1 simulation in nursing : moving forward thailand...
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Simulation in Nursing :
Moving Forward Thailand 4.0
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Now….there is currently a
widespread movement to use
simulations of all types in
medical education as a
teaching-strategy and/or as an evaluation mechanism.
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dCurrent state of clinical nursing education
Education : Higher education paradigm shift from teaching to learning
paradigms
More emphasis on outcome-based then process-based education
More evidence-based education strategies and curriculum
Graduates: Errors correlated to new graduates inability to make clinical
decisions
New graduates do not meet their expectation for clinical judgment
as identified by employment in clinical agencies
Critical thinking and reflective skills of the practitioner are
correlated with quality of patient care
( Clinical simulation in health care conference, 2010)
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d Changing in nursing education
1. Faculty skills sets changing and required :
Changes in teaching student-centered approach
High technology must include technology into clinical and
classroom teaching
Must be creative, innovative keep student engaged
High quality, real skills, high expectation of students
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d2. Need for better prepared students exiting
nursing programs :
A gap exists between the academic preparation of
nursing students and the needs of clinical agency
Clinical education is not currently working using only the
traditional models we have used for decades
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The evolution of the new educator
( Clinical simulation in health care conference, 2010) Sumolc
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dToday………..nurse educators : Facilitators of learning
Innovative, creative
Technology-savvy or willing to learn
Focus : student-centered learning
Providing students with real-world experiences and
examples
Knowledge workers, creators, and designers
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dThe future…. Uses of simulation expanding in nursing education
Teaching students differently by simulation
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Why do nurse
educators want to use simulation ?
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9 We need simulations because …….
• Decreasing number of clinical sites for
practice
• Nurse educator shortage
• Decision-making/problem-solving skills
needed
• Cost-effective clinical education needed
• Gap between education and practice
• Increasing patient safety**
• New model of education needed ( e.g.
technology and diagnostic reasoning
skills)
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Simulation in nursing : Simulated practice learning has been used as an
adjunct to clinical skills gained in practice settings
for a number of years.
The increased use of simulation has been aided by
some of the technological advances mentioned
above and to some extent has been driven by
policy change.
The use of simulation in health care education is
gaining popularity and is becoming a foundation for
many undergraduate nursing programs.
(Nurse Education Today, 2011)
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dWhat is simulation?
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dDefinition of terms Simulation: “… as a strategy – not a technology – to mirror,
anticipate, or amplify real situations with guided experiences in a fully
interactive way.” (http://www.ahrq.gov) Simulation : “…is a technique to replace or amplify real-patient
experiences with guided experiences, artificially contrived, that evokes or
replicates substantial aspects of the real world in a fully interactive
manner…..” (Society for Simulation in Healthcare, 2009)
Clinical simulation : “…is an attempt to replicate some or
nearly all of the essential aspects of a clinical situation so that the
situation may be more readily understood and managed when it
occurs for real in clinical practice….” ( Morton,1995)
Simulator: “…replicates a task environment with sufficient
realism to serve a desired purpose” (http://www.ahrq.gov)
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dThe Role of Simulation :
A teaching strategy
An evaluation tool
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(Teaching and learning in health science, 2012)
Using simulation to assess students’ performance
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dSimulation framework
( Jeffries, 2012)
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Simulation has the potential to improve education
outcomes :
In health, a meta-analysis of studies relating to health professions
education concludes that “In comparison with no intervention,
technology-enhanced simulation training in health professions
education is consistently associated with large effects for outcomes of
knowledge, skills, and behaviors and moderate effects for patient-
related outcomes.” (Cook et al., 2011, p. 978).
In medical education, simulators help novice surgeons develop their
skills, retain knowledge, and reduce procedure times and error levels
for laparoscopic surgery (Al-Kadi & Donnon, 2013).
In nursing, simulation experiences may enhance knowledge gains
(Gates, Parr & Hughen, 2012; Shinnick, Woo & Evangelista, 2012;
Weaver, 2011), decrease medication errors (Shearer, 2013), be
equivalent to traditional clinical experiences promoting student
acquisition of fundamental knowledge (Hayden et al. 2014; Schlairet &
Pollock 2010), and increase self-confidence (Leavett-Jones, Lapkin,
Hoffman, Arthur & Roche, 2011) and efficacy (Dunn, Osborne & Link,
2014).
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dTypes of simulation
1. Part-task trainers
2. Simulated patients
3. Screen-based computer simulators
4. Complex task trainers
5. Human patient simulators
( Medical education, 2012)
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dLevel of simulators
1. Low – fidelity simulators (Task-trainers)
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….static and lack the realism or situational context…
https://www.armstrongmedical.com/index.cfm/go/product.detail/sec/2/ssec/11/cat/21/fam/2073
http://www.gtsimulators.com/Ostomy-Care-Model-p/he-26130.htm
https://www.squ.edu.om/Portals/57/Images/den_img/skills%20lab%20models/29.png
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d2. Moderate – fidelity simulators
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…..more resemblance of reality with such features as pulse, heart sounds, and breathing sounds but without the ability to talk and they lack chest or eye movement…..
https://www.simulaids.com/prod/images/products/06/F1/3137302D4C4633363136t.jpg
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d3. High – fidelity simulators
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……combine part or whole body manikins to carry the intervention with computers that drive the manikins to produce physical signs and feed physiological signs to monitors…... Sum
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Types of Simulation Description Advantages Disadvantages
Part-task trainers :
injecta pads, breast and
gyn/prostate models, eye/ear models, IV arms
Props, models, or mannequins used
to practice skills and procedures
No threat to patient safety
Reusable
Allows for return demonstration of
skills
Large groups of learners
Low to moderate cost
Task training
Consistency
Learner – memorization
Lower veracity
Return demo without critical
thinking
Simulated patients :
standardized patient (trained
actors), learner/learner,
educator/learner
Role-play patients for training,
simulates assessment of history
taking, physical exams,
communication, and therapeutic
psychiatric interventions
No threat to patient safety
Great tool for high communication
skills
Provides relatively consistent
experience for all students
Moderate to high cost with each
use
Limited learners
Screen-based computer
simulators :
computer-assisted instruction
(CAI), virtual reality excursions
(VRE), Web-based programs
Programs to train and assess
clinical knowledge and decision
making.
No threat to patient safety
Provides relatively consistent
experience for all students
Reusable
Variable amount of critical
thinking
Moderate cost
Complex task trainers :
virtual reality devices such as
bronchoscocpy, laparoscopic
surgery, haptic (touch cue)
simulators such as pelvic
exam
High-fidelity visual, audio, touch
cues with interfaces with computers
No threat to patient safety
Provides relatively consistent
experience for all students
Promotes realism
Improves psychomotor skills
Moderate to high cost
Limited learners
Human Patient Simulators : Low-fidelity
Moderate-fidelity
High-fidelity
Full-length human mannequins
Simulated anatomy and physiology
Computer-driven scenarios that
responds as programmed
Computer-driven physiologically
based that responds in real time to
interventions
No threat to patient safety
High degree of realism and veracity
Low educator/learner ratio (1:5)
Active involvement of learner
High cost (startup and ongoing
cost)
Maintenance
Resource intensive: monetary
and faculty
Limited learners
High staffing ratio
No validation of transfer of
learning to clinical setting
Learner’s disbelieving attitude
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(Simulation-based medical education: an ethical imperative, 2003) Sum
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22 The virtual reality simulation
http://www.21stcentech.com/wp-content/uploads/2011/12/pulse.jpg
http://simtalkblog.com/wp-content/uploads/2017/02/VR-iStock-636927696.jpg
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcTIVhXgiWmbjW6XW1wmcW7z0ElaaPIGX_MC_HMAt80BomeAlt7T
http://healthysimulation.com/wp-content/uploads/2017/07/sub-buzz-14640-1500056104-3-500x343.jpeg
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Selecting type of simulation to use
Should 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
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dThe stage of simulation implementation:
1. Choose or write a scenario
2. Obtain and set up equipment
3. Determine the student roles
4. Offer pre-briefing activities
5. Implement the simulation
6. Facilitate a debriefing discussion
7. Evaluate
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dElements of simulation-based learning A. Simulation Lab & equipment B. Staff C. Learners/participants D. Clinical Scenario E. Assessment tool
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dSimulation Lab & equipment :
1. Simulation room
2. Control room
3. Manikin
4. Debriefing room
5. Equipment
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Control room
Simulation room
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Control room
Control room
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SimMan is a full body simulator that represents an average-size adult
patient. As a high fidelity manikin. SimMan can teach core skills in airway,
breathing, cardiac, and circulation. He comes equipped with a patient
monitor that displays vitals, labs, and radiology.
Manikins
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Nursing Anne, Kelly and Kid
are specifically designed to assist
students in learning how to
properly care for a wide range of common in-hospital conditions.
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Nursing Anne
Nursing Kelly
Nursing Kid
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Megacode Kid is a tethered
moderate fidelity patient simulator. It
is able to provide repetitive practice
skills training and communication training on a pediatric patient.
SimBaby is a tethered high fidelity
patient simulator. It is the advanced
simulator for training in infant
emergencies.
http://laerdal.com/products/simulation-training/emergency-care-trauma/megacode-kid/ Sum
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SimMom is considered a tethered high fidelity patient
simulator. It is an advanced full body birthing patient simulator
with accurate anatomy and functionality to facilitate multi-professional obstetric training of delivery management.
http://laerdal.com/products/simulation-training/obstetrics-paediatrics/simmom/
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Control room
Equipements Simulation room Debriefing room
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Control room
Equipements Simulation room
Equipment
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dThe operating information in a simulation exercise
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(Understanding simulation –based learning, 2009) Sumolc
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Instructor Computer SimPad
http://www.laerdal.com/images/L/ADIBAEMM.jpg
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Computer screen (SimMan) 37
Instructor monitor VS Patient moniter
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Instructor monitor VS Patient moniter
How to show the EKG ?
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Instructor monitor VS Patient moniter
How to show the LAB ?
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dIntegrating simulation in Nursing Practicum
Pediatric Nursing
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d Adult & Elderly nursing
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d Leader course
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d Leader course
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Leader course (CCTV)
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Critical care program 45
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Student Exchange program 46
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Cardiac symposium (Pre-ICU program) 47
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Scenarios creating program 48
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dAdvantages of Simulation over actual clinical
experience :
Reduces training variability and increases standardization
Is more accurate reflective learning especially with HPS
Is student-centered learning
Allows independent critical-thinking and decision-making,
and delegation
Allows Immediate feedback
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Limitations of Simulation Compared to actual
clinical experience :
Not real
Limited realistic human interaction
Students may not take it seriously
No/incomplete physiological symptoms
(Practicing medicine without risk: students’ and educators’ responses to high-fidelity patient simulation., 2010)
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