The use of 3D printing could create cost-effective, quickly constructed and rapidly innovative products. But how this technology will disrupt and transform the fields that it touches remains unclear. Healthcare and education are hold some of the greatest potential for 3D printing. But what are the practical advantages and foreseeable weaknesses of this amazing technology, specifically around nursing and education?
Among learning styles, the hands-on approach of receiving information is the one most favored by nurses and nursing students. The kinesthetic approach enables learners to visualize anatomy and physiological concepts, and the benefits of active learning create a better understanding of the material, researchers have found.
Traditional approaches to health education focus primarily on a didactic model as an inexpensive way to relay information and concepts to large numbers of individuals. Research demonstrates that this teaching method rarely stimulates critical thinking in learners or results in lessons that extend beyond short-term memory. Other modalities such as discussion- and lab-based learning are more effective in solidifying understanding and critical thinking. However, these options are constantly being underused, or neglected, for lecture-based presentations of information due to cost or lack of available resources.
In the age of rapidly advancing technologies and radical innovation, there is one particular technology that has exploded into the public eye: 3D printing. It is becoming an important part of engineering, allowing for the production of physical models quickly, easily and inexpensively. This technology has the potential to meet the need for kinesthetic learning, especially in nursing education, while subsequently cutting the costs of holding practical, simulation or lab-based sessions for learning.
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Our common notion of the 3D printing process, called rapid prototyping, was originally developed by Chuck Hull in the 1980s. At that time, it was used primarily on an industrial level by companies and research organizations to create objects made of metal, paper, plastic and casting media (such as sand). The printer works by laying down thin layers of material, in cross-cuts of the whole object, until an image forms. The majority of 3D printing uses computer-aided design (CAD) and other digitalized data to create objects of interest. For example, one could use a scan like an X-ray of a foot, create a digital model of that scan on a computer and, in turn, print a 3D model of that foot in a variety of materials.
In recent years, 3D printing has become more accessible, gaining ground in the less-industrial but fertile fields of fashion, home decoration and even food. However, it is in the field of healthcare that 3D printing has a wealth of potential, especially in the realm of education. According to a 2014 study by Meehan-Andrews, nurses and nursing students found the most success in learning by a kinesthetic, or hands-on approach, to receiving information. The use of 3D printing would allow students to visualize anatomy and physiological concepts based on more realistic or individualized structures, rather than standardized models. Instructors would be better able to demonstrate anatomical differences between individuals, give visual examples of disease progression and provide more realistic models based on size or texture. Furthermore, rapid prototypes could facilitate training for procedures in general, simulating conditions, diversity of tissues and other anatomical differences without risk to a patient. This practice could increase confidence in a learner before entering a clinical setting or performing a new procedure; the simulation of a specific and complex procedure provides a unique opportunity to determine the best strategy and to practice the steps to take.
However, being in a relatively early phase in its growth, 3D printing has its limitations and challenges. The foremost challenge is the process chain from imaging to 3D model. It takes significant interdisciplinary teamwork and close collaboration among radiologists, clinicians and computer and material scientists to create relevant and accurate 3D models. Following that, the biggest limitations regarding 3D printing are time, cost and limited dimensions.
First, 3D printing takes a significant amount of time. Even using the simplest plastic material to form a basic model of a heart can take up to three hours. This time grows exponentially depending on the size, complexity and materials used. Cost follows a similar pattern. The size, complexity of the design and materials can increase the price of production significantly. 3D printing is also limited by dimensions. The printers are only so large. Therefore, objects such as a whole body model or even an entire limb cannot be created as single units. To overcome this limitation, the larger model would have to be divided into smaller parts to be combined later or a scaled-down replica would have to be substituted. Concurrently, matters of fragility (depending on materials used) and inadequate materials to completely simulate human tissue and texture are also limitations to overcome.
Second, copyright and intellectual property issues remain. Case law has not been established regarding repercussions of using a 3D printer for nefarious purposes. Who is liable? The person who printed a copyrighted object, the printer maker or the material supplier? There are a few existing defenses such as the Digital Millennium Copyright Act, which provides a safe harbor defense for websites that host 3D models if they post a policy agreeing to remove infringing material upon copyright holder’s request. Future legal battles will shape the 3D printing environment and regulations.
Despite challenges with 3D printing, the technology is ripe for future implementation into nursing programs and clinical care. No longer will learning and exams exist in 2D. Students will learn by holding 3D printed models that they can take home and study. Similarly, exams will require students to identify structures in, for example, a 3D-printed heart, and may even require them to print models that represent a certain pathophysiology. Clinicians will use these models to deliver clinical education to patients and their communities.
The role of nursing care will change as well. The transplant nurse will have new duties to monitor the signs of transplant success and the failure of 3D-printed organs. Orthopedics nurses will provide instructions about how to care for a patient’s newly printed prosthetic arm — an arm that may be printed from composite materials or even the patient’s own cells. Nursing homes will 3D print food that is tailored specifically to the nutritional needs of the patient.
But these changes will require academic programs and clinical educators to prepare to adopt new methods of instruction that incorporate this relatively new kind of kinesthetic learning. Curricula will include new ways of teaching students how to deliver clinical care and expand current instructional methods.
Nathan Hatch, BSN, R.N., and Ryan J. Shaw, Ph.D., R.N. work for the Duke University School of Nursing.
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