Simulation Training for Nurses, Capstone Project Example

Benefits of Simulation Training for Nurses

Simulation training is the single most important trend in the education and training of healthcare personnel. The use of simulation training has historically been successful in other industries to include aviation and military personnel. Simulation training involves one of three categories; live, virtual, and constructive. Live simulation is the use of simulated, or dummy, equipment by real people in the real world. Virtual simulation refers to real people using simulated equipment in a simulated, or virtual, world. A constructive simulation situation is the use of simulated people using simulated equipment in a simulated world; commonly referred to as ‘war-games’.

The use of medical simulators has increased through this decade to teach therapeutics and diagnostics procedures, medical concepts and medical decision making. Original simulators were simple and basic human models. Today with the use of technology the models now can be as complex as the anatomy and musculoskeletal system and internal organ systems. Simulators involve computer technology linked to various equipment models for human bodies. Simulation training challenges and motivates individuals to break free from assumptions and freely learn from trial and error without patient harm. It allows nursing students and personnel to answer questions of ‘what if’ and sheds light on understandable and concealed hypothesis. Simulation training engages personnel interactively aiding them with the opportunity to practice and retain what they learn; applying it in a real life situation.

Advantages

Simulation training has several advantages for health care settings using this technology. A major advantage is the opportunity it presents for learners to critically analyze their actions or failure to act, to reflect on their technical, psychomotor and affective skills, as well as the opportunity to critique the clinical decisions of others (Broussard, 2008). Instructors and videotaping also aids in the learning experience. Nursing personnel and nursing students have the advantage of being able to see their mistakes or positive actions. They have the unique opportunity to be able to repeat the scenario for learning enhancement without human patient errors. Real life scenarios are limited due to patient safety concerns. This provides personnel the opportunity of making mistakes and discovering methods for correction and mistake elimination through trial and error.

Retention knowledge has been demonstrated by the active learning inherent in simulation training (Broussard, 2008). Retention of knowledge and trial and error practicing also provides enhanced confidence and decreases levels of anxiety through having successfully demonstrated a procedure or decision making process. Simulation training provides personnel with an increased level of comfort in multiple situations; developing a sense of professionalism and poise in all types of medical situations.

Challenges

Simulation training leaves little room for challenges for the learners involved.  The facilities and management are left with challenges through the costs of equipment, space, computer literacy and technical support (Broussard, 2008).  Ongoing support and maintenance are also considerations which should be thoroughly reflected before a final decision is made and implemented. The ability to properly train personnel on the use of the equipment and the level of personnel required for maintenance is a large portion of the decision making process for simulation training.

Project Objectives and Goals

Patient Safety

Simulation training provides a safe and effective means of preparing nurses for practice through various scenarios. Practicing on simulator mannequins built for use in the specific patient population the nurses will be serving helps demonstrate the various safety methods for best practice behavior. Mannequins are built to talk, cough, moan and breathe; they have audible heart, lung and bowel sounds (Waters, 2010). The mannequins are programmed for all various scenarios and the nurses are not aware of the program. They learn various things from these scenarios to include patient safety measures first. Students and beginning nurses will benefit from learning in a simulation lab since patient safety is still a theoretical concept to them (Day, 2007). The goal for this objective is less patient incidents and improved patient safety.

Clinical Skills Improvement

Simulation training in clinical skills improvement is important with the shortage of experienced nurses. Less experienced nurses affect new graduates since real life training on the job is limited. To address this problem nursing schools are increasing enrollment, putting more students in the hospital and expecting barely experienced nurses to take responsibility for teaching students the complexities of clinical practice (Day, 2007).  By implementing simulation training the goal is for new nurses and less experienced nurses to be able to spend time in the training labs to foster learning and experience without disrupting the routine of the normal workflow for continuity of live patient care.

Medical Error Disclosure

There are ethical and regulatory guidelines mandating the disclosure of medical errors which occur to families and patients (Wayman, et. al., 2009). The Joint Commission requires that all outcomes from a treatment or procedure be disclosed to the patient.  However, a formal training model is missing for teaching nurses and medical personnel how to deliver this type of communication. Simulation based training has more recently begun incorporating communication skill training such as end-of-life disclosure and experimental projects demonstrate simulation training can achieve significant changes in communication self-efficacy (Wayman, et. al., 2009). Using key medical personnel permits the trainee to feel at ease with learning through role playing to acquire skills at challenging situations. The goal of this simulation training is to teach nurses how to comply with the ethical, moral and regulations for health care error reporting effectively at all times.

Patient-Focus

While simulation training is well entrenched in a wide range of facilities, the need to incorporate professionalism and humility into the training should not be forgotten.  The nurse-patient relationship is one which impacts both individuals and can hinder or aid in the healing process. Incorporating real people who ‘act’ as the patient while using simulators for the procedure or surgery is an emerging trend which assist in keeping the border picture in mind as the trainee learns. This alternative of combining a human with the simulator creates a patient focused simulation training scenario (Kneebone, et. al., 2006). The goal is to keep the training experience rooted in real life practical experience for advanced learning in as close to a real world situation as possible.

Hand Off Event

A high risk aspect of health care is the changing of shifts; when one nurses leaves and the replacement steps in to take over patient care. This is referred to as ‘handing off’ and represents the point of transfer of the patient. This can be due to shift change or physical transfer of a patient. The communication and teamwork failures associates with handing off may be among the most important contributors to preventable adverse events in health care (Clancy, 2008). Nurses are key to the handing off events and often take unnecessary blame when things go wrong. Using simulation training with the use of mannequins is beneficial in teaching how to change the patient while communicating the diagnosis and treatment plans.  The goal of this stimulation training is to train personnel in the most efficient manner how to both be professional and patient focused for successful patient transfers.

Literature Review

Project Plan

The project plan for implementation of simulation training will include specific research on the five objectives and goals through literature research and benchmarking regional and national health care organizations. Developing simulation training should be designed so that healthcare providers can learn from practicing situations that they are likely to encounter (Brookes, 2009).

The plan will include a comprehensive model to offer a theoretical framework for processes measurements for nursing outcomes. Improved outcomes based on limitations and opportunities of simulation training between environment and technology is the goal of the project plan. Evidence based practice is the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances (Straus, et al., 2005). The project plan is to provide evidence based practice techniques to train nursing personnel in forming good clinical questions while searching for the evidence through effective search techniques through simulation training combined with individual investigation through databases, peer reviewed journal articles and internet services.

Action Plan

The use of wireless simulation equipment and mannequins as well as live volunteer individuals for incorporating patient focused training will be the focal point of the plan. Simulation specialists will be employed to operate the equipment from a control booth (Mercer, 2010).  Conducting the simulation training where the situation is likely to occur while videotaping the event will provide continuing learning for the trainee. A patient history should be given; one which is as close to a real human patient (Brookes, 2009).  Identification of problem areas will be documented and the trainee will use trial and error to perfect technique and behaviors.  Ultimately simulation training should be considered a mandatory practice (Brookes, 2009).

Simulation Model

The teacher in the model will be more of a facilitator and provide support as needed throughout the simulation and the debriefing that concludes the experience (Jefferies, 2005). Students will learn determined by the specific program difficulty, the level of experience they possess and their age. The teacher and student will work together as a team towards educational practices to include active learning, feedback, and collaboration.

The design characteristics of the simulation include the specific objectives of the training, the complexity and debriefing at the completion of the training. This phase of the model is considered the intervention phase. The outcomes will measure specifically the knowledge acquired, skill performance, learner satisfaction, critical thinking and the self-confidence as a result of the simulation training (Jeffries, 2005).

The simulation design should be created based on the goal of supporting the course goals; dependent on the clinical activity.  Goals for a medical procedure will differ from a surgical procedure. All simulation training is interdependent on the goal associated with the specialty. The design specifically must address the objectives, planning, fidelity, complexity, cues, and debriefing as the teacher and student interact (Jeffries, 2005).

Implementation Process

The implementation process should carefully consider all of the needs and assess the process from start to completion; with ongoing training and evaluation. Developing a model for optimization of simulation-based training systems should encompass a top-down systematic design procedure. Five vital tools should be used to address several problems of implementation. First it should be determined the tasks that will be needed to train both mannequin and human simulation techniques. Training for task efficiency and the instructional features needed is the next consideration and determination to be made. Methods should be developed to determine if training requirements can be done with cost limitation satisfaction. A determination will be made of the training devices needs which will comply with cost minimums. Training time to training device needs and constraints will be important in the implementation process.

Implementation Outcomes

Implementation outcomes should demonstrate the methodical and meticulous use of training tools and devices which will consistently share common data for the task requirements, device features and cost containment. A prototype decision support system should be developed with formative evaluation to demonstrate the need for simulation training on all levels for the nursing personnel. Successful implementation outcomes should demonstrate compliance with needs assessment, training utilization and cost limitation observance. Simulation training will be successful if it is implemented properly (Mamula, 2008).

Evaluation

Impact of Project

This project could drastically end unplanned learning where nurses, students and teacher work together to understand the experiences they encounter by chance in a hospital or clinic setting (Day, 2007).  Rather the impact of simulation learning and training would give control to healthcare personnel to be able to meet the objectives and goals of the project. It would greatly impact and improve hospital based nursing education.

Nurses face performance pressure on a regular basis through unexpected patient emergencies. Simulation training provides skills acquisition through experience and requires the right kind of engagement with practice situations (Day, 2007). This project will empower nursing personnel to work through a comprehensive model to acquire the skill set needed to work between structural factors and nursing outcomes; provided by the context of the organization.

Financial Benefits

Financial benefits include procedural time and instructor time savings with reduction in errors. Faster time to competence is a major financial benefit. There is a reduction in equipment breakage costs and other alternative training costs. There is a return on investment (ROI) documented through various studies. A study conducted in 2008 related to catheter-related bloodstream infections after simulation training revealed an annual cost of simulation-based training of $112,000 with a net annual savings greater than $700,000 which is a seven to one rate of return on simulation training intervention (Cohen, et al., 2010). Another study by Immersion Medical in association with Frost & Sullivan to determine the payback period was conducted with 237 attending staff physicians, risk management managers, CFOs and other personnel revealed traumatic results with payback periods ranging from just 57 days to 169 days. Return on revenue demonstrated an opportunity from $23,250 up to $150,000 per year (ExecutiveHM, 2010).

Cost of Project

The cost of this project will vary depending on the specific type and specialty of the simulation training and equipment. This is considered an investment one-time expense necessary to the development of the nursing simulation training center; incurred over a period of several years as allowable by the vendor.  Federal funding is also an area of consideration as a source of additional funds. The investment costs will include not only the purchase of equipment, but will also encompass the framework and time for implementation as well as staff time needed to set up the labs and training modules and develop the clinical scenarios to be used in competency education and validation (Harlow & Sportsman, 2007)

Measureable Outcomes

Developing an instrumental tool for measureable outcomes of nursing simulation training is beneficial to ensure quality controls and to measure the hierarchical cognitive processes and knowledge basis for training. The outcomes will be dependent upon the degree to which best practices in education are used in the simulation training. Specifically the participants in the training process will be evaluated for the knowledge and skill performance demonstrated. Additionally critical thinking and self-confidence will be expected to increase. Learner satisfaction is also important in gathering to assess the outcomes and success of simulation training. When faculty, students and nurses have high expectations for simulation process and outcomes, positive results can be achieved (Jeffries, 2005)

Areas for Improvement

Improvement needs will be derived by examining the simulation content, design and structure for complex medical and surgical training. External benchmarking in similar organizations for comparison will be an important step in ensuring quality training. The simulation type may need to be re-evaluated for quality training. Continue evaluation for improvement will be an ongoing factor after implementation of nursing simulation training in the hospital setting.

Summary

Nursing simulation training is complex and incorporates many elements and factors.  A thorough investigation into the components of the entire process will help guide the project from the inception and throughout the activities. Developing goals and objectives before implementation will build the foundation for the process of designing and implementing procedures and training modules. Careful consideration of the costs and return on investment should be a guiding factor throughout the entire process of research, implementation and evaluation of the project.

Simulation training aids in the critical thinking and confidence of nurses. It promotes teamwork among all levels of trainers and trainees. Successful implementation and continuation of simulation training provides complex scenarios necessary for group and individual exercises geared towards performance measurement and improvement for best practices in patient safety and quality patient care.

References

Brookes, L. (2009, May 21). Developing simulation training for medical emergencies. Medscape General Surgery, Retrieved from http://www.medscape.com/viewarticle/702989

Broussard, L. (2008). Simulation-based learning. Nursing for Women’s Health, 12(6), Retrieved from http://www3.interscience.wiley.com/cgi-bin/fulltext/121576216/PDFSTART\

Clancy, C.M. (2008). The Importance of simulation: preventing hand-off mistakes. Association of periOperative Registered Nurses, 88(4), Retrieved from http://www.nursingconsult.com/das/journal/view/200674544-2/N/21253129?issn=00012092&ja=664983&ANCHOR=text&PAGE=1.html

Cohen, E.R., Feinglass, j., Barsuk, J.H., Barnard, C., & O’Donnell, A. (2010). Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. The Journal for the Society for Simulation in Healthcare, 5(2), Retrieved from http://journals.lww.com/simulationinhealthcare/Abstract/2010/

Day, L. (2007). Simulation and the teaching and learning of practice in critical care units. American Journal of Critical Care, 16(5), Retrieved from http://ajcc.aacnjournals.org/cgi/reprint/16/5/504

ExecutiveHM.  (2010). How Hospitals benefit from surgical simulation systems. (2010). ExecutiveHM, Retrieved from http://www.executivehm.com/article/How-Hospitals-Benefit-from-Surgical-Simulation-Systems/

Jeffries, P.R. (2005). A Framework for designing, implementing and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), Retrieved from http://livingbooks.nln.org/hits/chapter_03/Jeffries_article_NEP.pdf

Harlow, K.C\., & Sportsman, S. (2007). An Economic analysis of patient simulators for clinical training in nursing education. BNET, Retrieved from http://findarticles.com/p/articles/mi_m0FSW/is_1_25/ai_n27168044/pg_3/?tag=content;col1

Kneebone, R, Nestel, D, Wetzel, C., Psych, D., & Black, S. (2006). The Human face of simulation: patient focused simulation training. Academic Medicine, 81(10), Retrieved from http://journals.lww.com/academicmedicine/Abstract/2006/10000/The_Human_Face_of_Simulation__Patient_Focused.15.aspx

Mamula, K.B. (2008, June 6). University of Pittsburgh subsidiary bringing simulation training products to market. Pittsburgh Business Times, Retrieved from http://www.bizjournals.com/pittsburgh/stories/2008/06/09/story12.html?t=printable

Mercer, B. (2010). Simulation training for nurses: technology provides nurse educators with new tools of the trade. Advance for Nurses, Retrieved from http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=221332

Strauss, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). Evidence-based medicine: How to practice and teach EBM (3rd ed.). Edinburgh; New York: Elsevier/Churchill Livingstone.

Waters, S. (2010). Simulation education for nurses; high-tech patient simulators offer educators exciting training alternatives for all nursing staff. Advance for Nurses, Retrieved from http://nursing.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=212561

Wayman, K.L., Yaeger, K.A., Sharek, P.J., Trotter, S., & Wise, L. (2009). Jhq 198 simulation based medical error disclosure training for pediatric healthcare professionals. National Association for Healthcare Quality, Retrieved from http://www.nahq.org/journal/ce/article.html?article_id=283