Using Simulation to Create the Competencies You Want

Hospitals today are looking for a broader range of talents in new nurse hires. At the top of the list are leadership skills.

今天的护士不仅完成了由医生分配的任务，还做出了关键和挽救生命的决定。从北威彻斯特医院的CEN的Rosanne Greenan拿走：

“Nurses are no longer caretakers to the healthcare team, carrying out tasks ordered by physicians. Now we are leaders of the team as well as patient advocates and educators. In the ED where I work, nurses are the first to assess patients and often establish the goals for their hospital stay. Physicians view us as colleagues who make concrete observations and offer valuable suggestions.”¹

A nurse graduate who lacks leadership skills can be at a disadvantage in today’s new environment. The same holds true for an experienced nurse whose skills are not kept current and reinforced. The prerequisites to meeting today’s nurse expectations are not only hard skills, but soft skills, like teamwork and problem-solving. This is much different than what was expected of nurses 25 years ago.

为了满足这些日益增长的期望，护士教育者正在不断转向模拟。根据国家护理委员会（NCSBN）的说法，我们现在知道，多达50％的临床时间可以取代模拟。²但，并非所有模拟都相等。就像护理发生了变化一样，模拟也是如此。

临床模拟过去是“任务培训”的代名词。现在，模拟是关于在任务培训只是一小部分的环境中进行现实生活的排练。

Nursing has settled into a new norm. In this article, we discuss how nursing has changed in the past 25 years, and how increasing your simulation fidelity can help you impart the necessary skills in today’s nursing environment.

1.以患者为中心的护理在显微镜下

护理一直是以患者为中心的护理的核心。改变的是与该护理相关的透明度和关键绩效指标的评估。

Hospitals today are held to strict government standards regarding patient satisfaction and safety measures. In addition, hospitals operate under an unprecedented influence from major patient safety advocacy groups – and with a bold transparency to the public.护士是可能影响结果的最大员工元素。

护士雇主正在寻找对人为因素，系统因素和态度如何影响以患者为中心的护理的护士。这对您的仿真程序意味着什么是忠诚的计算。提供更高水平的现实主义可以更好地为学习者做好现实生活的准备。

在Laerdal，我们坚持认为模拟与模拟器无关 - 这与学习经历有关。但是，当您试图在现实世界中赋予硬和软技能时，模拟器仍然是基础。

了解您的情况，目标和期望的结果是基于您所需的现实主义水平的绝佳基础。坚持这些构建基础，并避免在可能损害参与者需要学习的经验的领域妥协。

2. A New Importance Placed on Diagnosis & Assessment

There is a general expectation – within nursing and among patients – that nurses can give an accurate, detailed patient analysis and make recommendations to other members of the care team. And, while a nurse’s scope of practice has clear limits in the context of assessment and diagnosis, the limits are not what they were 25 years ago.

每年在美国，估计有1200万人遇到诊断错误。³这个数字每年相当于每20名成年人中有1个，通常是常见的疾病。

这是忠诚计数的另一种情况。为了实现诊断忠诚度，请选择一个可以呈现逼真的生命体征，可以显示意识迹象并具有正确的解剖结构和关键地标的模拟器。

You should also consider features like:

• Correct auscultation sites
• 逼真的肢体关节
• 执行基本治疗程序的能力

这些功能对于您的学习者的最初患者评估至关重要，并将提供进行生理监测的机会。During a high-fidelity simulation, learners can truly grasp the reality of their actions.

当与经过验证的方案结合使用时，高保真模拟器允许基于证据的决策，然后进行临床干预措施，采用“真实”人类反应。当训练低频，高巨大的紧急情况作为团队的一部分时，这一点尤其重要。

在这种情况下，模拟有助于促进护士专注于批判性思维，临床推理和临床判断技能的环境，此外还可以促进知识。

3.“过渡冲击”是一个日益关注的问题

“Transition shock”, the jump from nursing education to nursing practice, is credited as one of the major reasons for high turnover rates among new nurses.⁴在工作第一年内，新护士流失率高达25％，因此令人担忧。⁵

Managerial confidence in new nurses is also a concern within many hospitals. A survey shows that only 10% of nurse executives believe that new nurses are competent to perform their jobs.⁶同时，普通护士主管的愿望平均是护士主管的愿望。

所有这些都可能导致劳动力压力，并且可以在患者的安全和患者满意度的下降中表现出来。一项研究表明，已经看到75％的新护士被认为犯了药物错误。⁷

通常，机构将寻求通过教学培训，咨询或协议和程序的审查来解决此类问题。这样的措施很少产生证明有效的参与度。

高保真模拟不仅是一种培训形式，而且是一种干预形式，都会对这种情况产生重大影响。模拟吸引学习者,提高学习者受潮湿腐烂ention, and directly impacts patient care management.^9,10,11

无论您代表护理学校还是医院，将模拟作为干预措施都可以帮助您缩小注意力，并赋予护士在当今护理环境中所需的信心和能力。

模拟什么护士ReallyNeed to Achieve

在过去25年中，护理领域看到的变化表明，需要在培训中为护士提供更多的动手，包容和沉浸式经验。对团队合作，沟通技巧和安全护理实践的更多关注，护士受益于早期和额外接触基于模拟的培训。

Research findings suggest that students who engage in simulations experience an increase in overall self-efficacy, develop confidence to assess vital signs, and provide an improved patient education.¹²

Nursing now requires an extraordinary focus on patient safety, diagnosis, assessment, and clinical reasoning. At every level, nursing today involves a new level of leadership, and a new sense of ownership.

High-fidelity simulation can provide the necessary support for nurses to develop with competence, with compliance, and positioned to optimize patient care. If you would like to better prepare your nurses to meet the challenges in healthcare today, please contact us. We are here to help.