Hospital-based Simulation Research Articles

Simulation translation differences between craft groups

BackgroundMany simulation-based clinical education events (SBCEE) aim to prepare healthcare professionals with the knowledge, skills, and features of professionalism needed to deliver quality patient care. However, how these SBCEE learnings are translated into broader workplace practices by learners from different craft groups has not been described.ObjectivesTo understand how learners from different craft groups (doctors and nurses) anticipate simulation-based learnings will translate to their workplaces and the process by which translation occurs.DesignQualitative descriptive study design using pre- and post-SBCEE questionnaires.SettingsA large tertiary Australian hospital-based simulation centre that facilitates SBCEE for multi-professional graduate and undergraduate clinicians from 16 hospitals.MethodsParticipants who attended SBCEEs between May and October 2021 completed questionnaires at two touchpoints, on the day of attending a SBCEE and 6 weeks after. Based on a phenomenological approach, the study examined clinicians’ experiences in relation to simulation education, intended simulation learning use in the workplace, and perceived success in subsequently using these learnings to improve clinical outcomes. Qualitative inductive thematic data analysis was used to develop narratives for different learner cohorts.ResultsThree overarching themes were identified regarding simulation participants’ perceptions of the success of translating simulation learnings into the workplace. These were: scenario-workplace mirroring, self-assessment, and successful confidence. Doctor participants found it difficult to map SBCEE learnings to their workplace environments if they did not mirror those used in simulation. Nurses sought peer evaluation to analyse the effectiveness of their workplace translations, whereas doctors relied on self-assessment. Learners from both craft groups highly prized ‘confidence-building’ as a key indicator of improved workplace performance achieved through SBCEE learning.ConclusionA diverse range of factors influences healthcare workers’ experiences in translating simulation learnings to their workplace. To equip simulation learners to translate learnings from a SBCEE into their clinical practices, we suggest the following areas of focus: co-development of translation plans with learners during the delivery of an SBCEE including the indicators of success, above table discussions on the generalisability of learnings to different environments and contexts, smart investment in simulation outputs, and cautious championing of confidence-building.

Application of 3D Printing in Training Health Care Providers; the Development of Diverse Facial Overlays for Simulation-Based Medical Training.

The medical simulation manikins used by healthcare learners provide the training of numerous clinical skills but often lack diversity with respect to race, ethnicity, age, and sex. Having a diverse medical education environment is imperative for exposing learners to the diverse population of patients they may encounter when in practice. In this technical report, the development of diverse and cost-effective facial overlays produced using 3D scanning, 3D printing, and silicone to be used on top of the current medical manikins at Lakeridge Health Hospital (Oshawa, Ontario, Canada) is described. To obtain consistent feedback throughout the development process, an advisory committee was consulted monthly at Lakeridge Health Hospital. The process began by determining that two facial overlays would be developed based on the two groups that represent the highest percentage of visible minorities in the Durham Region (Ontario, Canada). Facial overlays representing the South Asian (31.8%) and Black (29.6%) races were chosen. To prevent the generalizability of the facial features of these two races, volunteers who identified as specific ethnicities (East Indian and Jamaican) within each race were selected. To add variation in age for the facial overlays, the East Indian facial overlay was edited to represent an adolescent teenager (15 to 17 years old) and the Jamaican overlay was edited to represent an elderly citizen (over 60 years old). The facial overlays were developed from the 3D scans of the two volunteers and were used to create the design of 3D printed molds, in which silicone was poured in. Pigments were added to the silicone to match the skin tones of the two volunteers, and these specific tones were used as the base color for each facial overlay. Details, such as wrinkles, eyebrows, and lip color, were painted on top of the base using additional pigmented silicone. Additionally, neck overlays were created to provide continuity of the skin tone of the facial overlay. To retain the functionality of the medical manikins, the eyes of the facial overlays were cut out, and the mouth was cut open to allow for intubation training. For stability purposes, Velcro attachments were added to the facial and neck overlays so that they could be secured onto the medical manikins. Overall, the costs to manufacture both facial overlays resulted in CAD 235.65, including local taxes. Once manufactured, both facial overlays were tested by medical students (n=18) during two separate advanced cardiovascular life support (ACLS) training sessions in the local, hospital-based simulation laboratory at Lakeridge Health Hospital. The feedback obtained suggested a need to improve the functionality of the facial overlays by making the mouths bigger and less stiff for easier intubation. However, the overlays were accepted overall as a means to add diversity to the current medical manikins. In the end, cost-effective and diverse facial overlays were created to be used on top of the medical manikins that are currently being used by healthcare learners at Lakeridge Health Hospital.

The Scope of Hospital-Based Simulation.

Healthcare simulation has expanded dramatically; however, little is known about the scope of simulation in acute care hospitals. A descriptive, cross-sectional online survey was used. Participants included nurse executives from acute care hospitals in California. Most organizations (96%) used simulation primarily for education, 37% used simulation for health system integration and systems testing, 30% used it for error investigation, 15% used it for research, and 15% used it for patient/family education. Organizations have a substantial opportunity to increase the scope of simulation beyond education to include systems integration, clinical systems testing, and other translational simulation activities. This targeted focus on patient safety and quality will allow hospitals to improve financial performance and maximize scarce resources.

Hospital-Based Simulation.

This chapter discusses the current state of hospital-based simulation, including the unprecedented events of 2020's global COVID-19 pandemic. Hospital-based simulation training requires a new approach. The realities of social distancing and the operational demands of hospital staffing ratios warrant creative adaptations of traditional simulation training methods. Hospitals used simulation to improve patient outcomes by training healthcare staff and students through telesimulation, and tested systems and equipment using in situ simulation (ISS). Latent safety threats (LSTs) were identified and corrected to improve patient outcomes. Hospital-based simulation has been incorporated into newly licensed registered nurses (NLRNs) residency programs to prepare them for competent practice. Simulations are also used for preparing staff for low-incidence, high-risk medical emergencies or disasters, such as active shooter events. Hospital-based simulation training adds value to healthcare systems, but requires more evidence of its quantitative and qualitative impacts.

Inspiring Young Learners Toward a Career in Healthcare Using Simulation.

To inspire young learners toward a career in healthcare and provide them opportunities to learn lifesaving skills, a hospital-based simulation center collaborated with a local middle school to develop a 88-minute simulation-based educational activity. The activity consisted of eight 10-minute stations on lifesaving and basic medical skills. One hundred fifty students participated. Evaluation surveys showed students favored stations with extensive hands-on activities and valued the opportunity to interact with health professionals. Students also reported more interest in science careers after the visit. This collaborative effort is time-efficient and low-budget simulation-based learning experience that had an immediate impact on middle school students.

"Ready SIM Go": An Adapted Simulation "Service Line" for Patients and Caregivers.

Changing healthcare systems and efforts to decrease medical costs have resulted in many more patients and caregivers (PCs) needing to manage life-sustaining therapies on their own. Given the potential for underpreparedness to result in increased morbidity and mortality, developing safe and efficient homecare training methods for PCs is essential. Medical simulation with PCs is an underused tool, which has the potential to decrease anxiety and increase preparedness through opportunities for repeated practice of medical procedures within a safe, controlled environment. This article describes the development of a hospital-based simulation service line for PCs, leveraging lessons learned from training for 250 patients and 450 caregivers in 14 different departments and subspecialties, and explains adaptations of standard simulation methods necessary for safe and effective use of simulation with this unique population. Process blueprint, examples of specific programs, as well as feedback from participants and clinicians are included.

ORGANIZATION OF SIMULATION MEDICAL EDUCATION

The article discusses the prioritization of hospital-based simulation training, such as in-house training and in-situ simulation training.

Evaluating Nurse-Physician Communication With a Rubric: A Pilot Study.

Poor communication is a leading cause of sentinel events. The aims of this pilot study were to determine whether the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Interprofessional Communication Rubric (IICR) was a reliable tool among nurses and to examine the communication performance of new graduate nurses in a hospital-based simulation center. The IICR demonstrated reliability among raters in this setting (rs = .91). The new graduate RNs' communication performance scores were low, warranting continued professional development. The IICR may be used to guide continued education and development for nurse-physician communication. [J Contin Educ Nurs. 2019;50(4):163-169.].

The Use of Hospital-Based Simulation in Nursing Education—A Systematic Review

BackgroundThe purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of hospital-based simulation with clinical nurses. The research question that guided this study was as follows: what research related to hospital-based simulation with clinical nurses emerged in the literature between January 2012 and October 2015? The design of this review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources are as follows: literature search was completed in PubMed, CINAHL, Cochrane Library, EMBASE, and Web of Science using a combination of medical subject headings, or MeSH terms, as well as keywords to retrieve non-indexed citations. MethodsThe inclusion criteria for this review were broad in order to disseminate information on future research needed; however, the sample had to include clinical bedside nurses, either alone or in conjunction with another professional group. The intervention had to include simulation, although no limits were made on the type of simulation. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language and between January 2012 and October 2015. ResultsThe database search strategy yielded 224 citations. These results were narrowed down to 65 studies based on identified inclusion criteria. ConclusionsMore randomized controlled trials and studies with power analyses and validated measurement instruments are needed to fully understand the impact simulation has on the practicing nurses at the bedside. There is also a need to investigate the effects of simulation education on patient outcomes.

Student Evaluation of Simulation in a New Hospital-Based Simulation Center

Student Evaluation of Simulation in a New Hospital-Based Simulation Center

LO064: Simulation in Canadian postgraduate emergency medicine training — a national survey

Introduction: Simulation-based medical education (SBME) is an important training strategy in emergency medicine (EM) postgraduate programs yet the extent of its use is variable. This study sought to characterize the use of simulation in FRCP-EM residency programs across Canada. Methods: A national survey was administered to residents (PGY2-5) and program representatives (PR), either a program director or simulation lead at all Canadian FRPC-EM programs. Residents completed either paper or electronic versions of the survey, and PR surveys were conducted by telephone. Results: The resident and PR response rates were 60% (187/310) and 100% (16/16), respectively. All residency programs offer both manikin-based high fidelity and task trainer simulation modalities. Residents reported a median of 20 (range 0-150) hours participating in simulation training annually, spending a mean of 16% of time in situ, 55% in hospital-based simulation laboratories, and 29% in off-site locations. Only 52% of residents indicated that the time dedicated to simulation training met their training needs. All PRs reported having a formal simulation curriculum with a frequency of simulation sessions ranging from weekly to every 6 months. Only 3/16 (19%) of programs linked their simulation curriculum to their core teaching. Only 2/16 programs (13%) used simulation for resident assessment, though 15/16 (93%) PRs indicated they would be comfortable with simulation-based assessment. The most common PR identified barriers to administering simulation by were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Both PRs and residents identified a desire for more simulation training in neonatal resuscitation, pediatric resuscitation, and obstetrical emergencies. Multidisciplinary involvement in simulations was strongly valued by both residents and PRs, with 76% of residents indicating that they would like greater multidisciplinary involvement. Conclusion: Among Canadian FRCP-EM residency programs, SBME is a frequently used training modality, however, there exists considerable variability in the structure, frequency and timing of simulation exposure for residents. Several common barriers were identified that impact SBME implementation. The transition to competency-based medical education will require a national, standardized approach to SBME that includes a unified strategy for training and assessment.

Transcending Competency Testing in Hospital-Based Simulation.

Simulation is a frequently used method for training students in health care professions and has recently gained acceptance in acute care hospital settings for use in educational programs and competency testing. Although hospital-based simulation is currently limited primarily to use in skills acquisition, expansion of the use of simulation via a modified Quality Health Outcomes Model to address systems factors such as the physical environment and human factors such as fatigue, reliance on memory, and reliance on vigilance could drive system-wide changes. Simulation is an expensive resource and should not be limited to use for education and competency testing. Well-developed, peer-reviewed simulations can be used for environmental factors, human factors, and interprofessional education to improve patients' outcomes and drive system-wide change for quality improvement initiatives.

Education and simulation training of pediatric intensive care unit nurses to care for open heart surgery patients.

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD. The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD. At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.

Playful Simulations Rather Than Serious Games

Medical simulation has historically been studied in terms of the delivery of learning outcomes or the social construction of knowledge. Consequently, simulation-based medical education has been researched primarily in terms of the transfer of skills or the reproduction of professional communities of practice. We make a case for studying simulation-based medical education as a cultural practice, situating it within a history of gaming and simulation, and which, by virtue of distinctive aesthetics, does not simply teach skills or reproduce professional practices but rather transforms how medicine can be made sense of. Three concepts from the field of game studies—play, narrative, and simulation—are deployed to interpret an ethnographic study of hospital-based simulation centers and describe underreported phenomena, including the cooperative work involved in maintaining a fictional world, the narrative conventions by which medical intervention are portrayed, and the political consequences of simulating the division of labor.

Board 235 - Program Innovations Abstract Launching and Sustaining an Interprofessional Community Hospital-Based Simulation Program (Submission #1420)

Introduction/Background Due to the emphasis on interprofessional learning, our hospitals launched an Interprofessional Simulation Program in 2011. The complexity of medical care, in addition to the inherent limitations of human performance, make it important for clinicians to use standardized communication tools, create an environment in which individuals can speak up and express concerns and share common language to alert team members of unsafe situations. Simulation is an ideal methodology for teaching and promoting these behaviors. Although we had many years of experience with nursing simulation, interprofessional simulation was new territory for us. We now had to consider issues such as recruitment and training of interprofessional faculty, recruitment of MD participants, coordinating schedules of interprofessional teams and funding. Several challenges arose during the process and there were very few non academic hospitals to serve as mentors for us along the way. This presentation will outline how to design, implement and sustain an interprofessional community hospital based simulation program. This is significant because it serves as a program template that can be replicated at other institutions as they launch interprofessional simulation. Methods Methods were as follows: 1)Create a shared need for interprofessional simulation; 2) Secure funding; 3) Identify and train MD/RN faculty; 4) Write interprofessional scenarios; 5) Hold interprofessional simulation sessions; 5) Create a plan for ongoing simulation faculty development; 6) Replicate the program in other departments. Results: Conclusion It was found that: 1) Program participants highly satisfied with interprofessional simulation; 2) Qualitative data that interprofessional simulation has improved teamwork and patient outcomes; 3) Commitment from administration to continue interprofessional simulation; 4) Plans to expand interprofessional simulation to other hospitals within our system. Disclosures None.

Closing the Gap: Simulation for Orientation of New Graduate Nurses Hospital-Based Simulation and Practice

Closing the Gap: Simulation for Orientation of New Graduate Nurses Hospital-Based Simulation and Practice

Establishment of a Hospital-Based Simulation Skills Laboratory

Today's healthcare environment requires that nurses be prepared for increasingly complex patient populations. Simultaneously, managers and educators are challenged to provide competency verification programs and continuing education opportunities with fewer resources. Hospital clinical educators share a staff development initiative of launching a unique simulation skills laboratory. The laboratory is designed to ensure nurses can meet the needs of patients in today's healthcare arena.