1. 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

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

3. 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!

4. 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

5. 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

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

7. 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

8. 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

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

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

11. 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.

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

13. Why do we train?

14. 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

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

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

17. 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

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

19. Debriefing: A chance to discuss

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

21. 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

22. 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

23. 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

24. 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

25. We’ve Come A Long Way!

26. References www.ssih.org www.sirc.nln.org
Various slides from my coworkers: Dr. Gaba, Dr. Howard, Dr. Harrison