Do No Harm – It's More Than a Promise

While the phrase, “First, do no harm,” does not appear, as such, in the Hippocratic Oath, it is widely accepted as one of the significant principles under which physicians, and, by extension, others in the healthcare field operate in the practice of medicine.

With few exceptions, those who pursue careers in healthcare, do so from a sincere desire to help others in achieving, maintaining and recovering an appropriate level of physical and mental health. While some clinical interventions can be temporarily painful or unpleasant, there is no intent by the care provider to inflict pain or discomfort on a patient.

FIRST DO NO HARM, by BENJAMIN SCHWARTZ ,  New Yorker Cartoons

FIRST DO NO HARM, by BENJAMIN SCHWARTZ, New Yorker Cartoons

For some of the more routine clinical activities, it takes more than a lack of intent to keep from inflicting unnecessary pain, it takes practice, practice and more practice. And, not just any practice - it takes realistic practice.

For example, take the skill of drawing blood or starting an IV. These are a fairly straight forward activities requiring the clinician to safely insert a needle into the vein of a patient. It is a task covered early in clinical training, but is it practiced as often or as realistically as we believe? Many of us have experienced the real pain and discomfort some providers unintentionally cause when drawing blood or starting an IV.

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Now, some might say it’s “just” a bruise, but in fact, a bruise is an injury producing an area of discolored skin due to the rupturing of the underlying blood vessels. For many it may be “just” uncomfortable and unsightly, but depending on the patient and other medical variables, it may pose a real danger or at least complicate other elements of the patient’s health.

To make good on their commitment to “Do No Harm,” clinical learners and practitioners alike must attain and maintain their hands-on skills to ensure they do not hurt the patient in the process of delivering the care they need.

It was for that very reason ReaLifeSim products were created. ReaLifeSim’s wearable IV training simulator permits students to conduct safe, repeated, realistic practice on a live people (SP’s, volunteers, or each other) to build both the competence and confidence necessary to “do no harm.”

Photo credit: ENA2018

Photo credit: ENA2018

Repetition

When you first start doing something, you focus on the mechanics.

In healthcare, we need repeated practice to move our skills to mastery. And, not just any practice will do - it must be high quality, perhaps perfect realistic practice.

In sports, baseball for example, that could mean swinging the bat over and over and over until you develop the proper mechanics to consistently hit the ball.

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For more than a century, neuroscientists have recognized the existence of “automatism,” which is the ability to perform complicated actions without conscious thought or intention. C. Bergland, https://www.psychologytoday.com/us/the-mysterious-neuroscience-learning-automatic-skills

Automaticity can be achieved by practicing with increasing memory load meaning, purposefully add distractions to your training regimen. It’s about making a newly learned skill a part of who you are, as opposed to just a thing you can do. B. Hardy, https://www.fastcompany.com/how-to-learn-a-new-skill-well-enough-to-do-it-automaticall

Providing the practice and repetition necessary to perfect new clinical skills and develop critical thinking in a safe, observable environment are just some of the many benefits of clinical simulation education.

Providing tools for realistic practice experiences for task training and advanced scenarios is what we do. ReaLifeSim wearable vascular access training simulators - durable, adaptable, portable.

Photo credit: Disaster Medical Solutions

Photo credit: Disaster Medical Solutions

Photo Credit: Pocket Nurse & ENA2018

Photo Credit: Pocket Nurse & ENA2018

How do YOU choose new products?

Most responses will likely include (in no particular order):

  • function,

  • interoperability,

  • realism,

  • durability & maintenance,

  • and of course, budget.

Recommendations from peers and demonstrations at conferences may also influence the decision maker.

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The choices seem limitless with VR and AR and AI and Mixed Reality and Fidelity to fit every need!

Can it still be argued that real practice on real people is the best way to develop real competence and real confidence?

Perhaps it’s best when the two are blended….

"Simulation specialists who add the human component to the simulated experience were found to make the simulated environment more realistic and consequently more conducive to learning caring behaviors." Ward et al., Int J Nurs Clin Pract 2017, 4: 257 https://doi.org/10.15344/2394-4978/2017/257

How can we provide simulated learning on real people without risking injury? This was a problem we decided to solve when we created ReaLifeSim wearable vascular access training simulators.

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Worn by real people to encourage provider-patient communication and add the human dimension, they can also be used as an “add-on” to high-cost high-fidelity manikins for enhanced function and extended sustainability so as not to have to damage costly equipment for routine skills.

But, it can and will be even better:

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“If people would realize how important it is to exploit those aspects of reality that cannot yet be replicated in VR, then we'd be much further ahead in healthcare sim than we are.  Now, take the techniques shown here and add the VR for simulating different training contexts, as we're doing with our Mixed Reality Medical Emergency Response Team trainer and you have a real recipe for success.” Bob Stone, Director, Human Interface Technologies Team at University of Birmingham (UK), credit for above image.

Real practice on real people may always play an important role in developing and maintaining hands-on and interpersonal skills, but advances in clinical simulation are challenging that premise every day.

My "Realism in Clinical Scenarios" Soapbox…

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As recently as in the past few months, I again observed a mock emergency response scenario, and I kid you not - they taped/wrapped IV tubing to the manikin arm saying, “IV started”.

I’m a veteran emergency nurse and educator, an inventor of wearable vascular access products, and I am “a tough stick” when it comes to IVs. That said, here we go…

That kind of limitation, the lack of realism, extends the gap between what we prepare them to do and what they will actually experience regardless of their status as soon-to-be new providers or salty old veterans.

That simple omission feels awfully close to a “pretend you started the IV” situation and we DO NOT PRETEND in clinical simulation.

“In the simulation, it is important to make a simulation experience as real as possible.  This is accomplished primarily by having the students perform the task and not just pretend to do it,” shared S. Howard, Ph.D., RN, CHSE, in “Increasing Fidelity and Realism in Simulation”, 2018, LWW.com.

C. Kroboth, NRP, CCEMT-P, LT, Fairfax County Fire and Rescue adds, “Don’t cut corners here; it’s nearly impossible for students to “imagine” or “pretend” that certain stimuli are present in the simulation when they’re not. Take advantage of all the resources at your disposal using simulated smells, moulage, and even recorded sounds, so that these sensory elements are familiar when they encounter them in the field.”

Of course, there’s always an exception, like when the provider is in a hospital/clinic setting scenario and the patients would have established IVs … but not in an external emergency or disaster situation. The percentage of the population walking around with an established IV is, I’m sure, quite small.

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To be fair - I must also include a sincere thank you to those of you who consistently try to maintain the highest level of realism in scenarios - you know who you are.

There are a variety of wearable products to increase the clinical realism of SPs (our ReaLifeSim products would be some of them), plus manikins that can be programmed to do nearly everything.

Let’s keep it real people - so we don’t do a disservice to those we’re teaching.

Emotional Resilience

Traumatic stress. Compassion stress. Physical stress. Social stress.

Regardless of their place on the responder spectrum of care, everyone from hospice nurse to combat medic can become victims, affected by the incidents to which they respond, day in and day out.

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It’s been said that people in other careers dream about retirement while First Responders just dream of surviving. The environmental stressors and trauma routinely confronted by medical professionals and emergency responders affect their emotions, decisions and actions and we are doing better to prepare the next generations of providers.

From “The Importance of Emotional Resilience for Staff and Students in the ‘Helping’ Professions: Developing an Emotional Curriculum”, L. Grant, Prof of Social Work and G. Kinman, Prof of Occupational Health Psychology, Univ of Bedfordshire, “Educators need to prepare students for the realities of caring work and encourage them to be assertive in seeking out the support they require to protect their own wellbeing, to advocate for working conditions which optimize the wellbeing of their patients and clients.”

The summer conferences are providing a variety of clinical challenges from simulated complicated childbirths to simulated mass casualty scenes taken from the headlines.

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Realism in clinical simulation practice is helping them to identify what they feel and why they are feeling it - in a safe environment, supported by facilitators, instructors, and peers.  

We must continue to provide effective learning experiences that are immersive - simulating a “real-life” situation that can engage the learners’ senses, emotions, thinking, and behavior.

National EMS Week

This is Emergency Medical Services Week.

Why should you care?

Well, given the more than 240 million calls received by 9-1-1 operators each year, in the U.S. alone, there’s a good chance you may be making one of those calls or be the subject of one of those calls in the near future.

So?

So, wouldn’t it be good to know when you call there will be a trained professional always available to answer your call, or the call about your injury or health challenge? And wouldn’t it be reassuring to know highly trained Paramedics and Emergency Medical Technicians (EMTs) are being directed to your location as quickly as possible with the most current equipment, medications, training and communications to provide you the best medical care possible and transport you to an appropriate health care facility quickly and safely?

“Yes,” you said?

Excellent. This week-long recognition event is a reminder, to all of us, of the importance of this vital service we routinely take for granted. Like water and power, we don’t give much thought to them until we turn a faucet or flip a switch and nothing happens! Then we want answers and we want them now.

This reminder is also an invitation – an invitation to attend an “open house;” to learn more how the emergency response system in your community works; contribute to fund-raising activities; participate in public discussions about policies, requirements, staffing, equipping and funding.

Perhaps most importantly, it is a reminder to say “Thank you,” to the thousands of professionals who give of their time and expertise to help their neighbors in need, often as volunteers.

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We, at ReaLifeSim, are proud to partner with the EMS community by providing tools to help deliver the most realistic clinical training experiences possible, so they in turn can deliver the best care with competence and confidence.


Nurse Appreciation Week 2019

ReaLifeSim was created by Nurses, FOR NURSES! We are so thankful for those on our team. Elizabeth Roth Benson and Linda Goodman are innovators, educators, teachers and Nurses that are paving the way in this industry. 

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Elizabeth Benson, MEd, RN, FCN, FACHT – Co-founder and CEO, Elizabeth leads the team that created globally utilized ReaLifeSim medical and VetReaLifeSim veterinary wearable hybrid IV and blood draw task trainers. Under her leadership, the ReaLifeSim has garnered international recognition as a Top 10 Healthcare Simulation Solution provider for 2018, a Top 12 company leading in the area of patient safety advocacy 2019, and the provider experts choose for simulated IV scenarios in eight international EMS competitions. Elizabeth mentors women entrepreneurs and is an active #STEM/#STEAM advocate.

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Linda Goodman RN, MS, CHSE – Co-founder, Linda brings her expertise as a Certified Healthcare Simulation Educator to every level of development, scenario creation and competency measures. Linda’s current work as a college-based simulation coordinator and small business owner continue to provide critical insights she applies to every product presentation, functional demonstration and clinical education opportunity.

ReaLifeSim Uncovers New Market in Post Disaster Rubble

ReaLifeSim’s innovative hybrid IV/blood draw trainer was used recently by Disaster Medical Solutions, LLC, (DMS) who presented a course to firefighters, paramedics and other clinical personnel from around Florida, nine other states, as well as Japan, Taiwan and the United Arab Emirates.

The Medical Team Specialist course, certified by the Federal Emergency Management Agency (FEMA), is part of a series of training opportunities offered in support of the National Urban Search and Rescue (US&R) Response System under the auspices of the Department of Homeland Security. The course was conducted on the campus of the Florida State Fire College (FSFC) in Ocala.

A variety of buildings, collapsed structures, vehicles and assorted rubble occupy a good portion of the Florida State Fire College’s 37-acre fire-rescue-technical training facility in Ocala, FL.

A variety of buildings, collapsed structures, vehicles and assorted rubble occupy a good portion of the Florida State Fire College’s 37-acre fire-rescue-technical training facility in Ocala, FL.

The four-day course focuses on the challenges of delivering immediate medical care in an urban search and rescue environment. Whether caused by natural events such as fires, floods and hurricanes or man-made disasters such as explosions, vehicle crashes or terrorist incidents, these sites often remain unstable and dangerous, for victims and first responders alike, for some time after the causative event.

“This program exposes the student to the injury types consistent with structural collapse incidents,” explained Joe Hernandez, CEO and course coordinator of Disaster Medical Solutions.

“A heavy focus is placed on providing care in a confined space,” Hernandez added.

We, at ReaLifeSim, are excited to have our IV trainers used to help create the most realistic training environment possible for such an important function.

The wearable simulation device, designed to enhance the training of nurses and other clinical specialists, was used to add another level of realism to the scenarios by requiring students to successfully start an IV on a live person often in dark and confined spaces.

Reaching, assessing and treating injured victims in confined spaces adds significantly to the realism and effectiveness of the training.

Reaching, assessing and treating injured victims in confined spaces adds significantly to the realism and effectiveness of the training.

Tyler Steele, 32, a veteran paramedic from the Rogers, Arkansas Fire Department, confirmed the challenges of working in uncomfortable situations and confined spaces. To cope requires you to “focus on your breathing and fall back on your training and teachings,” Steele said.

Rescue workers assess a “victim’s” condition and extraction options from a simulated building collapse.

Rescue workers assess a “victim’s” condition and extraction options from a simulated building collapse.

Instructor Matt Haywood, a 50-year old paramedic from Palm Beach County, FL, who served as a simulated patient, complimented the ReaLifeSim IV trainer, citing its flexibility and function, as adding significant realism when compared with manikins.

The ReaLifeSim wearable IV trainers were used to add another level of realism to the scenarios by requiring students to successfully start an IV on a live person often in dark and confined spaces.

The ReaLifeSim wearable IV trainers were used to add another level of realism to the scenarios by requiring students to successfully start an IV on a live person often in dark and confined spaces.

DMS lead instructor, Vincent Johnson, 48, a rescue paramedic from the New York City Fire Department, confirmed the importance of the multi-sensory overload within the various scenarios to create the very real distractions students will find in real-life rescue situations.

The presence of loud noises, heat, wind, rain, tight spaces and the absence of light all contribute to the difficulty of maintaining focus on the critical tasks at hand. The key to success, according to Johnson, is to “work slowly and methodically,” through each task.

When evaluating a team’s performance, Johnson looks for “clear communications and demonstrating respect for other members of the team.”

It is gratifying to be providing an affordable product that improves clinical training creating competent, confident paramedics and leading to better patient outcomes.

Clear communication between rescue workers, who are often members of different organizations or even from different countries, is critical to delivering safe and effective care, treatment and evacuation.

Clear communication between rescue workers, who are often members of different organizations or even from different countries, is critical to delivering safe and effective care, treatment and evacuation.