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.
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.
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
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
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.
