interventions Evaluate patient responses to medications, Evaluate patient responses to medications,

interventionsinterventions Act as team leader, team memberAct as team leader, team member


RemediationRemediation TeachingTeaching TestingTesting

• Scenario that tests application of Scenario that tests application of classroom contentclassroom content

Assess patient for specific risk factors Assess patient for specific risk factors Assess patient and implement appropriate Assess patient and implement appropriate

nursing interventionsnursing interventions Evaluate patient responses to medications, Evaluate patient responses to medications,

interventionsinterventions Act as team leader, team memberAct as team leader, team member

Pitfalls to simulation in nursing Pitfalls to simulation in nursing educationeducation

Potential barrier: Financial Potential barrier: Financial constraintsconstraints• SimMan costs $34,000SimMan costs $34,000• VitalSim costs $2035VitalSim costs $2035• SimBaby costs $31,770 without the SimBaby costs $31,770 without the

computercomputer

Potential solutions to pitfalls of Potential solutions to pitfalls of simulation in nursing educationsimulation in nursing education

Get help finding the moneyGet help finding the money• Laerdal has people who find grant Laerdal has people who find grant

moneymoney• NC state is looking favorably toward NC state is looking favorably toward

money for allied health, simulationmoney for allied health, simulation


Potential problem: SpacePotential problem: Space• Rooms are tight everywhereRooms are tight everywhere• SimMan must be securedSimMan must be secured

Possible solutions to pitfalls of Possible solutions to pitfalls of simulation in nursing educationsimulation in nursing education

Make SimMan mobileMake SimMan mobile• Put SimMan on a rolling stretcherPut SimMan on a rolling stretcher• Put his components on a rolling cartPut his components on a rolling cart• Role him out when you need him and Role him out when you need him and

lock him up when he is donelock him up when he is done

Pitfalls of simulation in nursing Pitfalls of simulation in nursing educationeducation

Potential barrier: Mannequin is based Potential barrier: Mannequin is based on medical modelon medical model• ““Bells and whistles” that nurses don’t Bells and whistles” that nurses don’t

needneed• Settings lend themselves to Settings lend themselves to

pathophysiology, medical differential pathophysiology, medical differential diagnosis and medical interventiondiagnosis and medical intervention


Focus on the nursing processFocus on the nursing process• Select the product you want based on Select the product you want based on

what you needwhat you need• Develop scenarios based on nursing Develop scenarios based on nursing

experiences, nursing literatureexperiences, nursing literature• Define the objectives in nursing termsDefine the objectives in nursing terms• Use only the “bells and whistles” that Use only the “bells and whistles” that

support the scenariosupport the scenario


Potential barrier: Faculty resistancePotential barrier: Faculty resistance• ““We’ve always done it this way”We’ve always done it this way”• No one knows how to do thisNo one knows how to do this• Time to develop learning activitiesTime to develop learning activities• Time and faculty intensive to run the Time and faculty intensive to run the

scenariosscenarios


Have a planHave a plan• Take advantage of educational sessionsTake advantage of educational sessions

Manufacturer offers free educationManufacturer offers free education Many articles in the literatureMany articles in the literature Inexpensive educational opportunitiesInexpensive educational opportunities NetworkNetwork

• Have a championHave a champion Develop one or two expertsDevelop one or two experts All faculty have a role, but the champion is All faculty have a role, but the champion is

the simulation expertthe simulation expert


Integrate slowly into the curriculum Integrate slowly into the curriculum • Start small and work upStart small and work up

Find a need and fill itFind a need and fill it Enlist content experts in scenario buildingEnlist content experts in scenario building

• Consider simulation when preparing a courseConsider simulation when preparing a course Identify content that can be taught or reinforced Identify content that can be taught or reinforced Look at what other programs are doingLook at what other programs are doing

• Look at simulation with curriculum reviewLook at simulation with curriculum review Develop a systematic plan for implementationDevelop a systematic plan for implementation Make simulation fit your curriculum, not the other Make simulation fit your curriculum, not the other

way aroundway around


Involve the studentsInvolve the students• Faculty to develop pre-programmed Faculty to develop pre-programmed

scenarios that a peer tutor can runscenarios that a peer tutor can run• Students write scenarios to runStudents write scenarios to run• Senior students can run scenarios for Senior students can run scenarios for

the newer studentsthe newer students• Have the students evaluate themselves Have the students evaluate themselves

and each otherand each other

Nuts and bolts of simulation in Nuts and bolts of simulation in nursing educationnursing education

Getting startedGetting started• Identify purpose of simulationIdentify purpose of simulation

RemediationRemediation TestingTesting Teaching new contentTeaching new content Application of multiple conceptsApplication of multiple concepts

A Teaching Simulation Activity: A Teaching Simulation Activity: Client AssessmentClient Assessment

Objectives:Objectives:• Discuss components of a head to toe Discuss components of a head to toe

assessment.assessment.• Perform a head to toe assessment of the Perform a head to toe assessment of the

SimMan with a partner.SimMan with a partner.• Assist fellow students in performing a Assist fellow students in performing a

head to toe assessment.head to toe assessment.


The PlanThe Plan• Groups of 4 studentsGroups of 4 students• General worksheet and group discussionGeneral worksheet and group discussion• Partners perform assessment while fellow Partners perform assessment while fellow

students observe and coach as appropriatestudents observe and coach as appropriate• A student who is observing will be the voice of A student who is observing will be the voice of

the client.the client.• The facilitator is actively teaching throughout The facilitator is actively teaching throughout

the simulation.the simulation.• All assessment findings on the SimMan will be All assessment findings on the SimMan will be

normal.normal.


DebriefDebrief• The facilitator is active participant The facilitator is active participant

throughout the experience. throughout the experience. • Review the objectives for the activityReview the objectives for the activity• Summarize the activitySummarize the activity• Give feedback on students’ performanceGive feedback on students’ performance• Ask the students’ feedbackAsk the students’ feedback

What techniques were usefulWhat techniques were useful Anxiety level related to assessmentAnxiety level related to assessment

A Teaching Simulation Activity: A Teaching Simulation Activity: Client Assessment (Part II)Client Assessment (Part II)

Objectives:Objectives:• Perform a head to toe assessment of the Perform a head to toe assessment of the

SimMan with a partner.SimMan with a partner.• Assist fellow students in performing a Assist fellow students in performing a

head to toe assessment.head to toe assessment.• Identify abnormal findings during the Identify abnormal findings during the

physical assessment.physical assessment.• Discuss nursing implications related to Discuss nursing implications related to

abnormal assessment findings.abnormal assessment findings.


The PlanThe Plan• Groups of 4 studentsGroups of 4 students• Partners perform assessment while fellow Partners perform assessment while fellow

students observe and coach as appropriatestudents observe and coach as appropriate• A student who is observing will be the voice of A student who is observing will be the voice of

the client.the client.• The facilitator is actively teaching throughout The facilitator is actively teaching throughout

the simulation.the simulation.• Some assessment findings on the SimMan will Some assessment findings on the SimMan will

be abnormal.be abnormal.• Students will call “time out” to stop the Students will call “time out” to stop the

simulation to discuss findings and implicationssimulation to discuss findings and implications


DebriefDebrief• The facilitator is active participant The facilitator is active participant

throughout the experience. throughout the experience. • Review the objectives for the activityReview the objectives for the activity• Summarize the activitySummarize the activity• Give feedback on students’ performanceGive feedback on students’ performance• Ask the students’ feedbackAsk the students’ feedback

Comfort level with the assessment processComfort level with the assessment process Understanding of assessment in the context Understanding of assessment in the context

of client careof client care

A Teaching Simulation Activity: A Teaching Simulation Activity: Evaluation of Assessment Skills Evaluation of Assessment Skills

Objectives:Objectives:• Perform an assessment on the post Perform an assessment on the post

operative client.operative client.• Identify appropriate nursing and medical Identify appropriate nursing and medical

interventions for the client.interventions for the client.• Discuss rationales for nursing and Discuss rationales for nursing and

medical interventions.medical interventions.• Document the nursing assessment and Document the nursing assessment and

care of the client.care of the client.

A Teaching Simulation Activity: A Teaching Simulation Activity: Evaluation of AssessmentEvaluation of Assessment

The PlanThe Plan• Students receive a brief report from Students receive a brief report from

PACUPACU• Admission orders are providedAdmission orders are provided• Some assessment findings will be Some assessment findings will be

abnormalabnormal• Some medical interventions will be Some medical interventions will be

incorrect or incompleteincorrect or incomplete

A Teaching Simulation Activity: A Teaching Simulation Activity: Evaluation of Assessment SkillsEvaluation of Assessment Skills

The Plan:The Plan:• Each individual will perform assessment on the Each individual will perform assessment on the

post operative client.post operative client.• The facilitator is the voice for the client, but is The facilitator is the voice for the client, but is

otherwise not an active participant.otherwise not an active participant.• Write a narrative nursing note to document the Write a narrative nursing note to document the

client assessment and interventions client assessment and interventions performed.performed.

• Complete the worksheet asking for each Complete the worksheet asking for each intervention and the rationale.intervention and the rationale.

A Teaching Simulation Activity: A Teaching Simulation Activity: Evaluation of AssessmentEvaluation of Assessment

DebriefDebrief• Each student’s written work was returned with Each student’s written work was returned with

comments made by the instructorcomments made by the instructor• Discussion with entire group about observations Discussion with entire group about observations

made by the instructor and facilitator as well as made by the instructor and facilitator as well as common themes noted in written workcommon themes noted in written work

• Review the objectives for the activityReview the objectives for the activity• Discuss the RN’s role in this scenarioDiscuss the RN’s role in this scenario• Summarize the activitySummarize the activity• Ask the students’ feedbackAsk the students’ feedback

What do the students feel was valuable in this activityWhat do the students feel was valuable in this activity

The EndThe EndTo request a copy of this To request a copy of this

presentation, e-mail me atpresentation, e-mail me at

[email protected]@davidsonccc.edu

using the human patient simulator in nursing education sarah j. clark, rn-c, msn davidson county...

Documents

patient responses

direct patient care

team member slide

real time slide

interventions act

courses of action slide

risk free environment

clinical skills