Using Simulation to Teach CRM for Nurses Introduction Using Simulation to Teach CRM for Nurses Cynthia Shum, RN, BScN, MEd Veteran’s Administration Palo Alto Health Care System Palo Alto, California

Faculty Disclosure : Cynthia Shum: none Dr. Weinberg holds a US Patent related to lipid resuscitation. Faculty disclosure: none

What are we going to do today? Learn about: Simulation Using simulation to train Nursing staff Scenarios CRM to improve Patient Safety Debriefing What are we going to do today. High overview Some interactive Have Fun!

Learning Objectives At the end of this session you should be able to: Summarize what simulation is and discuss how you can use it to train with. Illustrate how to create learning scenarios incorporating CRM principles Propose scenarios which can improve patient safety Appraise different methods of debriefing Learning Objectives Learning Objectives

Simulation Simulation is the imitation or representation of one act or system by another. Healthcare simulations can be said to have four main purposes - education, assessment, research, and health system integration in facilitating patient safety. Simulation education is a bridge between classroom learning and real life clinical experience. (SSIH) SSIH definition

Simulation…. What is Simulation? Aviation: long history, CRM Crew Resource Management birthplace Also, Nuclear reactors OB simulation: 1600’s Current day: high tech simulators

Definition of Simulation: A Nursing Perspective “activities that mimic the reality of a clinical environment and are designed to demonstrate procedures, decision-making, and critical thinking through techniques such as role playing … and be very detailed and closely simulate reality” Jefferies (2005, p97) Nursing definition: Pamela Jeffries NLN has a simulation website : SIRC

WHY use “Immersive and Simulation-based Learning”? I hear and I forget I see and I remember I do and I understand (Confucius) Why do we do simulation? Imersive type of learning that has context

Simulation is…. Serious Games…. BUT……. No one gets injured or dies… We can laugh…..but overall the aim is serious

Hybrid Simulation Task/Skills Trainers Standardized Patients Patient Simulators One shoe does not fit all! You have choices.

SCENARIOS Possible situation An imagined sequence of possible events Based on learning objectives Can be based on actual medical cases Scenarios: stories MUST know what your objectives are, where you want to start and how you want to end. ALWAYS have contingency plans.

Examples? Local toxicity from Regional Anesthesia Anaphylaxis in the PACU Get group to think of examples

Why do we train?

It’s ALL about the Patient Systems integration refers to the integration of simulation into institutional healthcare training and delivery systems. Simulation-based processes may include quality assessment mechanisms, thereby facilitating patient safety. In Situ: practicing in a real environment allows you to practice “for real” Simulation offers the freedom to make mistakes; see the outcome of their mistakes; gain insight into the consequences of their mistakes; and “get it right” National Patient Safety goals

What if this was you? OR someone you loved? This could be you or your loved one! OR someone you loved?

Team Training: Building STRONG Teams Team training is critical! Must learn to work together High Performance Teams = Highly Reliable Teams

If you are going to work in a stressful environment, then you need to practice in a stressful environment.” Should be stressful to some degree. If it is not stressful then we can go ahead and continue the same methods we have always used before

Crisis Resource Management principles We use all of these/or choose to discuss in debriefing Build concepts into scenarios

Debriefing: A chance to discuss

Goal of simulation and debriefs is to translate lessons into reality of practice translational

Tips for the Debriefing Sessions Explore pros, cons, & alternatives but be sensitive to the feelings of others Critique the performance, not the performer Learn from each other - constructive critique; ideally the instructor only facilitates debriefing Emphasize crisis management behaviors 60% behaviors / 40% medical-technical issues Many different styles of debriefing Pro/con CRM Technical/medical/system Guided reflection

Debriefing Session – Participant Role Raise issues and initiate discussion Discuss issues with each other Discuss CRM techniques that were used or could have been used during the scenario Evaluate how and why things turned out Discuss what could be done differently in the future

Confidentiality Your performance Is to remain within the walls of the center Is NOT graded Does not become part of your file The performance of other participants is also to be kept confidential General rules of simulation Really important to gain trust

Rules of Simulation Talk Out Loud Private Suspend Disbelief - - ignore the parts that are not " We are NOT here to Trick you! Don’t let people “blame” it on the simulator or the scenario. IF something is not real or does not go as planned try to extrapolate to real life experiences

We’ve Come A Long Way!

References www.ssih.org www.sirc.nln.org www.jointcomission.org/standards_information/npsgs.aspx Various slides from my coworkers: Dr. Gaba, Dr. Howard, Dr. Harrison