Simulation Training for New Emergency Nurses

Simulation Training for New Emergency NursesSimManMargaret M Miller FNP,BC

IntroductionThe Emergency Department (ED) is one of the areas that is the forefront of Nursing. Since the ED is both fascinating and challenging for the new nurse, a comprehensive orientation with high technology is warranted for success. The use of Simulation in the orientation process will set standards and guidelines for various kinds of learning and assessments

ObjectivesCompare simulation technology to traditional learning modelsIdentify potential advantages and disadvantages of simulation as a teaching strategyEvaluate how simulation help the new nurse transcend to the ED

The Role of Simulation as a Trend in Nursing EducationA teaching StrategyAn evaluation toolCan be use to provide a more experiential learning opportunityProvides increase use of learning technologyIt is more outcome based Provides more evidence-base education

Rationale for Incorporating the SimMan in Orientation ProgramTo promote better preparation of the new ED nurseTo simulate a patient safety environmentTo support innovative teaching strategiesTo have a better prepare nurse for the Preceptors To create complicated patients presenting to the ED, and implementation of Emergency Care

Types of SimulationScreen-based/PC-based simulationVirtual PatientsPartial task trainersHuman patient simulatorStandardized patientsIntegrated models

DefinitionWikipedia, the free encyclopedia defines Simulation as the imitation of some real thingSimulation is widely used for educational purposes. Such as Aviation, Military, Medical and Transportation. A good example of this was seen recently when the pilot landed the plane in the Hudson River. A situation that was practice by simulation for a long time and was eventually put to use which save over 100 lives

SimulationIn the Healthcare systems simulators are increasingly being developed and deployed to teach therapeutic and diagnostic proceduresThere are human simulators for every patient we care for from birthing to the neonatal to the adultOne of the amazing features of simulation is the see the real life reaction of the mannequins

Type of ModelsActive models: Attempt to reproduce living anatomy or physiology such as palpations, electrocardiography and auscultationInteractive models: Responds to interactions taken by a user. This has the advantage of allowing a student to make judgments or errors. The process of iterative learning through assessment, evaluation, decision making and error correction

Types of ModelsComputer Simulators: Simulators have been proposed as an ideal tool for assessment of student for clinical skills

Simulation

Simulation

Wooden mechanical horse during WW1

What Is a SimManHuman simulatorComputer controlled manikin that displays physiologic data, such as heart rate, blood pressure, respirator rate and prerecorded sounds.Supports clinical decision making activitiesPreset scenarios available and the ability to generate scenarios

SimManComputer driven It provides highly realistic training experience: To master decision makingPatient care skillsSimulate team work

Features of the SimManInteractive manikin that responds physiologically to interventions Examples are:DefibrillationAirway system: Its anatomically realistic airways systems allows practice of all types of difficult airway managementDifference in heart sounds and breath sounds

SimManAllow practice of IV insertionsLife threatening emergencies can be simulation through the injections of drugs and fluidsImprovement in patients safety and outcomesDecrease in errors Best standards use for care and training

SimMan in EducationHelps health the providers to think on their feetProvides feedback as they practiceAbility to witness how quickly a patient can become unstableRealize how important the application of their assessment skills and response time can improve a patients outcome

SimMan in EducationThe ability to recognize deviations from expected baselinesRefocusing for skilled nurses in their assessment techniques

AdvantagesOffers opportunities to practice rare and critical eventsCan be manipulatedAllows for updates of new medications and new calibrationsScenarios can be reproducedOffers opportunities to make and learn from mistakes

AdvantagesThe use of simulation saves lives and money by reducing medical errors, training time Allows for the nurse to practice on a variety of patientsEach patient can present with a different case history and unique symptomsResponds to user action with appropriate physiological responses

AdvantagesThe system is able to generate detail evaluation after each session which helps with feed back and the debriefing process

Limitations/DisadvantagesNot realLimited realistic human interactionStudents may not take it seriouslyIt is costlyMust have trained educators Must maintain trained technical support

SummaryWe can conclude that simulation training for the new ED nurse will increase both productivity and creativityIt will create patient safetyIt will increased and build on the new nurse confidenceAnd will help with nurse retention and decrease in nursing turnover

ReferencesDonohue, A J., Durbin, DR., Nadel, FM., Stryjewski, GR., Kost, SI., Nadkami, VM. (2010). Perception of realism during mock resuscitations by pediatric house staff: The impact of simulated physical features (1) 16 20Hoyt, RE., Sutton, M., Yoshihashi, A., Practical Guide for the Healthcare Professional 3rd edition, 2009ReferencesMCGonigle, D., Mastrian, K., (200). Nursing Informatics and the foundation of Knowledge

Ruesseler, M., Weinlich, M., Muller, MP., Byhahn, C., Marzi, I., Walcher, F. (2010). Simulation training improves ability to manage medical emergencies. Emergency J. (10) 734 -8.

ReferencesSutton, RM., Niles, D., Meaney, PA., Aplenc, R. (2010) Booster training: Evaluation of instructor led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during stimulated cardiac arrest. http://www.ncbi.nln.nih.gov/pubmed/20605336ReferencesThomas, F., Carpenter, J., Rhoades, C., Holleran, R., Snow, G. (2010). The usefulness of design of experimentation in defining the effect difficult airway factors and training have on simulation oral tracheal intubation success rate in novice intubators. Academy of Emergency Medicine (4) 460 - 3ReferencesWeidman, EK., Bell, G., Walsh, D., Small, S., Edelson, P. (2010). Assessing the impact of immersive simulation on clinical performance during actual in hospital cardiac arrest with CPR sensing technology: A randomized feasibility study. http://www.ncbi.nlm.nih.gov/pubmed/20724057