Simulation Genres and Student Uptake: The Patient Health Record in Clinical Nursing Simulations

Drawing on fieldwork, this article examines nursing students’ design and use of a patient health record during clinical simulations, where small teams of students provide nursing care for a robotic patient. The student-designed patient health record provides a compelling example of how simulation genres can both authentically coordinate action within a classroom simulation and support professional genre uptake. First, the range of rhetorical choices available to students in designing their simulation health records are discussed. Then, the article draws on an extended example of how student uptake of the patient health record within a clinical simulation emphasized its intertextual relationship to other genres, its role mediating social interactions with the patient and other providers, and its coordination of embodied actions. Connections to students’ experiences with professional genres are addressed throughout. The article concludes by considering initial implications of this research for disciplinary and professional writing courses

Incorporating remote visits into an outpatient clinic

Copyright @ 2009 Operational Research Society Ltd. This is a post-peer-review, pre-copyedit version of an article published in Journal of Simulation. The definitive publisher-authenticated version Eatock and Eldabi (2009), "Incorporating remote visits into an outpatient clinic", Journal of Simulation, 3, 179–188 is available online at the link below.Most telemedicine studies are concerned with either the technological or diagnostic comparisons, rather than assessing the impact on clinic management. This has attributed to the retrospective nature of the studies, with lack of data being the main cause for not using simulation for prospective analysis. This article demonstrates the use of simulation to assess the impact of prospective systems by utilising data generated from clinical trials. The example used here is the introduction of remote consultations into an outpatient's clinic. The article addresses the issues of using secondary data, in terms of the differences between the trial, the model and future reality. The result of running the simulation model show that exchanging the mode of service delivery does not improve patient wait times as expected, and that a protocol change in association with the introduction of remote visits is necessary to provide a substantial reduction in patient wait times

Addressing the challenges of ECMO simulation

This document is the Accepted Manuscript. The final, definitive version of this paper has been published in Perfusion, May 2018, published by SAGE Publishing, All rights reserved.Introduction/Aim: The patient’s condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants’ suspension of disbelief. This is especially relevant to ECMO SBE as circuit/patient interactions are difficult to fully simulate without confusing circuit alterations. Methods: Our efforts concentrate on making ECMO simulation easier and more realistic in order to reduce the current gap there is between SBE and real ECMO patient care. Issues to be overcome include controlling the circuit pressures, system failures, patient issues, blood colour and cost factors. Key to our developments are the hospital-university collaboration and research funding. Results: A prototype ECMO simulator has been developed that allows for realistic ECMO SBE. The system emulates the ECMO machine interface with remotely controllable pressure parameters, haemorrhaging, line chattering, air bubble noise and simulated blood colour change. Conclusion: The prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants. Future developments will encompass the patient cannulation aspect.Peer reviewe

Using computer simulation in operating room management: impacts of information quality on process performance

High quality information has a significant impact on improving operation performance and patient satisfaction, as well as resolving patient disputes. Based on the analysis of the perioperative process, information quality is considered as an important contributory factor in improving patient throughput. In this paper, we propose a conceptual framework to use computer simulations in modeling information flow of hospital process for operating room management (ORM). Additionally, we conduct simulation studies in different levels of the information quality for ORM. The results of our studies provide evidence that information quality can drive process performance in several phases of the ORM

Use of functional near-infrared spectroscopy to evaluate cognitive change when using healthcare simulation tools

This is an accepted manuscript of an article published by BMJ on 01/11/2020, available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936993/ The accepted version of the publication may differ from the final published version.Background The use of brain imaging techniques in healthcare simulation is relatively rare. However, the use of mobile, wireless technique, such as functional nearinfrared spectroscopy (fNIRS), is becoming a useful tool for assessing the unique demands of simulation learning. For this study, this imaging technique was used to evaluate cognitive load during simulation learning events. Methods This study took place in relation to six simulation activities, paired for similarity, and evaluated comparative cognitive change between the three task pairs. The three paired tasks were: receiving a (1) face-toface and (2) video patient handover; observing a simulated scene in (1) two dimensions and (2) 360° field of vision; and on a simulated patient (1) taking a pulse and (2) taking a pulse and respiratory rate simultaneously. The total number of participants was n=12. Results In this study, fNIRS was sensitive to variations in task difficulty in common simulation tools and scenarios, showing an increase in oxygenated haemoglobin concentration and a decrease in deoxygenated haemoglobin concentration, as tasks increased in cognitive load. Conclusion Overall, findings confirmed the usefulness of neurohaemoglobin concentration markers as an evaluation tool of cognitive change in healthcare simulation. Study findings suggested that cognitive load increases in more complex cognitive tasks in simulation learning events. Task performance that increased in complexity therefore affected cognitive markers, with increase in mental effort required

Simulation of Patient Flow in Multiple Healthcare Units using Process and Data Mining Techniques for Model Identification

Introduction: An approach to building a hybrid simulation of patient flow is introduced with a combination of data-driven methods for automation of model identification. The approach is described with a conceptual framework and basic methods for combination of different techniques. The implementation of the proposed approach for simulation of acute coronary syndrome (ACS) was developed and used within an experimental study. Methods: Combination of data, text, and process mining techniques and machine learning approaches for analysis of electronic health records (EHRs) with discrete-event simulation (DES) and queueing theory for simulation of patient flow was proposed. The performed analysis of EHRs for ACS patients enable identification of several classes of clinical pathways (CPs) which were used to implement a more realistic simulation of the patient flow. The developed solution was implemented using Python libraries (SimPy, SciPy, and others). Results: The proposed approach enables more realistic and detailed simulation of the patient flow within a group of related departments. Experimental study shows that the improved simulation of patient length of stay for ACS patient flow obtained from EHRs in Federal Almazov North-west Medical Research Centre in Saint Petersburg, Russia. Conclusion: The proposed approach, methods, and solutions provide a conceptual, methodological, and programming framework for implementation of simulation of complex and diverse scenarios within a flow of patients for different purposes: decision making, training, management optimization, and others

Improving Proficiency in Central Venous Catheter Insertion: Standardized Simulation Based Training for Internal Medicine House Staff

Objectives: The objectives of this study are to assess residents\u27 pre-workshop ability and comfort with CVC placement, undergo a standardized online didactic and hands-on clinical training simulation workshop, and subsequently undergo a proficiency test using simulation models to assess competency. The goal of a standardized training module is to create a universal approach to CVC placement in our institution and improve comfort and technical ability of house staff. We hypothesize that this will reduce complications and improve patient care and safety.https://jdc.jefferson.edu/patientsafetyposters/1063/thumbnail.jp

Family Centered Rounds Simulation and Medical Students\u27 Perceptions

Background: Studies show that family centered rounds (FCR) improve family satisfaction by involving the families in their children’s care. Medical students consistently find FCR beneficial to families but have differing attitudes regarding benefits to the medical team. Some concerns raised by the students include longer rounds, decreased bedside teaching, and lack of opportunities to improve FCR skills. We developed a FCR simulation to aid medical students in FCR presentation. Methods: On the first day of the clerkship, medical students presented a patient admission to two evaluators playing a parent and an attending physician. The patient admission note was emailed to the students prior to the simulation. Students were provided immediate feedback and asked to complete a survey. The survey asked if they thought FCR would benefit family, nurses, physicians, students, and efficiency of rounds. The students provided answers based on five point Likert scale. Finally, they completed a similar survey at the end of the clerkship. Results: The vast majority (95%) of the students had never participated in FCR prior to the simulation. The simulation made students more comfortable presenting in FCR (average score 4.5 on 5 point Likert Scale). There were no significant differences in positive attitudes towards FCR to families, nursing, physician, and medical education in the pre and post clerkship surveys. Most (67%) students’ perception towards FCR changed positively by the end of the clerkship. Discussion: Most of the medical students had never participated in FCR presentation prior to the start of the clerkship, and they found the simulation helpful in preparing for FCR. Although specific attitudes about the benefit of FCR to the family and medical team did not change likely due to ceiling effect, most of the students did have positive perception of FCR by the end of the clerkship

Innovative learning from simulated patient complaints

Repeated inquiries have highlighted issues with patient safety, communication and the exploration of complaints, emphasising the interplay between each in securing the optimum patients’ journey through health and social care provision (Francis 2013, Keogh 2013). The Care Quality Commission (2014) highlighted that every concern or complaint is an opportunity to improve. A complaint may signal a problem, with the potential to help save lives, and well-handled concerns can help to improve the quality of patient care. Despite these potential benefits there is a wide variation in how complaints are handled or the fostering of an open culture where all complaints are welcomed and learnt from. The University of Derby in delivering pre-registration nursing education utilises simulation to explore patient complaints in order to facilitate recognition of the value they offer, providing transferability to enhance nursing practice and improve patient safety. The simulated experience consists of examining the reasons for complaints; impacts upon service users; lessons for nurses and other health professionals; means of address and preventing repetition of similar incidents;enhancements for practice and lessons for organisations. As part of this process the inclusion and effects of Human Factors are explored from the inception of the simulation experience. Students’ simulate three phases: root cause analysis; the development of a response letter; and a proposal for practice enhancement. These are all subsequently explored via a simulated Boardroom experience. This consists of a panel of allocated ‘experts’ to which the students’ present their findings and recommendations to enhance potential future patient experience and safety. Robust exploration of students’ thought processes and actions are incorporated within this experience via questioning, observation and reflections of the panel. Resulting from this simulation, students develop key transferrable skills: critical thinking; team working; leadership; knowledge of systems and processes; communication skills; customer care; quality assurance, governance and promoting patient safety that are mapped against the competencies outlined in the Nursing and Midwifery Council (2010) Standards for Pre-registration Nursing Education. This experience and feedback is recorded within each students practice document. This is used for subsequent review by their practice mentor, and can be used as part of their practice assessment at the applicable progression point. Learning from service user complaints is high on the agendas of commissioners and healthcare providers. This simulated experience has the potential to be transferred in to not only nursing practice but also any other healthcare professional pre-registration education and continued professional development. References Care Quality Commission (2014) Complaints Matter. Newcastle Upon Tyne: CQC. Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, London: The Stationery Office. Keogh, B. (2013) Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England: An overview report. London: The Stationary Office. Nursing and Midwifery Council (2010) Standards for Pre-registration Nursing Education. London: NMC. Key words: • simulation • complaints • patient safety • enhancing practice. Bullet points that indicate how your work contributes to knowledge development: • innovative approaches to teaching and learning through the application of simulated complaints • enhancement of patient safety and the quality of care • development of transferable competence for nursing practice