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
 - 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 HIGH-FIDELITY PATIENT SIMULATION INTO

NURSING CURRICULUM INCLUDES:

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
 • 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. Define educational objectives

2. Construct the clinical scenario
3. Define underlying physiological concepts
4. Modify programmed patients and scenarios, as necessary
5. 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.