The use of simulated learning to promote safe blood transfusion practice

Simulation in the field of transfusion medicine: Scope and utility

Simulation in medical education has made significant inroads in most of the specialties in some form or the other. Transfusion medicine, as a branch, being a new specialty, is imbibing a few things from the world of simulation and provides immense scope for its utilization, given its broad applicability as well as necessity. In the current Indian scenario of transfusion medicine, wherein the transfusion process has undergone significant changes involving critical steps, with fewer but can be serious complications arising due to the transfusion process, it is desirable for students and the staff involved to practice on the simulators to attain the desired level of competency as it allows the practice of hands-on invasive procedures before performing the actual process. The principles, pedagogies, and educational strategies with their modalities used in health care simulation like case-based scenarios, physical models, computer systems, standardized patients, mannequins, virtual reality, and integrated simulators are all being used and the scope for improvisation is always in the fore with technical advancements. The transfusion and related activities include significant risks, so regular training is essential. The costs are also reasonably high, and focusing on being time-efficient is essential as many scenarios need immediate attention and management. Simulation in transfusion medicine has farsighted returns wherein there is the possibility of defining goals and objectives and ensuring that they could be adjusted to the individual learners as per their knowledge and skill level. The simulations can be set up that can train as well as assess cognitive, affective, and psychomotor domains simultaneously in transfusion using multiple modalities.

Student Nurses' Assessment of Medical Errors

PURPOSE

The aim of this study was to evaluate the quality of nursing students' assessment of cases of medical error.

METHOD

This descriptive cross-sectional study was conducted with 145 nursing students in İzmir, Turkey. The epidemiology of the medical errors that the students witnessed during clinical practice was examined. Then, the success of the students in using the Text-Based Medical Error cases tool developed by the researchers was examined.

RESULTS

Of the students, 24.1% had witnessed medical errors during clinical practice. The percentage of students successfully analyzing cases of medical errors related to patient identification, falling, medication administration, blood transfusions, health-care-associated infections, and pressure ulcers were 51.72%, 7.59%, 17.24%, 8.28%, 45.52%, and 56.55%, respectively.

CONCLUSION

The students' ability to evaluate cases of medical error needs improvement.

Simulation-Based Continuing Education in Health Care Social Work: A Case Study of Clinical Training Innovation

Health care social workers practice in a fast-paced, demanding work environment, and do not always have the opportunity to reflect meaningfully on their work or to practice new skills. This article describes an innovative program, the Partnership for Excellence in Social Work Practice in Health Care ("the Partnership"), which provides a professional development opportunity for health care social workers and contributes to the larger mission of providing comprehensive and coordinated care to high-risk populations. The Partnership aims to help social workers respond to the current challenges of health care practice through simulation learning as an educational reflective practice technique. Through this program, social workers at all levels of experience have the opportunity to practice real-world scenarios in a safe and structured space, receive feedback, and reflect on their skills. The Partnership utilizes professional actors who portray patients, doctors, and care partners (formal or informal caregivers) in case examples that explore key issues in the field. This enables learners to be exposed to a representative set of patient experiences, expediting the development of their skills, enhancing their competence, and facilitating the habit of ongoing reflection in practice and in the development of one's professional identity. Implications of the program for clinical social work practice and directions for future study are discussed.

A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation

Interprofessional simulation has been linked to improved self-efficacy, communication, knowledge and teamwork skills in healthcare teams. However, there are few studies that synthesize learners' perceptions of interprofessional simulation-based approaches and barriers or facilitators they encounter in such learning approaches. The aim of this review was to explore these issues through synthesis of the published literature on healthcare staff engaging in interprofessional simulation to inform enhancement of instructional design processes. Searches of four major databases resulted in the retrieval of 2,727 studies. Following screening and full-text review, a total of 13 studies were included in the final review and deductive content analysis was used to collate the findings, which were then synthesized using a narrative approach. Three categories of barriers and facilitators were identified: characteristics of the simulation learning process, outcomes of interprofessional simulation, and interprofessional dynamics. Related to the latter, the findings indicate the instructional design of interprofessional simulation-based approaches may benefit from a greater focus on the context of healthcare teams that prioritizes teamwork. Furthermore, greater emphasis on designing realistic clinical situations promotes effectiveness of simulation. It is important to recognize the perspectives of healthcare team members engaging in these learning approaches and how they may affect clinical performance and influence patient outcomes.

Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial

BACKGROUND

Preparing nursing students for the knowledge and skills required for the administration and monitoring of blood components is crucial for entry into clinical practice. Serious games create opportunities to develop this competency, which can be used as a self-directed learning strategy to complement existing didactic learning and simulation-based strategies.

AIM

To describe the development and evaluation of a serious game to improve nursing students' knowledge, confidence, and performance in blood transfusion.

METHOD

An experiential gaming model was applied to guide the design of the serious game environment. A clustered, randomized controlled trial was conducted with 103 second-year undergraduate nursing students who were randomized into control or experimental groups. After a baseline evaluation of the participants' knowledge and confidence on blood transfusion procedure, the experimental group undertook a blood transfusion serious game and completed a questionnaire to evaluate their learning experience. All participants' clinical performances were evaluated in a simulated environment.

RESULTS

The post-test knowledge and confidence mean scores of the experimental group improved significantly (p<0.001) after the serious game intervention compared to pre-test mean scores and to post-test mean scores of the control group (p<0.001). However, no significance difference (p=0.11) was found between the experimental and control groups on the post-test performance mean scores. The participants evaluated the serious game positively.

CONCLUSION

The study provided evidence on the effectiveness of a serious game in improving the knowledge and confidence of nursing students on blood transfusion practice. The features of this serious game could be further developed to incorporate additional scenarios with repetitive exercises and feedback to enhance the impact on clinical performance. Given the flexibility, practicality, and scalability of such a game, they can serve as a promising approach to optimize learning when blended with high-fidelity simulation.

Simulation as a toolkit-understanding the perils of blood transfusion in a complex health care environment

Background

Administration of blood is a complex process requiring vigilance and effective teamwork. Despite strict policies and training on blood administration, errors still occur and can lead to mistransfusion with adverse patient outcomes. We used an in situ simulated scenario within an operating room (OR) to identify weaknesses in the current process and hazards that could contribute to mistransfusion.

Methods

A process checklist of critical steps of safe transfusion was developed based on a large academic centre’s internal hospital policy and practice. Ten standardized operating room scenarios were conducted involving management of postoperative bleeding. Scenarios lasted 20 min or until blood transfusion was started. Debriefing followed immediately. Video recordings were reviewed, scored, and evaluated for team performance. Latent safety threats were identified. Focus groups further helped to identify rationale for decisions made. Participants completed questionnaires to evaluate the exercise.

Results

Forty-three experienced OR professionals participated. Of the 19 steps identified as essential for the safe administration of blood components, the median number of steps correctly completed per team was 11. The largest number of errors occurred when different team members interacted and during the immediate pre-transfusion check. We report that this type of learning immediately increased participants’ self-reported ability to perform in a team (90%) and to improve clinical care (88%).

Conclusions

In situ simulation is valuable in identifying common susceptibilities in blood administration error in a complex healthcare organization. Administrators and clinicians may wish to use simulation as an opportunity for system improvement in the delivery of quality care.

Sexual Assault Simulation Course for Healthcare Providers: Enhancing Sexual Assault Education Using Simulation

Patients who have been sexually assaulted disproportionately experience gaps in healthcare delivery. Ensuring that healthcare providers who care for this population are adequately prepared is one way of addressing this gap. At the Brigham and Women's Hospital, a 4-hour long interprofessional Sexual Assault Simulation Course for Healthcare Providers (SASH) was developed and conducted at the hospital's Simulation, Training, Research, & Technology Utilization System Center. The SASH is offered using a variety of teaching methodologies including didactics, skill stations comprising how to collect forensic evidence, simulation experience with standardized patient, and debriefing. Using simulation as an educational method allows healthcare professionals to gain hands-on skills in a safe environment. Ultimately, the goal of the SASH is to enhance collaborative practice between healthcare professionals and to improve knowledge, with the purpose of improving care for patients who have been sexually assaulted.

The role of ultrasound simulators in education: an investigation into sonography student experiences and clinical mentor perceptions

Simulation as an effective pedagogy is gaining momentum at all levels of health care education. Limited research has been undertaken on the role of simulated learning in health care and further evaluation is needed to explore the quality of learning opportunities offered, and their effectiveness in the preparation of students for clinical practice. This study was undertaken to explore ways of integrating simulation-based learning into sonography training to enhance clinical preparation. A qualitative study was undertaken, using interviews to investigate the experiences of a group of sonography students after interacting with an ultrasound simulator. The perceptions of their clinical mentors on the effectiveness of this equipment to support the education and development of sonographers were also explored. The findings confirm that ultrasound simulators provide learning opportunities in an unpressurised environment, which reduces stress for the student and potential harm to patients. Busy clinical departments acknowledge the advantages of opportunities for students to acquire basic psychomotor skills in a classroom setting, thereby avoiding the inevitable reduction in patient throughput which results from clinical training. The limitations of simulation equipment to support the development of the full range of clinical skills required by sonographers were highlighted and suggestions made for more effective integration of simulation into the teaching and learning process. Ultrasound simulators have a role in sonography education, but continued research needs to be undertaken in order to develop appropriate strategies to support students, educators and mentors to effectively integrate this methodology.

[New training tools in haemovigilance]

The transfusion of blood and blood products is a complex, multi-professional task which is liable to errors from donor to recipient. Simulation is a new training tool in medicine which may result with an improvement for safety and quality of care without any risk for the patient. Different simulators are available: haptic system and low fidelity mannequin for technical skills, software, full scale intermediate to high fidelity mannequin, actors and virtual reality. For haemovigilance training, actors and intermediate to high fidelity mannequins could be used to simulate complex professional situations with identity mistake and crisis management. The environment of full scale simulation is expensive and need technical and pedagogic skills.

The role of simulation for learning within pre-registration nursing education - a literature review

Simulated learning in a clinical skills centre has become more popular within undergraduate nursing education and is increasingly used to teach and assess clinical skill acquisition. Current literature suggests that there is some validity in teaching psychomotor skills in a designated simulated clinical skills centre, whilst other sources still question its value in terms of experience. Such contradictions demand further exploration and appraisal of the current literature. The findings show that simulated learning in a clinical skills laboratory is reported to increase student confidence and prepares students for real clinical setting, however, this acquisition of skill is often achieved at different rates by different students. A standardised approach to simulated learning in nursing education and the development of further holistic clinical scenarios which are linked to related theory and lectures, would offer measurable learning outcomes to meet professional and regulatory requirements. Therefore, further evaluation of the current learning methods within simulation may offer appraisal of the preparation of students for clinical practice, to ensure that students are offered quality-learning opportunities that are flexible and responsive to both their needs and the demands of the Health Care Services.

A concept analysis of simulation as a learning strategy in the education of undergraduate nursing students

Simulation is increasingly referred to in the nursing literature and its use in healthcare has developed dramatically over the past decade. Whilst the concept of simulation is not new, there is now a greater emphasis on its use in nurse education (Murray et al., 2008). The purpose of this article is to develop understanding and define the concept of simulated learning as a strategy used in the education of undergraduate nursing students. The analysis outlined in this paper was guided by a systematic process of studying a concept presented by Walker and Avant (2005). The analysis sought to identify how the concept of simulation is interpreted in the existing literature printed in English and retrieved from databases (Medline, CINAHL, PubMed, and Cochrane Library), internet search engines (GoogleScholar) and hand searches. The definition offered is a work in progress and presents a theoretically grounded understanding of what simulated learning currently represents. The identified antecedents, critical attributes and consequences are presented as a basis to stimulate further research, development and understanding.

A survey of first year student nurses' experiences of learning blood pressure measurement

Blood pressure (BP) measurement is an important clinical nursing skill. Informal evaluation triggered concerns about first year student nurses' opportunities to practise it. Therefore 447 first year pre-registration nursing students completed evaluative questionnaires following two 6-week clinical placements. The data were analysed using SPSS v.13 for analysis; open comments were analysed thematically. A third of the respondents (n=137) had pre-course experience in measuring BP. Ninety-five percent (n=425) attended the university skills laboratory session. Only 36% (n=158) of students measured BP using both electronic and manual equipment in both placements and 6% (n=27) did not practise this skill in either placement. Students undergoing non-hospital placements reported fewer practice opportunities. A large number of students reported never having been supervised while measuring BP; they were more likely to be supervised while measuring BP manually than electronically. Students' self-confidence in BP measurement increased over the first year but larger number of students were confident in electronic BP. To conclude, experiences of learning BP measurement varied in terms of opportunities to practise, equipment used, supervision levels and self-confidence. Students' experiences of learning other clinical skills may also differ, which has implications for healthcare education generally.

The use of simulation as a teaching and learning approach to support practice learning

Simulation is an approach to teaching and learning which is gaining a greater emphasis within nurse education. This has been fueled by the Nursing and Midwifery Council's (NMC) decision to identify a baseline standard for using simulation safely and its inclusion as a contributory part to practice learning [Nursing and Midwifery Council (2006a). This paper presents some of the advantages and issues for consideration in relation to its effectiveness as a teaching and learning method. Of particular concern is the limited empirical evidence to support its effect on clinical practice. Debate and further research is needed to help consolidate our knowledge and develop an evidence base for its continued use.