Simulation
AN EVOLUTION IN HEALTH SCIENCE EDUCATION
Hord Coplan Macht recently polled over 50 nursing school deans about their needs for simulation in the academic environment. The results showed a preference for flexibility in simulation environments and the incorporation of virtual and augmented reality.
Hord Coplan Macht recently polled over 50 nursing school deans about their needs for simulation in the academic environment. The results showed a preference for flexibility in simulation environments and the incorporation of virtual and augmented reality.
As healthcare delivery continues to evolve, health sciences education needs to follow. We predict the next decade will see a transformative emphasis on simulation and technology in health sciences education. Our research, and that of others in this field, supports this theory.
Health science educators continue to search for high-quality clinical tools and assignments for their students. Technology is rapidly advancing in the healthcare professions world, and educators struggle to stay on the cutting edge and provide quality courses for higher education students.
students has created an urgency to develop clinical simulation as a replacement for a portion of this experience. Simulation has been a part of nursing and allied health for over a century, but recently there have been dramatic changes that are shaping the pedagogy of clinical education and the physical environments of health sciences education facilities.
Clinical rotations have been the traditional way for students to gain hands-on experience. While clinical rotations will always be part of health sciences education, the inadequate number of clinical assignments available for all
This continues to be a widely deliberated topic, and at the 2019 American Association of College of Nursing (AACN) Meetings in Washington, DC, Hord Coplan Macht joined the conversation.
What is the best way to teach students and prepare them for a career in health sciences?
toward the benefits of a 2:1 clinical to simulation ratio. This study will undoubtedly influence state boards of nursing to adjust the levels of simulation accepted as clinical experience in nursing education.
While researchers have been confirming the effectiveness of simulation, other technologies such as high-fidelity manikins, software, and digital connectivity, have also advanced, creating exciting new opportunities for health sciences education. The limited resources of colleges and universities have also challenged institutional leadership and architects to find opportunities to create program spaces that
support multiple uses and provide flexible environments.
The study found that students who spent 50% of their time in simulation education, as compared to a control group of those spending no more than 10% in simulation, had no statistical difference in their clinical competency. However, the 50% group outperformed the control group in areas such as maternal/newborn care, mental health
care, medical-surgical care, and community health nursing.
In 2019, another complementary study, Emerging Evidence Toward a 2:1 Clinical to Simulation Ratio: A Study Comparing the Traditional Clinical and Simulation Settings,
further confirmed the effectiveness of simulation. This study concluded that the “intensity and efficiency of simulation” was demonstrated through the “completion of more activities in higher levels of competency in significantly less time” than in a clinical setting. This provided emerging evidence
Studies over the past five years have proven that clinical simulation can be as effective, and perhaps even more beneficial, than clinical experience to health sciences students, especially nursing students. While each state board of nursing regulates the percent of simulation allowed to be used in nursing education, the boards continue to receive requests from educational institutions to increase the allowable hours for simulation to allow them to meet student needs.
The comprehensive National Council of State Boards of Nursing (NCSBN) study, published in the July 2014 Journal of Nursing Regulation, was conducted to provide evidence to the state boards of the benefits in utilizing clinical simulation as a replacement strategy for up to half of the traditional clinical hours.
Research
Trends + Best Practices
Through Hord Coplan Macht’s recent work with schools of nursing, allied health, and health professions, we have identified the use of specialized simulation environments in the following environments.
Intensive
Care Units
Public Health
Environments
Surgical
Suites
Objective Structured Clinical Examination Suite
(OSCE)
Multi-Sensory
Environments
Intensive Care Units
As healthcare delivery changes to more ambulatory care and hospital buildings become smaller with more emphasis on acute care, institutions of health science have had to continue to develop specialized environments that prepare their students for the workforce. High-fidelity ICU Simulation Units, with isolation rooms, have become increasingly common in new health professions buildings and renovations. These units are often two-bed configurations with movable partitions to convert into single-bed units, and have debriefing rooms and control rooms physically adjacent to them. These typically range from 750 – 900 sf.
Harford Community College Nursing & Allied Health Professions Building – ICU Simulation
Public Health Environments
The continued evolution of hospitals toward focusing more exclusively on the acutely ill, have created a need for follow ups and monitoring to take place in non-institutional settings, such as apartments and single-family homes. These environments pose challenges to health providers, specifically for Occupational Therapists and Emergency Medical Technicians. Higher education institutions have responded by creating simulation environments that include residential settings, complete with the challenging spaces such as kitchens, bathrooms and living rooms. Sizes can vary based on the type of cohort, but typically range from1,000 – 1,200 sf.
Front Range Community College Gray's Peak Health Care Careers Center
Surgical Suites
Interprofessional practice and education is paramount to successful patient care and is essential in the highly complex environment of patient surgery. A surgical suite simulation environment is considerably larger than most environments and is typically between 400 – 450 sf. Components include an operating table, multiple booms with surgical lights, monitors, anesthesiology cart, electronic charting, equipment cabinets, instrument cabinet and an adjacent scrub sink. These are environments where multiple health professions students come together to learn specifics of the surgical process.
Mercy Health Services – A typical operating room within the surgical suite
Objective Structured Clinical Examination (OSCE) Suite
An OSCE includes a timed examination for students at a series of stations or exam rooms, where a standardized patient is examined on a one-to-one basis with one or two impartial examiners. Students rotate through, completing all the stations on their circuit. This allows all students to encounter the same scenarios individually. This tightly controlled scenario is an improvement over traditional exam simulation methods because it minimizes deviation.
George Washington University School of Nursing - OSCE Suite
Multi-Sensory Environments
In institutions with Occupational Therapy programs, there has been a growing emphasis on training students to treat patients with autism, Alzheimer’s disease, traumatic brain injury, and mental health issues. Multi-sensory environments, such as Snoezelen rooms, have been incorporated in several institutions in the United States since their initial development in Europe in the 1970’s. By incorporating a variety of controlled stimuli, these spaces simulate rooms for treating patients that are not able to organize or respond appropriately to multi-sensory stimulation. In addition to the five well-known senses, some patients need assistance and development with the Vestibular and Proprioception senses; these multi-sensory environments help students learn to care for these patients.
Snoezelen Environment
This interest has arisen due to the desire for interprofessional education, driven by the healthcare industry's embrace of interprofessional practice and whole patient care. These environments require different physical parameters to accommodate flexibility and larger groups of students.
More recently, colleges and universities have explored combining diverse schools and departments into the same building in order to share facilities, create greater efficiency, and provide collaborative and synergistic academic opportunities. There has also been an interest in creating a more flexible approach to health sciences simulation.
Historically, medical schools and nursing schools existed as silos and developed their own distinct educational buildings and simulation environments.
Flexible Simulation Environments
White Box Environments
Hord Coplan Macht is currently designing “white box” and “sand box” environments that accommodate a variety of simulation scenarios, larger scale simulations, event functions, and active learning lessons. These types of environments originated in performing arts “black box theater” design, and need to be carefully planned and designed to function well and provide flexibility. They are typically two-story spaces and are planned with accessory spaces including control rooms, debrief rooms, and storage rooms. They can also include retractable seating, allowing the space to serve as large lecture rooms. The size of these spaces can vary widely based on the simulation scenarios or events the institution wishes to accommodate. The open arrangement of these rooms provides a highly adaptable space that will serve institutions for years to come.
WHITE BOX ENVIRONMENTS
Virtual and Augmented Labs
Virtual and augmented reality is on the rise in many areas, including gaming, manufacturing, and business; now, health sciences simulation has embraced it as well. The complexities of anatomy and human systems are particularly well suited to incorporating virtual and augmented reality systems. These systems can increase student comprehension and allow students to improve critical thinking skills. The environments for these spaces need to be sized to the technology and number of interactive stations. Like white box environments, these rooms are technology rich and highly flexible. Technologies typically include multiple electronic displays, projectors, controllable lighting, and sensors to track human movement. In a number of our projects, we are utilizing these spaces as ‘sandbox classrooms’ (classrooms that are highly flexible with adaptive technology) when they are not in use as labs. This increases the utilization rates of the rooms and overlays an innovative use over a conventional one. In a recent project at a public university in Virginia, we expanded the augmented reality well beyond the confines of the labs into a fully intelligent building.
Virtual and Augmented Labs
By Paul R. Lund, Principal
AIA, LEED AP BD+C
Contributors:
Gwen Gilley, Leanne Phillips
The trends identified in the studies by the NCSBN point to greater reliance and acceptance of simulation in nurse education. The simulation trends are emphasizing flexibility, and that is achieved through virtual and augmented reality. As educational methods continue to evolve, the facilities housing these unique spaces will continue to adapt. Informed by continued research, changing pedagogy, and rapidly evolving technology, these specialized spaces offer increased opportunities for student success.
When asked in our survey, what deans would like to improve or add to their simulation environments, we gave them nine options to rank. The results provide valuable insight into what’s important to nurse educators today.
Conclusion
2%
Large Scale Simulations
(Mouse over the pie chart to see stats)
19%
Flexibility
12%
Visibility of
Activities
4%
Third Party Use of Sim Center
10%
Student Amenity Space
15%
Interprofessional Simulations
8%
Specialization
20%
Augmented/Virtual
Reality
9%
Standardized Patients
Sources:
http://www.hcm2.com/next-generation-nursing-schools/
Hayden, Jennifer K.; Smiley, Richard A.; Alexander, Maryann; Kardong-Edgren, Suzan;
Jeffries, Pamela R. (2014) The NCSBN National Simulation Study:
A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education
Sullivan, Nancy; Swoboda, Sandra M.; Breymier, Tonya; Lucas, Laura; Sarasnick, Janice P; MSN, Rutherford-Hemming, Tonya; Budhathoki, Chakra; Kardong-Edgren, Suzan
Emerging Evidence Toward a 2:1 Clinical to Simulation Ratio:
A Study Comparing the Traditional Clinical and Simulation Settings
https://www.snoezelen.info/
hcm2.com
(Mouse over the pie chart to see stats)
20%
Augmented/Virtual
Reality
Which elements of nursing simulation environments are most important to educators?
Washington Adventist University – Health Professions Building
Washington Adventist University – Health Professions Building
Washington Adventist University – Health Professions Building
George Washington University School of Nursing - OSCE Suite
Confidential Public University - White Box
Colorado State University Health Education Outreach Center – Virtual Reality Studio
Back to trends
Virtual and Augmented Labs
Virtual and augmented reality is on the rise in many areas, including gaming, manufacturing, and business; now, health sciences simulation has embraced it as well. The complexities of anatomy and human systems are particularly well suited to incorporating virtual and augmented reality systems. These systems can increase student comprehension and allow students to improve critical thinking skills. The environments for these spaces need to be sized to the technology and number of interactive stations. Like white box environments, these rooms are technology rich and highly flexible. Technologies typically include multiple electronic displays, projectors, controllable lighting, and sensors to track human movement. In a number of our projects, we are utilizing these spaces as ‘sandbox classrooms’ (classrooms that are highly flexible with adaptive technology) when they are not in use as labs. This increases the utilization rates of the rooms and overlays an innovative use over a conventional one. In a recent project at a public university in Virginia, we expanded the augmented reality well beyond the confines of the labs into a fully intelligent building.
Colorado State University Health Education Outreach Center – Virtual Reality Studio
Back to trends
Confidential Public University - White Box
Hord Coplan Macht is currently designing “white box” and “sand box” environments that accommodate a variety of simulation scenarios, larger scale simulations, event functions, and active learning lessons. These types of environments originated in performing arts “black box theater” design, and need to be carefully planned and designed to function well and provide flexibility. They are typically two-story spaces and are planned with accessory spaces including control rooms, debrief rooms, and storage rooms. They can also include retractable seating, allowing the space to serve as large lecture rooms. The size of these spaces can vary widely based on the simulation scenarios or events the institution wishes to accommodate. The open arrangement of these rooms provides a highly adaptable space that will serve institutions for years to come.
WHITE BOX ENVIRONMENTS
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