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.

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。

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.

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.

Embracing different languages and local differences:Coconstructive patient simulation strengthens host countries’clinical training in psychiatry

BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

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.

Navigating the Storm of Deteriorating Patients: Seven Scaffolds for Simulation Design

Recent trends in simulation use have necessitated a more considered approach in the use of this teaching/learning tool. The aim of this research is to discover ways to improve simulation as a teaching/learning platform. Action research was used to answer the question, “How can I improve pedagogical practices with undergraduate nurses in simulation?” This study was implemented at a University in Auckland, New Zealand between November 2012 and March 2014. A purposive sample was sought from second and third-year nursing students (n = 161) enrolled in the three-year undergraduate bachelor of nursing program. Methods included focus groups, questionnaires, debriefing sessions, pre- and post-tests, and Lasater clinical judgment rubric analysis. Seven instructional scaffolds emerged which maximized student learning and retention. These scaffolds: 1) helped move students from known into unknown knowledge;2) provided situated coaching;3) modeled expected performance;4) gave opportunity for improvement;5) reduced confusion;6) taught effective communication;and 7) promoted new learning through debriefing. These strategies resulted in a simulation experience which improved clinical reasoning in undergraduate nursing students.

Optimizing the Dosage Regimen of Micafungin against <i>Candida spp</i>in HIV Positive Patients with EC Based on Mote Carlo Simulation

The objective of our study was to explore the possibility of the antifungal efficacy of various micafungin dosage regimens against Candida spp in HIV positive patients with EC. According to pharmacokinetic/pharmacodynamics parameters of micafungin in HIV positive patients and MICs distribution of micafungin against Candida spp. in published studies, the dosage regimens of micafungin were 50, 100 and 150 mg QD iv. Monte Carlo Simulation analysed the probability of target attainment and cumulative fraction of response. The results showed that micafungin has good antifungal effect in treating HIV positive patients with EC when pathomycetes are Candida albicans, Candida glabrata or Candida tropicalis, in dosage at 100 mg QD and 150 mg QD.

Simulated patient methodology as a“gold standard”in community pharmacy practice:Response to criticism

The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.

Patients' specific simulations of coronary fluxes in case of three-vessel disease

In this work, we propose a model of the coronary circulation based on hydraulic/electric analogy. This model aims to provide quantitative estimations of the distribution of flows and pressures across the coro-nary network for patients with stenoses of the left main coronary artery (LMCA), left anterior de-scending artery (LAD) and left circumflex branch (LCx), and chronic occlusion of the right coronary artery (RCA), undergoing off-pump coronary sur-gery. The results of the simulations are presented for 10 patients with various stenoses grades and collat-eral supply. For each patient, the four revasculariza-tion situations (no graft operating, pathological situa-tion (0G);right graft only (1G), left grafts only (2G), complete revascularization (3G)) are considered. It is shown that: 1) the complete revascularization is fully justified for these patients because neither the right graft alone, nor the left grafts alone can ensure a suf-ficient perfusion improvement for the heart;2) the capillary and collateral resistances (and the propor-tion between them) have a major impact on the flows and pressures everywhere in the network;3) in the presence of the left grafts, the flows in the native stenosed arteries become low and this could promote the development of the native disease in these branches.

New simulation model for bone formation markers in osteoporosis patients treated with once-weekly teriparatide

Daily 20-mg and once-weekly 56.5-mg teriparatide（parathyroid hormone 1–34） treatment regimens increase bone mineral density（BMD） and prevent fractures, but changes in bone turnover markers differ between the two regimens. The aim of the present study was to explain changes in bone turnover markers using once-weekly teriparatide with a simulation model. Temporary increases in bone formation markers and subsequent decreases were observed during once-weekly teriparatide treatment for 72 weeks. These observations support the hypothesis that repeated weekly teriparatide administration stimulates bone remodeling, replacing old bone with new bone and leading to a reduction in the active remodeling surface. A simulation model was developed based on the iterative remodeling cycle that occurs on residual old bone. An increase in bone formation and a subsequent decrease were observed in the preliminary simulation. For each fitted time point, the predicted value was compared to the absolute values of the bone formation and resorption markers and lumbar BMD. The simulation model strongly matched actual changes in bone turnover markers and BMD. This simulation model indicates increased bone formation marker levels in the early stage and a subsequent decrease. It is therefore concluded that remodeling-based bone formation persisted during the entire treatment period with once-weekly teriparatide.

Comparison of Snellen and Early Treatment Diabetic Retinopathy Study charts using a computer simulation

AIM：To compare accuracy,reproducibility and test duration for the Snellen and the Early Treatment Diabetic Retinopathy Study（ETDRS）charts,two main tools used to measure visual acuity（VA）.·M ETHODS：A computer simulation was programmed to run multiple virtual patients,each with a unique set of assigned parameters,including VA,false-positive and false-negative error values.For each virtual patient,assigned VA was randomly chosen along a continuous scale spanning the range between 1.0 to 0.0 log MAR units（equivalent to 20/200 to 20/20）.Each of 30 000virtual patients were run ten times on each of the two VA charts.·RESULTS：Average test duration（expressed as the total number of characters presented during the test±SD）was12.6±11.1 and 31.2±14.7 characters,for the Snellen and ETDRS,respectively.Accuracy,defined as the absolute difference（±SD）between the assigned VA and the measured VA,expressed in log MAR units,was superior in the ETDRS charts：0.12±0.14 and 0.08±0.08,for the Snellen and ETDRS charts,respectively.Reproducibility,expressed as test-retest variability,was superior in the ETDRS charts：0.23±0.17 and 0.11±0.09 log MAR units,for the Snellen and ETDRS charts,respectively.·CONCLUSION：A comparison of true（assigned）VA to measured VA,demonstrated,on average,better accuracy and reproducibility of the ETDRS chart,but at the penalty of significantly longer test duration.These differences were most pronounced in the low VA range.The reproducibility using a simulation approach is in line with reproducibility values found in several clinical studies.

Implementation of high-fidelity neutronics and thermal–hydraulic coupling calculations in HNET

To perform nuclear reactor simulations in a more realistic manner,the coupling scheme between neutronics and thermal-hydraulics was implemented in the HNET program for both steady-state and transient conditions.For simplicity,efficiency,and robustness,the matrixfree Newton/Krylov(MFNK)method was applied to the steady-state coupling calculation.In addition,the optimal perturbation size was adopted to further improve the convergence behavior of the MFNK.For the transient coupling simulation,the operator splitting method with a staggered time mesh was utilized to balance the computational cost and accuracy.Finally,VERA Problem 6 with power and boron perturbation and the NEACRP transient benchmark were simulated for analysis.The numerical results show that the MFNK method can outperform Picard iteration in terms of both efficiency and robustness for a wide range of problems.Furthermore,the reasonable agreement between the simulation results and the reference results for the NEACRP transient benchmark verifies the capability of predicting the behavior of the nuclear reactor.

Lebanese Student’s Experience of Benefits of High Fidelity Simulation in Nursing Education: A Qualitative Approach

Background: Simulation is perceived as an important part to the nursing clinical educational experience since it can offer a safe learning environment for the students’ clinical practice. Objective: The purpose of this study was to explore the Lebanese student’s experience of benefits of high fidelity simulation in nursing education. Design: A qualitative study using open-ended questionnaire. Setting: This study was implemented at private university in Lebanon between January and April 2015. Participants: A purposive sample was sought from those who have a simulated experience. Methods: Qualitative data were collected via interviews and analysed using a thematic approach. Findings: Four major themes were identified: “Bridging Theory to Clinical Practice”, “Developing Critical Thinking and Decision-making”, “Practicing Safely Leads to Enhancing Confidence”, “Teamwork Spirit and students’ motivation to earn and practice more”. Conclusion: Simulation was found to be an acceptable learning strategy for novice nursing students. The use of simulations is a useful and effective learning strategy. Students with a higher positive attitude towards the simulation experience displayed better learning outcomes. Thus, the integration of simulation into the learning experience of nursing students will bridge the gap between theory and practice;enhance their critical thinking and motivation aptitudes along with traditional clinical practice by sparing them a safe milieu.

Perceptions on the Efficacy of Simulation

This qualitative case study addressed recent graduates’ perception of the efficacy of simulation in registered nursing education. Finding clinical placement is one of the greatest challenges faced by schools of nursing. One possible solution is to use high-fidelity simulation manikins to substitute for clinical experience. The research that exists regarding nursing simulation laboratory experiences focuses on improvement on exam scores and preparation for national board examinations. Very little research explores recently graduated nurse’s perceptions about the efficacy of simulation experiences. The conceptual framework for this study was the constructivist theory. This is a process of experience and reflection. It is a dynamic process that changes as the learner internalizes the experience. This study allowed the researcher to understand how recent graduates perceive the value of simulation experiences. Two research questions were identified: 1) How do recent graduates of registered nurse (RN) education programs view the simulation lab experiences from nursing school? 2) In what ways do the perceptions of simulation experiences differ between associate degree RN program graduates and bachelors program RN graduates? A case study research design was used to explore the perceptions of recently graduated RN about their experience with simulation. By interviewing recent graduates’ perceptions about their experiences with high-fidelity simulation in nursing school, and documenting their perceptions about the efficacy of those simulation experiences, information was obtained that might allow schools of nursing to increase the effectiveness of the simulation experience or validate its applicability in the real world setting.

Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology

Aim: As the primary aim of this study, we analysed whether the quality of advice provided by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up study) could actually be increased using a single written performance feedback given to each pharmacy in 2014. The secondary aim of the follow-up examination was to analyse whether the quality of advice differed depending on the professional group providing the advice. Methodology: To ensure the least possible distortion in the comparison between the baseline and the follow-up studies, the study design used for the follow-up examination in 2017 was not changed compared to the baseline examination in 2014. The data for the follow-up examination were therefore collected using the simulated patient method in all 21 pharmacies in a city in the north-east of Germany. Three female and two male test buyers used four different scenarios for self-medication of acute diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There were significant differences between the overall results from the baseline study (2014) and the follow-up study (2017) (Wilcoxon signed rank test;z = &ndash;2.065, p = 0.039, r = 0.225). In the overall average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points whereas in 2014 they achieved 3.3 (37%). The quality of advice between the professional groups did not show any significant differences (Kruskal-Wallis test: χ2(2) = 1.946;p = 0.378, r = 0.027). Conclusions: The quality of advice for acute diarrhoea in adults declined over time. A written performance feedback intended to improve the quality proved ineffective. Interventions with a far greater impact are required to achieve an improvement in the quality of advice provided.

Arterial pulsation on a human patient simulator improved students’ pulse assessment

Even with basic cardiovascular lectures, undergraduates do not usually experience the reality of palpation and, therefore, cannot integrate their physiological knowledge. We created a pulse training scenario of human patient simulators (HPS) to recognize and assess the normal and arrhythmic pulse of the radial artery. All 25 participants were recruited as volunteers to the study from the School of Allied Health Sciences, Kitasato University. Participants received training in radial palpation of arrhythmias on HPS. The test scenario included 10 arrhythmic pulses combined with normal pulses and weak pulses. The average examination scores significantly improved, from 23.8 ± 2.8 of the pretest to 72.9 ± 3.4 of the posttest (mean and SE, N = 25, p < 0.00001). A questionnaire and general written comments for the palpation training were positive. The palpation training improved the participants’ assessment of radial pulses.

Novel Simulation Workshop Improves Performance in Vacuum Delivery

Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.

Evaluating the Combined Optimization of Oxygenation and Ventilation in a Patient Simulator

The use of mathematical models can aid in optimizing therapy settings in ventilated patients to achieve certain therapy goals. Especially when multiple goals have to be met, the use of individualized models can be of great help. The presented work shows the potential of using models of respiratory mechanics and gas exchange to optimize minute ventilation and oxygen supply to achieve a defined oxygenation and carbon dioxide removal in a patient while guaranteeing lung protective ventilation. The venti-lator settings are optimized using respiratory mechanics models to compute a respira-tion rate and tidal volume that keeps the maximum airway pressure below the critical limit of 30 cm H2O while ensuring a sufficient expiration. A three-parameter gas ex-change model is then used to optimize both minute ventilation and oxygen supply to achieve defined arterial partial pressures of oxygen and carbon dioxide in the patient. The presented approach was tested using a JAVA based patient simulator that uses various model combinations to compute patient reactions to changes in the ventilator settings. The simulated patient reaction to the optimized ventilator settings showed good agreement with the desired goals.

Leveraging Simulation Models in Healthcare for Improving Patient Flow in King Abdulaziz Medical City in Riyadh, Saudi Arabia (KAMC-RD)

Leveraging digital technology for effective decision making requires tools that can comprehend detailed complex process of healthcare organizations. Considering all dimensions, simulation is applicable in many ways throughout the healthcare system due to its ability to capture and mimic detail complexity in clinical operations decisions. Healthcare simulation not only helps ensure that providing services of the highest quality, but simulation ultimately increases the ability of following best practices, quality improvement, and risk management activities. Moreover, this representation of healthcare system has become a primary tool by which increased patient safety can be integrated and facilitated into clinical practices. This article presents a simulation model for healthcare outpatient clinics. This model aims to aid in setting up management guidelines and propose procedure to improve the operation of the clinics and to optimize the performance of such dynamic healthcare clinic. Model optimization is used to find out the optimal staff as resources, which includes physician, nurses, and clinics minimize patient length of stay and smooth patient flow.