Human Patient Simulation

Human Patient Simulation Laboratory

Introduction

Human patient simulation has proven to be an excellent training resource for developing medical students. Doctors, nurses and clinicians have been able to effect health outcomes by practicing on simulators instead of real people. The College of Health Sciences Nursing program at Eastern Kentucky University has adapted this philosophy and successfully uses simulation in a low fidelity capacity. Striving to advance their program, they have determined the need for a high fidelity simulator, laboratory with advanced equipment and a technology expert who will research, design, train and implement a plan of action to bring this desire into full fruition.

While simulation has been used for quite some time at EKU, more advanced simulators have been engineered through the years and exist on the market. These technological masterpieces have the capability of real life situations and scenarios creating a much higher fidelity simulation than ever before. The Baccalaureate and Graduate Nursing program researched such simulators and with the help of grant money were able to secure the Emergency Care Simulator (ECS) man. He is capable of breathing, heart and lung sounds, live pulse rhythms in neck, wrist, arm and feet, eyes blinking and many more options.

One major issue with such highly engineered equipment is a steep learning curve. This adaptability to new technology is difficult for engineers and technicians, not to mention to a doctor or clinician. The ECS man was difficult to understand and operate, hard to setup and would be unusable without proper space and additional equipment. These factors and more mounted and caused the ECS man to live under a sheet in a closet for several years.

The College of Health Sciences decided to create a technology position that would allow them to utilize technology with instruction to better equip their students. This position would be responsible for researching, analyzing, planning and learning the philosophy of human patient simulation. Securing both a high fidelity simulator and a technology employee dedicated to the college, their hopes are that the ECS man would be used in a clinical setting, he would provide higher fidelity simulation and that students would be more prepared for their fields of study.

The Problem

This project addresses several components in the planning, development and Implementation of a high Fidelity Human Patient Simulation laboratory. There will also be a high matrix of technologies that will need to be custom fabricated to fit our needs. The roadblocks experienced in this project were Human Patient Simulator learning curve, limited facilities, Technical architecture and time restrictions for implementation.

The first problem addressed is the learning curve. As stated in the introduction, a human patient simulator by the name of ECS Man, was purchased with grant money several years ago. This simulator has the capability of breathing, eyes movements, speech through mouth using a wireless mic, pulse, heartbeat, bladder, blood flowing into veins and more. The ECS Man is a highly engineered medical masterpiece created to improve health outcomes and training in medical students. The ECS man is large and as heavy as a healthy six foot human being. He has a tethered cord protruding from his back that includes more than eighty connectors that facilitate his many functions. This cord is to be connected to a control box which in turn connects to a laptop computer with software that determines his functions through various scenarios. He also requires an air compressor regulated to 50 PSI which fill his lungs and provide movement to internal parts for other procedures. Simply looking at this technological construction would make even the robust of engineers anxious. While the previous indicators of a steep learning curve are very evident, there is more to the puzzle. The ECS man is controlled by an Apple computer pre-loaded with a physiologically programmed proprietary piece of software. This software has never been seen by any of the current or past staff of the Nursing program at Eastern Kentucky University. To clarify physiological, this software has undergone scrupulous testing by a multitude of medical doctors, information technologists and quality control engineers. While many medical companies have software programs that allow a person to independently manipulate the heart rate, oxygen levels, respiratory rate and more, physiological means the program responds as a human. If the heart rate is changed to specific setting, the software reads the change and conforms the other aspects of the virtual person to adjust accordingly. A nursing student could increase the blood pressure in the software and watch the other vital signs respond and change to a corresponding level. This software program in itself is revolutionary and quite intimidating.
The second problem in the successful implementation of a human patient simulation center was limited facilities. The space used already seemed well proportioned and high utilized. While the ECS man currently lived inside a closet under a sheet for many years, there would have to be a location created to utilize his simulation capabilities. This requires evaluating every potential space including areas already being used. The identification of equipment needed or furniture no longer operated play a role in creating an appropriate environment. Developing plans that would potentially require the use of construction would also be introduced. The knowledge to create such an environment did not currently exist and would have to be obtained by research and on-site visits to existing simulation laboratories.
Thirdly, we were unaware of which technological architecture we needed to make this a success. This is where my technical aptitude came into play. I could already envision an aspect of the design for this laboratory. A control room was a must and that meant a center focal point or convergence of data cables to communicate to each simulation room independently. Since a system did not currently exist to mimic, a drawing was developed using different color markers indicating the wiring diagram. Inside the control room would be a face plate that housed the following connections: HDMI, multiple Ethernet, Audio In, Audio Out and VGA. A Pan-Tilt-Zoom (PTZ) and an Internet Protocol (IP) security camera would need to be installed in each room for the real-time video needed to make simulation high fidelity. Upon careful research and on-site visits, we discovered a system that enveloped multiple technologies that met our needs. This involved researching the system along with two others similar in kind systems to evaluate the best technical and financial decision for the College. The system that passed the test would include a windows server loaded with 2012 R2. This server would need to be strategically placed, properly connected, effectively secured and continually managed. These recordings would also need to have policies for retention and protection.

The final problem to the human patient simulation laboratory would be the pressed time to implement. A timeline was set and expected to be completed within a one year window. Keeping in mind the previous two detailed roadblocks, this seemed almost impossible to perform. Much of this time would consist of overcoming the learning curve, accurately evaluating the facilities and structural limitations and doing so in the timeline provided.

Rationale

Why is simulation needed in the College of Health Sciences at Eastern Kentucky University? The Nursing program at Eastern Kentucky University is a nationally accredited as well as internationally known program of excellence. Distinguished Faculty have worked tirelessly to produce the best possible graduates a nursing program can provide. With that in mind, why spend the time, money and energy to create a human patient simulation laboratory?

Dr. JoDee Anderson is an Associate Professor and the Medical Director of the Neonatal Intensive Care Unit at Oregon Health & Science University. Dr. Anderson made the following statement concerning Human Patient simulation in a clinical education setting, “My first experience with neonatal resuscitation was a simulation during my internship at the Stanford VA Simulation center. I had a really hard case – meconium aspiration and asphyxiation.” Anderson found the simulation challenging, but she didn’t know how much it had impacted her learning until three days later. “I was on call at the county hospital and the exact same case came up. I knew what to do as an intern. It was amazing to me that this transfer of learning had happened, and I knew what to do for a real patient. That changed everything.” (HPSN 2014)

While Dr. Anderson’s experience alone is enough to justify the furtherance of research in developing simulation in a clinical setting, the chair of the nursing department at Eastern Kentucky University made a decision that it was going to be implemented to better prepare students for real world situations.

Review of Literature

There is no shortage of resources highlighting the studies of human patient simulation. While many sources focused on improving health outcomes, others focused on reducing anxiety levels in students and the utilization of advanced technology to create real experiences in a controlled environment.

Scope of Proposal

There are several delimiting factors that make this project unique. There is no real budget set for this project. While that may sound ludicrous, it comes with an impeccable amount of confidence and trust in the professionals enlisted to be in charge. The exact words of the person writing the checks were, “we have money”. How does an individual prepare for a project with an open checkbook? While it might seem convenient and relieving to know there is no set limitation, this provided pressure to provide the best possible solution at the most economically proportional and effective price. The second boundary set was that of time. The project was enlisted to the Technology Resource Administer in August and was expected to be complete by the following August. Research, education, strategic design, construction, training, facilitation and incorporation into student curriculum all had to take place in the span of a year. To better understand the clinical side of the project, the manager for the Clinical Skills Lab was enlisted as a co-project administrator. The position of the clinical skills lab manager was to provide ideologies to the technology specialist of room design and layout conducive of a hospital environment. This project will undoubtedly require the careful design and coordination of construction. This role played into the project effectively being able to bridge the gap between technology and clinical skills training. This created teamwork paved the way for researching the idea of a simulation lab together and developing a plan of action. This project came with little oversight and depended highly on self-motivation and self-regulation.

Methods and procedures

The ECS man seemed to be the first logical step in the operation. After all, he is the motivation in creating a human patient simulation laboratory. Therefore, this particular aspect of the project will be broken down in four stages.

Stage 1

Locate all available information on what type of simulator the ECS man is and what company is responsible for servicing.
Find out every intricate detail about what he was designed to do and if he still operates after 10 years of dormancy.
Create a financial analysis report on the justification to activate the aging ECS man or buy a brand new simulator that does what we want.
Present our findings to the chair of the department for decision and approval or advancement.
Proceed with an action plan to restore ECS man to a workable state which will require coordination with the engineering company, logistics on shipping and timeframe for completion.

Stage 2

Find a successful simulation center and make an onsite visit. Take pictures, notes and ask questions pertaining to our task.
Meet together after on-site visit and determine usable information.
Evaluate facilities and begin design phase.
Notify budget personal for the need of construction and submit proper work orders to notify construction project administrators of work to be done.
Setup a planning session with construction group and discover what can and cannot be accomplished.
Evaluate the cost of the construction and present findings to the chair of the department for approval.
Execute plan for construction and maintain constant communication with construction administrator to ensure electrical, mechanical and aesthetical areas are all covered properly.

Stage 3

Attend conference on Human Patient Simulation to provide a clearer picture of the learning outcome mission we intent to complete.
Incorporate a Faculty member to assimilate the use of human patient simulation utilizing ECS man into their curriculum.
Schedule formal training on both the ECS man and the specific software that operates his functions and scenarios.
Setup and use the ECS man in our facility the exact way design engineers educated us during training.
Complete project in year time frame that coincides with the fall school semester in which the Faculty member will introduce students to high-fidelity Human Patient Simulation.

Bibliography Page

Banks, C. M., & Sokolowski, J. A. (2011). Modeling and Simulation in the Medical and Health Sciences. Hoboken: Wiley.

Murray, W. B., & Kyle, R. R. (2008). Clinical Simulation : Operations, Engineering and Management. Burlington, MA: Academic Press.

Daley, K. M., & Campbell, S. H. (2013). Simulation Scenarios for Nursing Educators : Making It Real. New York: Springer Publishing Company.

Radhakrishnan, K., Roche, J. & Cunningham, H. (2007). Measuring Clinical Practice Parameters with Human Patient Simulation: A Pilot Study. International Journal of Nursing Education Scholarship, 4(1), pp. -. Retrieved 4 Nov. 2015, from doi:10.2202/1548-923X.1307

Rabia Khalaila, Simulation in nursing education: An evaluation of students' outcomes at their first clinical practice combined with simulations, Nurse Education Today, Volume 34, Issue 2, February 2014, Pages 252-258, ISSN 0260-6917, http://dx.doi.org/10.1016/j.nedt.2013.08.015.

(http://www.sciencedirect.com/science/article/pii/S0260691713003067)

Judy Irene Murphy, Using Plan Do Study Act to Transform a Simulation Center, Clinical Simulation in Nursing, Volume 9, Issue 7, July 2013, Pages e257-e264, ISSN 1876-1399, http://dx.doi.org/10.1016/j.ecns.2012.03.002.

(http://www.sciencedirect.com/science/article/pii/S1876139912000461)

Brewer, E. P. (2011). Successful Techniques for Using Human Patient Simulation in Nursing Education. Journal Of Nursing Scholarship, 43(3), 311-317 7p. doi:10.1111/j.1547-5069.2011.01405.x

Maria Overstreet, The Use of Simulation Technology in the Education of Nursing Students, Nursing Clinics of North America, Volume 43, Issue 4, December 2008, Pages 593-603, ISSN 0029-6465, http://dx.doi.org/10.1016/j.cnur.2008.06.009.

(http://www.sciencedirect.com/science/article/pii/S0029646508000509)