Simulation in a hospital setting

A 76-year-old man is hospitalized in the general medicine department of the Forcilles hospital. He is obese, diabetic, and suffers from heart failure. A nurse and nursing assistant pair enters his room for the evening round.

Emergency response during the simulation

"Good evening, Mr. Deschamps, we are bringing your medications," says Clarisse, the nursing assistant, as she enters the room. "Mr. Deschamps? Mr. Deschamps? Squeeze my hand! Open your eyes! He is unresponsive," she tells Cyprien, the nurse. "I am starting cardiopulmonary resuscitation."

Calling for assistance

Meanwhile, Cyprien calls the emergency physician. Dr. Leila Lavagna, an emergency physician and pedagogical reference for healthcare training within the Cognacq-Jay Foundation, answers the phone in the adjacent room. Cyprien describes the patient's clinical condition to her. She gives him instructions.

Support from the healthcare team

At the same time, the nurse shouts "emergency" to his colleagues in the department to get additional support. Dr. Lavagna then asks a first nurse to go to the patient's room; a second nurse will arrive later and take over the cardiopulmonary resuscitation. After a few minutes, the emergency physician also enters the patient's room.

Training and observation

Throughout the entire duration, Lionel Henriques, a nurse, healthcare manager, and trainer, observed the four participants behind a curtain. "I analyze the achievement of the three objectives of the simulation, namely clinical reasoning, technical skills, and non-technical skills or CRM for crisis resource management," he explains.

Live monitoring of the simulation

In the adjacent room, the other healthcare professionals in the training session were able to follow the simulation via a live feed on a large screen. Before the creation of the center, we already did simulations to reassure the healthcare workers and build their confidence in their skills.

Expanding the training program

In February 2024, the foundation decided to create a dedicated organization and offer certified Qualiopi training, particularly in simulation on various topics (stoma therapy, emergency management, palliative care). "We offer them internally and sell them to surrounding structures," she says.

Benefits of simulation training

For healthcare workers, the main interest of the simulation is to learn how to perform the right gestures at the right time. These days are organized since 2024, five times a year, aimed at nurses and nursing assistants, sometimes interns, advanced practice nurses (IPA), and nursing students.

Enhancing learning through simulation

All of them intervene on scenarios related to the management of vital emergencies: cardiac arrest, shock state, etc. "The simulation allows for diversifying methods to impact learning and thus better retain the teachings over time," supports Lionel Henriques. Indeed, the High Authority for Health (HAS) recommends that simulation tools be included in the continuing education of healthcare workers.

Preparation and discussion

Before starting a simulation session, Lionel Henriques and Dr. Leila Lavagna always conduct a briefing. After a brief history on the role of simulation in the healthcare system and within the institution, they conduct a round table with the nine participants to allow each to share their knowledge about simulation and express their feelings and expectations regarding this training day.

Participants' perspectives

"I have already done simulation, and I find this format very interesting because it allows us to review our knowledge throughout the day," says Catherine, an advanced practice nurse. "The simulation allows for a real-life scenario," continues Anne, a palliative care nurse. "It is more meaningful than having only theory, and the teachings remain more in the mind."

Emotional reactions to the simulation

Other healthcare workers admit to being stressed by the session, particularly about being filmed. "My department tested the simulation before it was officially introduced in the training center," reports Justice, a nurse. "Certainly, there is a theatrical and overacted aspect, and we always fear a bit of judgment from others. But it helps us react better in real situations."

Debriefing after the simulation

Each simulation session is followed by 45 minutes of debriefing to draw lessons from the clinical situation studied. Lionel Henriques starts by asking the participants about their feelings. If three of them feel rather well, one of the nurses admits to feeling stressed. "I came into the room and wondered if I was effective compared to others," she shares.

Reviewing the team's performance

Overall, the team correctly managed the patient. They declared his cardiac arrest after 53 seconds spent in the room. The physician also uses this opportunity to ask the participants about the signs of a cardiac arrest. Each one also analyzes the care they provided and what they could have done differently.

Encouraging reflection and teamwork

The two trainers push them further in their reflection and reasoning, highlight their teamwork, discuss the practice, stress management, knowledge sharing, and skills, and especially the importance of communication among themselves. "It is essential to be consistent in terms of communication," insists Lionel Henriques. "For example, when you call an emergency physician, you must always clearly state your request, it is essential," reminds Dr. Lavagna.

Learning from mistakes

This simulation project is part of the risk culture. "I always tell the participants that if they make a mistake during a session, it is not serious, it is even constructive," supports Lionel Henriques. "The message may seem surprising, but it is through errors that they will retain the lessons."

Conclusion of the training approach

"The main objective with the simulation is first to work together and accept that error is inherent to learning, without forgetting that it allows the implementation of the principle that a healthcare worker should never perform an act for the first time on a patient," concludes Dr. Lavagna.