Creating a culture of patient safety with computerized patient simulators.

Patient Simulators Improve Nursing Education and Patient Safety

by Chita Farrar, EdD, RN, Kim French, MSN, RN, APRN, Amy Hamlin, MSN, RN, Michele Robertson, MSN, FNP, Wendy Baumann, MSN, FNP

Austin Peay State University nursing faculty responded to the charge to use computerized patient simulators to promote a culture of patient safety by purchasing simulators for use in the skill labs. We were so excited when these awesome technological tools arrived. We quickly learned that we did not possess the knowledge to operate these simulators. This is our story of our quest to learn about computerized patient simulators. We learned that three simulators, SimMan, SimBaby, and a maternal and neonatal birthing simulator are needed to create a Center for Clinical Excellence.

Increasing concern about widespread patient safety issues spurred the Institute of Medicine to recommend systematic examination of the complex relationships between the work of nursing, the workplace, and patient safety. The Institute of Medicine recommends the use of simulators to prevent human error. This interactive teaching format allows for realistic training from basic technical skills to advanced life-saving skills. Simulation technology is an excellent medium to teach skills in settings where decision-making is a critical issue. Computerized patient simulators can empower critical thinking skills in nurses in their quest for mastery of skills in a simulated environment without risk to patients and healthcare providers. Simulators can also provide realistic practice of teamwork, leadership, communication, delegation, and disaster-training skills.

The Institute of Medicine's recommendation to use simulators to create a culture of patient safety serves as an impetus to thrust computerized patient simulators to the forefront of healthcare education as important training tools for nurses. This innovative educational technique can be integrated into any educational program including schools of nursing and medical centers. Simulators can also be used to validate competency skills before a nurse provides patient care in a clinical setting. Research validates the use of computerized patient simulators as a best practice methodology to promote a culture of safety.

Three nursing faculty members traveled to Gatesville, Texas, to learn about the Laerdal SimMan and SimBaby. Both simulators are made in a factory located at this training center. Laerdal provides free training to faculty to learn how to operate the simulators. The SimMan mirrors human responses to procedures. He is a full body patient simulator controlled by a computer. SimMan is anatomically realistic to allow a wide range of medical interventions to be practiced. He can talk, breathe, and even die to create a realistic environment. SimMan can blink his eyes, and the pupils react to light. His head, neck, and airway is realistic to provide simulation of difficult airway procedures. SimMan has audible lung and heart sounds. He can be programmed to display arrhythmias including asystole. Cardiopulmonary resuscitation can also be performed on him. Pulses are present to assess circulatory conditions and traumatic injuries. SimMan has vocal sounds and bowel sounds that mimic disease disorders. SimMan has a blood pressure arm, and an intravenous therapy arm. He has realistic responses to administration of medication. Patient care scenarios programmed into the computer that controls SimMan allow the learner to practice mastery of basic to emergency treatment they might face in real life.

The SimBaby is a portable advanced simulator for training in infant emergencies. It has realistic anatomy for an infant, and is similar to SimMan. Case scenarios create critical thinking exercises for realistic emergency treatment of the infant using the team training approach. Debriefing is conducted following case scenario simulation. The learner is able to analyze the experience, and a gap analysis can be performed to evaluate the current learner's competencies. Mastery of skills can be done during this process. Communication skills, teamwork, leadership, and delegation skills can also be assessed.

A concurrent training session was being done at the time Austin Peay State University nursing faculty underwent training at Gatesville. Military nurses were attending a training session for Combat SimMan. The Combat SimMan is used in military training of advanced life support measures, trauma, and bioterrorism. By using combat simulators, advanced scenarios including traumatic limb amputations, and chemical ingestions can be created. Faculty recognized a relationship between Combat SimMan and community health nurses' needs for disaster management. Arrangements were made for several faculty members to tour the Combat Simulation Trauma Center at Fort Campbell Army Military Base.

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Faculty toured the facility and were allowed to observe a realistic battleground scenario for traumatic limb amputation. We entered a room that had a scenario of a bombing attack. The simulation showed soldiers thrown to the ground with traumatic injuries and limb amputations. Red water covered the area to simulate blood. Parts of bodies were spread on the floor. The room was filled with war sounds. The learner crawled on their belly in the dark with a glow stick thrown to guide them to the injured soldiers. Emergency measures were implemented to demonstrate mastery of skills learned on the Combat SimMan. The scenario was very realistic, bringing visions of the war in Iraq and the need for training in advanced life support and trauma measures. We saw the significance of developing a partnership with the military training program to learn preparation for disaster situations. Partnerships like these could train nurses to key roles in a disaster and foster relationships between agencies that do respond to real life disasters.

A personal service contract was done to bring a trainer from the Gaumard training site in Miami, Fla., to provide a training workshop for the Gaumard Maternal and Neonatal Birthing Computer Interactive Simulator that had been purchased. Since Clarksville is expecting a baby boom in the next few months with the return of deployed soldiers, faculty invited nurses from Gateway Medical Center and Blanchfield Army Medical Center to attend the training session. This simulator is a full body interactive female with a birthing baby that mirrors human responses to obstetric management. Through simulation technology, the learner is introduced to the normal labor and delivery process as well as complications that may present during the labor process. The learner can also practice C-section and forceps delivery, and post partum suturing. Advanced life support for the mother and neonate can be mastered. Faculty recognized the value of developing a partnership with local medical facilities to help with mastery of the birthing process by allowing hospital staff to utilize the simulator as part of their orientation process.

With the completion of the training for simulation technology, Austin Peay State University nursing faculty found that computerized patient simulators are a fun teaching strategy that builds self-confidence and mastery of skills from basic fundamental skills to advanced critical care skills. Human error can be prevented by creating a culture of safety through the simulation experience. Faculty envision the creation of a Center for Clinical Excellence that can be shared with medical centers and the community. Simulators are an important teaching tool for critical thinking and mastery of skills in a safe environment with no harm to the patient or learner.

References

Gaumard. (2007). Simulators for Health Care Education. Retrieved May 4, 2007 from http://www.gaumard.com

Laerdal. (2007). Laerdal SimMan Press Packet. Retrieved May 4, 2007 from http://www.laerdal.com

About the authors. Amy Hamlin, Kim French, Michele Robertson, and Wendy Baumann are assistant professors at Austin Peay State University School of Nursing. Chita Farrar is the Director of the School of Nursing and president of TNA District 3. She is also chair-elect for the Tennessee Deans and Directors Board and chair-elect for the Board of Regents Deans and Directors Board.