Clinical simulation provides healthcare educators with the opportunity to provide learners with concrete experiences for abstract concepts. Infection control is one of these abstract concepts. Infection control and hand hygiene continue to have a major impact on preventable medical deaths and the increase in healthcare costs. To control these factors, content taught in the classroom must be translated into clinical practice. Simulation has proven to be an effective educational method to increase the competence of healthcare providers through concrete experiences. This HealthySimulation.com article by Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, provides an example of a simulation learning experience.
Kolb’s Experiential Learning Theory
Kolb’s Experiential Learning Theory (ELT) (1984) promotes the transfer of didactic information into simulation and clinical application. Frequently, learners experience difficulty in the transfer of information into their clinical practice. Kolb’s ELT has four stages in the learning cycle.
- Simulation-based learning is an experiential learning opportunity that provides a concrete experience in the scenario for participants. Simulation allows the participant an opportunity to experience ‘what if’ between their actions and the patient outcomes in a safe environment.
- The reflective observation of the concrete experience occurs in the debriefing session after the simulation when the learners connect the dots of actions and consequences.
- Through this reflection, participants can develop their own abstract concepts to connect actions and outcomes to patient care.
- These abstract concepts can lead the participants to use active experimentation. During active experimentation, participants can implement the concepts in clinical practice or apply them to patient care. Active experimentation can occur in later simulations or clinical practice.
Involve the Senses in Healthcare Simulation
In a high-fidelity simulation environment, a visual and olfactory increment to physical fidelity did not affect subjects’ overall ratings of fidelity, perceptions of realism, and engagement in the learning experience. The inclusion of more sense can cause guttural reactions because of the increased realism and buy-in by the participants. Participants can experience guttural reactions that cause a strange, unpleasant, or disagreeable feeling about the situation.
Infection Control and Isolation Precautions Simulation Experience
The simulation provided a powerful impression that encouraged the students to recognize and appreciate the significance of isolation precautions and hand hygiene to control hospital-acquired infections (Pope et al., 2014). The expected outcome was to show the students how infection can easily be transmitted and prevented in a healthcare environment. The scenario was a hospitalized nine-year-old patient with cystic fibrosis for resistant pneumonia. The patient was alone in his room and yelling out, “I can’t breathe, help me!” The objectives of the simulation were to implement standard isolation precautions, identify and implement age-appropriate strategies for this patient for deep breathing and incentive spirometer exercises, and physical assessment.
To help the students learn infection control and isolation precautions, a product, ‘Glo Germ’, was applied to equipment and surfaces in the patient’s hospital room. This product is not recognized in normal lights but glows under ultraviolet or black light. The product was placed in a spray bottle and misted to indicate coughing contamination. The product in the lotion form was placed on the siderails, oxygen equipment, hot and cold water levers, door handles, and IV equipment.
Key Takeaways from Learners and Faculty
During the simulation and debriefing sessions, the faculty facilitators observed some consistent trends. The facilitators noted that over 90% of the students donned personal protective equipment (gown, gloves, and mask) appropriately. However, several infection control principles were violated in this simulation experience.
- Some students did not properly tie their isolation gowns or fit the mask to their faces, leading them to repetitively touch their faces or clothing to adjust their personal protection equipment. The most prevalent breach in infection control by the students was bringing items such as stethoscopes, clipboards, patient records, and pens into the simulation environment.
- Students touched their masks, hair, and other items in the patient environment with contaminated gloves.
- The application of age-appropriate interventions to encourage patient compliance was not implemented by most of the students. Several students removed their isolation masks and put the patient’s oxygen mask on their face to encourage the pediatric patient to wear his mask. These students focused on trying age-appropriate interventions but failed to recognize the infection control issues.
During the simulation debriefs with Socratic questions, the learners provided feedback on how the simulation made them feel and what they would take into their clinical practice. During a conversation with a former student, they stated that every time they entered an isolation room, the memory of the contaminated surfaces would come to mind. Summarization of statements received from students during the debrief included:
- Students felt they were actually contaminated after the visualization of the infection.
- “Even if I do everything right, it only takes one person before me to contaminate something then I spread the infection.”
- “The ability to see the infection really helped me understand why these skills are so important.”
After completion of the simulation experiences, the participating faculty and simulation personnel conducted a debriefing session to determine what went well and what could be improved.
- Incorporation of the visual aspect helped the students see the contamination and connect their actions and outcomes.
- Some cues seemed too obvious; however, they were not.
- The pediatric patient added more urgency for the students to enter the room and take their learning to a higher level with the addition of a sense of urgency to respond to a child in isolation.
Learn More About the Development of Simulation Scenarios!
References:
- Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, N.J: Prentice-Hall.
- Pope, S., Baggett, S., Dubois, E. J., Martin, C., & Gore, T. (2014). Using visualization in simulation for infection control. Clinical simulation in nursing, 10(12): 598-604.
- Nanji, K. C., Baca, K., & Raemeran, D. B. (2013). The effect of an olfactory and visual cue on realism and engagement in a health care simulation experience. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 8(3): 143-147, DOI: 10.1097/SIH.0b013e31827d27f9
