There is little doubt that our current healthcare system has placed increased pressure on providers to deliver patient care in a safe, effective, and highly efficient manner. A well-educated and dedicated team of nurses and care givers is essential to meet these goals. The development of simulation programs in both educational and acute care settings is proactively addressing the challenge to maintain this valuable nursing resource.
In a January 2012 analysis of the nursing workforce, the Washington Center for Nursing (WCN) found that the current economic downturn has delayed an expected nursing shortage as many veteran nurses have put off retirement and others have taken on additional shifts or moved from part-time to full-time status. However, the workforce continues to age and our state’s population growth, coupled with increased access to healthcare brought about by the Affordable Care Act, will result in nursing demand outpacing supply over the next decade. WCN recommends an increase in education capacity and workforce retention improvements such as continuing educational support, to address this coming shortage.
To complicate efforts to develop new educational resources, the traditional nursing model of “learning by doing” within a clinical setting has been impacted by shorter hospital stays and a shift to outpatient treatment for many procedures. Simulation programs have stepped in to bridge this gap in available clinical sites, and to relieve the pressure on over-extended nursing programs.
Simulation Goal: Optimize Safety, Quality, and Efficiency
Healthcare simulation is coming of age, having learned much from established simulation methodologies used in aviation, space flight, nuclear power and military applications. The National Council of State Boards of Nursing (NCSBN) reports that 87% of nursing schools have incorporated patient care simulation into their curriculum.
Simulation includes a wide range of activities, sharing the common purpose of improving patient safety, increasing the effectiveness of healthcare delivery, and providing learning opportunities in a risk-free and supportive environment. Elements of a simulation program vary from the use of “standardized patients”( actors trained to present certain symptoms), to low fidelity, non-mechanical mannequins designed to practice skills, to high fidelity, computerized human patient simulators with names like SimMan, which can cost in excess of $70,000.
Although the investment in equipment and space can be considerable, advantages of simulated learning include: the ability to experience a crisis situation on-demand, with no harm to a patient; the ability to expose every student to the same clinical experience, reducing training variability; and the ability to provide immediate feedback on performance in a controlled, non-threatening environment. Beyond the teaching environment, simulation techniques are used to observe team interaction and develop improved collaboration within multi-discipline teams.
Design Considerations for Simulation Environments
Key design concepts drawn from the review of successful simulation environments include:
Location: Whether in an academic or institutional setting, a simulation center brings together multiple disciplines. A location that is highly visible and easily accessible will build on the collaborative nature of the experience and will promote higher utilization of the space.
Flexibility: As in other educational and healthcare environments, the ability to adapt to new equipment, advances in technology, and program changes is essential. Shared or reconfigurable support spaces as well as defined paths for future expansion should be considered.
Access to debriefing spaces: While the simulation lab may be ground zero for the training experience, adjoining debriefing spaces are essential to facilitate the learning process that happens after the clinical exercise. Real-time audio and video capacity should be available in these spaces as well.
Accurate patient care spaces: Duplicating all equipment and furnishings found in the true patient care setting is critical to a realistic simulation. Room dimensions and layout should also be replicated.
Opportunities for interaction: Providing break-out or mixing spaces that foster interaction between team members or informal conversations between student and instructor will enhance the learning experience for all.
Health Sciences Building for Clover Park Technical College
An example of the expanded role of simulation environments in health training programs can be found in the Health Sciences Building for Clover Park Technical College. Designed by McGranahan Architects, the facility, located in Lakewood, Washington, was completed in September of 2013.
At nearly 56,000SF, the Health Sciences Building is more than double the size of the school’s existing facilities and will bring together eleven health training programs, including Nursing, Surgical Technician, Pharmacy Technician, Medical Assistant, and Health Unit Coordinator programs, that account for 2,166 full-time equivalent students.
The building is designed as a pair of two-story wings, joined near one end by a transparent connector containing lounge/study alcoves and connecting stair. At the opposite end of each wing, a wall of glass defines a double-height space containing an open stair with student and faculty study areas.
The northern wing houses a combination of flexible classrooms, lecture halls, and computer labs. The second floor includes a large open-plan faculty suite. The first floor of the building’s southern wing houses the primary simulation spaces which include two nursing labs with a total of 26 typical treatment stations, a clinic pod with three exam rooms, two simulated operating rooms with an adjoining sub-sterile room, and central service area with decontamination, processing and storage room. Above the simulation spaces are two integrated science labs as well as specialized labs for Pharmacy, Histology, Hemodialysis and the Medical Lab Tech programs.
In addition to providing state-of-the-art teaching labs and simulation spaces, the Health Sciences Building supports interaction between disciplines through shared labs and numerous collaboration spaces as well as open lounge and study alcoves clustered around primary circulation nodes.