This chapter discusses human patient simulation as a teaching method in nursing education. It defines simulation as using lifelike mannequins and computer software to recreate clinical scenarios for students to practice skills. Theoretical foundations for simulation include situated cognitive learning theory. Key frameworks that guide simulation include the Simulation Framework for Nursing Education and the Clinical Judgment Model. Resources needed for simulation include physical space, equipment, and support personnel. Proper scenario development and debriefing are important when using this method. Potential problems include overgeneralizing findings to real patients and incorrect attribution of responses.

1. Chapter 14
Human Patient Simulation

2. Human Patient Simulation
• Definition and Purpose
• Theoretical Foundations
• Types of Learners
• Conditions for Learning
• Resources
• Using the Method
• Potential Problems

3. Human Patient Simulation
• Patient simulators have been used for more
than 50 years.
• Computer software may be used to teach a
variety of courses.
• Technical skills, such as those associated with
CPR, can be developed with the use of task
trainers.
• Virtual reality simulation enable the learner to
learn technical skills.

4. Definition and Purposes
• The first high-fidelity patient simulators
(HFPS) were developed in the 1960s.
• Their use became widespread in the
1990s when anesthesia educators and
researchers began to use them to
improve education and study clinical
performances.
• Computerized infant mannequins were
introduced in 2005.

5. Definition and Purposes
• Applications of HFPS have included
procedure training, evaluation of
individual responses to critical incidents,
equipment evaluation, task analysis, and
team training.
• The first nursing HFPS users were nurse
anesthetists.

6. Definition and Purposes
• Applications in nursing have expanded
to include acute care, critical care,
perioperative, and emergency nursing
situations.
• Areas of focus have included the
development of skills, critical thinking,
patient safety, competency testing, and
team development.

7. Definition and Purposes
• Components of Simulators
– Lifelike mannequin
– Freestanding enclosure
– Computer
– Interface

8. Definition and Purposes
• Simulation Experience
– A well-planned simulated clinical
experience allows the healthcare provider
to practice nursing skills under realistic
conditions in real time, using real supplies,
in a safe environment.
– Educational advantages include
opportunities for learners to improve skill
performance and clinical thinking, gain self-
confidence, and experience learner
satisfaction.

9. Definition and Purposes
• Simulation Experience
– Disadvantages include the investment costs
associated with the initial set up,
maintenance of the simulation laboratory,
and additional supporting personnel.
– The transfer of knowledge to actual clinical
practice is not well documented.

10. Theoretical Foundations
• Scientific curriculum in nursing has
historically featured lecture-based
instruction during the first two years of
training.
• Clinical practicum involved students
more effectively as active participants
with a contextual experience for the facts
they learned.

11. Theoretical Foundations
• Achieving a successful balance between
academic and clinical education has been
a challenge for educators.

12. Theoretical Foundations
• Principles of Situated Cognitive
Framework
– Thinking and learning as measures of
knowledge make sense only in particular
situations.
– People act and construct meaning within
communities of practice.
– Knowledge depends on the use of a variety
of artifacts and tools.
– Situations make sense with a historical
context.

13. Theoretical Foundations
• Insert Figure 14-1

14. Theoretical Foundations
• Principles of Situated Cognitive
Framework
– Thinking and learning as measures of
knowledge make sense only in particular
situations.
– People act and construct meaning within
communities of practice.
– Knowledge depends on the use of a variety
of artifacts and tools.
– Situations make sense with a historical
context.

15. Conceptual Frameworks
• Simulation Framework for Nursing
Education
– Recognized as a useful framework for the
implementation of research designs in
nursing education
– Skill performance levels were higher during
clinical rotation for those who prepared
with simulation than for those who did not

16. Conceptual Frameworks
• Simulation Framework for Nursing
Education
– Insert Figure 14-2

17. Conceptual Frameworks
• Clinical Judgment Model
– describes the variety of reasoning processes
that nurses experience as they provide care
in complex patient care situations
– nurses are continually learning as they
develop their expertise through experiences
and reflection

18. Conceptual Frameworks
• Clinical Judgment Model
– Insert Figure 14-3

19. Conceptual Frameworks
• Lasater Clinical Judgment Rubric
– From the conceptual framework of the CJM
– 4 phases of the CJM profived the basis for
the 11 dimension rubric
– Effective noticing involves focused
observations, recognizing deviations from
expected patterns, and information seeking.
– Effective interpreting involves prioritizing
data and making sense of data.

20. Conceptual Frameworks
• Lasater Clinical Judgment Rubric
– Effective responding involves a calm, confident
manner, clear communication, well-planned
intervention/flexibility, and being skillful.
– Effective reflecting involves evaluation/self-
analysis, and commitment to improvement.
– Offers students an opportunity to reflect on their
performance and rate themselves as exemplary,
accomplished, developing, or beginning following a
simulation experience.

21. Types of Learners
• Zone of proximal development–learning
is most effective where the content of
learning is just beyond the current
knowledge level of the student.

22. Conditions for Learning
• HPSs can be used in a wide variety of
situations for all types of students.
• Simulation used to precede, complement,
or replace actual clinical experience.
• Simulation can be used to orient
students to care on an unfamiliar unit.

23. Conditions for Learning
• Simulation can be used to allow students
to practice technical skills and decision
making before actual clinical
experiences.
• Students and faculty can replicate real
clinical experiences and then use the
simulator for reflection to explore
alternative strategies for managing a
given situation.

24. Conditions for Learning
• Simulation can be used to create learning
opportunities that are not ordinarily
available
• Simulation has been recognized for its
potential for formative and summative
evaluation of student skills.

25. Conditions for Learning
• Applications of simulation in summative
evaluation are controversial because the
relationship between the performance of
the student in a simulated environment
and the actual clinical setting has not
been demonstrated

26. Resources
• Simulators require a lot of physical space.
• Simulators require electricity and, in some
cases, gas.
• Patient care equipment may include
physiologic monitors, infusion pumps,
ventilators, anesthesia machines, and a
defibrillator.
• Support equipment includes airway devices,
needles, syringes, dressings, chest tubes, and
catheters.

27. Resources
• Video recording of sessions with subsequent
debriefing enhances the learning in a session
• Control room adjacent to the training room
with one way glass windows to allow
observation of simulation session
• Adequate personnel support is essential

28. Using the Method
• Scenario Development
– Determine educational objectives or goals.
– Construct a clinical scenario to facilitate
attainment of educational objectives.
– Define underlying physiologic concepts to
be manifested throughout the scenario.
– Modify programmed patients and scenarios
as necessary.

29. Using the Method
• Scenario Development
– Identify required equipment
– Run program and collect feedback.
– Repeat steps until satisfied.

30. Potential Problems
• Dependency on faculty support.
• Takes time to become comfortable with
the equipment.
• Incomplete presentation of reality
• Controlling the overgeneralization of
findings to the real world.
• Participants can become hypervigilant.

31. Potential Problems
• Applying an observed response in one
situation to all situations
• Incorrect attribution of simulation
responses.

32. Conclusion
• Used correctly, whole-body HFPS can
effectively bridge the gap between static
classroom-based instruction and the
dynamic, unpredictable clinical
environment.
• Simulation may eventually be used for
the majority of clinical time for nursing
education.