High-fidelity Human Patient Simulation Research Articles

Empathy and High-Fidelity Human Patient Simulators: A Critical Analysis of Undergraduate Nursing Education

Empathy and High-Fidelity Human Patient Simulators: A Critical Analysis of Undergraduate Nursing Education

Using High‐fidelity Human Patient Simulation to Teach Functional Aerodigestive Tract Anatomy And Bridge Clinical Skills: Student Perceptions of Clinical Preparedness

Introduction & ObjectiveHigh‐fidelity human patient simulation (HPS) improves emerging clinical competencies in medical training programs. HPS simulates complex learning environments while minimizing risks. Limited evidence is available regarding HPS use in aerodigestive tract (AT) disorders. Our objective was to explore clinical graduate students’ perceptions regarding their knowledge, skills, and confidence in functional AT anatomy across three different learning environments: didactic, standardized patient (i.e., role play), and HPS.Materials & MethodsUsing a cross‐over design, and following completion of didactic head and neck anatomy lectures, graduate students in a speech‐language pathology clinical program were randomly assigned to one of two case‐based scenarios: standardized patient (STP) or HPS. Following the completion of their assigned scenario, students then completed the alternate. A self‐administered survey using a 10‐pt Likert scale (1 = none/no, 10 = extreme/strongly agree) rated student perceptions across domains of knowledge (K), skills (S) and confidence (C) at four time points (baseline, after didactic, STP, and HPS). Between and within subject comparisons were conducted using the repeated measures. For each domain (K, S, and C), separate and aggregate group mean differences were calculated comparing the domains using t‐test with Welch modification (assuming unequal variance). Within subject changes following each learning environment were calculated using Pearson product moment. Statistical significance was p< .05.ResultsA total of 66 (N) students participated with 227 surveys completed (50% response rate). Across participants, mean (SD) baseline knowledge (4.6 [2.3]), skills (3.6 [2.3]) and confidence (3.2 [2.0]) significantly improved to 7.7 (1.2), 7.1 (1.5) and 6.7 (1.7) respectively following all learning environments. Significant overall increase across K, S and C (aggregate) was 1.5 and strongly correlated to didactic lecture r(35) = .76 (p<.001) and the completion of one scenario r(27) = .84 (p<.001). When comparing STP and HPS, significant improvements were reported in the areas of knowledge (+0.4, p<.05) and confidence (+0.3, p<.05) only with strong correlation to HPS (K=r(23) = .80, p<.001; C = r(23) = .90, p<.001). The majority strongly agreed that both STP and HPS are extremely useful (9.3 [1.2]). Overall, mean (SD) perceived clinical reasoning increased from 3.7 (2.2) to 6.7 (1.1) with significant improvements following didactic (p<.01) at least one case scenario (p<.001), however no significant differences were observed when comparing STP to HPS. Students rated the value of both STP and HPS highly (9.4 [1.2] vs. 9.3 [1.1]).Conclusion & SignificanceStudents perceived that multiple learning environments enhance their knowledge, skills and confidence in AT disorders. While they determined that STP and HPS are equally valuable, their knowledge and confidence improved significantly following HPS. Clinical skills did not change between STP and HPS. This study was the first to develop HPS modules while incorporating functional AT anatomy with clinical skills training across didactic and STP environments. Student learning and confidence is maximized through these environments and using HPS is feasible and effective in our clinical training program.

The Use of Simulation Based Learning: With Bachelor of Science Pharmaceutical Science and PharmD Students

Background and purpose Interprofessional education between bachelor of science pharmaceutical science (BSPS) students and Doctor of Pharmacy (PharmD) students is rare. According to the Association of American Medical Colleges, more than 80% of medical schools incorporate simulation based teaching within all four years of the curriculum. Educational activity and setting: The University of Rhode Island College of Pharmacy healthcare simulation lab has developed integrated educational opportunities for both groups of students by offering independent study opportunities that allow BSPS students to collaborate with PharmD students. A recent example of this model includes BSPS student development of patient cases which are integrated into high-fidelity human patient simulators with faculty assistance. A senior BSPS student researched and designed four clinical patient cases which were presented to P3 pharmacy students. Findings: In all four cases, there was an increase in knowledge and attitudes following the simulation. Qualitative comments from students noted the importance of patient education and an enhanced ability to manage disease and side effects. Summary: The nature of the simulation lab at the University of Rhode Island is a platform that can be modeled by other institutions with both PharmD and BSPS programs.

Increasing Student Confidence With Medically Complex Infants Through Simulation: A Mixed Methods Investigation.

The purpose of this study was to compare student knowledge and confidence, related to the assessment and management of oral feeding readiness in medically complex infants, following a written case study versus a high-fidelity human patient simulation (HPS). A sequential, two-phase, embedded mixed methods design was conducted. Participants were two sequential cohorts of second-year speech-language pathology graduate students enrolled in a didactic Pediatric Dysphagia course. At the end of the course, students completed the same case scenario presented as a written case study (control group; N = 28) or as an HPS (experimental group; N = 24). Pre- and post-knowledge assessment results and self-assessments of confidence conducted at three time points were compared. All students made gains in knowledge, regardless of intervention (written case study or HPS). Despite different baselines, the percent change in knowledge was significant with the control group improving 33% and the experimental group improving 76% from baseline. Students in the experimental group demonstrated significantly greater gains in confidence with skills enhanced by the hands-on, immersive experience of HPS. Qualitative analysis further identified factors contributing to increased confidence with all students reporting that experience significantly contributes to their confidence in their ability to treat patients. While knowledge outcomes were similar between the groups, the confidence that the experimental group gained through the hands-on experiences of HPS fosters student development as confident professionals in assessing feeding readiness and managing medically complex infants. Results support integration of simulation into the graduate curriculum to support student learning. https://doi.org/10.23641/asha.19233504.

Using Simulation to Teach Transitions of Care for Hospitalized Patients.

Understanding and facilitating the seamless and safe transitions of patients across high-acuity hospital settings are important for students to grasp in order to meet patient and family care needs. Clinical placements do not always give students the opportunity to care for patients in various hospital settings or apply complex knowledge and skills learned in their didactic courses. Furthermore, the global pandemic has limited student clinical experiences in health care settings, underscoring the need for simulated clinical learning opportunities. A multiscenario simulation using a high-fidelity human patient simulation manikin was incorporated into a senior-level capstone course. Simulated hospital settings included the (1) emergency department, (2) critical care unit, and (3) progressive care unit. Student evaluations revealed positive perceptions of learning, enhanced proficiency of clinical skills, and increased confidence regarding transitions of care. Faculty held agreeable opinions of the simulation's ease of facilitation and effectiveness as a teaching tool. Application of complex knowledge and skills, understanding the use of bundles of care, and an appreciation for transitions of care hospitalized patients were successfully achieved.

The Effect of Simulation Method on Nursing Students' Burn Patient Care Planning: A Randomized Controlled Trial.

In nursing education, the rate of students to practice for burn patient care is low. This research was carried out as a single-blind randomized control group intervention trial to determine the effectiveness of simulation method performed using high-fidelity human patient simulator in nursing students' burn patient care planning. The research was conducted with randomly selected 61 students including 31 in intervention and 30 in control groups. In the application process of the research, knowledge tests were administered as a pretest, second test, and posttest, and the first and second applications of burn patient care plans were performed with all students. In the research, the application of burn patient scenario was performed only with the intervention group. As a result of the research, it was found that the posttest knowledge scores of the students in the intervention group increased significantly compared with the control group (P < .05). According to the intergroup evaluations, there was no significant difference between the intervention and control groups in terms of care plan scores (P > .05), whereas the scores for the second burn patient care plan of the intervention group were higher compared with those of the control group. The simulation method was found to increase students' knowledge levels, and the employment of the method in nursing education is recommended.

Effect of high fidelity simulation on clinical decision-making among nursing students

ABSTRACT It became necessary to integrate alternative teaching methods having excellent results in the nursing curriculum such as high-fidelity human patient simulation. High fidelity simulation improves nursing students’ thinking, and emotional and decision-making capabilities. The pretest – posttest control group design was conducted to examine the effect of high-fidelity simulation (HFS) intervention on clinical decision-making for pediatric nursing students at the Arab American University in Palestine. One hundred fifty participants took part in the present study, where 50% (n = 75) were in each of the intervention and control groups. The intervention group received theory-based learning and high fidelity simulation, while the control group was provided with theory based learning and usual training in the nursing laboratory. Findings showed that after implementing the intervention, a significant change was noticed in means of clinical decision-making between the control and intervention groups. Therefore, high fidelity simulation intervention was effective, thus it could benefit the nursing students by enhancing clinical decision-making. The results support nursing educators and universities especially in developing countries to adopt such an intervention strategy for nursing students.

Simulation-Based Operations.

Simulation pedagogy and the operations of simulation-based experiences have become an integral part of healthcare education. Academic and healthcare institutions constructed simulation centers or dedicated simulation spaces to provide simulation-based experiences for multiple health professions. Architectural designs resemble acute care settings that have the flexibility to change or include virtual reality and enhanced technology. Professional organizations have standards of best practice, credentialing requirements, and accreditation standards that support the need for high-quality, high-fidelity simulation experiences. Within healthcare education, simulation operation has become a specialty in itself that requires knowledge and experience of healthcare, education, and simulation pedagogy (INACSL Standards Committee, 2017). Simulation center administration needs an understanding of personnel management, including standardized patients (SPs), staff, faculty, and learners, as well as knowledge of budgeting, revenue streams, and technology. Personnel with unique skills and knowledge in engineering, healthcare, or information technology are required to support the simulation activities. Resources that manage inventory, supplies, equipment assets, and audiovisual requirements will increase efficiency and enhance fiscal responsibility. Technology assets such as high-fidelity human patient simulators can be used to enhance high-quality simulation, while audiovisual and data capturing software can be used for assessment, evaluation, and quality improvement. Simulation operations provides the infrastructure that supports the daily activities of simulation-based education.

Seeking reality through the unreal: Interviewing high-fidelity human patient simulation in undergraduate nursing education

Abstract This article examines the use of high-fidelity mannequins in simulation scenarios as used in nursing undergraduate education. Notwithstanding a lack of robust support in the research literature regarding outcomes, these mannequins have been broadly taken up by educators. Employing a form of posthuman inquiry, I explore how the use of high-fidelity mannequins may affect the student nurses’ relation with real living bodies, and therefore the people they eventually look after. Ways to mitigate the potential side-effects of the medium are offered, including a reframing of the simulation scenario.

Differential Ventilation Using Flow Control Valves as a Potential Bridge to Full Ventilatory Support during the COVID-19 Crisis.

Background:During the COVID-19 pandemic, ventilator sharing was suggested to increase availability of mechanical ventilation. The safety and feasibility of ventilator sharing is unknown.Methods:A single ventilator in pressure control mode was used with flow control valves to simultaneously ventilate two patients with different lung compliances. The system was first evaluated using high-fidelity human patient simulator mannequins and then tested for 1 h in two pairs of COVID-19 patients with acute respiratory failure. Patients were matched on positive end-expiratory pressure, fractional inspired oxygen tension, and respiratory rate. Tidal volume and peak airway pressure (PMAX) were recorded from each patient using separate independent spirometers and arterial blood gas samples drawn at 0, 30, and 60 min. The authors assessed acid-base status, oxygenation, tidal volume, and PMAX for each patient. Stability was assessed by calculating the coefficient of variation.Results:The valves performed as expected in simulation, providing a stable tidal volume of 400 ml each to two mannequins with compliance ratios varying from 20:20 to 20:90 ml/cm H2O. The system was then tested in two pairs of patients. Pair 1 was a 49-yr-old woman, ideal body weight 46 kg, and a 55-yr-old man, ideal body weight 64 kg, with lung compliance 27 ml/cm H2O versus 35 ml/cm H2O. The coefficient of variation for tidal volume was 0.2 to 1.7%, and for PMAX 0 to 1.1%. Pair 2 was a 32-yr-old man, ideal body weight 62 kg, and a 56-yr-old woman, ideal body weight 46 kg, with lung compliance 12 ml/cm H2O versus 21 ml/cm H2O. The coefficient of variation for tidal volume was 0.4 to 5.6%, and for PMAX 0 to 2.1%.Conclusions:Differential ventilation using a single ventilator is feasible. Flow control valves enable delivery of stable tidal volume and PMAX similar to those provided by individual ventilators.

Anesthetists’ Heart Rate Variability as an Indicator of Performance During Induction of General Anesthesia and Simulated Critical Incidents

Abstract. In the environment of anesthesia, good performance describes the absence of threat for the patient as well as a quick reaction to challenging and possibly life-threatening circumstances. Elsewhere, performance and cognitive function have been linked to indicators of vagally-mediated heart rate variability (HRV). This exploratory study examines the correlation between anesthetists’ HRV and their performance during uneventful induction of general anesthesia and during a simulated critical incident. For this study electrocardiograms (ECG) were obtained from two different groups of anesthetists providing general anesthesia in uneventful real cases in the operation room (OR, n = 38) and during the management of a hypotension scenario in a high-fidelity human patient simulator environment (SIM, n = 23). Frequency, time domain, and nonlinear HRV metrics were calculated from 5-min ECG recordings. To separate high performing (HP) and low performing (LP) individuals, the time needed for induction (in the OR setting) and the length and depth of hypotension (in the SIM setting) were used as performance correlates. The Mann-Whitney- U-test was used to assess differences in HRV within the groups. In both settings (OR and SIM), linear and nonlinear HRV metrics did not differ significantly between the HP and LP group. Also, the anesthetists’ work experience and sex were not related to performance. While providing general anesthesia and during a simulated critical incident, high and low performing individuals do not differ with respect to HRV metrics, sex, and work experience. Further research including the HRV under resting conditions is necessary.

How to increase knowledge from lectures of vitaly endangered patient and resuctitiation - mobile simulation training for rural providers

With simulations in healthcare we can successfuly increase knowledge from lectures of vitaly endangered patient and resuctitiation (Kalischi, 2014, Kneebone, 2005, Cook idr, 2011; Eppich, Howard). Simulation is an excellent way for health care worker to train their skills in a safe environment. But sadly, learning with simulations in healthcare is usually not available to professionals. Contributing factors to this problem are the lack of knowledge and poor equipment combined with high education costs and time shortage in medical teams. We have developed a mobile simulation unit (»SIM mobile«) that will enable all medical teams in primary healthcare access to modern simulation equipment. »SIM mobile« is a mobile education unit which brings state of the art, hands–on training, using high fidelity human patient simulators, to prehospital and hospital professionals. The »SIM mobile« is a 16 metres long trailer with two simulation spaces.

Effect of case study versus video simulation on nursing students' satisfaction, self-confidence, and knowledge: A quasi-experimental study

BackgroundResearch on simulation in nursing education has demonstrated the positive impact active, experiential learning has on student satisfaction, self-confidence, and knowledge. As a result, simulation laboratories with high-fidelity human patient simulators have become a common adjunct to clinical teaching. It is important to also promote active learning in the classroom setting; however, there is limited evidence on using video simulations in large classrooms. ObjectivesThis study sought to determine if using a video simulated unfolding case study as part of the didactic classroom, as compared to a traditional written case study, improved students' satisfaction, self-confidence, and knowledge. DesignA two-group, quasi-experimental design was used. SettingsThe study occurred at a University in the southeastern United States. ParticipantsA total of 165 baccalaureate nursing students participated. MethodsThe control group received a written case study, while the intervention group received video simulation of the same case study and student satisfaction, self-confidence, and knowledge were measured upon completion. Data analysis used descriptive statistics and t-tests. Qualitative comments were also provided by students and analyzed for themes. ResultsThere were no statistically significant differences, with both groups reporting a high level of satisfaction and self-confidence. The percent of knowledge questions answered correctly was higher for the video simulation group for all seven questions. Four themes were identified from participant words: A better understanding, Able to apply learning to a patient scenario, Engaged in learning, and Visualizing it helps. ConclusionsResults suggest the use of video simulation in the classroom may deepen students' understanding of classroom content and provide an additional mode for learning to enhance classroom lecture. Use of video simulation to augment classroom teaching is suggested as a strategy for engaging learners.

Promoting experiential learning through the use of high-fidelity human patient simulators in midwifery: A qualitative study.

BackgroundThe need to use innovative teaching and learning strategies in the nursing pedagogy is important in the 21st century. The challenges of clinical sites and opportunities for nursing students to gain clinical experience are a growing concern for many nurse educators. High-fidelity human patient simulators (HFHPS) are computerised mannequins that replicate a real-life patient, and when integrated into classroom teaching they allow students to become fully immersed into an almost real-life scenario.ObjectivesThe aim of this study was to describe how HFHPS can promote experiential learning following the management of postpartum haemorrhage as a midwifery clinical emergency.MethodA descriptive qualitative research approach was carried out in this study. The research setting was a local university in KwaZulu-Natal. The total population included all (N = 43) fourth-year baccalaureate of nursing undergraduate student midwives who participated as observers and/or role-players of a scenario role-play. An all-inclusive sampling was performed. There were 43 student midwives involved in the simulation teaching session with 6 of these students actively participating in each role-play at a time, while the remaining 37 observed. This occurred in two separate sessions and all the student midwives were involved in a debriefing session. These student midwives were then followed up and asked to participate in a focus group. The data in this article came from two separate focus groups which comprised 20 student midwives in total. Data were analysed using content analysis.ResultsFour categories emerged from the data, namely HFHPS offers a unique opportunity for student midwives to manage complex real-life emergencies; promotes reflection by allowing student midwives to reflect or review their roles, decisions and skills; allows student midwives to learn from their own experiences and encourages student midwives to try out what they learnt in a real-life situation.ConclusionHigh-fidelity human patient simulators can be used in a complex case scenario to promote experiential learning of a clinical emergency.

High-flow nasal cannula therapy reduced the respiratory rate and respiratory distress in a standard model simulator and in patients with hypoxemic respiratory failure.

High-flow nasal cannula (HFNC) therapy has been increasingly applied to treat patients with severe hypoxemic respiratory failure. We investigated whether vital signs reflect the reduction of work of breathing in a simulator study and a clinical study. In the simulator study, a standard model high-fidelity human patient simulator (HPS) directly received 35 L/minute of 100% O2 via the HFNC. In the clinical study, the medical records of patients with hypoxemic respiratory failure who received HFNC therapy between January 2013 and May 2015 were retrospectively reviewed. Statistical analysis was performed using a one-way repeated analysis of variance followed by Bonferroni post-hoc testing. In the HPS, HFNC therapy significantly reduced the partial pressure of alveolar CO2, respiratory rate, and tidal volume (p < 0.001), and all values returned to baseline following HFNC therapy termination (p < 0.001). In the clinical study including 48 patients, the respiratory rate was significantly reduced from 27 ± 9 (baseline) to 24 ± 8 (3 hours), 24 ± 8 (5 hours), and 24 ± 8.0 (6 hours) (p < 0.05). The heart rate also decreased significantly (p < 0.05). Our results suggested that HFNC therapy reduced work of breathing and assessing vital signs can be important.

A High-Fidelity Human Patient Simulation Initiative to Enhance Communication and Teamwork Among a Maternity Care Team

ObjectiveTo use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies. DesignQuality improvement initiative. Setting/Local ProblemThe labor and delivery team at a large suburban Level 2 facility in the Midwestern United States sought to apply evidence and use simulation to improve communication and teamwork. ParticipantsApproximately 170 maternity care staff members, including nurses, anesthesia providers, and pediatric and obstetric physicians. Intervention/MeasurementsDuring each simulation, there were two scenarios with a debriefing session at the end of each. Teamwork and communication were evaluated using participant surveys. ResultsParticipants reported improved communication (p = .031) and teamwork (p = .041) after simulation. Additionally, 81% of respondents believed that their ability to perform clinical skills improved. ConclusionUse of high-fidelity human patient simulation was associated with improved teamwork and communication for a maternity care team. Simulation has been incorporated into standard education. We hope to sustain successful outcomes by providing ongoing simulation experiences for labor and delivery staff annually.

Bridging burn care education with modern technology, an integration with high fidelity human patient simulation

ObjectiveThe Advanced Burn Life Support (ABLS) program is a burn-education curriculum nearly 30 years in the making, focusing on the unique challenges of the first 24h of care after burn injury. Our team applied high fidelity human patient simulation (HFHPS) to the established ABLS curriculum. Our hypothesis was that HFHPS would be a feasible, easily replicable, and valuable adjunct to the current curriculum that would enhance learner experience. MethodsThis prospective, evidenced-based practice project was conducted in a single simulation center employing the American Burn Association’s ABLS curriculum using HFHPS. Participants managed 7 separate simulated polytrauma and burn scenarios with resultant clinical complications. After training, participants completed written and practical examinations as well as satisfaction surveys. ResultsFrom 2012 to 2013, 71 students participated in this training. Simulation (ABLS-Sim) participants demonstrated a 2.5% increase in written post-test scores compared to traditional ABLS Provider Course (ABLS Live) (p=0.0016). There was no difference in the practical examination when comparing ABLS-Sim versus ABLS Live. Subjectively, 60 (85%) participants completed surveys. The Educational Practice Questionnaire showed best practices rating of 4.5±0.7; with importance of learning rated at 4.4±0.8. The Simulation Design Scale rating for design was 4.6±0.6 with an importance rating of 4.4±0.8. Overall Satisfaction and Self-Confidence with Learning were 4.4±0.7 and 4.5±0.7, respectfully. ConclusionsIntegrating HFHPS with the current ABLS curriculum led to higher written exam scores, high levels of confidence, satisfaction, and active learning, and presented an evidenced-based model for education that is easily employable for other facilities nationwide.

Simulation provides deep learning opportunities for medical students intercalating in the biosciences.

Intercalation in the biosciences is popular with medical undergraduates in the UK and is mandatory at some institutions. It is considered important that medical students develop skills and an interest in innovation and research1 and is recognised as one way to enhance the knowledge of research methodology.2 The intercalated year helps to meet these aims by including research project work as part of the core course content. Projects are often practical and laboratory-based, as well as other out-of-laboratory options such as literature review or producing a grant proposal. Projects must fulfil a set of intended learning outcomes, for example, in final-year degree courses in this School: ‘deep understanding of a scientific or educational question; the ability to gather information from the scientific and/or educational literature and critically evaluate and appraise competing theories; the ability to present original findings and ideas to a specialist audience’. We offer projects that fulfil these outcomes exploring key areas of integrative, human physiology using high-fidelity human patient simulators.3 The simulators used here are manikin-based with an integrated and real-time model that provides …

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success

Introduction: Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance.Objectives: The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success.Methods: The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation.Results: A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311).Conclusions: An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

Faculty Experiences with Integrating Mandated High-Fidelity Human Patient Simulation (HF-HPS) Into Clinical Practice: A Phenomenological Study.

Background High fidelity human patient simulation (HF-HPS) is a teaching innovation in nursing education which may not be used to its full potential. This study seeks to understand the lived experiences of nurse faculty who are required to integrate HF-HPS into their teaching practice. Method A phenomenological methodology was used. Seventeen female nurse faculty teaching in the second year of a new collaborative bachelor of science in nursing program were interviewed about their experiences integrating mandated HF-HPS into their teaching practices. Results Six themes describing the participants' experiences were identified: striving for self-efficacy, struggling to maintain autonomy, being part of a community of practice, adopting HF-HPS as a teaching innovation, being an advocate, and being proud. An emerging theme, being an outsider, was discussed. Conclusion This research has implications for nurse faculty and educational administrators integrating a new teaching innovation.