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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