Using Simulation Technologies to Teach Nursing at HEIs in Jamaica

 

Patientsimulation (1)

What is Simulation? Simulation is essentially an imitation of what is real. Gaba (2007) defined simulation as a technique which replaces or amplifies real experiences with guided experiences. These situations replicate substantial aspects of the real world in an interactive fashion. A simulator is the device used for simulation. Is the use of simulation new in teaching nursing one may ask…the simple answer would be ‘NO.’ Traditionally in teaching nurses, simulation has always been used. Examples of these would be the practice of demonstrating skills in a lab and having students return the demonstration; the many role plays that are used to concretize concepts; using case studies and problem-based scenarios are all forms of simulated learning.  However, many senior nurses may well remember practicing giving an injection on oranges…and of course on patients hospitalised to be cared for. ‘Am I in the muscle?’

Injected Orange

Nursing is both a science and an art which requires both the theoretical knowledge and clinical expertise. Jamaica has consistently educated nurses who are highly sought after around the world with many nurses migrating to North America. The challenges that have arisen for some years now are the expansions of nursing programmes and the large numbers of students being admitted since nursing is being taught in the university settings. At the University of Technology, Jamaica, where I teach, for example, there is usually 100 students accepted in year one on the Kingston campus and another 50 at the Montego Bay campus. At the same time the University of the West Indies School of Nursing would be accepting even more than 100 students on their Kingston campus, with additional numbers at their Western campus and at franchised institutions in some of the Community Colleges in Kingston and other parishes; Northern Caribbean University also accepts very large numbers of students. Are you getting the picture? With so many students to be trained and all of them using the same clinical facilities, the overcrowding is inevitable. This results in students not being able to get ample clinical practice for the skills that they need. This is also occurring in a setting where so many nurses are migrating to other countries. In 2015, the Nurses Association President, Mrs. Janet Farr, raised the alarm that migration and resignation of specialist nurses from the public health system in 2014 resulted in extreme shortages and contributed to an increase in workload (Porter, 2015). This trend has continued steadily and in 2016, Minister of Health Christopher Tufton was reported as saying that migration of nurses has creating a health care crisis (The Jamaica Observer, 2016).

Why Simulation?

'Correct. And in the case of a cardiac arrest, every second counts. Who can tell me why? Anyone? Clock's ticking.'

The use of patients to teach and practice within the clinical setting will always be relevant in nursing and cannot be fully replaced. However, patient safety must be paramount. Patient safety is a major reason to use simulation in teaching nursing or any other health discipline for that matter. McGaghie, Issenburg, Cohen, Barsuk and Wayne (2011), reported that for the field of medicine a growing body of evidence supports improved patient care practices and better patient outcomes when clinical skills are acquired in medical simulation laboratory settings.

Other reasons, in addition to the changes in the clinical environment outlined above; are to facilitate deliberate practice and assessment; team training; research, improved technology as well as being more effective; facilitates immediate feedback; allows deliberate practice; curriculum integration; outcome measurement; skill acquisition and maintenance; transfer to practice among others. Simulation is also fun while learning! You can “kill” the patient without suffering terrible consequences (Gaba, 2007; McGaghie, Issenburg, Petrusa and Ross, 2010).

https://www.youtube.com/watch?v=rAXptP1Reqw

How much is the simulation technologies used to teach nursing in Jamaica. The three major universities have a variety of simulators used to assist nursing students to learn. At UTech there are a mix of regular mannequins, medium fidelity simulators and high fidelity simulators. The simulators can be programmed to replicate many human responses such as crying, groaning, coughing; students can take vital signs, pass naso-gastric tubes, pass urinary catheters, set up intravenous lines; simulators can display illnesses such as asthma, heart failure etc. These abilities can allow the students to practice and become proficient in a safe place. The big BUT is do the institutions have all the human and material resources needed to fully utilize these simulators? Are there dedicated simulation labs that would replicate a hospital setting? These are challenges that the institutions face. Much more resources need to be put into this…more staff is needed and to be trained in simulation; more space is needed to create the proper environment and the nursing curriculum importantly must be revised to reflect the changes in teaching methodologies.

https://www.youtube.com/watch?v=tr70-Ho-cQU

Examples of the simulators available in the simulation learning environment in Jamaica are:

20170405_093520

Medium Fidelity Simulators

20170405_093717          20170405_093854

High Fidelity Simulators Including a Pregnant Woman, SimMan & an ICU SimMan

Norman (2012) sums up at that time what the literature indicated on simulation in nursing education; the simulation learning environment proves that knowledge, skills, safety, communication and confidence is improved, however, there is a gap in literature on transfer of these outcomes to the clinical setting. In Jamaica, the simulation learning environment is still taking ‘baby steps’ and therefore will not yield the type of results that is seen in some countries. In addition the research is sparse and must be undertaken so that evidence can be used to support the use of simulation technologies to teach nursing in Jamaica. I fully support the use of simulation technologies to teach nursing in HEIs in Jamaica!

Cartoon Simulated

 

References

Gaba, D.M. (2007) The future vision of simulation in healthcare. Simul Health c, 2, 126-135.

Porter, R. (2015). Public health sector lost 200 nurses last year- NAJ. The Jamaica Observer. http://www.jamaicaobserver.com/news/Public-health-sector-lost-200-nurses-last-year—NAJ_19219817

McGaghie, W.C., Issenburg, S. B., Cohen, E. R., Barsuk, J.H., & Wayne, D.B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, vol. 86 (6), pp. 1-6.

McGaghie, W.C., Issenburg, S. B., Petrusa, E.R, & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education; 44: 50-63

Migration of nurses creating health care crisis – Tufton. (2016, January 26). The Jamaica Observer.  http://www.jamaicaobserver.com/news/Migration-of-nurses-creating-health-crisis—Tufton

Norman, J. (2012). Systematic review of the literature on nursing education. The ABNF Journal; Spring 2012: pp. 24-28.

By: Keron Jones-Fraser

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Using Simulation Technologies to Teach Nursing at HEIs in Jamaica

15 thoughts on “Using Simulation Technologies to Teach Nursing at HEIs in Jamaica

  1. tanneice says:

    This was a really informative blog. I knew very little about the training process and practices of our Jamaican nurses, so thank you for sharing this.

    I fully support the use of technology in any area of learning, I would be a little nervous if we got to the place where it is only simulators are being used to train our nurses, as I think when it comes to human beings (and other natural living things) the “real” experience cannot be replicated in a lab by robots and machines. At the same time, I shudder to think that a nurse or doctor may be getting their required practice on me or my family member – what if they do something wrong! What if it is not the muscle. It is a toss up in my mind that has not been resolved.

    As I am new to this area, I do have a few questions as we consider the value of the use of technology in training nurses. Is there a programme in place for the teaching staff to be trained in how to use the simulators and any other new technologies in the field? I wondered too whether the trained teachers/trainers are among those migrating to other countries? What are the steps being considered to fill the gaps between learning in a simulation environment and putting that knowledge into real life situations?

    Do you think that a day is coming when machines will be our nurses, our teachers and doctors?

    Liked by 1 person

    1. kerjfra says:

      Happy you found this informative Tanneice. Wow…great questions. A national research and training programme started a few years ago but was stalled due to lack of funding. Each institution initiates some level of training, for example, my institution had someone trained for a short period overseas and that person did some training for the other staff. However, it is still not where it should be, much more is required.
      As it relates to migration, as in other specializations, educators migrate too and a few would have some training in simulation as well. To allay your fears though, we would never get to a place where simulation totally replaced humans in training nurses…the human touch cannot be replaced. The standard internationally is that up to 30% of clinical learning can be replaced by simulation. Yes, the clinical setting is a place for health professionals to learn and practice similar to teachers going on teaching practice. Simulation, therefore if properly utilized would allow for greater efficiency and confidence in a safe setting before meeting real people! But do remember…even the best nurses or doctors do make errors.

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  2. shenzhem says:

    Indeed our nurses are migrating to greener pastures and as such anything that will improve/enhance the teaching of nursing in HEIs in Jamaica is welcomes.

    I had no knowledge of this content and simulators in nursing, informative. If HEIs in Jamaica should expand and obtain more simulators to aid the teaching and learning experience, then more aspiring nursing students might see it fit to study nursing here than travelling abroad. This new pedagogical approach will allow nursing students to think critical and how to react to “real-life” situations as opposed to having to inject an orange in the past. Simulators would be great assets to the nursing classrooms providing new and innovative ways of delivering the lesson, utilizing less theory and more practical with “almost” humans mannequins.

    Our nurses are famous for being well trained and highly competent, therefore the use of simulators would enhance these characteristics of our already highly-trained nurses. Simulation based education would not only contribute to the students’ academic performance but would also speak to the level of quality teachers at the HEIs who are trained in this area.

    Like Tanniece, I am of the view that or rather wonder if these trained teachers/nurses are the ones who are migrating and as such each time new teachers would have to be trained as to how to use new technology, in this case, simulators.

    Being a developing country we lack the resources to outfit all nursing schools with these equipment. Nevertheless, I agree that simulators should be used in nursing education. Perfect combination of integrating theory with practice.

    Liked by 1 person

    1. kerjfra says:

      Like your thoughts Shen. Some of the comments made in response to Tanneice would apply here too. In addition though, the government does not fund nursing education as in the past. The Universities have the responsibility to provide the necessary resources to train those who they accept, including putting in the necessary simulation technologies, especially since they want large numbers. Nursing students pay about $2 million or more to do their degree. Many of them have to takeon student loans, vie for scholarships or work to fund their education. It is no surprise therefore that most of them will migrate in order to survive.

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  3. Lotoya Bond says:

    The use of simulation Technology to teach nurses is totally new to me, I had no idea that the nurses use this in their training. I thought they practice on human in the presence of their supervisor who is there to guide and facilitate them during the entire procedure. I have a mixed opinion based on the use of simulation technology. I dont think using this technolgy gives the nurses a true feedback on what they are practicing. How can you be sure that whatever is practiced can work effectively on human when it was not practiced on a human. On the other hand which human is going to risk their life to let a nurse in training practice on them, Surely not me because i have only one life to live and i am not taking any risk with it. It is what it is right now using simulation technology to help in the training process of nurses will just have to continue. Who to tell at the rate of how technology is increasing rapidly simulation will phase out and the nurses will use something more advance in their training process.

    Liked by 1 person

  4. realchez says:

    Just awesome.
    I would not have given it a second thought. Very informative. Real hands on however the real feed back would come from the ‘real’ patients who can respod to the different questions.

    It is important to produce nurses and other health care professionals who are efficient. Hence, nursing education programs are faced with increased pressure to produce graduates who are capable of providing safe patient care. “The instructional strategies utilized in both didactic and clinical components of nursing education courses are highly influential” (Fowler and Alden, 2010) in determining critical thinking and clinical decisionmaking ability as well as in developing the psychomotor skill performance of new graduates. As a result simulating patients through role play between learners and educators is commonly used in medical and nursing education.

    Again, I had no idea. Good choice.

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  5. vestinao says:

    As a drama educator, I agree that there’s no better way to learn than by doing. At least the errors aren’t harmful. For nurses, this means training in simulation labs, using medical mannequins and other technological tools to hone patient care skills will offer a great way to get started.Once nurses complete this initial training, they should be able to apply what was learnt in an externship or internship, allowing work with real patients to get accustomed to performing tasks in a live health care environment. However, for some field, like cosmetology, I do not believe that this is an effective strategy.

    I once hired a young cosmetologist to work in my beauty salon. She had just completed 2 levels at a prominent skills training centre in Kingston, where training involved practice on mannequins using dummy products. Yet, a basic task such as a perm was not a task she was equipped to do. This concept was taught using cholesterol and on a mannequin, as oppose to a relaxer and a real person. As such, the student was knowledgable on theory but not in practice. Hence, application skills were lacking.

    I agree that many persons are skeptical in allowing students to “practice” on them as I often hear persons mention their disapproval and fears of a “practice / school hospital”. Hence, stimulation labs provides an environment whereby simulated training can lead to clinical improvement.

    However, the main issue I have with stimulation, is that there is really no true substitute for real-life patient care. While training on a mannequin can help nurses in gaining confidence by building valuable skills, each patient offers a new challenge and a new test of such skills. Whereas, for a cosmetologist, training to become a professional, it’s difficult to determine how such skills will translate until they are applying them for real on an actual client.

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    1. realchez says:

      Vestino if you look at UWI well and other hospitals if we are to be honest several persons have died because we use real people to practice on. I am tentative to go to a hospital that uses people to practice as I am wondering how equipped they are. It is really touchy I think. If they make an error then my family member or I am at risk. Touch and go situation. However, there is no true getting it until we use people to study or train on but, there are so many implications…are we playing God as to who lives or dies when we use humans to do our training on…?

      Russian roulette… who is next if and when they get it wrong…

      Simulation technology yes and no…touchy… but using real persons to do our teaching that too has so many implications as we have seen in the past..wrong limbs being cut, misdiagnosed…who corrects those mistakes…

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  6. I understand the benefits of using the simulations in teaching nurses, but somehow the skeptic in me wonders if this method is really and effective one or does it really prepare the students to deal with real patients. For example, there may be certain circumstances that involve a real patient that cannot be imitated or simulated, and it under these conditions that the student would be introduced to the real world of medicine and nursing. Think about it, using a simulator and knowing that if it dies you can just always press a restart button doesn’t necessarily prepare you for the stress of a hospital environment where a patient may die and there’s no button to press restart.

    I think a mixture of both real and simulated experiences would be best.

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  7. Jamaica finds itself in both an enviable as well as an unenviable position at the same time as far as training nurses is concerned. This is as a consequence of the great demand for Jamaican trained nurses globally. Gone are the days when nurses are trained and graduate only to have great difficulty in obtaining employment in their chosen field. Nowadays student nurses are being offered employment opportunities years before graduation.
    As a consequence Jamaica now finds herself training nurses for export. Against this background Jamaica has to ensure that student nurses are ‘employment ready’ immediately upon graduation. For quite a few years now simulation techniques have been employed in a wide cross section of areas during the training of nurses. Gaba (2007) defined simulation as a technique which replaces or amplifies real experiences with guided experiences. To this end, life-like medical dummies are employed as teaching aids to ensure that a most realistic experience can be had during their training. The good thing is that there are a number of different types of dummies; each designed for the specific area(s) in which they will serve e.g. dummies to simulate broken bones, dummies to simulate wounded internal organs, dummies for eyes. The most convenient thing is that a medical dummy does not have to be full figured. Hence top half dummies and or bottom half dummies can be employed as necessary. As new treatment techniques and developed and more life-life dummies created and much richer much more realistic training provided for the student nurses, they become much more ready to ‘hit the ground running’ from day one, whether they are employed in Jamaica, The US, Canada or Germany.

    As outlined above, Jamaica is training now nurses for export and it has not already started, it may not be far in the future that a foreign language e.g. Spanish or French becomes are requirement or possibly an elective, in the nursing program.

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  8. wkeisha says:

    Human life is irreplaceable, so simulation plays an important role in any life or death practice. After all, simulation helps prevent costly mistakes and potential malpractice suits. It was, therefore, not surprising to learn that our local training facilities were keeping up with the rest of world by integrating simulation technology into the training process. The off-the-cuff simulation such as sticking practicing injections on oranges was, however, a surprise. I am still wondering how that works!!!

    There is currently a shortage of specialized nurses on the island. Why is that the case if according to the article, there is an over-abundance of nurses being trained across the island? Could it be that there is a high dropout rate in the pool, so graduate numbers are substantially lower than accepted numbers? This is quite a conundrum. It is just not adding up. I understand that the Nurses Association of Jamaica (NAJ) sets the guidelines on the number of persons that can be accepted each year by these institutions, so in truth, there should be no over-excess of nurses being trained.

    Considering the importance of the work provided by nurses, institutions should be outfitted with the required training equipment to perform. Despite any challenges they may have, the Jamaican nurse remains a highly sought after ‘commodity’ by developed countries. Which leads me to once again recommend that the Government (and the NAJ) consider doing what has been said on countless occasions, train our nurses and supply them to the world. Structure the recruitment of nurses by overseas ‘takers’ and use a portion of the funds earned from this activity to bolster/improve the programmes in these training institutions.

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    1. kerjfra says:

      Thanks for your comments wkeisha, most appreciated. I just wanted to clear up and correct two aspects in your comment.

      First, there is a difference between the specialized nurses and the general trained registered nurses (RNs). So when the large numbers are taken for education initially within the HEIs, they do the BSc in Nursing to gain the general training and become RNs. After some experiences in hospital further education takes place to train some of the RNs in specialized areas of interests. This is done in far less numbers, as capacity allows. In relation to the attrition rate, there are always students who drop out for various reasons, so yes the numbers will vary between admission and graduation.

      Secondly, the organization responsible as the legal body to regulate the training of nurses in Jamaica is the Nursing Council of Jamaica (NCJ) and not the Nurses Association of Jamaica (NAJ). They both play important roles in the nursing profession.

      Essentially, it is difficult for the government to regulate the free movement of skilled workers who are independent agents in a free market economy.

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  9. verinica5 says:

    Kerjfra You wrote about the use of simulation to train nurses. You stated that the University of technology have in training 100 in Kingston and 50 on the Montego Bay in the first year. you mentioned also the other places that trains such as and Northern Caribbean University of the West Indies You however interestingly made reference to the overcrowding in the training areas . In fact you wrote “The big BUT is do the institutions have all the human and material resources needed to fully utilize these simulators? Are there dedicated simulation labs that would replicate a hospital setting? These are challenges that the institutions face.” You imply that the training of our nurses could be more effective. My question is therefore, why are our nurses so attractive to the industrialized countries of USA and Canada
    In a published report Sunday January 8, 2017 the headline read Jamaica To Lobby WHO Over Recruitment Of Nurses . It said the ongoing issue was that major foreign countries such as the United States and Canada bleeding Jamaica of its specialist care nurses. and the , the Government is to lobby the international health community for help to stop the poaching of the island’s nurses.

    [Porter,(2015) speaks of the extreme shortage if nurses The Gleaner also confirmed that at least 10 specialist nurses in the Accident and Emergency Unit of the Kingston Public Hospital have resigned, effective the end of this month These nurses are heading for ‘greener pastures’, putting a strain on the island’s main trauma treatment facility The OAS Special Committee on Migration on 13 January 2009.states that of the– 1,199 new nurses graduated (2000-2004) /900 nurses left the region in the same period .But the teachers are leaving too Jamaica with a population of under 3 million lost to the UK between 2001– 3 nearly 1000 teachers, more than Canada with a population of 30 million– Guyana trains 300 teachers each year and loses that number to migration overseas

    What a brain drain and a brain waste. A brain waste because the non-recognition of qualifications, a devaluation of skills and competencies for example.teachers not holding European qualifications are paid less The nurses are obliged to pursue 3-6 month programmes before they carry out their professional duties. It gets worse about 70 percent of tertiary graduates of Caricom region migrate.

    Could this be indirectly impacting government reduction of subsidy to tertiary education. After all the graduates are not staying to build where they were groomed. Is it all about money?. Teachers in Toronto made US$26,000 annually in London central US$.4,2000 and in New York US$2576. While in Jamaica US$9000. For nurses in Toronto made monthly US$2812, in London US$3056 monthly and in New York US$2516 monthly and only T&T$ 913(The OAS Special Committee on Migration on 13 January 2009).
    I know we need to live but what about patriotism and loyalty to country. After all this training our nurses are leaving. The industrialized countries should perhaps, be addressing the shortage of training equipment and building training rooms ,Just saying but Kerjfra interesting

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  10. ventomspecial says:

    Kerifra this is an eye opening article. I never knew that stimulators are used to teach nursing at higher education institutions in Jamaica and the world by extension. It is also interesting to note the abilities that the stimulators can be programmed to replicate many human responses. I so appreciate this mannequin because it will definitely allow students to practice and become proficient in the teaching and learning process. This will also save higher institutions from putting human being at risk by practicing immaturely on them, moreover as mentioned by my fellow classmate that human life is irreplaceable. But my question is how long these robots will be used by students? I would recommend that this practice does not exceed second year in this discipline.

    Another area of concern as stated by Kerifra the lack of human resources, materials and facilities to create that desired success or progress especially in Jamaica stated by Norman (2012) that we “still taking baby steps and therefore will not yield the type of results that is seen in some countries”.

    I totally support the use of this technology, but I am concern about the various resources need to put in place to fully equip to accommodate a growth-promoting environment for nursing students.

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  11. judsbloggy says:

    I am all for simulation in nursing mainly because it is important that nurses in training get plenty of chance to practice different procedures on mannequin before they begin to do these procedures on actual patients. I was not aware of the fact that here in Jamaica out nurses are being trained using simulations and that is very assuring to me.
    It is a profession that is under scrutiny in providing safe and effective care. So nursing education programmes are pressured to provide training that is as real as can be. Coupled with the instructional strategies that highly influence critical thinking and clinical decision making. Now with the skills and competencies these students develop this drastically minimizes errors when dealing with actual patients.
    Patient safety is key in experimental education and patient simulation scenarios provide opportunities for practitioners to prefect the craft, working collaboratively alongside each other. Working as a team and communicating with each other.
    Using simulation makes nurse training centred to help students to build on pervious knowledge and experiences.

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