Integrating High-Fidelity Simulation in Nursing and Medical Training for Seamless Care

➣ By Lingjun Kong

 For decades, simulation in nursing education and medical training has been incorporated into the teaching and learning process in the form of static mannequins, role playing, scenario settings, case studies and other techniques. However, the use of high-fidelity simulations to prepare students in critical thinking, selfreflection and complex clinical environments has recently become a progressively popular educational tool. The ability of high-fidelity simulations to simulate realistic clinical situations without risk to patients opens up new avenues in the development of medical and clinical competence for nursing students.

In healthcare, simulations provide a natural framework for the integration of basic and clinical mechanisms, allowing nurses to learn how to accurately and safely care for patients in less threatened environments.

Furthermore, high-fidelity simulations can mimic the environments in disaster situations, especially those that involve outside professionals such as paramedics, policemen, or firemen. SimMan, made by Laerdal, is an example of a high-fidelity simulator. SimMan is a computerized, interactive, lifesized mannequin driven by pre-defined software to provide realistic patient responses and outcomes for care training. Utilizing this innovative technology decreases the need for diverse clinical sites, equipping nursing schools with a cost-effective tool they have needed. The National Council of State Boards of Nursing anticipates that high-fidelity simulation will continue to grow in presence as an evaluation and teaching strategy tool in the future of clinical and nursing education.

The use of high-fidelity patient simulation effectively facilitates learning under the right conditions, according to a systematic review by B. Issenberg et al. In addition to its use in offering clinical variations and diverse situations, high-fidelity simulation provides a range of difficulty levels for tasks and innovative learning strategies, as well as controlled and safe practice environments allowing for repetitive practice. Furthermore, simulations let nurses capture clinical variations and conduct individualized and outcome-based learning experiences to fulfill the unique needs of each user. New graduates are prepared for critical thinking and reflective skills, and real-time nursing practice correlated with the quality of patient care.

In Asia, Singapore was the first country to integrate advanced simulation facilities for nursing education. Funded by the Lee Foundation, the Critical Care Nursing Simulation Laboratory of the National University Hospital (NUH) opened in 2007. The $250,000, 100- square foot laboratory is used to conduct practical training in its High Dependency and Intensive Care Unit rooms.

The most integral component of the laboratory is a high-fidelity simulation mannequin, which can simulate almost all critical medical conditions when coupled with their state-of-the-art computer and audio-visual system. The mannequin can replicate critical medical conditions with vital statistics, ECG waves, and even physical responses. Nurses at NUH are able to safely practice their clinical skills prior to interacting with real patients, thus greatly improving the quality of care that they provide. In addition to allowing students to gain experience in critical skills such as airway management, immobilization, and basic and advanced life support, the integration of the Critical Care Nursing Simulation Laboratory has offered the systematic training of doctors and nurses alongside one another. When tailored for a specific situation, the high-fidelity simulation allows both doctors and nurses to practice their skills to provide cooperative care for patients. NUH is continuing to expand their program to offer the course to a larger percentage of their staff. Hospitals in neighboring countries, such as Indonesia, Thailand, and Malaysia, have also expressed interest in using the laboratory to train their own nurses.

The second high-fidelity simulation laboratory in Asia was The Virtual Integrated Nursing Education Simulation Laboratory (VINES) at The Far Eastern University Institute of Nursing in the Philippines. VINES integrates hospital-like qualities into their laboratory, as well as high-fidelity mannequins for safe and controlled environments for its student nurses.

According to results from the Philippine Nurse Licensure Examination, as well as employment statistics, The Far Eastern University Institute of Nursing is consistently one of the top nursing schools in the country. Since the incorporation of VINES, the school can provide repetitive and customized nursing lessons in a non-threatening arena, further expanding the avenues of education provided at the Institute.

Despite the many benefits of simulation education in nursing schools, a large gap exists between academic simulations and clinical reality.

It is still a recently adopted technology that raises many questions in nursing education: How can it be used effectively in its role of the clinical development of students? How can it be seamlessly integrated to be a key part of education curriculum? Factors that need to be considered include variations in faculty skill sets and how these changes can be addressed; changes in teaching evolving into student-centered approaches; high technology practices being integrated into clinical settings; and the need for high quality training devices, and high expectations of students. With further development, the integration of high-fidelity simulations holds the promise of bridging the gap between nursing education and clinical practice.

Lingjun Kong, PMP
Virtual Reality Medical Center
San Diego, California
lkong@vrphobia.com
www.vrphobia.com