I need a response to this post from a peer. It has to be at least 800 words.
This weeksarticles were both interesting and enlightening. Having trained initially as anLPN in 1983 the simulations used differed greatly from those in play today. Wemostly had an inanimate manikin to practice skills with. No feedback, noscenarios but it was a safe atmosphere to practice skills and discuss mistakesmade. The practice room was set up like an open ward in a hospital would havebeen with all the appropriate equipment including hospital beds, overbedtables, bedside stands, IV poles, O2 outlets, curtains and a bedside chair. Forskills sessions requiring a more realistic patient the students would becomethe patient. The Patient would be given a set of instructions to follow, andthe student nurse would have a set of instructions to follow. Skills practicedin this manner included bed baths and backrubs, AM and HS care, vital signs anddressing changes. LPNs were taught how to monitor and discontinue IVs but notstart them. We used manikins for injection practice and suctioning practice. Overall,this would resemble more of a low fidelity set up. Fidelity meaning how realisticor closely imitates reality (Howard, 2020) In the LPN to RN program I attendedthere were no clinicals with the courses until the end when you did a three-dayperformance exam. The skillsdemonstrated for medications and sterile procedure were done on inanimatemanikins with voices or responses voiced by the instructors. A safe atmosphereto demonstrate skills and make mistakes but far from reality. The review courseI took prior to this exam was a hands-on review in a simulated hospital room.Several patient areas were set up for different scenarios- adult (we were thepatient), peds with an animated manikin that could cry or speak in response tothe care and an infant programmable manikin. The programable manikins ran a preprogrammedscenario that required nurse response. The Adult patient was given a script tofollow. The nurses were given a Kardex and had to perform certain skills basedon the patient care scenario they received. Other students would critic andcorrect the student as needed. Slightly higher fidelity but not as realistic asthe ones referred to in the article describing what Johns Hopkins is building.
WoltersKluwer (Howard,2020) describes the importance of increasing fidelity andrealism for nursing students. Faithfulness to reality in a simulation is crucialto it being an important lesson for students. If it doesnt feel real, then theimpact of the lesson isnt as effective. Simulation based learning provides a safeenvironment for learning, activities can be structured to meet specificobjectives and can be interrupted for teaching or correction as needed. Wellthought out and planned simulations provide for safe practice with the opportunityfor debriefing afterwards. Some sim labs are set up with the ability to videothe simulation and then can play it back for the students to critic or seewhere they didnt perform well. This allows students to employ critical thinkingskills, use of clinical judgment and get feedback.
We have learned that simulation canreplace up to 50% of the traditional clinical placements (Howard, 2020). Covidhad many nursing programs using online simulation programs like the Shadow Healthprogram used by Elms College. The problem with Shadow Health is that while thepatients give feedback it is often in a flat monotone voice. Use of simulationlabs and programmable manikins provides a more realistic experience. A funny sidenote on the Shadow Health program. My grandson aged twelve who play manydifferent types of games on his Switch and phone and has been my practicepatient once or twice told me that the patients dont seem real because theytalk funny. He is referring to their emotions and affect or rather the lack ofthem compared to his games. If we are going to continue with simulation training,we must ensure that the patient and the scenarios are as real as possible.
A clinical situation where usinglow fidelity could be CNA training. I taught CNA training in a local high schoolto students aged 17 and 18. Using programmable manikins to teach bed baths, hygieneskills, transfers, positioning and dressing skills was a safe noninvasive wayto have them learn the skills. Slightly higher fidelity was after they learnedsome skills using a manikin, they would practice with each other. Skillspracticed this way included transfers, positioning and feeding along with handand foot care and tooth brushing. By practicing on each other in class or ourlab area they learned how important It is to work with people and how to workwith patients who might not be as cooperative. The last step was going to anursing home and providing basic AM care and feeding for the residents. Again,slightly higher fidelity. Teaching the high school students was a learningexperience I treasure. Helping them helped me adapt as a teacher and encouragedme to seek out specific learning opportunities for them. Helping a student understand the process ofam care or bed baths was like watching a light bulb go off. Starting head to toe,how to properly fold the washcloth into a mitt and to refold as you changedbody areas, using clean ones for the face, main part of the body and limbs anda separate one for the private areas, maintaining patient privacy by only uncoveringthe specific part being washed and making sure all soap was rinsed off and the patientwas dried completely. The transition oflab to clinical setting connected the dots between low fidelity in the lab andmedium fidelity with a patient. High fidelity is the most realistic simulation perour readings. This is putting the student in a complex clinical where they haveto connect the dots, use critical thinking in patient care with a patient whomay have multiple comorbidities. A cardiac patient with fluid overload andrenal failure. The student has to do I&Os, monitor cardiac vital signs,watch labs for signs if increasing renal issues and teach the patient andfamily about the diet the patient must follow. Another simulation can be providingwound care for different types of wounds. The treatment regime is different forsurgical dressing changes compared to decubitus ulcers or burns. Simulationallows the student to learn and practice these skills safely. The differentlevels of fidelity also allow the student to be exposed to skills that they mightnot see otherwise.
To provide quality simulation learningrequires having quality sim labs. The labs mut be set up exactly as the clinicalunit would be to provide the right experience for the student. Johns Hopkins isessentially setting up a simulation hospital in one of their older buildings.This will allow nursing students and medical students to experience training inthe OR, medical surgical units, OB-Gyn situations like labor and delivery and postpartumcare. They plan to have debriefing rooms, classroom space for didacticlearning, videography for training and feedback, and all the needed suppliesincluding programmable manikins and actors who play the part of a patient. Thisis current and next generation learning.
In conclusion simulation has becomean accepted means to provide clinical experiences in a safe manner. It allowsstudents to apply skills and develop clinical thinking without putting a humanpatient in jeopardy and to get the appropriate debriefing and feedback tocorrect errors in the skills. My overall rationale for using simulationtraining is safety. The student can learn in a safe environment and thus willpotentially be exposed to more hands-on skills practice and scenarios than theymight see in traditional clinicals. Simulation has come a long way since my CNAand LPN days and further since I earned my RN. AS a nurse educator I look forwardto seeing simulation training facilities become part of the fabric of allnursing students training. I lookforward to seeing where the opportunities lie for faculty to become trained inthe use of simulation and perhaps be one of them. I look forward to the simulationclinical experience being created and its inclusion of high-quality simulationin properly furnished labs. The downside of this trend is a financial one. Itis costly to create, set up and maintain a state-of-the-art facility. Largerteaching hospitals will find it easier to do this because they can utilizeolder areas that furnish some of the required space and equipment as evidencedby the model Johns Hopkins is setting up (Dodson, 2016). Nursing schools willeither require more funding and space or perhaps may need to collaborate withlocal hospitals to use their training facilities. The future of simulation looksinnovative and exciting.
References-
Dodson, A. & Stone, V., (2016). Planning a simulationcenter. HFA Magazine. .
Howard, S., (2020). Increasing fidelity and realism in simulationfor nursing students. Wolters Kluwer. -realism-in-simulation
