UNIT–BASED (IN-SITU) SIMULATION MANUAL First Edition Purpose of this Manual To provide a framework for the development and implementation of a simulation program within the clinical environment. This guide provides a set of best practices upon which to build your Unit-based program in collaboration with NYC Health + Hospitals Simulation Center. SIMULATION CENTER SIMULATION CENTER NYC Health + Hospitals Simulation Center Unit-based Simulation Manual First Edition, July 2016 I TABLE OF CONTENTS FUNDAMENTALS OF SIMULATION DEFINITIONS FUNDAMENTALS OF SIMULATION • Definitions ......................................................1 Debrief (Debriefing) \ dēˈbrēf \ noun (verb) • Potential Applications of Etym. debrief “obtain information (from someone) at the end of a mission,” 1945, from de- + brief (verb). Unit-based Simulation .................................5 Related: Debriefed; debriefing. Definition ELEMENTS OF SIMULATION • (noun) A formal, collaborative, reflective process within the simulation learning activity. • Element 1: Secure Interprofessional • An activity that follows a simulation experience and Leadership Buy-In and Assemble led by a facilitator. Core Team ......................................................6 • (verb) To conduct a session after a simulation event where educators/instructors/facilitators and • Element 2: Perform a Needs learners re-examine the simulation experience for Assessment to Identify the Problem the purpose of moving toward assimilation and The Basic or Gap .............................................................7 accommodation of learning to future situations Assumption: (Johnson-Russell & Bailey, 2010; NLN-SIRC, 2013); Everyone • Element 3: Planning and Rollout ........... 10 debriefing should foster the development of participating in clinical judgment and critical thinking skills • Element 4: Key Processes of (Johnson-Russell & Bailey, 2010). the simulation Curriculum Design .................................... 13 • To encourage participants’ reflective thinking and is intelligent, • Element 5: Evaluation and provide feedback about their performance while capable, and various aspects of the completed simulation are Sustainability ............................................... 14 wants to learn discussed. • To explore with participants their emotions and new things. to question, reflect, and provide feedback to one RESOURCES another (i.e., guided reflection). • Unit-based Simulation Checklist ........... 15 Compare: FEEDBACK, GUIDED REFLECTION, ADVOCACY, INQUIRY. • Simulation Activity Tracker ...................... 16 • Example Simulation Announcement .... 18 Fiction Contract \ˈfik-shən\ ˈkän-ˌtrakt \ (noun) Etym. fiction (noun) something that is not true; • Whiteboard Schematic ............................ 20 something invented by the imagination or feigned; an assumption of a possibility as a fact irrespective • References ................................................... 20 of the question of its truth; a useful illusion or • Simulation Center Resource Team ........ 21 pretense; the action of feigning or of creating with the imagination. Etym. contract (noun) a binding agreement between two or more persons or parties. Definition • A concept which implies that an engagement in simulation is a contract between the instructor and NYC Health + Hospitals Simulation Center NYC Health + Hospitals Simulation Center II Unit-based Simulation Manual First Edition, July 2016 Unit-based Simulation Manual First Edition, July 2016 1 FUNDAMENTALS the learner: each has to do his or her part to make In Situ/In Situ Simulation \ in - sɪtju \ sim-yuh-ley-shuh n FUNDAMENTALS OF SIMULATION the simulation worthwhile (Rudolph, Dieckmann, (noun \ adjective) OF SIMULATION et al.). Etym. in situ 1740, Latin, literally “in its (original) • The degree of engagement that healthcare place or position,” from ablative of situs “site.” trainees are willing to give the simulated event; Etym. simulation noun of action from past participle also known as the “suspension of disbelief,” it is stem of simulare “imitate,” from stem of similis “like.” a literary and theatrical concept that encourages Meaning “a model or mock-up for purposes of participants to put aside their disbelief and experiment or training” is from 1954. accept the simulated exercise as being real for the Definition duration of the scenario. • Taking place in the actual patient care setting/ environment in an effort to achieve a high level of Fidelity \ fə-’de-lə-tē \ (noun) Think about the fidelity and realism; this training is particularly Etym. fidelity early 15c., “faithfulness, devotion,” suitable for difficult work environments due to space whole healthcare from Middle French fidélité (15c.), from Latin constraints or noise. Examples: ambulance, small fidelitatem (nominative fidelitas) “faithfulness, team to create aircraft, dentist’s chair, catheterization lab (Kyle & adherence, trustiness,” from fidelis “faithful, true, interprofessional Murray, 2008). This training is valuable to assess, trusty, sincere,” from fides “faith.” From 1530s as troubleshoot, or develop new system processes. scenarios. “faithful adherence to truth or reality;” specifically of sound reproduction from 1878. Developing Psychological Safety \ sahy-kuh-loj-i-kuh l \ seyf-tee (noun) a sustainable, Definition Etym. psychology (noun) 1650s, “study of the soul,” effective program • The degree to which the simulation replicates the from Modern Latin psychologia, probably coined real event and/or workplace; this includes physical, mid-16c. in Germany by Melanchthon from Latinized takes time. psychological, and environmental elements. form of Greek psykhe – “breath, spirit, soul” + logia • The ability of the simulation to reproduce the “study of.” Meaning “study of the mind” first recorded reactions, interactions, and responses of the real 1748, from Christian Wolff’s “Psychologia empirica” world counterpart. It is not constrained to a certain (1732); main modern behavioral sense is from early type of simulation modality, and higher levels 1890s. Etym. safety (noun) early 14c., from Old French of fidelity are not required for a simulation to be sauvete “safety, safeguard; salvation; security, surety,” Treat participants successful. earlier salvetet (11c., Modern French sauveté), from as peers, • The level of realism associated with a particular Medieval Latin salvitatem (nominative salvitas) “safety,” respect and simulation activity; fidelity can involve a variety of from Latin salvus. honor opinions. dimensions, including (a) physical factors such as Definition environment, equipment, and related tools; (b) • A feeling (explicit or implicit) within a simulation- psychological factors such as emotions, beliefs, based activity that participants are comfortable and self-awareness of participants; (c) social factors participating, speaking up, sharing thoughts, and such as participant and instructor motivation and asking for help as needed without concern for goals; (d) culture of the group; and (e) degree of retribution or embarrassment. openness and trust, as well as participants’ modes • The perception of members of the team that the of thinking (INACSL, 2013). team is safe for risk taking, and mistakes will be See also: ENVIRONMENTAL FIDELITY, HIGH FIDELITY, considered learning opportunities rather than there LOW FIDELITY, PSYCHOLOGICAL FIDELITY, REALISM, being embarrassment or punitive consequences SIMULATION FIDELITY. FUNCTIONAL FIDELITY (Edmondson, 1999; Higgins et al., 2012). See also: SIMULATION LEARNING ENVIRONMENT NYC Health + Hospitals Simulation Center NYC Health + Hospitals Simulation Center 2 2 Unit-based Simulation Manual First Edition, July 2016 Unit-based Simulation Manual First Edition, July 2016 3 FUNDAMENTALS Simulated Patient (SP) \ sim-yuh-leyt-id \ pey-shuh nt Simulation \ sim-yuh-ley-shuh n \ (noun) FUNDAMENTALS OF SIMULATION (noun) Etym. simulation (noun) noun of action from past OF SIMULATION [Note: This term is often synonymous with participle stem of simulare “imitate,” from stem of Standardized Patient] similis “like.” Meaning “a model or mock-up for purposes of experiment or training” is from 1954. Etym. simulated (adjective) 1620s, “feigned,” past participle adjective from simulate (verb). Meaning Definition “imitative for purposes of experiment or training” • A technique that creates a situation or environment is from 1966; commercial jargon, “artificial, imitation” to allow persons to experience a representation by 1942. Etym. patient (noun) “suffering or sick of a real event for the purpose of practice, learning, person under medical treatment,” late 14c., from Old evaluation, testing, or to gain understanding of French pacient (noun), from the adjective, from Latin systems or human actions. patienten. • An educational technique that replaces or amplifies real experiences with guided Definition experiences that evoke or replicate substantial • A person who has been carefully coached to aspects of the real world in a fully interactive simulate an actual patient so accurately that the Faculty members manner (Gaba Future Vision Qual Saf Health simulation cannot be detected by a skilled clinician. learn as much Care 2004). In performing the simulation, the SP presents the • A pedagogy using one or more typologies to from participants gestalt of the patient being simulated; not just promote, improve, or validate a participant’s the history, but the body language, the physical as participants progression from novice to expert (INACSL, 2013).