The effect of high-fidelity simulation in medical nursing based on the healthcare simulation standards of best practice

Background:High-fidelity simulation has been demonstrated to make great progress in learning.However,there is still ongoing exploration on how to fully harness the advantages of this teaching method and enhance its effectiveness.This study conducted high-fidelity simulation in medical nursing based on the Healthcare Simulation Standards of Best Practice and evaluated its effect.Methods:The study was conducted from September 2019 to June 2020.A total of 82 undergraduate nursing students from a university in Shanghai participated in the high-fidelity simulation in medical nursing.The simulation design scale,educational practices in simulation scale,and students’satisfaction and self-confidence were used to evaluate the effect.Results:The mean score of simulation design scale was 4.06±0.63 with the mean scores of all dimensions being over 3.0.The mean score of educational practices in simulation scale was 4.14±0.56 with the mean scores of all dimensions being over 4.0.The mean scores of students’satisfaction and self-confidence were 4.07±0.72 and 3.89±0.58,respectively.Conclusion:Students reported high levels of simulation design and educational practices in simulation.They were also satisfied with learning and reported high levels of self-confidence.Some key points need to be considered so that the learning effects might be optimized.

A review of clinical reasoning in nursing education:based on high-fidelity simulation teaching method

Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinical reasoning skills to deliver safe and effective patient cam. It is therefore of paramount importance to enhance nursing students＇ clinical reasoning ability. High-fidelity simulation （HFS） is proved to be an effective teaching and learning method, which may also have some advantages over other teaching methods. Methods： The authors retrospectively reviewed the related literature, illustrated the application of high-fidelity simulation teaching method in nursing education, putting the focus on the use of it in teaching with clinical reasoning. Results： The application of high-fidelity simulation to nursing education can simulate the clinical situation, thus to create a safe, continuous and efficient learning environment for students, and it can effectively improve students＇ clinical reasoning ability. Conclusions： high-fidelity simulation is effective for clinical reasoning teaching in nursing education. The extension of its application in China should be of great value. The relevant further study is suggested focusing on how to overcome its own limitations and have it better applied in nursing education in China.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Multiple Perspective of Multipredictor Mechanism and Multihistogram Modification for High-Fidelity Reversible Data Hiding

Reversible data hiding is a confidential communication technique that takes advantage of image file characteristics,which allows us to hide sensitive data in image files.In this paper,we propose a novel high-fidelity reversible data hiding scheme.Based on the advantage of the multipredictor mechanism,we combine two effective prediction schemes to improve prediction accuracy.In addition,the multihistogram technique is utilized to further improve the image quality of the stego image.Moreover,a model of the grouped knapsack problem is used to speed up the search for the suitable embedding bin in each sub-histogram.Experimental results show that the quality of the stego image of our scheme outperforms state-of-the-art schemes in most cases.

Two Monte Carlo-based simulators for imaging-system modeling and projection simulation of flat-panel X-ray source

The advantages of a flat-panel X-ray source(FPXS)make it a promising candidate for imaging applications.Accurate imaging-system modeling and projection simulation are critical for analyzing imaging performance and resolving overlapping projection issues in FPXS.The conventional analytical ray-tracing approach is limited by the number of patterns and is not applicable to FPXS-projection calculations.However,the computation time of Monte Carlo(MC)simulation is independent of the size of the patterned arrays in FPXS.This study proposes two high-efficiency MC projection simulators for FPXS:a graphics processing unit(GPU)-based phase-space sampling MC(gPSMC)simulator and GPU-based fluence sampling MC(gFSMC)simulator.The two simulators comprise three components:imaging-system modeling,photon initialization,and physical-interaction simulations in the phantom.Imaging-system modeling was performed by modeling the FPXS,imaging geometry,and detector.The gPSMC simulator samples the initial photons from the phase space,whereas the gFSMC simulator performs photon initialization from the calculated energy spectrum and fluence map.The entire process of photon interaction with the geometry and arrival at the detector was simulated in parallel using multiple GPU kernels,and projections based on the two simulators were calculated.The accuracies of the two simulators were evaluated by comparing them with the conventional analytical ray-tracing approach and acquired projections,and the efficiencies were evaluated by comparing the computation time.The results of simulated and realistic experiments illustrate the accuracy and efficiency of the proposed gPSMC and gFSMC simulators in the projection calculation of various phantoms.

Application of Patient Simulators Combined with Internet plus Scenario Simulation Teaching Models on Intravenous Infusion Nursing Education in China

Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.

Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.

Evaluation of undergraduate students’nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient

Objective:To evaluate nursing students’assessment and communication skills through an objective structured clinical examination(OSCE)within a high-fidelity simulation using a student-simulated patient(SSP)and analyze the validity,reliability,degree of difficulty,and discriminability of the OSCE.Methods:A descriptive study was conducted at one nursing school in Macao.All scenarios were designed using a high-fidelity simulator combined with SSPs.A convenience sample of 54 baccalaureate nursing students completed the OSCE.The nursing assessment OSCE checklist(NAOC)and the communication evaluation rubric(CER)were used as observational measurements with three-point Likert scales(2=Achieved,1=Partly achieved,0=Not completed/Incorrect).Results:Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills.The discrimination index of the majority items of the NAOC(86.4%)was>0.20,showing a better to good discriminability.The items of the CER had satisfactory indexes of item discrimination(from 0.38 to 0.84).Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment.Students presented good communication skills in eye contacting and listening,but culture assessment needs to be improved.The students with experiences in simulation or simulated patient(SP)interactions had better assessment and communication skills than students without those experiences.There was a positive relationship between nursing assessment and communication skills(r=0.67,P=0.000).Conclusions:SSPs were involved in enhancing the realism of interactions in simulated scenarios.Nursing students can conduct nursing assessments specific to patient conditions,explain the conditions to the patient,and ensure that the patient remains informed at all times of the precautions to be taken.However,students’cultural awareness and some communication skills need further training.With moderate difficulty and high discrimination index,OSCE showed satisfactory reliability and validity.

The effectiveness of a high-fidelity teaching simulation based on an NLN/Jeffries simulation in the nursing education theoretical framework and its influencing factors

Objective： To investigate the effectiveness of a high-fidelity teaching simulation based on an NLN/Jeffries simulation in the nursing education theoretical framework and its influencing factors. Methods： A high-fidelity teaching simulation on clinical nursing practices using intelligent human analogues was conducted with 200 students, and The Simulation Design Scale, and the Student Satisfaction and Self-Confidence in Learning Scale developed by the National League for Nursing were used to evaluate the training effectiveness and its influencing factors. Results： For the high-fidelity teaching simulation, students gave scores of 4.36± 0.54 points for satisfaction and 4.33 ± 0.46 points for Self-Confidence. The students highly rated the five dimensions of teaching design, i.e., teaching objectives/information, assistance/support for students, problem solving, guided feedback, and fidelity. The teaching design was closely correlated with the satisfaction of the high-fidelity teaching simulation and self-efficacy, and the dimensions of teaching objectives/informa- tion and assistance/support for students were particularly strong predictors of teaching effectiveness. Conclusions： A high-fidelity teaching simulation based on Jeffries＇ theoretical framework improved student satisfaction with the simulation and their Self-Confidence. In planning simulations, teachers should take into account five characteristics, i.e., teaching objectives/information on simulation education, assistance/support for students, problem solving, guided reflection, and fidelity, to achieve better teaching effectiveness.

NeTrainSim:a network-level simulator for modeling freight train longitudinal motion and energy consumption

Although train modeling research is vast, most available simulation tools are confined to city-or trip-scale analysis, primarily offering micro-level simulations of network segments. This paper addresses this void by developing the Ne Train Sim simulator for heavy long-haul freight trains on a network of multiple intersecting tracks. The main objective of this simulator is to enable a comprehensive analysis of energy consumption and the associated carbon footprint for the entire train system. Four case studies were conducted to demonstrate the simulator's performance. The first case study validates the model by comparing Ne Train Sim output to empirical trajectory data. The results demonstrate that the simulated trajectory is precise enough to estimate the train energy consumption and carbon dioxide emissions. The second application demonstrates the train-following model considering six trains following each other. The results showcase the model ability to maintain safefollowing distances between successive trains. The next study highlights the simulator's ability to resolve train conflicts for different scenarios. Finally, the suitability of the Ne Train Sim for modeling realistic railroad networks is verified through the modeling of the entire US network and comparing alternative powertrains on the fleet energy consumption.

Marine Predator Algorithm-based Sliding Mode Control of a Novel Motion Simulator for High Column Sloshing Experiments

Sloshing experiment is crucial to determine the reaction performance of regeneration columns on an offshore floating platform.A novel type of column motion simulating device and a Marine Predator Algorithm-based Sliding Mode Controller(MPA-SMC)are proposed for such sloshing experiments.The simulator consists of a Stewart platform and a steel framework.The Stewart platform is located at the column's center of gravity(CoG)and supported by the steel framework.The platform's hydraulic servo system is controlled by a sliding mode controller with parameters optimized by MPA to improve robustness and precision.A numerical sloshing experiment is conducted using the proposed device and controller.The results show that the novel motion simulator has lower torque during the column sloshes,and the proposed controller performs better than a well-tuned PID controller in terms of target tracking precision and anti-interference capability.

Blast waveform tailoring using controlled venting in blast simulators and shock tubes

A critical challenge of any blast simulation facility is in producing the widest possible pressure-impulse range for matching against equivalent high-explosive events.Shock tubes and blast simulators are often constrained with the lack of effective ways to control blast wave profiles and as a result have a limited performance range.Some wave shaping techniques employed in some facilities are reviewed but often necessitate extensive geometric modifications,inadvertently cause flow anomalies,and/or are only applicable under very specific configurations.This paper investigates controlled venting as an expedient way for waveforms to be tuned without requiring extensive modifications to the driver or existing geometry and could be widely applied by existing and future blast simulation and shock tube facilities.The use of controlled venting is demonstrated experimentally using the Advanced Blast Simulator(shock tube)at the Australian National Facility of Physical Blast Simulation and via numerical flow simulations with Computational Fluid Dynamics.Controlled venting is determined as an effective method for mitigating the impact of re-reflected waves within the blast simulator.This control method also allows for the adjustment of parameters such as tuning the peak overpressure,the positive phase duration,and modifying the magnitude of the negative phase and the secondary shock of the blast waves.This paper is concluded with an illustration of the potential expanded performance range of the Australian blast simulation facility when controlled venting for blast waveform tailoring as presented in this paper is applied.

Photonic implementation of quantum gravity simulator

Detecting gravity-mediated entanglement can provide evidence that the gravitational field obeys quantum mechanics.We report the result of a simulation of the phenomenon using a photonic platform.The simulation tests the idea of probing the quantum nature of a variable by using it to mediate entanglement and yields theoretical and experimental insights,clarifying the operational tools needed for future gravitational experiments.We employ three methods to test the presence of entanglement:the Bell test,entanglement witness,and quantum state tomography.We also simulate the alternative scenario predicted by gravitational collapse models or due to imperfections in the experimental setup and use quantum state tomography to certify the absence of entanglement.The simulation reinforces two main lessons:(1)which path information must be first encoded and subsequently coherently erased from the gravitational field and(2)performing a Bell test leads to stronger conclusions,certifying the existence of gravity-mediated nonlocality.

Molecular simulation study of the microstructures and properties of pyridinium ionic liquid[HPy][BF_(4)]mixed with acetonitrile

The microstructures and thermodynamic properties of mixed systems comprising pyridinium ionic liquid[HPy][BF_(4)]and acetonitrile at different mole fractions were studied using molecular dynamics simulation in this work.The following properties were determined:density,self-diffusion coefficient,excess molar volume,and radial distribution function.The results show that with an increase in the mole fraction of[HPy][BF_(4)],the self-diffusion coefficient decreases.Additionally,the excess molar volume initially decreases,reaches a minimum,and then increases.The rules of radial distribution functions(RDFs)of characteristic atoms are different.With increasing the mole fraction of[HPy][BF_(4)],the first peak of the RDFs of HA1-F decreases,while that of CT6-CT6 rises at first and then decreases.This indicates that the solvent molecules affect the polar and non-polar regions of[HPy][BF_(4)]differently.

Effects of Bifidobacterium lactis BLa80 on fecal and mucosal flora and stem cell factor/c-kit signaling pathway in simulated microgravity rats

BACKGROUND Simulated microgravity environment can lead to gastrointestinal motility disturbance.The pathogenesis of gastrointestinal motility disorders is closely related to the stem cell factor(SCF)/c-kit signaling pathway associated with intestinal flora and Cajal stromal cells.Moreover,intestinal flora can also affect the regulation of SCF/c-kit signaling pathway,thus affecting the expression of Cajal stromal cells.Cajal cells are the pacemakers of gastrointestinal motility.AIM To investigate the effects of Bifidobacterium lactis(B.lactis)BLa80 on the intestinal flora of rats in simulated microgravity and on the gastrointestinal motility-related SCF/c-kit pathway.METHODS The internationally recognized tail suspension animal model was used to simulate the microgravity environment,and 30 rats were randomly divided into control group,tail suspension group and drug administration tail suspension group with 10 rats in each group for a total of 28 days.The tail group was given B.lactis BLa80 by intragastric administration,and the other two groups were given water intragastric administration,the concentration of intragastric administration was 0.1 g/mL,and each rat was 1 mL/day.Hematoxylin&eosin staining was used to observe the histopathological changes in each segment of the intestine of each group,and the expression levels of SCF,c-kit,extracellular signal-regulated kinase(ERK)and p-ERK in the gastric antrum of each group were detected by Western blotting and PCR.The fecal flora and mucosal flora of rats in each group were detected by 16S rRNA.RESULTS Simulated microgravity resulted in severe exfoliation of villi of duodenum,jejunum and ileum in rats,marked damage,increased space between villi,loose arrangement,shortened columnar epithelium of colon,less folds,narrower mucosal thickness,reduced goblet cell number and crypts,and significant improvement after probiotic intervention.Simulated microgravity reduced the expressions of SCF and c-kit,and increased the expressions of ERK and P-ERK in the gastric antrum of rats.However,after probiotic intervention,the expressions of SCF and ckit were increased,while the expressions of ERK and P-ERK were decreased,with statistical significance(P<0.05).In addition,simulated microgravity can reduce the operational taxonomic unit(OTU)of the overall intestinal flora of rats,B.lactis BLa80 can increase the OTU of rats,simulated microgravity can reduce the overall richness and diversity of stool flora of rats,increase the abundance of firmicutes in stool flora of rats,and reduce the abundance of Bacteroides in stool flora of rats,most of which are mainly beneficial bacteria.Simulated microgravity can increase the overall richness and diversity of mucosal flora,increase the abundance of Bacteroides and Desulphurides in the rat mucosal flora,and decrease the abundance of firmicutes,most of which are proteobacteria.After probiotics intervention,the overall Bacteroidetes trend in simulated microgravity rats was increased.CONCLUSION B.lactis BLa80 can ameliorate intestinal mucosal injury,regulate intestinal flora,inhibit ERK expression,and activate the SCF/c-kit signaling pathway,which may have a facilitating effect on gastrointestinal motility in simulated microgravity rats.

Müller cells are activated in response to retinal outer nuclear layer degeneration in rats subjected to simulated weightlessness conditions

A microgravity environment has been shown to cause ocular damage and affect visual acuity,but the underlying mechanisms remain unclear.Therefore,we established an animal model of weightlessness via tail suspension to examine the pathological changes and molecular mechanisms of retinal damage under microgravity.After 4 weeks of tail suspension,there were no notable alterations in retinal function and morphology,while after 8 weeks of tail suspension,significant reductions in retinal function were observed,and the outer nuclear layer was thinner,with abundant apoptotic cells.To investigate the mechanism underlying the degenerative changes that occurred in the outer nuclear layer of the retina,proteomics was used to analyze differentially expressed proteins in rat retinas after 8 weeks of tail suspension.The results showed that the expression levels of fibroblast growth factor 2(also known as basic fibroblast growth factor)and glial fibrillary acidic protein,which are closely related to Müller cell activation,were significantly upregulated.In addition,Müller cell regeneration and Müller cell gliosis were observed after 4 and 8 weeks,respectively,of simulated weightlessness.These findings indicate that Müller cells play an important regulatory role in retinal outer nuclear layer degeneration during weightlessness.

Nursing student perspectives of high-fidelity simulation in Macao

Objective The purpose of this study was to explore student perspectives of high-fidelity simulation.Methods A descriptive study with semi-structured focus group interviews was conducted in Macao.Twenty-one focus group interviews were held with 113 baccalaureate nursing students who had experienced 36-hour of simulation.Results Students perceived that simulation created a nonrisk learning environment,and was helpful in knowledge and skill enhancement and nurse role understanding.However,lack of realistic interactions in psychosocial responses made it difficult for students to relate simulation experience to real-working situations,and poor group contributions affected their learning.ConclusionInteracting with a human patient simulator does not replicate the experience of working with a live patient.Tutors need to come up with ideas about how to make scenarios more real and give more forthright responses to improve the realism of psychosocial responses during simulation.Students experienced uncertainty with clinical decision making and commented on the minimal contributions of some group members.Tutors should be prepared to provide students with substantial supports in developing their understanding of simulation and engaging in the learning process.

基于simulator+技术的动态驾驶安全教育系统

交通事故频发已经严重影响到了人们的生活,并对社会经济造成了巨大的损失。提升驾驶员的驾驶能力能有效减少驾驶事故发生。聚焦典型违法驾驶行为,基于simulator实验平台开发的沉浸体验式教育系统(DSIES),通过系统教育纠正驾驶行为进而减少事故。通过典型违法驾驶行为致因分析,基于计划行为理论提出"知-教-行"动态教育系统。为验证系统有效性,选取具有代表性的4项违法驾驶行为作为实验对象,42名被试者被随机均分为2组进行传统教育及新型教育。采用描述性统计、显著性方差分析及灰度关联分析方法验证不同教育方式的效果。实验结果表明,新型教育系统能有效提升驾驶员驾驶能力;但随着时间的流逝,教育效果均有所降低。另一方面,该教育系统从短时教育及长时教育效果方面均优于传统教育,通过动态教育系统能有效提高驾驶员危险预测能力、降低交通违法行为。

基于OPNET Simulator的低压电力线载波通信路由算法仿真

为了提高低压电力线载波通信的可靠性,以基于传输矩阵的动态路由算法为例,探讨基于OPNET Simulator的低压电力线载波通信路由算法。探讨数据帧设计、进程建模、节点建模和网络结构建模的方法,由仿真结果可以分别确定创建传输矩阵所需时间与传输速率和节点数量之间的关系。

可视化软件包Power World Simulator在电力系统教学中的应用

介绍一种先进的电力系统仿真软件Power World Simulator,其以潮流分析为核心,采用动画式多色彩的单线图可视化技术,模拟电力系统在给定时间段内的运行状况,从而直观、生动地阐述电力系统的基本概念,是辅助教学的有力工具。