Journal of Cardiovascular Nursing
Vol. 22, No. 1, pp 16Y24 x Copyright B 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins
Simulator Technology as a Tool for
Education in Cardiac Care
Marilyn Hravnak, PhD, RN, ACNP-BC, FCCM, FAAN; Michael Beach, MSN, RN, ACNP-BC;
Patricia Tuite, MSN, RN, CNS
Assisting nurses in gaining the cognitive and psychomotor skills necessary to safely and effectively care for
patients with cardiovascular disease can be challenging for educators. Ideally, nurses would have the opportunity
to synthesize and practice these skills in a protected training environment before application in the dynamic
clinical setting. Recently, a technology known as high fidelity human simulation was introduced, which permits
learners to interact with a simulated patient. The dynamic physiologic parameters and physical assessment
capabilities of the simulated patient provide for a realistic learning environment. This article describes the High
Fidelity Human Simulation Laboratory at the University of Pittsburgh School of Nursing and presents strategies for
using this technology as a tool in teaching complex cardiac nursing care at the basic and advanced practice
nursing levels. The advantages and disadvantages of high fidelity human simulation in learning are discussed.
KEY WORDS: cardiovascular, crisis intervention, curriculum, education, patient simulation
C
ardiovascular disease comprises complex inter-
actions between the right and left heart, arterial
and venous peripheral vascular system, and the
neurohormonal system. Cardiovascular patient care
situations may range in intensity from stable chronic
disease up through the assessment, diagnosis, and
management of acute and life-threatening hemody-
namic compromise. The care of cardiovascular patients
therefore requires clinicians to use a wide array of
cognitive, assessment, and technical skills. Cognitive
skills may include critical thinking and problem
solving, as well as diagnostic reasoning. Assessment
skills may include physical examination, single and
12-lead electrocardiogram interpretation, and hemo-
dynamic monitoring. Technical skills may include
intubation and cardiopulmonary resuscitation, as well
as (for advanced practice nurses in particular) intu-
bation and placement of central and arterial lines.
Assisting both students and practicing clinicians
to master these skills can represent a challenge for
educators. The didactic background for cardiovas-
cular physiology, pathophysiology, assessment, and
management most frequently occurs in the tradi-
tional classroom setting. However, such an approach
does not necessarily translate into knowledge syn-
thesis and application in the dynamic clinical setting.
A newer technology known as high fidelity human
simulation (HFHS) places the learner in a realistic
simulated patient care environment, where practice
can be observed and evaluated across a broad range
of clinical scenarios. The purpose of this article is to
describe the use of HFHS as a tool in cardiovascular
education.
High Fidelity Human Simulation
Historical Background
High Fidelity Human Simulation was initially used
in aviation, providing a setting in which pilots could
perfect their flying skills and practice emergency
responses in a controlled environment. Anesthesiol-
ogy programs then adopted the use of simulation
technology with the goal of providing trainees with
protected opportunities to perform in critical clinical
situations and use resources efficiently, while maxi-
mizing safe patient outcomes.
1
Simulation continued
to gain popularity in healthcare, and certified
registered nurse anesthesia programs began to incor-
porate simulation into their programs. The goals of
the programs were very similar to those of the
anesthesiologist programs, and over time the certi-
fied registered nurse anesthesia programs have
refined their simulation settings and scenarios to
provide for increasingly realistic experiences.
2Y5
16
Marilyn Hravnak, PhD, RN, ACNP-BC, FCCM, FAAN
Associate Professor, School of Nursing, University of Pittsburgh,
Pittsburgh, Pa.
Michael Beach, MSN, RN, ACNP-BC
Instructor, School of Nursing, University of Pittsburgh, Pittsburgh, Pa.
Patricia Tuite, MSN, RN, CNS
Instructor, School of Nursing, University of Pittsburgh, Pittsburgh, Pa.
Corresponding author
Marilyn Hravnak, PhD, RN, ACNP-BC, FCCM, School of Nursing,
University of Pittsburgh, 336 Victoria Building, Pittsburgh, PA 15261
(e-mail: mhra@pitt.edu).
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