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Design and Development of Bioterrorism Response Education Programs
Clinical Simulation in Nursing Education (2006) 2, e65-e68
Clinical Simulation in Nursing Education
Design and Development of Bioterrorism Response Education Programs Elizabeth L. Beam, RN, MSN, Stephen M. Smith, BSc, Carol Pullen, RN, EdD, Patricia Carstens, MS
Abstract: Issues related to bioterrorism, public health emergencies, and disasters have been brought to the forefront in the past few years. A small, competitive grant was the catalyst for the development of a new educational program using Web-based gaming and simulation for training in bioterrorism and public health emergency response for both health care students and professionals. Interactional activities reinforce learning from reputable internet links, and simulations assess the ability of participants to translate this new information into more appropriate action when faced with a scenario. The educational program is expected to enhance community preparedness while promoting teamwork, respect, and trust across disciplines. This article outlines the steps taken to design and develop a new bioterrorism educational training program to be implemented at the University of Nebraska Medical Center in the fall of 2006. Copyright Ó2005 INACSL.org
Design and Development of Bioterrorism: Response Education Programs Issues related to bioterrorism, public health emergencies, and disasters have been brought to the forefront in recent years. It is impossible to handle a disaster of any kind without strong leadership and reliable communication. A coordinated response requires all healthcare disciplines to work together along side public health, law enforcement, and other governmental or military agencies (Butler, Cohen, Friedman, Scripp, & Watz, 2002;Gerberding, Hughes, & Koplan, 2002). A basic level of competency for preparedness should be established and maintained by all health care professionals and students through educational programs to ensure best practices and promote positive outcomes in the event of a terrorist event or public health emergency (Gebbie, Merrill, & Tilson, 2002; Markenson, DiMaggio, & Redlener, 2005). 1876-1399/09/$ - see front matter Copyright Ó2005 INACSL.org
doi:10.1016/j.ecns.2009.05.026
Program Design A small, competitive grant through the University of Nebraska Medical Center was the catalyst for a new educational program using gaming and simulation for training in bioterrorism and public health emergency response. The grant had strong leadership with individuals from Nebraska’s biopreparedness education center and key members of multiple disciplines within the university system. Such a massive undertaking would likely fail without champions. As budget planning for the grant proceeded, it was obvious this project would fail without a full time faculty position and a dedicated information technologist. The budget was allocated to meet these needs. There were two key components to the initial phase of program design. First, a literature and content review was initiated. Information available regarding bioterrorism, public health emergencies, and disaster response is
Design and Development of Bioterrorism Response Education Programs
Figure 1
relatively new and frequently being updated. While some key literature exists, a variety of essential resources are available online through training modules, Webcasting, and free government publications. A thorough initial review took approximately two months, and further periodic review is required to keep the resource database current. The second key component to the initial program design was analysis and comparison of the available technology distribution methods. Technologies from simple Web-based modules to three dimensional gaming applications were considered. The methods chosen had to be easy to deliver and use. The team next delineated two main program objectives. The first objective was to increase awareness of preparedness concepts and terminology for nursing and other health disciplines through Web-based materials. The use of technology to distribute the educational program was chosen to simplify the integration of the content into an already full curriculum or training schedule. A second program objective was to develop simulation materials and provide access to equipment to intensify drill experiences. The simulation equipment addressed a need in the local community.
e66
created with links to the Web-based simulations and a reference center. First, we concentrated on the chemical agent exposure simulation. In our scenario, we chose a situation involving a nerve agent. An interactive mapping activity explained the basic concepts of a chemical agent exposure site. The participant would learn the different zones and the effects of environmental issues such as wind direction. In another exercise, the participant organized the steps to appropriately don and doff personal protective equipment. One of our most ambitious endeavors was an interactive game which was developed to simulate the experience of triaging victims during a mass casualty incident. The next phase of the Web-based simulation involved dealing with the biological agent exposure. We developed gaming applications to address disease identification and vaccination issues in a response to a smallpox outbreak. A simple multiple choice game was used to differentiate chickenpox, smallpox, and monkeypox viruses given specific characteristics. A true or false game was developed to help participants measure knowledge of basic smallpox vaccine facts. Images from the Centers for Disease Control Website were embedded in question slides to identify vaccine reactions, differentiate normal variants from adverse events, and select appropriate treatment strategies. A reference center was established as a resource in our online environment for access by participants as they progress through the simulations and identify their personal learning issues. Existing educational programs, webcasts, and other online experiences were reviewed and links were established on our website to reputable sites. Some narrated presentations and video references were developed in areas that were either identified as gaps or as areas that needed more specificity for our Web-based simulations. The website, simulated experiences and gaming applications will be introduced to undergraduate nursing students in the fall of 2006 as a pilot study. Student and faculty evaluations will occur at that time.
Simulation Opportunities and Integration
Program Development
Initial Purchases
Website
Through the budget provided by the grant, we were able to purchase equipment for the development of high fidelity simulations to meet the second main program objective. The initial purchases included a human patient simulator (HPS) with accessories for portability, arterial access, a mask with drooling and tearing capabilities, an army cot, a wireless microphone, and moulage makeup. The makeup was important to enhance the realism of our simulations and included modeling gels and waxes, blood effects, and cream makeup specifically for simulating trauma and bruising.
After delineating the design of our program, we focused on development. The team created its own website to focus on the first main program objective. The instructional technologist provided essential expertise at this point in web design, software use, and digital video skills. The initial framework for the website involved the release of both a chemical and biological agent after sundown during a fireworks display in a local park. This original scenario was approved by the entire grant team. A menu screen was
pp e65-e68 Clinical Simulation in Nursing Education Volume 2 Issue 2
Design and Development of Bioterrorism Response Education Programs
e67
Figure 2
Local Involvement As we progressed with our project development, opportunities arose to assist in local drills. An example of this was the opportunity to assist the biocontainment unit of our local hospital in an avian influenza drill by integrating the HPS. The scenario began in the emergency room by placing the HPS in an isolation pod for transport. The staff followed a predetermined pathway with security escort to the locked unit. Care of the patient’s respiratory distress was performed by appropriate patient care and support staff upon arrival to the unit. In the scenario, the patient did expire from the disease and the use of the body sealer to contain the virus was practiced. Clinical skills and procedures were demonstrated with appropriate levels of personal protection. The debriefing process was valuable. The staff was able to identify gaps in their current policies and procedures which had not previously come to light in group discussions. The drill was videotaped with permission of the manager and staff. Video clips and images collected will be used for integration into future Web-based simulations. The manager of the unit was given a copy of the drill exercise as well for the staff to review as needed. Feedback during the debriefing session was positive. The staff was pleased with the more scenario-based exercise, as previous drills had been more skills-based. The team learned that exposure to multidisciplinary exercises is invaluable experience in developing appropriate scenarios. The team also learned that it is helpful to have multiple reliable team members to plan the different components of a large-scale drill.
Development of Simulations for Nursing Students We have worked specifically to develop an appropriate simulation for the senior level nursing students. The simulation development team included three nursing faculty and a graduate assistant. One of the nursing faculty
members received extensive training from the manufacturer on the HPS used for the scenario. A linear scenario was developed to demonstrate an unknown illness in the emergency room. A study guide was developed to help the student’s prepare for the experience. The patient presents in respiratory distress, eventually develops acute respiratory distress syndrome, and expires from complications of mechanical ventilation. The unknown illness is eventually identified as avian influenza. Student and instructor guides were developed to parallel the experience. Supplementary assignments regarding calculating nutritional requirements and intravenous insulin management were developed as optional activities. This simulation activity will be initiated with our 2006 undergraduate senior level nursing students in the fall.
Future Directions Virtual Institute As we look to the future, the plan is to broaden our webbased content beyond the dual attack scenario. A virtual institute (see Figure 1) will be created by using building images to define different preparedness centers. New links and content will be developed with applications to natural disasters, radiological events, pandemics, and other public health emergencies. The site will have different levels of access for students and instructors. The instructors will have scoring and tracking capabilities in the Web-based applications. To further integrate simulation on the site, a center for gaming and simulation will include case studies, handouts, and instructor guides for different scenarios as they are developed and improved.
A Mobile Training Lab High-fidelity simulations are best developed for specific scenarios and audiences. In order to facilitate our
pp e65-e68 Clinical Simulation in Nursing Education Volume 2 Issue 2
Design and Development of Bioterrorism Response Education Programs availability to the entire state of Nebraska, we decided that some form of mobile all-hazards simulation lab would be ideal. Our grant budget would not allow for the purchase of a vehicle, so we began brainstorming other options. A trailer met our needs best for both web-based and high fidelity simulation (see Figure 2). The trailer will be 8 feet wide and 16 feet long. It will have built-in desks with laptops on each side wall for our computer simulations and a small flat panel television on the front wall to display theatrical introductions to scenarios. The desk tops will be retractable so that the rear doors can be opened and the space can also be used for a simulated ambulance-like environment complete with a gurney, disposable supplies, and equipment. The space can also be used as an incident command center equipped with two-way radios, maps, and other necessary resources. This training lab should be operational by early 2007.
Summary This web-based bioterrorism educational training program is expected to provide university faculty an easy option for covering material on emergency preparedness within a curriculum that is already full of other essential material,
e68
thus leaving little room for new information. Combining Web-based materials with HPS activities will provide teaching options for different styles of learners. Maintaining our collaboration with Nebraska’s biopreparedness education center should allow us to assist with their educational offerings and allow for exposure to other organizations in the region. By supporting health professions students and health care professionals via the mobile simulation laboratory, the team expects the equipment to be used frequently and ultimately have a role in Nebraska’s community preparedness.
References Butler, J. C., Cohen, M. L., Friedman, C. R., Scripp, R. M., & Watz, C. G. (2002). Collaboration between public health and law enforcement: New paradigms and partnerships for bioterrorism planning and response. Emerging Infectious Diseases, 8(10), 1152-1156. Gebbie, K., Merrill, J., & Tilson, H. H. (2002). The public health workforce. Health affairs, 21(6), 57-67. Gerberding, J. L., Hughes, J. M., & Koplan, J. P. (2002). Bioterrorism preparedness and response: Clinicians and public health agencies as essential partners. JAMA, 287(7), 898-899. Markenson, D., DiMaggio, C., & Redlener, I. (2005). Preparing health professional students for terrorism, disaster, and public health emergencies: Core competencies. Academic Medicine, 80(6), 517-526.
pp e65-e68 Clinical Simulation in Nursing Education Volume 2 Issue 2
Clinical Simulation in Nursing Education
Design and Development of Bioterrorism Response Education Programs Elizabeth L. Beam, RN, MSN, Stephen M. Smith, BSc, Carol Pullen, RN, EdD, Patricia Carstens, MS
Abstract: Issues related to bioterrorism, public health emergencies, and disasters have been brought to the forefront in the past few years. A small, competitive grant was the catalyst for the development of a new educational program using Web-based gaming and simulation for training in bioterrorism and public health emergency response for both health care students and professionals. Interactional activities reinforce learning from reputable internet links, and simulations assess the ability of participants to translate this new information into more appropriate action when faced with a scenario. The educational program is expected to enhance community preparedness while promoting teamwork, respect, and trust across disciplines. This article outlines the steps taken to design and develop a new bioterrorism educational training program to be implemented at the University of Nebraska Medical Center in the fall of 2006. Copyright Ó2005 INACSL.org
Design and Development of Bioterrorism: Response Education Programs Issues related to bioterrorism, public health emergencies, and disasters have been brought to the forefront in recent years. It is impossible to handle a disaster of any kind without strong leadership and reliable communication. A coordinated response requires all healthcare disciplines to work together along side public health, law enforcement, and other governmental or military agencies (Butler, Cohen, Friedman, Scripp, & Watz, 2002;Gerberding, Hughes, & Koplan, 2002). A basic level of competency for preparedness should be established and maintained by all health care professionals and students through educational programs to ensure best practices and promote positive outcomes in the event of a terrorist event or public health emergency (Gebbie, Merrill, & Tilson, 2002; Markenson, DiMaggio, & Redlener, 2005). 1876-1399/09/$ - see front matter Copyright Ó2005 INACSL.org
doi:10.1016/j.ecns.2009.05.026
Program Design A small, competitive grant through the University of Nebraska Medical Center was the catalyst for a new educational program using gaming and simulation for training in bioterrorism and public health emergency response. The grant had strong leadership with individuals from Nebraska’s biopreparedness education center and key members of multiple disciplines within the university system. Such a massive undertaking would likely fail without champions. As budget planning for the grant proceeded, it was obvious this project would fail without a full time faculty position and a dedicated information technologist. The budget was allocated to meet these needs. There were two key components to the initial phase of program design. First, a literature and content review was initiated. Information available regarding bioterrorism, public health emergencies, and disaster response is
Design and Development of Bioterrorism Response Education Programs
Figure 1
relatively new and frequently being updated. While some key literature exists, a variety of essential resources are available online through training modules, Webcasting, and free government publications. A thorough initial review took approximately two months, and further periodic review is required to keep the resource database current. The second key component to the initial program design was analysis and comparison of the available technology distribution methods. Technologies from simple Web-based modules to three dimensional gaming applications were considered. The methods chosen had to be easy to deliver and use. The team next delineated two main program objectives. The first objective was to increase awareness of preparedness concepts and terminology for nursing and other health disciplines through Web-based materials. The use of technology to distribute the educational program was chosen to simplify the integration of the content into an already full curriculum or training schedule. A second program objective was to develop simulation materials and provide access to equipment to intensify drill experiences. The simulation equipment addressed a need in the local community.
e66
created with links to the Web-based simulations and a reference center. First, we concentrated on the chemical agent exposure simulation. In our scenario, we chose a situation involving a nerve agent. An interactive mapping activity explained the basic concepts of a chemical agent exposure site. The participant would learn the different zones and the effects of environmental issues such as wind direction. In another exercise, the participant organized the steps to appropriately don and doff personal protective equipment. One of our most ambitious endeavors was an interactive game which was developed to simulate the experience of triaging victims during a mass casualty incident. The next phase of the Web-based simulation involved dealing with the biological agent exposure. We developed gaming applications to address disease identification and vaccination issues in a response to a smallpox outbreak. A simple multiple choice game was used to differentiate chickenpox, smallpox, and monkeypox viruses given specific characteristics. A true or false game was developed to help participants measure knowledge of basic smallpox vaccine facts. Images from the Centers for Disease Control Website were embedded in question slides to identify vaccine reactions, differentiate normal variants from adverse events, and select appropriate treatment strategies. A reference center was established as a resource in our online environment for access by participants as they progress through the simulations and identify their personal learning issues. Existing educational programs, webcasts, and other online experiences were reviewed and links were established on our website to reputable sites. Some narrated presentations and video references were developed in areas that were either identified as gaps or as areas that needed more specificity for our Web-based simulations. The website, simulated experiences and gaming applications will be introduced to undergraduate nursing students in the fall of 2006 as a pilot study. Student and faculty evaluations will occur at that time.
Simulation Opportunities and Integration
Program Development
Initial Purchases
Website
Through the budget provided by the grant, we were able to purchase equipment for the development of high fidelity simulations to meet the second main program objective. The initial purchases included a human patient simulator (HPS) with accessories for portability, arterial access, a mask with drooling and tearing capabilities, an army cot, a wireless microphone, and moulage makeup. The makeup was important to enhance the realism of our simulations and included modeling gels and waxes, blood effects, and cream makeup specifically for simulating trauma and bruising.
After delineating the design of our program, we focused on development. The team created its own website to focus on the first main program objective. The instructional technologist provided essential expertise at this point in web design, software use, and digital video skills. The initial framework for the website involved the release of both a chemical and biological agent after sundown during a fireworks display in a local park. This original scenario was approved by the entire grant team. A menu screen was
pp e65-e68 Clinical Simulation in Nursing Education Volume 2 Issue 2
Design and Development of Bioterrorism Response Education Programs
e67
Figure 2
Local Involvement As we progressed with our project development, opportunities arose to assist in local drills. An example of this was the opportunity to assist the biocontainment unit of our local hospital in an avian influenza drill by integrating the HPS. The scenario began in the emergency room by placing the HPS in an isolation pod for transport. The staff followed a predetermined pathway with security escort to the locked unit. Care of the patient’s respiratory distress was performed by appropriate patient care and support staff upon arrival to the unit. In the scenario, the patient did expire from the disease and the use of the body sealer to contain the virus was practiced. Clinical skills and procedures were demonstrated with appropriate levels of personal protection. The debriefing process was valuable. The staff was able to identify gaps in their current policies and procedures which had not previously come to light in group discussions. The drill was videotaped with permission of the manager and staff. Video clips and images collected will be used for integration into future Web-based simulations. The manager of the unit was given a copy of the drill exercise as well for the staff to review as needed. Feedback during the debriefing session was positive. The staff was pleased with the more scenario-based exercise, as previous drills had been more skills-based. The team learned that exposure to multidisciplinary exercises is invaluable experience in developing appropriate scenarios. The team also learned that it is helpful to have multiple reliable team members to plan the different components of a large-scale drill.
Development of Simulations for Nursing Students We have worked specifically to develop an appropriate simulation for the senior level nursing students. The simulation development team included three nursing faculty and a graduate assistant. One of the nursing faculty
members received extensive training from the manufacturer on the HPS used for the scenario. A linear scenario was developed to demonstrate an unknown illness in the emergency room. A study guide was developed to help the student’s prepare for the experience. The patient presents in respiratory distress, eventually develops acute respiratory distress syndrome, and expires from complications of mechanical ventilation. The unknown illness is eventually identified as avian influenza. Student and instructor guides were developed to parallel the experience. Supplementary assignments regarding calculating nutritional requirements and intravenous insulin management were developed as optional activities. This simulation activity will be initiated with our 2006 undergraduate senior level nursing students in the fall.
Future Directions Virtual Institute As we look to the future, the plan is to broaden our webbased content beyond the dual attack scenario. A virtual institute (see Figure 1) will be created by using building images to define different preparedness centers. New links and content will be developed with applications to natural disasters, radiological events, pandemics, and other public health emergencies. The site will have different levels of access for students and instructors. The instructors will have scoring and tracking capabilities in the Web-based applications. To further integrate simulation on the site, a center for gaming and simulation will include case studies, handouts, and instructor guides for different scenarios as they are developed and improved.
A Mobile Training Lab High-fidelity simulations are best developed for specific scenarios and audiences. In order to facilitate our
pp e65-e68 Clinical Simulation in Nursing Education Volume 2 Issue 2
Design and Development of Bioterrorism Response Education Programs availability to the entire state of Nebraska, we decided that some form of mobile all-hazards simulation lab would be ideal. Our grant budget would not allow for the purchase of a vehicle, so we began brainstorming other options. A trailer met our needs best for both web-based and high fidelity simulation (see Figure 2). The trailer will be 8 feet wide and 16 feet long. It will have built-in desks with laptops on each side wall for our computer simulations and a small flat panel television on the front wall to display theatrical introductions to scenarios. The desk tops will be retractable so that the rear doors can be opened and the space can also be used for a simulated ambulance-like environment complete with a gurney, disposable supplies, and equipment. The space can also be used as an incident command center equipped with two-way radios, maps, and other necessary resources. This training lab should be operational by early 2007.
Summary This web-based bioterrorism educational training program is expected to provide university faculty an easy option for covering material on emergency preparedness within a curriculum that is already full of other essential material,
e68
thus leaving little room for new information. Combining Web-based materials with HPS activities will provide teaching options for different styles of learners. Maintaining our collaboration with Nebraska’s biopreparedness education center should allow us to assist with their educational offerings and allow for exposure to other organizations in the region. By supporting health professions students and health care professionals via the mobile simulation laboratory, the team expects the equipment to be used frequently and ultimately have a role in Nebraska’s community preparedness.
References Butler, J. C., Cohen, M. L., Friedman, C. R., Scripp, R. M., & Watz, C. G. (2002). Collaboration between public health and law enforcement: New paradigms and partnerships for bioterrorism planning and response. Emerging Infectious Diseases, 8(10), 1152-1156. Gebbie, K., Merrill, J., & Tilson, H. H. (2002). The public health workforce. Health affairs, 21(6), 57-67. Gerberding, J. L., Hughes, J. M., & Koplan, J. P. (2002). Bioterrorism preparedness and response: Clinicians and public health agencies as essential partners. JAMA, 287(7), 898-899. Markenson, D., DiMaggio, C., & Redlener, I. (2005). Preparing health professional students for terrorism, disaster, and public health emergencies: Core competencies. Academic Medicine, 80(6), 517-526.
pp e65-e68 Clinical Simulation in Nursing Education Volume 2 Issue 2