Integrating Simulation into Nursing Curriculum: Creative Solutions

1. Laerdal SUN meeting Dallas Texas October 2009 Integrating Simulation into Nursing Curriculum: Creative Solutions Mary Cato MSN, RN Oregon Health & Science University

3. “The true value of simulation lies in its ability to offer experiences throughout the educational process that provide students with opportunities for repetition, pattern recognition, and faster decision making.” Doyle & Leighton, 2010 Value of simulation integration

4. 25% of studies cite integration of simulation-based exercises into the curriculum as an essential feature of their effective use. Simulation-based education should not be an extra-ordinary activity, but must be grounded in the ways learner performance is evaluated, and should be built into learners’ normal training schedule. Issenberg

5. Effective medical learning stems from learner engagement in deliberate practice with clinical problems and devices in simulated settings in addition to patient care experience.

6. 90% of nurse educators think their graduates are ready to safely practice 10% of hospital and health system executives think graduates are ready to safely practice Why integrate simulation? JONA November 2008

7. Mainly NOT in “motor skills” • New graduates often have little experience in: • Delegation • Taking “a full load” • Utilizing resources (for themselves and their clients) • Interprofessional communication Where is improvement needed?

8. Cognitive: mental skills (Knowledge) Affective: growth in feelings or emotional areas (Attitude) Psychomotor: manual or physical skills (Skills) Multiple domains

9. Original Terminology Revised Terminology Bloom’s Taxonomy

10. Experiential Learning • Because simulation is experiential learning, objectives can be higher level • Creating and evaluating, for example, rather than simply understanding or remembering

12. Determine Goal of Simulation

13. Classroom or lecture • Techniques of assessment • Effects of a drug (use monitor) • Role model communication • Skills lab • Demonstrate procedure • Increase realism by doing procedure in context of patient care Demonstration

14. Utilize as clinical hours? • Impact of increasing fidelity • Able to provide context to situation • Encourage use of clinical judgment, communication, resource management, “thinking on your feet,” teaching skills, management of emotional situations Practice

15. Possibilities for practice High, mid, and low fidelity manikins Standardized patients and participants Role-playing Computer simulation Virtual reality

16. Give students opportunities to make decisions Reinforce important concepts Teach and practice clinical judgment Practice professional communication Reflect on case Why practice in simulation?

17. An Integrative Model of Clinical Judgment Responding Noticing Interpreting Reasoning Patterns Analytic Intuitive Narrative Expectations Context Background Relationship Action Initial Grasp Reflection on Action Outcomes Reflection on action and Clinical Learning Reflecting Tanner, CA (2006) Thinking like a nurse: A research-based model of clinical judgment. Journal of Nursing Education, , 45(6), 204-211

18. Who are the client case exemplars? • Common situations • Highly prevalent nursing practice situations • What students will most likely see in clinical • High risk, low frequency situations • Lack of clinical experiences • Apply previously learned content • “Spiral up” the curricular content • Resources available • Faculty & content experts • Space & equipment Determine types of experiences

19. Objectives need to be attainable Tasks should be appropriate Consider “just manageable” situations – (the experience is challenging enough to move the learner to a higher level, but not so difficult that the learner becomes frustrated or discouraged) (Bransford, Brown and Cocking, 2000) Leveling Scenario

20. When can the objectives be met?

21. Preparation • Participant Handout • Sent prior to simulation • Policy/procedure review • Skill review • Role review • Evidence-knowledge review • Benefits • Promotes self-directed learning • Promotes accountability • Increases confidence through preparation • Identifies expectations

22. During the Scenario

23. During the Debriefing

24. Occurs after the simulation session • Reflective journaling • Use of rubric • Individual learning – availability of faculty outside of simulation session if needed Reflection on Learning

25. Formative vs summative or “high stakes” • Clarity of objectives, what is being tested • Participants need to know what the stakes are • How will the results be communicated to the participants? Evaluation

26. Consequences of Participation

28. Organizations • INACSL • SSiH • NLN • Courses • Workshops • Apprenticeships • Graduate courses Resources for faculty

29. Laerdal Nursing Scenarios SIRC (NLN/Laerdal Medical) has 2 samples in Designing & Developing a simulation course MedEdPORTAL (Association of American Medical Colleges) STORC OB Safety Initiative PNCI Sources for Scenarios

30. “Real Nursing Simulations,” (2009) Pearson Education Inc. “Simulation Scenarios for Nurse Educators,” (2009) Campbell and Daley: Springer Publishing "High-Fidelity Patient Simulation and Nursing Education," (2009)Nehring and Lashley: Jones and Bartlett Sources for Scenarios: Publications

31. Jeffries Simulation Framework

32. Simulation Innovation Resource Center The SIRC

33. SIRC Components: Template

34. What do students need in real-world clinical practice and what can we simulate • How much, How often • When • What aspects are most important for learning • Does simulation make a difference to patient safety • Does simulation improve patient care outcomes Research Questions

35. Use of standardized patients Use of hybrid simulations Increased focus on management, delegation, and leadership Integration of Electronic Medical Record Interprofessional activities Graduate programs Future of simulation