High-Fidelity Simulation

Introduction

Simulation can be presented to learners in many forms including such examples as case study or role playing.  For purposes of this blog, only high-fidelity simulation will be discussed. This technique has seen an increased interest and use in the last 10 years for several reasons.  The concept of improving safety for patients seems to be paramount.  Simulation can be used for both learning and evaluation purposes.  There is a plethora of literature and information on simulation with new articles published frequently.  The subjective experience of perceiving more confidence and competence has been well documented.  There has not been much support for finding differences using objective measures of safety and competence. One important article by written by Onello and Regan (2013) discusses how many simulation scenarios are at the rare, acute, emergent level possibly sensitizing them to be the nurse needs to be hypervigilant as the patient may become worse very quickly where, in most cases, patients' status changes much slower.  This is all related to the evolution of simulation.

History

In 2004, UINDY was given money by a benefactor to purchase the first high-fidelity simulator.  The administration felt that buying this equipment would, at the very least, function as a method of recruiting new students.  It gave the impression that UINDY was a cutting-edge school at the time. At the very most it was felt there would be some use for particular types of procedures that could be practiced. I was given the opportunity to learn Sim-man and operate it for learner use.  The simulation program has grown now to accommodate two simulation rooms that have at least two simulation mannequins in each along with a control room.  Usage has grown from once a semester to scenarios at least once a day.  The increase use not was not only due to faculty understanding the technology and but also healthcare facilities started feeling overwhelmed by the large number of requests for student learning experiences. This is the typical history of most academic institutions with the use of simulation.

Current Literature

As was described above, little objective data exists supporting the use of simulation even in current literature.  Here is one example where subjective data of confidence was measured but not the objective information that needs to be completed about competence and safety.  Mills, et al (2014). Another article that focuses on the current need for research and a review of the literature is by Garrett, et al (2010) from the journal called Nursing Education in Practice. 

Educator Learning Resources

Dr. Margie Porter has found the University of Washinton website to be a good resource for educators to learn about simulation. You will have to sign up for an account but then anyone can use the site.  There are lessons within the site including how to write scenarios to matching simulation with clinical education outcomes.  Thank you, Dr. Porter!   

 Use of Simulation for Objective Structured Clinical Examination

There is some controversy with the use of simulation in an evaluation setting.  One evaluation example that is well used in healthcare is the Objective Structured Clinical Examination (OSCE).  There has been some success with the use of this method.  Below are examples of both the simulation and debriefing using the OSCE format.  The example is evaluation of RN circulating nurse after orientation to the OR.  A graduate nursing student class took this technique on as a class project with successful results.  The orientees felt they had a fair evaluation and felt they had also learned in the simulation. 

The first movie shows a standardized patient wheeled into the OR after there was preparation and discussion with the patient.  The standardized patient was then replaced with the high-fidelity simulation mannequin for the actual procedure. 
OSCE Camera 2 

The second movie shows a clip of the OR simulation at the closing of the surgery from the OSCE performed by OR staff with the help of the graduate nurse educators.
OSCE Camera 1

This third movie shows a clip from the debriefing of the OSCE performed by OR staff with the help of the graduate nurse educators.

  OSCE Debrief