Developing Healthcare Skills through Simulation

Matthew Aldridge, Stephen Wanless, Matthew Aldridge, Stephen Wanless

• Publisher: SAGE Publications Ltd
• Year: 2012
• Print ISBN: 9781446201251, 9781446201244
• eBook ISBN: 9781446292136
• Edition: 1
• Topic: Medicina
• Subtopic: Habilidades de enfermería

?This book provides an essential resource for educators of clinical skills who want to utilise simulation based education to provide optimal learning opportunities for their students.?

Andrew Bland, University of Huddersfield

?In this book, a team of experienced authors have put together a much needed text that takes an evidence-based, practical approach to skills development.?

Lauren Mawson, University of Cumbria

?A really exciting new text.?

Sarah Burden, Leeds Metropolitan University

Practice educators and mentors are now expected to have the skills and techniques needed to implement a ?learning skills through simulation? programme into established curricula, yet using simulation to teach - while of huge importance - requires careful and time-consuming planning. This valuable resource takes away some of that burden by providing clear, ready-made activities and guidance from leading practitioners in a range of fields, which healthcare and practice educators and mentors can use to enhance their teaching of all the essential and commonly-taught clinical and management skills and knowledge.

Dedicated chapters, which all follow a defined step-by-step format, provide simulation scenarios, alongside facilitator guidance, which will help develop confidence in the teaching of key skills such as:

- Drug administration

- Conflict management

- Infection control

- Breaking bad news

- Catheter and bowel care

These scenarios and accompanying guidance can be used as a framework for teaching, promoting a greater understanding of the skill being taught, and providing a risk-free opportunity for the student to practice their clinical and managerial skills and judgement.

1

INTRODUCTION: BACKGROUND TO THE IMPORTANCE OF ESSENTIAL NURSING SKILLS

Stephen Wanless and Matthew Aldridge

The authors of this book have become renowned as experts in the teaching and development of clinical skills to healthcare students through simulation within the higher education arena. The team of academics and practitioners comprising the authorship of this book contribute to the development of simulation and practice-based teaching of many vocational qualifications, particularly in relation to pre-registration healthcare training courses.

This book has been written predominantly for academics and educators who work within the healthcare arena, in recognition of the challenges in the healthcare setting to deliver safe and competent care, and in order that the next generation of healthcare workers ease their transition to qualified practitioners; this book takes into account these issues and can serve as an essential resource for both healthcare academics and students. It is also a useful resource for educators who teach clinical skills and also for those who are involved in mentorship of students and those who are preceptors of newly qualified healthcare professionals.

The content of this book will provide the educator with the necessary skills to facilitate the progress of students with clinical and transitional skills. These skills are required by everyone studying healthcare and, with the context of healthcare evolving, every chapter has been linked with an example of a simulation.

The competency expected of healthcare professionals can vary from country to country as well as from one local healthcare institution to another. Some employers expect newly qualified staff to develop competency in some advanced skills within a short time of qualification. To ensure the reality shock caused during the transition from student to qualified practitioner is reduced the book has utilised simulation as a trigger to remind students of the practice that they have seen while in clinical practice.

The purpose of this book is to provide a resource that will truly meet the needs of the educator when teaching clinical and transitional skills through the use of simulation in content and style. It provides research-based evidence on how to perform and enhance skills and clinical procedures in a safe simulated context. It provides an optimal balance of theory and practice so that the reader will understand the rationale and evidence for the skill as well as how to teach it in a simulated environment.

The content is written in such a way as to aid learning and recall in the clinical environment through the use of simulation, helping the educator to assist the learner in gaining confidence and attaining competency. Educators often have to wade through large pieces of dense text; to guard against this here and to ensure a user-friendly layout, the text is full of many pedagogical features such as easy to find pictures, skills in table format, examples of simulation and a consistent approach to the formulation of each of the chapters.

The content of this book is divided into three sections with 21 chapters in total. We first look at the theory related to the use of simulation as a teaching tool. The text then covers the main aspects relating to the essential aspects of care that patients require, looking at common themes such as hygiene, drug administration and nutrition. The final part of the book covers the skills required to assist in the transition from student to qualified practitioner and looks at issues that may arise which the student may not have had exposure to, such as conflict management, incident reporting and breaking bad news. All skill-related chapters have an example of a simulation specific to that chosen skill for use or adaptation by the educator.

The book is meant as a useful and essential resource for anyone involved in healthcare education. The evidence base related to the skills that have been assembled for this edition, together with the unique range of contributors and their approaches, provides a rich source of information for a generation of healthcare professionals and their future practice.

2

DEFINING AND EXPLORING CLINICAL SKILLS AND SIMULATION-BASED EDUCATION

Matthew Aldridge

Studies have shown (Alinier et al., 2004; Lauder et al., 2008; Reilly and Spratt, 2007; Nursing and Midwifery Council (NMC), 2007) that the use of simulation in healthcare education curricula can have a positive impact upon learners’ self-efficacy and self-confidence. Furthermore simulation allows learners to rehearse skills and enact scenarios that would be considered undesirable or unsafe to practise on real patients or clients for the first time (Broussard, 2008). Simulation can be a relatively resource-intensive learning and teaching methodology when compared with more traditional classroom-based didactic methods; however, there is an ever-increasing body of evidence which suggests simulation is not only valued by learners, but also is having a positive impact upon healthcare curricula and patient/client care enhancement.

FIDELITY OF SIMULATION

Fidelity is a widely discussed term when considering simulation and is described by Maran and Glavin (2003) in terms of engineering fidelity, in which the equipment reflects the true nature of the clinical setting, and psychological fidelity which refers to the authenticity the learner attributes to the setting, that is, their perceptions of its realism. Fidelity is an important consideration when designing and implementing simulation scenarios as it can impact upon the learning experience, both positively and negatively. Great care and effort could be placed in creating a technologically competent scenario using human patient simulators, however, if careful consideration has not been given to the fidelity of the actual scenario or expectations of the learners, then overall fidelity of the simulation may suffer.

NOMENCLATURE OF SIMULATION

The nomenclature and taxonomy of terms used within simulation are often debated, with some terms used interchangeably by different commentators. Very often the taxonomy of the fidelity of simulation is discussed in the terms of part-task training, low fidelity, medium fidelity and high fidelity simulation.

PART-TASK TRAINING

The term ‘part-task devices’ refers to equipment which allows the replication and rehearsal of a skill in isolation from the rest of an anatomical model. For example, intravenous therapy ‘phantom arms’ which allow venous cannulation and therapy, or ‘phantom heads’ which allow for dental training or the assessment of facial injuries.

These devices are useful as they are relatively cheap when compared with a full human patient simulator, have a reasonably good level of fidelity in replicating the real look and feel of the anatomical area in question, and provide skills rehearsal without risk to a real patient.

Roger Kneebone from Imperial College London has done some novel work on the use of ‘hybrid models’ which allow the adaptation of a part-task training device to be attached to a real person, thus allowing the rehearsal of both technical and nontechnical skills simultaneously. This has been translated into a number of practice areas such as suturing, injection techniques, urinary catheterisation and female pelvic examination.

LOW FIDELITY SIMULATION

A low fidelity simulator may be just a static manikin or anatomical model, with no physiological signs or parameters, such as heart rate and blood pressure. However, this type of simulator may have some features such as an oral cavity or genitalia, which may allow the practice of some technical skills such as oral care or catheterisation. Another example may be the use of an orange to practise intramuscular injection techniques.

MEDIUM FIDELITY

Medium fidelity resources may include manikins which can replicate some physiological parameters or anatomical features. Examples of such devices are an electronic blood pressure training arm or a cannulation arm, which allow the learner to practise the skill with some degree of visual or tactile feedback.

HIGH FIDELITY SIMULATION

High fidelity resources include advanced physiological models and anatomical components which allow for the replication of medical and surgical conditions, often in the full context within which the situation would appear in the real-life setting. Examples may include advanced human patient simulators and advanced laparoscopic surgical trainers. Conversely, there may be no equipment used at all, and it may be the simulation of a communication scenario with a patient’s/client’s relative using a role player (Standardised Patient). Clearly the use of a human being to simulate a human interaction would give the highest degree of ‘engineering fidelity’, but the scenario and interaction would still require careful construction to ensure good ‘psychological fidelity’.

TEACHING A CLINICAL SKILL

The teaching of clinical skills is sometimes – wrongly it must be stated – not given the same credence as other academic content in the curricula of undergraduate healthcare professionals. If we are to train competent, intelligent and enquiring healthcare professionals to fulfil a clinical role, then it is absolutely vital that they are equipped with both the academic and technical skills in order to carry out their role competently and confidently.

The system of ‘master and apprentice’ has often prevailed in the teaching of clinical skills in the past, though fortunately in recent years there has been a shift to recognise that learning will not necessarily happen just because a learner is exposed to a skill by a competent person in clinical practice, and indeed this is not considered a safe way to learn and rehearse the majority of clinical skills. A structured and curriculum-integrated approach should be taken to the teaching of clinical skills so that the theory and practice of a skill can be embedded in educational design and delivery.

Objective Structured Clinical Examinations (OSCEs) are now an established means of assessing a learner’s ability to perform a clinical skill and are often included as a summative assessment somewhere in the majority of undergraduate healthcare curricula. OSCEs can be a reliable means of measuring a learner’s understanding and performance of a clinical skill, though can be resource-intensive in the room, equipment and examiners required. Hence they need careful forethought and planning to run smoothly.

It is true that classroom-based didactic teaching requires a different skill set to that of the clinical skills laboratory setting, though this certainly should not infer any order of merit.

Peyton (1998) describes a widely used four-stage approach to teaching a skill:

1	Demonstration – Educator demonstrates the skill at normal speed without commentary
2	Deconstruction – The skill is broken down into its component parts while the educator gives commentary
3	Comprehension – The educator demonstrates the skill while the learner describes the steps
4	Performance – The learner demonstrates the skill while describing the steps.

The use of a detailed step-by-step lesson plan which explains each step in the skill and its rationale can be useful for both educator and learner to refer to, and will allow the learner to continue to rehearse or review the skill at a later time.

It is acknowledged (Hamilton, 2005; Oermann et al., 2010) that ‘skills fade’ or the degradation of retention of the ability to perform a clinical skill can occur as little as three months after the learning of a given skill. For this reason, repeated rehearsal and use of a skill would seem to be recommended in order to maintain competency. Repetition would appear to be vital in the teaching and learning of a skill as, in the educational setting, learners are frequently exposed to the teaching of a skill for as little as one hour, and then may not have the opportunity to revisit or rehearse that skill until they experience it on a ‘real-life’ patient in the clinical setting. Some educational delivery organisations have acknowledged the need to allow learners to practise clinical skills in their own time, in an area of low or remote supervision, thus allowing for repeated rehearsal and mastery of the psychomotor aspects of clinical skills.

There is a widespread belief that for skills- and simulation-based education to have its maximum impact it should be integrated into curricula, where possible, rather than being a stand-alone entity which may have limited value as a training event when delivered out of context to the curriculum as a whole.

PROBLEM-BASED LEARNING (PBL)

Problem-based learning offers the educator a means of providing simulation which requires very little resource. PBL is not appropriate for teaching technical skills; rather it allows the learner to exercise their cognitive, analytical and problem-solving skills by exploring a problem for themselves and determining appropriate solutions. Jones (2008: 213) lists one of the key benefits of PBL as: ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Foreword
• About the Editors
• Notes on the Contributors
• 1 Introduction: Background to the Importance of Essential Nursing Skills
• 2 Defining and Exploring Clinical Skills and Simulation-based Education
• 3 Patient Assessment: The ABCDE Approach to Patient Assessment and Early Warning Scoring Systems
• 4 Observations: Blood Pressure, Pulse/Heart Rate, Temperature and Neurological Assessment
• 5 Pain Assessment
• 6 Acting in Emergencies: BLS and Summoning Assistance
• 7 Personal Hygiene: Bed Bath and Oral Care
• 8 Elimination: Urinalysis, Bowel Care and Catheter Care
• 9 Nutrition: Feeding a Patient, Fluid Balance and Nasogastric Feeding
• 10 Infection Prevention: Aseptic Non-Touch Technique, Hand Washing, Disposal of Sharps and Disposal of Waste
• 11 Medicines Management: Injection Technique – S/C and IM Drug Calculations, Oral Drug Administration and Storage of Medicines
• 12 Respiratory Care: O2 Therapy, Pulse Oximetry and Inhaled Medication
• 13 Dealing with Mental Health Emergencies
• 14 Principles of Patient Handling
• 15 Managing Conflict in Healthcare
• 16 Drug Administration Errors
• 17 Interview Techniques
• 18 Breaking Bad News/Dealing with Difficult Conversations
• 19 Incident Reporting
• 20 Discharge Planning
• 21 Documentation
• Index