Human Simulators to Teach Students and RNs - Research Paper Example

Running head: Human simulators to teach students Human Simulators to Teach Students and RNs Introduction There are various means and methods of teaching. These methods all contribute to the process of learning for most students and practitioners. The learning process in the health sector is particularly driven by actual applications of procedures. The effective teaching of these procedures is crucial to the efficient delivery of health services. This paper shall discuss informatics in health care, more particularly the use of human simulators in teaching students and Registered Nurses (RNs). It shall first present a description of the topic selected. It shall also discuss why this topic was selected and how it involves informatics. It shall also discuss the impact of human simulators and how they improve or deter patient care, and how they improve or deter nursing education. This research is being carried out in order to conceptualize a thorough and comprehensive understanding of human simulators as a teaching aid. Discussion Human patient simulation (HPS) is a teaching method which “allows nurses and other clinicians to refine and apply their skills in realistic health care situations and participate in learning experiences tailored to their education needs” (Beyea and Kobokovich, 2004). Human patient simulation is a new technology which was borne out of the advancement in informatics and computer technology. This new technology uses computer life-sized mannequins which can formulate life-like situations which can be adjusted accordingly in order to comply with instructor’s educational goals (Pacsi, 2008). The very first human patient simulator was seen in the late 1950s and was known as Mrs. Chase; it was basically a model with a torso and a separate computer software (Herrmann, 1981). This model was used to assist nursing students in their physical assessment process. The Harvey Model was seen in the 1960s and it model was built with simulated heart and lungs; and it assisted students in distinguishing between normal and abnormal cardiopulmonary indications. A fully equipped computerized human simulator Sim One was then built in order to simulate endotracheal intubations in order to teach medical and graduate nurse anesthesia students (Gaba and DeAndra, 1988). The simulators which are now being used (MetiMan, Laerdal SimMan, and BabySim) are equipped with computer software and can be connected to laptops and desktop computers. Some of these models are able to speak and blink; they have chest walls which expand on inspiration and then relax on expiration; and they also exhibit programmable audible lung and heart sounds (Pacsi, 2008). They can be intubated and can receive bag and masks for ventilation. When these devices are plugged into monitors, teachers can then program the heart rates, pulse oximetry readings into these machines (Pacsi, 2008). These simulators can also be programmed to exhibit human-like responses to different diseases and to the reactions to interventions, including administration of IV meds, intubation, ventilation, and CPR. Computers have now been used in classrooms in order to manage communication and the gathering of knowledge. The current computer applications now offer features which help facilitate and support clinical learning (Pacsi, 2008). Colleges and universities have established simulation centers in order for students to practice and develop their technical skills and to develop their critical thinking, decision-making, delegation, and coordination skills. Simulations are technologies which have been made possible with the availability of technology-equipped mannequins (Pacsi, 2008). With the hands-on availability of these technologies, students have been exposed to different scenarios; moreover, these simulations can also present students with different situations they may meet during their clinical experience. In effect, the students are able to come up with treatments and interventions and to try these out without fear of endangering the ‘patient’s’ life. There are different activities involved in human simulation. While the most popular form of simulation involves computer-based technologies, simulations may also involve activities which “mimic the reality of a clinical environment” (Durham and Alden, n.d, p. 2). The different types of human simulation are: part task trainers, simulated patients, screen-based computer simulations, complex task trainers, and integrated simulations (Durham and Alden, n.d). The part task trainers are low-tech task trainers which are fashioned to copy a portion of the body or of the environment. These trainers may include an orange where students can practice venipuncture or a mannequin where they can learn CPR. They are inexpensive tools of training; however, they can have limitations in the training process because the accuracy of the patient’s technique cannot be adequately gauged from the use of this trainer. The use of simulated patients involves role plays between learners and teachers. The trained simulated patients are used to create psychiatric interactions wherein learners try out different interventions. Live patients are used to provide dual roles which allow students to adjust their examination techniques on the model, while also acquiring feedback about their examinations (Durham and Alden, n.d). The screen-based computer simulations model different aspects of human physiology through computer programs and use information gained to make decisions and observe results in real-time. These simulations are reusable and inexpensive as they can be used individually or in groups. Complex task trainers include virtual reality and haptic systems. Haptic systems are the most complex forms of simulated learning processes because they can sense touch and can gauge the amount of pressure applied. It has sensors which provide feedback to the learner on the areas he has touched and the amount of pressure used (Durham and Alden, n.d). These are expensive technologies because they require a complex network of technological tools to implement. In effect, although it is highly effective in the learning process, it cannot be adapted on a more general scale. Integrated simulators combine computer technology with part or whole body mannequins in order to carry out a more realistic learning process (Durham and Alden, n.d). These are the different features in human simulation-based teaching and learning. In general, these methods of teaching are more effective than the pure lecture type classroom methods. Some of them however have peculiar qualities which make their implementation costly and impractical. Human simulation is a method of teaching which has been chosen because of its effective potential in teaching students and RNs the crucial learning tools they need in the clinical practice. Human simulations bring about major benefits for students, nurses, medical practitioners, and eventually, for patients. Tilghman (2006) points out that the inclusion of simulation technologies in nursing education is an opportunity to improve student learning. These technologies will also potentially arm nurses with the skills which they can utilize in order to thrive in a health practice which highlights the development of technologies and the promotion of patient safety (Pacsi, 2008). Human simulation is a method of teaching which provides students and RNs with the most current simulation technology which can be used by teachers to instruct health providers in all disciplines (Bremner, Adudell, Bennett, and VanGeest, 2006). This technology also gives a more objective means of assessing students’ competencies before actual patient contact. It can be utilized in order to provide students the opportunity to link theory with practice in a more controlled setting, allowing these students to focus on interventions without the fear of harming an actual patient (Spunt, Foster, and Adams, 2004). During the learning process, it is more important for the students to establish which treatments would work for patients under certain conditions – rather than to try these out during the actual interaction with the patient. In the study of Ravert (2002) where he carried out a simulation on education and learning of 523 studies which were focused on computer simulations, the author revealed that 75% of reviewed studies reflected favorable results in terms of skill development and the acquisition of knowledge of students. The study was also able to reveal one of the more crucial findings in these simulations – that some of these simulations amount to significant costs. In the current state of healthcare budget cuts, the high cost of these simulations may be considered a considerable drain on the healthcare budget. Pacsi, (2008) set out to evaluate the impact of using simulations in the remediation of graduate nurse anesthesia students – comparing it with the traditional means of addressing students’ knowledge gaps. In his study, it was established that the most significant part of remediation was debriefing because it could help establish how much more practice and improvement the student would need before he could be fielded in the actual clinical setting (Pacsi, 2008). As was exemplified by this study, the human simulation method helps identify gaps in a student’s knowledge – in order to give the student a more objective picture of his skills or lack thereof in some areas. In a study by McCausland, Curran, and Cataldi (2004), the researchers sought to evaluate whether using human simulations helped to highlight issues in the traditional teaching methods. The study highlighted a simulation for congestive heart failure. Respondents included students who were instructed on the carrying out of doctor’s orders. The study revealed that about 82% of student respondents indicated that they were prepared to make the necessary decisions in the clinical setting; 97% of these respondents expressed that the simulation would assist them when they would be placed in the actual clinical setting in the future. These students also highlighted the importance of debriefing in the aftermath of the simulation as it gave them a chance to be more critical of their own practice and of their activities (McCausland, Curran, and Cataldi, 2004). In Rhodes and Curran’s study (2005), the authors sought to evaluate 21 senior-level nursing students. The authors’ goal was to develop the students’ critical thinking skills in the actual clinical setting. The authors utilized the human simulation process in order to carry out their evaluation. After the study, the faculty discovered that their students were able to carry out the objectives of the simulation; the students were in fact able to focus on physical assessment and skill acquisition in IV monitoring, catheterization, and blood transfusion (Rhodes and Curran, 2005). The faculty was also able to establish that their students’ primary weakness pertained to the procedure for blood transfusion which showed some gaps in the application. All in all, the authors were able to establish the efficacy of the human simulation as a means of ensuring critical thinking among students (Rhodes and Curran, 2005). In effect, the studies cited above indicate the effectiveness of human simulations in evaluating the level of clinical competency, as well as the critical thinking abilities of students (Rhodes and Curran, 2005). These studies also point out that human simulations are efficient in different levels of learning – from the undergraduate to the graduate nurse program; however, these simulations may also be time consuming and may be too costly to implement (Pacsi, 2008). Human simulations have also been known to assist in the development of students’ skills in assessing patients and in the critical thinking processes. They also improve the refinement of nursing skills even without exposing the student to the actual clinical setting (Larew, et.al., 2006). As explained by Pacsi (2008), human simulations are set to give more chances for students to be exposed to the actual clinical setting and to carry out interventions safely. In effect, placing students regularly in human simulations is an effective means of enabling teachers to conceptualize case scenarios where their students would be able to enhance their basic nursing skills (Larew, et.al., 2006). The complexity of these clinical scenarios can be gradually increased as the training process progresses with the eventual introduction of technical skills and critical thinking scenarios. Moreover, reviewing the simulations would give opportunities in debriefing students and teachers. They would also assist teachers in supervising the clinical competencies of their students and in tailoring the remediation process to fit their student’s individual needs (Pacsi, 2008). Beyea and Kobokovich (2004) summarized the different benefits of human simulators. They point out that human simulators provide a variety of benefits in the clinical practice by supplying an experience in preprogrammed rare events; by repeating procedures and experiences; by helping students learn from their errors; by observing different outcomes in clinical situations which come from actions chosen; and by applying teamwork, debriefing, and team coordination (Beyea and Kobokovich, 2004). Human simulation also gives a major opportunity to reduce medical errors and to improve the delivery of patient care. This process can be done by managing the clinical learning experiences based on the patient population in specific settings and in creating opportunities to prepare students for high-risk events (Beyea and Kobokovich, 2004). Patient scenarios seen in the actual patient populations create opportunities for health practitioners to have access to the skills in handling emergencies and unexpected occurrences in a prescribed way. In the preoperative set-up, practitioners can train for specific medical crisis and doing this would give team members the chance to evaluate the processes which are effective and to identify those which may not provide favorable treatment results (Beyea and Kobokovich, 2004). Human simulations also give practitioners the chance to care for simulated patients with clinical issues like airway obstruction or hemorrhage or similar clinical situations. Simulators assist health care members manage their clinical issues by evaluating their presenting issues, and providing interventions (Beyea and Kobokovich, 2004). The conceptualization of well-planned conditions which include simulators call for practitioners to resolve issues, to work as a team, and to coordinate with their fellow practitioners and similar providers. Role play which is part of human patient simulation provides an opportunity for practitioners to improve communication and – by association, to improve patient safety (Beyea and Kobokovich, 2004). The skills gained from case-based incidents and simulations assist members of the health team transition to the actual patient practice and to the clinical setting. Integrating concepts in patient safety, including human elements in engineering and situational awareness, assist nurses and other practitioners in simultaneously learning different approaches in relation to patient safety (Beyea and Kobokovich, 2004). Patient management and avoidable medical mistakes are major concerns in most institutions. The Institute of Medicine report, “To Err is Human: Building a Safer Health System” sets forth simulated trainings as a method of preventing errors in the clinical setting (2004). Human simulations have been acknowledged for their ability to evaluate causes, circumstances and factors which refer to adverse events without harming the patient. Moreover, practitioners can practice their tasks and procedures under simulated conditions; and after working through the simulated crisis, they can utilize the feedback in order to respond accordingly and appropriately. In other words, simulators can transfer skills and evaluate processes (Beyea and Kobokovich, 2004). The simulated nature of the process helps learners to be more engaged in the learning process – to consider the systematic and targeted clinical experiences and create an opportunity to learn in a more controlled and safe environment. The risks in the actual learning experiences are significant; any efforts which can therefore be made towards minimizing such risks must be welcomed and accepted within the clinical setting in order to allow the efficient delivery of patient health services and the achievement of better patient outcomes. In a paper by Hoffman, et.al., (2007) the authors sought to evaluate whether the participation in instruction with regard to the use of human patient simulators help improve professional competence among undergraduate nursing students. Their study covered about 24 senior nursing students who were assigned to complete 7 weeks of traditional clinical experience. In the course of the study, the authors were able to establish that instructions involving human simulation are effective teaching methods for the improvement of basic knowledge acquisition (Hoffman, et.al., 2007). Health informatics refers to the “combination of computer science, information science, and health science designed to assist in the management and processing of data, information and knowledge to support healthcare and healthcare delivery” (Conrick, 2006, p. 4). Human patient simulation involves informatics in the sense that computers are mainly used in health education to facilitate the learning process and to ease the transmission of information from the teacher to the learner. Human simulation involves informatics in a big way because the learning process revolves around the tools of informatics – from the gathering of data to the transmission of information to the learner. The feedback and remediation process also includes informatics since the computer is mostly used to indicate an objective assessment of a student’s learning progress (or lack thereof). Conclusion Human simulations are a major part of the health informatics education trend. It is very much connected to health informatics because it combines the learning process with the use of computers and live simulations. There is a more hands-on approach to the learning process which allows the student to interact more with the teacher and the teaching modules. Human simulations have revolutionized the learning process through their ability to bring the patient to the classroom or to bring the student to the more clinical learning set-up. It has allowed for the student to apply the theories he has learned in the academe to the actual clinical set-up without fear of harming an actual patient. It has also allowed the learning process to be more interactive and more responsive to the needs of the patient and the learner. In effect, human simulations are important learning tools because they have allowed for a more realistic and practical application of the standard learning processes in health education. These standards often get lost in the process of learning because of gaps in the transmission of information; however, human simulations are now available for students and for teachers to be more engaged in a dynamic and an interactive learning environment. Although some methods of human simulations are too expensive and time consuming to implement; they represent trends for the future which would likely decrease in cost and be more accepted as effective and efficient methods of learning. Works Cited Beyea, S. & Kobokovich, L. (2004). Human patient simulation: a teaching strategy. AORN Journal. Retrieved 03 April 2011 from http://findarticles.com/p/articles/mi_m0FSL/is_4_80/ai_n6274052/pg_3/?tag=content;col1 Bremner, M., Aduddell, K., Bennet, D., & VanGeest, J. (2006). The use of human patient simulators: Best practices with novice nursing students. Nurse Educator, 31(4), 170-174. Conrick, M. (2006). Health Informatics. Australia: Elsevier Learning Durham, C. & Alden, K. (n.d). 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