Simulation in Nursing - Essay Example

Simulation in Nursing Abstract There has been a growing trend in nursing and medical sector aimed at improving the performance in medical operations. The demand for improvement has been driven by the difficulties experienced in coming up with methods so that maximum care training can be ensured. Simulation technology in medical training and care giving is considered to be a breakthrough within the framework of finding out the best solution for this problem. Larew, Sessans, Spunt, Foster, & Covington (2005) define the term ‘simulation’ as that based on four aspects of learning in the medical field: 1) students’ self-report of confidence in their clinical judgment skills, 2) students’ aptitude for critical thinking, 3) qualitative observations of students’ clinical judgment skill during simulation, and 4) students’ experience followed through a focus group. Based on these approaches, they state that simulation should entail techniques used to represent direct replication of the original object for purposes of detailed learning of the same object; for instance, the exposure of some vital parts which cannot otherwise be seen or studied using the real phenomenon (Larew, sessions, Spunt, Foster, & Covington, 2005). As Jha, & Bates (2001) note, simulation technique has made it easy for medical practitioners to acquire adequate hands on skills in providing adequate medical care to all patients seeking services. It has helped in building all round experts capable of handling various complications in the medical field with minimum errors compared to those made in the past. Extreme complications for instance excess hemorrhaging in mothers giving birth, occasionally resulting into deaths have been arrested. Minimizing perinatal hemorrhaging is the main agenda behind the introduction of simulation in medical education since it is the major source of death in delivering mothers (Adams, 1999; Alspach, 1995). This paper investigates the importance of simulations in obstetrics education aimed at minimizing prenatal hemorrhage, as well as analyzes the impacts of simulation and its benefits in obstetrics education. Introduction Excess hemorrhaging can cause death of mothers if not stopped soon after birth. Much blood is even lost in cases of caesarean deliveries where a c- section has to be cut as compared to cases of normal birth (Benner, 1984; Adams, 1999; Kahol K., 2009). There is, therefore, a great need for delivering mothers to be prevented from loosing a lot of blood during and after birth. It is estimated that about 140,000 deaths occur annually with 1 woman losing life every four minutes due to OB hemorrhage (American Association of Colleges of Nursing, 1998). Between 1995-1999 maternal mortality due to OB hemorrhage in the United States of America was 14%, leading to the second cause of death in the region, cardiomyopathy 21% (American Association of Colleges of Nursing, 2002). The majority of these deaths is however reported to be 93% preventable if care providers had been more vigilant, recognized the risk and symptom to intervene early (Benner, 1984; Seymour et al, 2002). This is actually in line with the WHO report in 2007 on OB hemorrhage which indicates that OB hemorrhage is one of the most preventable causes of maternal mortality. Driven by the dire need for immediate attention and response to such vital conditions, most institutions have resorted to using simulation techniques to train nurses and gynecologists in the field of obstetrics. Benner, Hooper-Kyriakidis, & Stannard (1999) point out that simulation education is currently becoming the most preferred mode of education and training in most institutions offering training for nurses and gynecologists. Different kinds of simulators have been identified for use by various institutions and training organizations. As a result, the chances of survival among mothers giving birth have been increased over the last few years (Adams, 1999; Case, 1995). Literature Review Currently, simulation is becoming much accepted as the most relevant mode of training for nurses in most institutions. The process however requires a lot of considerable amounts of investments in terms of equipments required for the same practice as well as the time for implementation and establishment of the technology (Kahol et al., 2009; Jha, & Bates, 2001). The pace of technological applications in medicine is becoming clearer. As a result, increasing levels of technological advancements has penetrated the medical fraternity and medical simulation is among these. Benner asserts that simulation education is now providing high quality training for nurses and gynecologists, adequately providing for the desire and needs of every institution and patients (Benner, 1984). This has improved the quality of services provided at various medical facilities around the globe. It is crucial to understand however that simulation is a tool and not an end to the accomplishment of all medical requirements of an institution. Alspach, 1995; Case, 1995; Derossis et al. (1998) maintain that training requirements and effective use of this technology is as well a need which has to be cultivated in persons using it. Simulation teaching and application is however better when compared to the former training mechanisms which concentrated much on the theoretical and on- the- job learning for nurses and Gynaecologists. These training techniques, as Benner, 1984; Case (1995) argue, did not look very deep into the possible errors which may occur in the course of such provisions. Simulation techniques have arrested such scenarios by offering solutions to various complications. Deriosis et al. (1998) identifies two major components used in medical simulation; these include the use of a manikin which actually provided the real time physiologic feedback. Besides, there is the virtual reality simulator created by Satava. Satava’s simulator created an enabling environment for close interlinking between computers based training techniques and adequate assessment of technical surgical skills (Seymour et al., 2002). Benefits of Simulation in Nursing Simulation has been used in various fields over time such as engineering, military, aviation, and mining among other sectors. The technique only came into medical field a decade ago and its impacts are already notable and felt all over the globe (Bastable, 1997; Adams, 1999). Simulation methods in medicine and nursing encompass all aspects of care provision from the initial screening of applicants to laboratory based training besides suit training in hospitals (American Association of Colleges of Nursing, 2002). Other areas where simulation technology has been applied in medicine include clinical preoperative planning and surgical rehearsals especially before undertaking a surgical operation (Derossis et al., 1998). The provision of certain preoperative planning or surgical rehearsals to surgeons enabled by simulation exposes them to a three- dimensional computer aided tomography giving an impression of the real patient (Bastable, 1997). The virtual image or manikin exposes the surgeons to most important and detailed anatomy of the patient while in practice, before real surgical adventures. If training is carried out on a real patient as was done before, errors are likely to be committed to the patient resulting in deaths (Derossis et al, 1998; Alspach, 1995). While using simulation techniques, corrections can be made immediately without actually carrying them on to the real patient. Use of simulation in OB education has been proven to offer a safety net for health providers to enable them master simple and complex skills needed in emergent clinical complications (American Association of Colleges of Nursing, 2002). This has helped improve the situation as compared to the past training mechanisms by providing warm up or preparatory techniques before the time of operations. Besides, some student practitioners are not much at home with the real cadaver especially at the beginning of the training process as it is very scary (Derossis et al, 1998). This may impair the training process leading to underdevelopment of the practitioners in terms of knowledge acquisition. Several studies show that using simulation gives one confidence in what he or she does and this is crucial in the OB unit environment (Alspach, 1995). Cases of OB hemorrhage in hospitals atmospheres require confidence and the ability to articulate the procedural requirements in a timely manner. Confidence is developed by carrying out several simulation drills on nurses and gynecologists. Cases of fear and discontent are therefore eliminated at an early stage. As Adams (1999) notes, upon reaching the real patient, Medicare givers are more courageous and fully capacitated thus able to give full attention even to slightest mistakes. The invention of simulation in medical field has brought with it a common slogan which states; “better make mistakes on the image patient that on the actual patient” (Benner, Hooper-Kyriakidis, & Stannard, 1999). This is because the medical fraternity is entitled to ensuring that life is restored to its normal capacity on every patient that visits any medical facility. During the preparation process, the student practitioners are offered a chance to communicate with each other and seek each other’s assistance just as they would do in a real operation room. This helps the learners to develop the necessary communication skills as well as know the importance of various roles played by various specialists always present during an operation. For instance, one is trained to be able to call for the assistance of various experts such as a cardiac specialist at the right time during an operation. Those who oppose simulation training mechanisms have argued that they do not actually provide students with the most appropriate training skills. Students carrying out simulation tests on manikins in a laboratory reported that they felt fooled up talking to a manikin during the practical operations (Bastable, 1997; Adams, 1999). Inability of a slim man to express both verbal and nonverbal communications, such as grimaces, discourages student learners and makes the entire process of studying quite non-realistic. Besides, some scholars have also noted the absence of some physical changes such as color changes and swellings in manikins making neurological and reflex assessments quite impossible ( Adams, 1999; Case, 1995). They referred to this as a mock disaster. Simulation has however been perceived to act as a bridge, integrating information acquired in classrooms and the psycho-motor skills in the lab. Most students however prefer simulation trainings based on the accounts that it provides a real surgical scenario hence a superior method compared to just reading about particular diseases or conditions. Conclusion In conclusion, it is good to note here that medical simulation has brought in a lot of change and advances in the field of medicine. Simulation training offers the trainees an appropriate chance to carry out preoperative exercises on a manikin adequately orientating them to the real process on a real human. Besides the success behind the adoption of simulation training in medicine, some scholars have argued otherwise and opposed this on the basis that it does not provide room for communication with the real patient. This makes it difficult to judge certain reflex reactions and color changes on the manikin thus a lack in the training process. References Adams, B. L. (1999). Nursing education in critical thinking: An integrative review. Journal of Nursing Education , 38 (3), 111 – 119. Alspach, J. G. (1995). The educational process in nursing staff development. St. Louis: Mosby. American Association of Colleges of Nursing. (2002). Nursing shortage fact sheet. Retrieved from www.aacn.nche.edu Bastable, S. B. (1997). Nurse as educator: Principles of teaching and learning. Sudbury: Jones and Bartlett Publishers. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison Wesley. Benner, P., Hooper-Kyriakidis, P., & Stannard, D. (1999). Clinical wisdom and interventions in critical care: A thinking approach in action. Philadelphia: W. B. Saunders. Case, B. (1995). Critical thinking: Challenging assumptions and imagining alternatives. Dimensions of Critical Care Nursing , 14 (5), 274 – 274. Derossis et al. (1998). Development of a model of evaluation and training of laparoscopic skills (Vol. 175). New York: McGraw. Jha, A. K., Duncan, W., B., & Bates, D. W. (2001). Simulator-based training and patient safety, making health care safer: A critical analysis of patient safety practices. Rockville, MD: AHRQ Publication 01-E058. Kahol et al. (2009). A randomized trial of the “preoperative warm-up” effect. Effect of short term pretrial practice of surgical proficiency in simulated environments: , 208 (2), 255 268. Larew, C., Sessans, S., Spunt, D., Foster, D., & Covington, B. (2005). Innovations in clinical simulation: Application of Benner’s theory in an interactive patient care simulation. Nursing Education Perspectives , 27 (1), 16- 20. Seymour et al. (2002). Virtual reality training improves operating room performance: results of a randomized, double-blinded study (Vol. 236). New York: Ann Surg. Read More