Simulation: Bridging the gap between textbook and patient

A simulation is a safe learning environment that recreates a real clinical scenario as closely as possible to enable a clinical team to understand how they would respond in an emergency situation.

A typical simulation would involve a resuscitation or early warning system-related scenario, such as a patient collapse or a patient whose condition deteriorates rapidly.

Simulation has a strong educational focus. It enables staff to practise skills that often have to be undertaken in very stressful situations, and to apply material they have learnt in textbooks or at skill stations in a realistic, practical, immersive environment. It can also be used for process improvement, as it offers a safe environment to identify problems, refine work processes and improve the way equipment is positioned and used.

Most often, simulation is used to gain insight into how team dynamics affect people’s ability to perform clinical tasks, to understand and improve communication within the team, to allocate roles and to prioritise tasks in situations where confusion in a real-life event could cost lives.

Simulation can be an effective tool for enhancing multidisciplinary teamwork, as medical staff, nursing staff and anaesthetic technicians often participate together. However, the staff mix present at a simulation should represent the clinical situation being addressed. For example, simulations that involve a limited number of staff or range of skills help participants prioritise confidently to manage an emergency situation when a full skill mix is not immediately available or the ward is not fully staffed.

A simulation has three parts: a pre-brief, the simulated event, and a de-brief.

The pre-brief is used to orient the clinical staff who are participating in the simulation. This is crucial for the simulation to accurately represent people’s behaviour during a real clinical event. Staff are informed of what is expected of them, introduced to the simulation equipment, and told how a simulation works. They are then introduced to the clinical scenario being enacted.

During the simulated event, the patient is represented by a mannequin. The mannequins can be programmed through a computer system to run a variety of clinical scenarios, and are designed to be as similar as possible to a real human body to enable staff to behave as they would with a real patient. Staff can insert intravenous lines into the mannequins, do chest compressions, defibrillate them, and monitor their vital signs. CTEC has a range of mannequins, from a neonate to an 80kg adult male, to represent patients of different genders and ages.

In the de-brief, a facilitator leads the staff who participated in the simulation through a guided discussion of how they felt working as a team and what became important during the scenario. It’s important that staff feel safe during the de-brief; it should not become punitive or personal, questions must be genuine and transparent, and raw emotions raised from real clinical experiences recreated by the simulation should be treated sensitively.

Altogether, the three phases take about 45 minutes.

At Counties Manukau Health, CTEC uses simulation as part of its three resuscitation courses. We also work closely with nurse educators to run simulations in-situ on the wards, particularly in Anaesthesia, Emergency Care, the Critical Care Complex and Kidz First. Many of these areas use simulation regularly to help staff feel more comfortable working together in high-stress situations.

CTEC has developed a number of simulation cases, and these can be matched to the clinical situation required. Alternatively, we tailor a simulation programme based on a ward or unit’s clinical and behavioural goals, motivation for working though a case, a clinical event they would like to work on, and the patients and staff who are representative of their clinical area.

Simulation plays an important part in developing a clinical culture of excellence. Practice and preparation are the best ways to produce a clinical team which responds quickly, efficiently and confidently in a crisis so we can do our best for our patients when they need us most.

To learn more about simulation or arrange a simulation for your area, contact Tristan Tully: tristan.tully@middlemore.co.nz