IU Indianapolis ScholarWorks :: Browsing by Subject "simulation"

Browsing by Subject "simulation"

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A Simulation Pre-Brief Scaffold to Support Clinical Judgment and Independence in Clinical Judgment Decision Making
(2024-01) McIntire, Emily S.; Friesth, Barbara Manz; Hendricks, Susan; Reising, Deanna; Danish, Joshua
It is essential that nurses independently assume patient care, yet new nurses lack necessary clinical judgment skills. The purpose of this study was to examine a simulation pre-brief scaffold to support nursing students’ clinical judgment development and clinical judgment independence. The pre-brief experiential learning scaffold for clinical judgment independence (PELS-CJI) framework informed simulation pre-brief in this experimental study. A convenience sample included traditional and accelerated Bachelor of Science in nursing students in their senior year. Participants were randomly assigned to complete a simulation pre-brief with or without the Interactive-Video Recorded Simulation (I-VRS). Nursing student’s total clinical judgment and individual components of clinical judgment (noticing, interpreting, and responding) in simulation were measured by a single evaluator blinded to condition using the Lasater clinical judgment rubric (LCJR) (Cronbach’s alpha .932). To measure clinical judgment independence, the number of unintended conceptual cues during simulation were counted. Participants in the intervention group had higher clinical judgment scores during simulation (n = 31, M = 28.45, SD = 5.163) as compared to the control group (n = 36, M = 25.06, SD = 5.275), t(65) = -2.653, p < .01. A significant relationship for the noticing and responding subscales of clinical judgment was observed between groups, but not for the interpreting subscale. No significant difference in the number of unintended cues was found between groups. Results support that using an I-VRS in simulation pre-brief enhanced clinical judgment in simulation. The use of the I-VRS adds to the existing limited evidence related to simulation pre-brief to support clinical judgment development among undergraduate nursing students. Future research using an I-VRS during pre-brief is necessary to determine if improvement in clinical judgment is retained and transferrable to the clinical setting. Additional testing of the PELS-CJI to guide simulation pre-brief is encouraged.
ANGLE STABILITY PREDICTIONS
(Office of the Vice Chancellor for Research, 2012-04-13) Nilchi, Maryam N.; Longbottom, Daniel W.; Vasquez, Diana C.; Rovnyak, Steven M.
The variance of phase angle changes over the network is a good display of total stress and angle stability. The integral square generator angle (ISGA) changes had been recommended earlier to evaluate how severe the stable and unstable transient contingencies in simulation are. This project offers its addition to bus voltage angles (ISBA) which could be measured with synchronized phasor measurement units (PMUs) over a wide-ranging area. By restructuring continuous paths that go outside the boundary be-tween positive and negative 180 degrees before calculating the ISBA, the cutoff of bus angles at positive and negative 180 degrees is recovered. The project also directs the matter of obtaining the best angle stability index as the threshold between stable and unstable classes with use of simulation da-ta. This issue becomes more difficult by the fact that large databases might include a few events for which loss of synchronism happens toward the end of the simulation sequence.
Attentional selectivity, automaticity, and self-efficacy predict simulator-acquired skill transfer to the clinical environment
(Elsevier, 2019-02) Anton, Nicholas E.; Mizota, Tomoko; Timsina, Lava R.; Whiteside, Jake A.; Myers, Erinn M.; Stefanidis, Dimitrios; Surgery, School of Medicine
Introduction Several studies demonstrated that simulator-acquired skill transfer to the operating room is incomplete. Our objective was to identify trainee characteristics that predict the transfer of simulator-acquired skill to the operating room. Methods Trainees completed baseline assessments including intracorporeal suturing (IS) performance, attentional selectivity, self-reported use of mental skills, and self-reported prior clinical and simulated laparoscopic experience and confidence. Residents then followed proficiency-based laparoscopic skills training, and their skill transfer was assessed on a live-anesthetized porcine model. Predictive characteristics for transfer test performance were assessed using multiple linear regression. Results Thirty-eight residents completed the study. Automaticity, attentional selectivity, resident perceived ability with laparoscopy and simulators, and post-training IS performance were predictive of IS performance during the transfer test. Conclusions Promoting automaticity, self-efficacy, and attention selectivity may help improve the transfer of simulator-acquired skill. Mental skills training and training to automaticity may therefore be valuable interventions to achieve this goal.
Automatic Modeling and Simulation of Networked Components
(2011) Bruce, Nathaniel William; Koskie, Sarah; Chen, Yaobin; Li, Lingxi
Testing and verification are essential to safe and consistent products. Simulation is a widely accepted method used for verification and testing of distributed components. Generally, one of the major hurdles in using simulation is the development of detailed and accurate models. Since there are time constraints on projects, fast and effective methods of simulation model creation emerge as essential for testing. This thesis proposes to solve these issues by presenting a method to automatically generate a simulation model and run a random walk simulation using that model. The method is automated so that a modeler spends as little time as possible creating a simulation model and the errors normally associated with manual modeling are eliminated. The simulation is automated to allow a human to focus attention on the device that should be tested. The communications transactions between two nodes on a network are recorded as a trace file. This trace file is used to automatically generate a finite state machine model. The model can be adjusted by a designer to add missing information and then simulated in real-time using a software-in-the-loop approach. The innovations in this thesis include adaptation of a synthesis method for use in simulation, introduction of a random simulation method, and introduction of a practical evaluation method for two finite state machines. Test results indicate that nodes can be adequately replaced by models generated automatically by these methods. In addition, model construction time is reduced when comparing to the from scratch model creation method.
A Collaborative In Situ Simulation-based Pediatric Readiness Improvement Program for Community Emergency Departments
(Wiley, 2017) Abulebda, Kamal; Lutfi, Riad; Whitfill, Travis; Abu-Sultaneh, Samer; Leeper, Kellie J.; Weinstein, Elizabeth; Auerbach, Marc A.; Pediatrics, School of Medicine
Background More than 30 million children are cared for across 5,000 U.S. emergency departments (EDs) each year. Most of these EDs are not facilities designed and operated solely for children. A Web-based survey provided a national and state-by-state assessment of pediatric readiness and noted a national average score was 69 on a 100-point scale. This survey noted wide variations in ED readiness with scores ranging from 61 in low-pediatric-volume EDs to 90 in the high-pediatric-volume EDs. Additionally, the mean score at the state level ranged from 57 (Wyoming) to 83 (Florida) and for individual EDs ranged from 22 to 100. The majority of prior efforts made to improve pediatric readiness have involved providing Web-based resources and online toolkits. This article reports on the first year of a program that aimed to improve pediatric readiness across community hospitals in our state through in situ simulation-based assessment facilitated by our academic medical center. The primary aim was to improve the pediatric readiness scores in the 10 participating hospitals. The secondary aim was to explore the correlation of simulation-based performance of hospital teams with pediatric readiness scores. Methods This interventional study measured the Pediatric Readiness Survey (PRS) prior to and after implementation of an improvement program. This program consisted of three components: 1) in situ simulations, 2) report-outs, and 3) access to online pediatric readiness resources and content experts. The simulations were conducted in situ (in the ED resuscitation bay) by multiprofessional teams of doctors, nurses, respiratory therapists, and technicians. Simulations and debriefings were facilitated by an expert team from a pediatric academic medical center. Three scenarios were conducted for all teams and include: a 6-month-old with respiratory failure, an 8-year-old with diabetic ketoacidosis (DKA), and a 6-month-old with supraventricular tachycardia (SVT). A performance score was calculated for each scenario. The improvement of PRS was compared before and after the simulation program. The correlation of the simulation performance of each hospital and the PRS was calculated. Results Forty-one multiprofessional teams from 10 EDs in Indiana participated in the study, five were of medium pediatric volume and five were medium- to high-volume EDs. The PRS significantly improved from the first to the second on-site verification assessment (58.4 ± 4.8 to 74.7 ± 2.9, p = 0.009). Total adherence scores to scenario guidelines were 54.7, 56.4, and 62.4% in the respiratory failure, DKA, and SVT scenarios, respectively. We found no correlation between simulation performance and PRS scores. Medium ED pediatric volume significantly predicted higher PRS scores compared to medium-high pediatric ED volume (β = 8.7; confidence interval = 0.72–16.8, p = 0.034). Conclusions Our collaborative improvement program that involved simulation was associated with improvement in pediatric readiness scores in 10 EDs participating statewide. Future work will focus on further expanding of the network and establishing a national model for pediatric readiness improvement.
DESIGN EVALUATION AND DEVELOPMENT OF A VEHICLE PHYSICS MODEL FOR A DRIVER TRAINING SIMULATOR
(2017-04-14) Stover, Tyler; Borme, Andrew; Hylton, Peter; Cooney, Elaine
As part of the development of the RLAPS Simulation Software Program (SSP) a vehicle physics model was developed around four subsystems – chassis and suspension, aerodynamics, powertrain, and tires. Tires are the most complex model, and have the most direct impact on the performance and feel of the vehicle model. A complex algorithm governing vehicle physics was presented in a generalized form to guide the programming of the RLAPS SSP. From the generalized algorithm, a practical model was implemented using Unity 3D game creation software (Unity, 2017). The simulation was tested and evaluated against data from numeric lap-time simulation software. Various parameters were opened for tuning to refine the performance and behavior of the vehicle in simulation. The tuned vehicle model performed in such a manner as to exercise the steering, braking, and throttle application skills of drivers using the simulator.
THE EFFECT OF CURRICULAR SEQUENCING OF HUMAN PATIENT SIMULATION LEARNING EXPERIENCES ON STUDENTS’ SELF-PERCEPTIONS OF CLINICAL REASONING ABILITIES
(2011-11-18) Jensen, Rebecca Sue; Ebright, Patricia; Pesut, Daniel J.; Fisher, Mary L., Ph.D.; Welch, Janet L.
It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students’ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students’ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students’ perceptions of clinical reasoning. Students who were older and had previous healthcare experience had higher scores, as well as students in the AS program, indicating larger changes in students’ perceptions of clinical reasoning abilities from Baseline to Time 2. Timing of HPS, mid or end of semester, had no effect on Difference scores, and thus students’ perceptions of clinical reasoning abilities.
Effective Teaching in Clinical Simulation: Development of the Student Perception of Effective Teaching in Clinical Simulation Scale
(2009-06-23T21:51:22Z) Reese, Cynthia E.; Jeffries, Pamela; Pesut, Daniel J.; Halstead, Judith; Bakas, Tamilyn
Clinical simulation is an innovative teaching/learning strategy that supports the efforts of educators to prepare students for practice. Despite the positive implications of clinical simulations in nursing education, no empirical evidence exists to inform effective teaching in simulated learning environments. The purpose of this research is to create an instrument to measure effective teaching strategies in clinical simulation contexts. The conceptual framework for this study is the Nursing Education Simulation Framework. The Student Perception of Effective Teaching in Clinical Simulation (SPETCS) is a survey instrument scored on a 5-point Likert scale with two response scales: Extent and Importance. The Extent response scale measures participants’ perception of the extent to which the instructor used a particular teaching strategy during the simulation, and the Importance response scale measures perception of the degree of importance of the teaching strategy toward meeting simulation learning outcomes. A descriptive, quantitative, cross-sectional design was used. Evidence to support content validity was obtained via a panel of simulation experts (n = 7) which yielded a content validity index of .91. A convenience sample of undergraduate nursing students (n = 121) was used for psychometric analysis. Internal consistency reliability met hypothesized expectations for the Extent (α = .95) and Importance (α = .96) response scales. Temporal stability reliability results were mixed; correlations between administration times met expectations on the Importance scale (ICC = .67), but were lower than expected on the Extent scale (ICC = .52). Both response scales correlated within hypothesized parameters with two criterion instruments (p < .01). The Importance scale was selected for exploratory factor analysis (EFA). EFA revealed 2 factors: Learner Support and Real-World Application. The result of careful item and factor analysis was an easy to administer 33 item scale with 2 response scales. The SPETCS has evidence of reliability and validity and can serve as a tool for the assessment, evaluation, and feedback in the ongoing professional development of nurse educators who use clinical simulations in the teaching/learning process. In addition, results of this study can support the identification of best practices and teaching competencies in the clinical simulation environment.
Human factors and simulation in emergency medicine
(Wiley, 2017) Hayden, Emily M.; Wong, Ambrose H.; Ackerman, Jeremy; Sande, Margaret K.; Lei, Charles; Kobayashi, Leo; Cassara, Michael; Cooper, Dylan D.; Perry, Kimberly; Lewandowski, William E.; Scerbo, Mark W.; Emergency Medicine, School of Medicine
This consensus group from the 2017 Academic Emergency Medicine Consensus Conference “Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes” held in Orlando, Florida on May 16, 2017 focused on the use of human factors and simulation in the field of emergency medicine. The human factors discipline is often underutilized within emergency medicine but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of human factors, its benefits in medicine, how simulation can be a catalyst for human factors work in emergency medicine, and how emergency medicine can collaborate with human factors professionals to affect change. Implementing human factors in emergency medicine through healthcare simulation will require a demonstration of clinical and safety outcomes, advocacy to stakeholders and administrators, and establishment of structured collaborations between human factors professionals and emergency medicine, such as in this breakout group.
Improving Emergency Preparedness in Pediatric Primary Care Offices: A Simulation-Based Interventional Study
(Academic Pediatric Association, 2022-09) Yuknis, Matthew L.; Abulebda, Kamal; Whitfill, Travis; Pearson, Kellie J.; Montgomery, Erin E.; Auerbach, Marc A.; Pediatrics, School of Medicine
Objectives Pediatric emergencies pose a challenge to primary care practices due to irregular frequency and complexity. Simulation-based assessment can improve skills and comfort in emergencies. Our aim was improving pediatric office emergency preparedness, as measured by adherence to the existing American Academy of Pediatrics policy statement, and quality of emergency care in a simulated setting, as measured by performance checklists. Methods This was a single center study nested in a multicenter, prospective study measuring emergency preparedness and quality of care in 16 pediatric primary care practices and consisted of 3 phases: baseline assessment, intervention, and follow-up assessment. Baseline emergency preparedness was measured by checklist based on AAP guidelines, and quality of care was assessed using in-situ simulation. A report-out was provided along with resources addressing potential areas for improvement after baseline assessment. A repeat preparedness and simulation assessment was performed after a 6 to 10 month intervention period to measure improvement from baseline. Results Sixteen offices were recruited with 13 completing baseline and follow-up preparedness assessment. Eight of these sites also completed baseline and follow-up simulation assessment. Median baseline preparedness score was 70% and follow-up was 75.9%. Median baseline simulation performance scores were 37.4% and 35.5% for respiratory distress and seizure scenarios, respectively. Follow-up simulation assessment scores were 73% and 76.9% respectively (P = .001). Conclusions Our collaborative was able to successfully improve the quality of care in a simulated setting in a group of pediatric primary care offices over 6 to 10 months. Future work will focus on expansion and improving emergency preparedness.

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