Simulation, which only a few years ago might have meant practicing cardiopulmonary resuscitation on an Annie mannequin, has evolved into a complex, high-tech learning experience.
Simulation has gone from having a mannequin and simulating a mock code to full-fledged human interactions … and very complex interdisciplinary patient care scenarios, said Roseann Pokoluk, RN-BC, MA, CNRN, LMT, director of nursing education at NYU Langone Medical Center in Manhattan.
NYU Langone partnered with the City University of New York to build the 25,000-square-foot New York Simulation Center for Health Sciences on the third floor of Bellevue Hospital in Manhattan. The center, which opens in July, will train nursing, medical, emergency and other healthcare personnel at the two universities and affiliated hospitals. It offers simulated OR and ICU rooms, and labor and patient interview suites.
Our plan is to utilize the center for different simulation opportunities, beginning with orientation of all members of the nursing department [not just RN staff] and, to create scenarios that are interdisciplinary, Pokoluk said. [These scenarios will] reflect the progression of staff through our clinical ladder, with increasing complexity for more advanced staff levels and including house staff, fellows, attending physicians and NPs.
Simulation also helps educators gauge students skills in action. We will be addressing psychomotor, cognitive and affective domain engagement through different types of scenarios, and utilizing high-fidelity equipment, video playback and debriefing and standardized patients, Pokoluk said.
High-tech simulations include computerized mannequins, which can be programed with vital signs and responses to various interventions. Patient care scenarios include trained actors or nursing and other staff, who play the roles of patients, family members and bystanders.
With the standardized patient, theres dialogue and interaction and youre really looking at the interpersonal communication, as well as engaging the learner at the affective level, Pokoluk said.
These high-tech simulation labs offer nurses and other healthcare providers an opportunity to practice real-life situations, without potential harmful effects, Pokoluk said.
Hackensack (N.J.) University Medical Center uses simulation with the high-tech mannequin SimMan made by Laerdal, according to Denise Occhiuzzo, RNC, MS, BC, administrative director of nursing, clinical education and nursing practice and Magnet program director at Hackensack.
We usually will follow an educational process that goes something like this: [Nurses] take a class. We then test their cognitive knowledge. From there, they will get a clinical experience in a laboratory, which is controlled (so, thats where simulation would be used in a controlled setting). Then, once they can perform in that controlled setting, they go to the clinical area with a preceptor, Occhiuzzo said.
Adding simulation, or hands-on learning, markedly increased nurses retention of what theyve learned, Occhiuzzo said.
Research has shown there are different levels of participation, which cause improved outcomes for learners, Occhiuzzo said. If you just read or hear something, youre going to get maybe 10% retention. If you read, plus see something, youre probably going to get [around] 20% retention. But if you read, see and act, within the scenario, and youre able to process with hands on, you can retain anywhere from 80% to 90%.
North Shore-LIJ Health System opened its state-of-the-art simulation lab five years ago. Its freestanding Patient Safety Institute features 10 simulation rooms, including med/surg, ICU, labor and delivery, and cardiac catheterization/OR, said Barbara DeVoe, DNP, FNP-BC, director of clinical education programs and the Patient Safety Institute, Center for Learning and Innovation at North Shore-LIJ Health System in Lake Success, N.Y.
DeVoe cites an example where the health systems cardiothoracic teams will use the center for a scenario with a post open-heart surgery patient, which is a mannequin.
Well have him dressed, with all the IV lines, bandages … as he would be if he were post-surgery, DeVoe said. Well then put a wife, or husband or a child in there to be a mild distractor and observe whether the interactions between the team and the family member are handled appropriately, all while caring for the sick patient.
Actually doing the simulation is only a part of the exercise, DeVoe says. Staff record audio and video of the simulated scenarios, so everyone can review the activity for the debrief.
The debrief is where all the learning happens because that is where the participants actually self-reflect upon what they just experienced, DeVoe said. Its about reviewing what the participants did in a safe, professional, knowledgeable manner, so that the learner walks away with ah-ha moments the take-away to improve their knowledge base.”
Big undertakingBarbara DeVoe, RN
Some simulation labs are independently staffed entities. Four of the six staff members at The Patient Safety Institute are nurses. One is an emergency medical technician; the other an administrative manager. Nurses roles include operations, writing scenarios, running and programming computers and conducting debriefings.
The Institute of Medicines recommendation to address medical errors with the use of simulation was among the inspirations for The Patient Safety Institute, DeVoe says.
While North Shore-LIJ is starting to measure behavioral outcomes associated with use of the simulation lab, it has linked one of its tertiary hospitals declining rate of central venous pressure infections to the centers CVP insertion line simulation class.
With the way that we need to deliver care in a team setting, this is a perfect environment. [Its safe] for physicians, nurses and any allied healthcare professionals to work together, she says. Simulation provides the environment for that to happen and, of course, the debrief provides the opportunity for reflection.