Strat

Southern Luzon State University College of Allied Medicine Lucban, Quezon

Innovative Teaching Strategies in Nursing

-A Report-

Submitted to: Mrs. Rosalinda A. Abuy Faculty Submitted by: Melanie V. Perez BSN IIId

SIMULATION - Is an excellent venue for students to learn experientially and provides opportunities for students to practice problem solving and psychomotor skills in a safe, controlled environment. - This innovative teaching strategy incorporates not just skill acquisition, but also cares management concepts into the scenario, while requiring only one faculty member. HIGH-FIDELITY SIMULATORS - Are life-sized mannequins with complex interrelated multisystem physiological and pharmacological models that generate valid observable responses from the mannequin and allow students to interact with the simulator as they would with an actual patient in the clinical environment. Purposes/Aims: - To describe necessary components for successfully integrating high-fidelity simulation into undergraduate nursing curriculum. Features: - A functioning cardiovascular system with synchronized palpable pulses, heart sounds, measurable blood pressure (by palpation or oscillometry), electrocardiographic waveforms, and invasive parameters such as arterial, central venous, and pulmonary artery pressures. - Respiratory system components include self regulating spontaneous ventilation, measurable exhaled respiratory gases, and breath sounds. - Pharmacological system capable of responding to anesthetic, analgesic, and vasoactive agents - A urologic system - Reactive pupils - The ability to accept defibrillation, needle cricothyroidotomy, jet ventilation, needle thoracocentesis, chest tube insertion, and pericardiocantesis. Four components: - a lifelike mannequin - a free standing enclosure containing many of the simulator’s components - a computer to integrate the function of simulator components - an interface that allows the user (either student or faculty depending on the objectives of the exercise) to control the simulation and modify physiologic parameters Advantages: - focusing on specific aspects of patient situations - practicing in a safe environment - predictable environment can be created Practical Advantages: - presenting serious/uncommon situations - allow management errors to develop or multiple treatment options to be explored without injury or discomfort to actual patients - manipulate time (compression, expansion, and replication). Educational Advantages: - opportunities to actively involve the learner - developing critical thinking/problem solving - provide relatively consistent experiences for all students

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collect physiologic, video, and audio data for use in reflective sessions following the simulation session

Disadvantages: - lack of realism of the simulator - the expense of the high-fidelity computer-based simulators - faculty hesitation to become involved in teaching using simulation/ extensive faculty time commitment - a tendency for the simulated environment to induce hypervigilance, or exaggerated caution - models are incomplete and imperfect - transfer of learning from the simulated environment to actual clinical practice is not well documented THEORETICAL FOUNDATIONS Two key components: - scientific curriculum - clinical practicum Two distinct pedagogical dimensions: - learner involvement - content control Two additional educational environments: - passive-random - active-controlled SUCCESSFUL IMPLEMENTATION OF NURSING CURRICULUM INCLUDES:

HIGH-FIDELITY

PATIENT

SIMULATION

INTO

1. a simulation expert or manager who oversees and is a resource to others 2. attendance (by expert/manager) at conferences to facilitate networking with others who use patient simulators 3. curriculum flexibility allowing adequate time/support 4. resources (simulators, supplies, personnel, and space) 5. creativity VYGOTSKY – a Russian psychologist, believed that learning was most effective when it occurred within what he termed the zone of proximal development, where what was to be learned was just beyond the current knowledge level of the student Conditions for learning: - simulation can be used to orient students to an unfamiliar unit - it can be used to allow students to practice technical skills and decision making before actual clinical experiences - simulation provides students and faculty the opportunity to replicate real clinical experiences and then use the simulator for reflection to explore different strategies for managing the situation - students also have the opportunity to create customized patients based on the knowledge of physiology and pathophysiology and then compare the responses of their simulated patients to actual patients observed in clinical practice - it can be used to create learning opportunities that are unavailable in the real clinical environment - simulation has also been used to develop higher order skills in a fashion that exactly parallels applications of simulation in commercial aviation. - Simulation potentially can be used for both formative and summative evaluation

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Techniques for formative evaluation of student skills and abilities include using simulation as a mechanism for providing feedback on current skills and decision-making processes of to observe the progression of a student’s abilities. Applications of simulation in summative evaluation are more controversial because the relationship between the performance of students in a simulated environment and actual clinical performance has yet to be demonstrated.

Resources: - space - electricity and gas sources - recording systems - simulation centers - adequate personnel support Using the Methods: The primary instructor is responsible for setting the scenario, guiding students through the simulation, providing important information and clinical cues not available through simulator, providing transition cues to the simulator operator, modeling behaviors, monitoring or correcting student performance, and correcting simulator errors. The operator’s responsibilities include activating the simulation system, starting patient software, overlaying clinical scenarios, monitoring the progress of a scenario, and adjusting the scenario as dictated by the primary instructor. Seven-Step Process for the Development of Simulation Session

1. 2. 3. 4. 5.

Define educational objectives Construct the clinical scenario Define underlying physiological concepts Modify programmed patients and scenarios, as necessary Assemble required equipment 6. Run program and collect feedback 7. Reiterate steps 2-6 until satisfied Potential Problems: - dependency on faculty support - incomplete presentation of reality - controlling the overgeneralization of findings to the real world • generalization of an observed response in one situation to all patients • an incorrect attribution of simulator responses - participants are often hypervigilant during simulation sessions because they anticipate the onset of a clinical problem Conclusion: Simulation is an exciting application of advanced technology in healthcare professions education. Used correctly, whole-body, high fidelity patient simulators can effectively bridge the gap between static classroom-based instruction and the dynamic, unpredictable clinical environment. Although the use of simulation in healthcare education was, at one time, limited to anesthesia, critical care, and emergency care; ongoing refinements in simulators, such as the introduction of pediatric models and open architecture for the development of new simulation in settings not imagined even 10 years ago.