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Getting the Most Out of Simulation

Lorretta Krautscheid, MS, RN Director, LRC University of Portland. Getting the Most Out of Simulation. Identify strengths and gaps within curriculum (didactic/lab/clinical) Evaluate clinical competency Clinical faculty development Nursing education research. Simulation

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Getting the Most Out of Simulation

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  1. Lorretta Krautscheid, MS, RN Director, LRC University of Portland Getting the Most Out of Simulation

  2. Identify strengths and gaps within curriculum (didactic/lab/clinical) Evaluate clinical competency Clinical faculty development Nursing education research Simulation Beyond Student Learning

  3. Junior level Med-Surg simulation ORIF 4 hours post-op Data Collection: what do you want to know? Determine what to assess (NPSG?) Define assessment items (what will it look like when ….?) Develop data collection form (objective) What is your benchmark? Data Review : what do you do with assessment information? Strengths and Gaps

  4. JR level Med-Surg 2005-2006 Assessment and Interventions summary (benchmark set at >73% by Summer 2006) Pain assessment: met Surgical Dressing: met ABC Assessment: met JP drain assessment: met Nasal cannula placement: met SpO2 reassessment: met Data Review – safe actions

  5. JR level Med-Surg 2005-2006 Unsafe Nursing Actions (benchmark set at <30% by Summer 2006) Nasal cannula hazard: met No reassessment of SpO2: met Unsafe med delivery: met No client ID: met No hand hygiene: met Tripping hazards avoided: met Data Review – unsafe actions

  6. SpO2 reassessment following application of O2 via nasal cannula When do students learn SpO2 and respiratory assessment? What opportunities do students have for deliberate repeat practice of assessment item? (cognitive, psychomotor, affective) What gaps are identified in curriculum/ course content / clinical? What is within our power to change & what do others need to “own”. (CI’s, students) Achieving and sustaining the benchmark

  7. Clinical Assessment Simulation

  8. Measure learning outcomes Objective measurement of clinical ability Reliable (consistent) and valid (representative) Evaluate teaching/program effectiveness Senior level Med-Surg course Hypovolemic Shock client Theoretical framework Simulation in Competency Assessment

  9. Identify learning objectives Design scenario and grading rubric Run through – multiple learner levels Re-design scenario and grading rubric Run through Pilot – information gathering CAS Development

  10. Data analysis Define test items? What will it look like if…? Test item validity? Level for cohort Interrater reliability Refine grading rubric Test with “grading” Data collection CAS Development

  11. SR level Med-Surg 2005-2007 (benchmark set at >80%) Client ID: met Baseline vital signs: not met (75%) Current vital signs: not met(75%) O2 Sat: met O2 LPM: not met (65%) NG output: not met (62%) Data Review MD Notification

  12. NG output description When do students learn what suction is and how to evaluate output? What opportunities do students have for deliberate repeat practice of assessment item? (cognitive, psychomotor, affective) What gaps are identified in curriculum/ course content / clinical? What is within our power to change & what do others need to “own”. (students & CI’s) Achieving and sustaining the benchmark

  13. Evaluating student application of theory Example: “How Should I Touch You? Instructing Male Nursing Students on Touch.” Nursing Education Research

  14. The centrality of touch in the discipline of nursing is documented Nursing literature is completely lacking information on how to instruct male students on the use of touch Nurse educators’ lack of attention to men and touch issues has led to feelings of resentment and confusion (Paterson et al., 1996). Male students fear that their touch might result in false accusations of sexual inappropriateness from female clients (O’Lynn, 2004, 2007). Simulations provide an active learning strategy for practicing and evaluating nursing assessment and skills. Why an intimate touch lab?

  15. Quasi-experimental, using a comparison/ control group Survey and simulation performance data collected and analyzed Data examined for possible differences between the two groups. Nursing is an applied discipline, skill performance must be evaluated Simulation in research

  16. Research Methods

  17. Implications For Nursing Practice Optimally prepared students for practice Deliberate practice “ideal” For Nursing Research Does an intimate touch simulation lab improve male student comfort with providing intimate touch? Does a pre-clinical intimate touch simulation improve transferability? Implications

  18. Clinical Faculty Development Simulations

  19. Clinical Faculty Experience Expert clinical = Expert faculty? New faculty orientation – what’s covered? Experienced faculty continuing education Barriers to immediate and consistent feedback on teaching What about clinical faculty?

  20. Didactic Recorded simulations of poor and best practices Facilitated discussion on teaching practices Active participation Clinical faculty simulation with student Reflection/debriefing Clinical Faculty Development

  21. Learner-focused clinical vs. teacher focused Teaching strategies developed and enhanced Verbal and nonverbal messages highlighted Faculty evaluation of simulation

  22. For Nursing Practice Optimally prepare clinical faculty for practice Deliberate practice – “ I don’t think anything is as valuable as walking through it – then reflecting on events and language.” For Nursing Research Transferability from simulation lab to clinical setting Application for preceptors with new grads or new hires Recommendations

  23. Clinical Faculty Development Simulation Preview

  24. Bucher, L (1993). The effects of imagery abilities and mental rechearsal on learning a nursing skill. Journal of Nursing Education, 32 (7), 318-324. Feingold, C., Calaluce, M, & Kallen, M (2004). Computerized patient model and simulated clinical experiences: Evaluation with baccalaureate nursing students. Journal of Nursing Education, 43 (4), 156-163. Inoue, M., Chapman, R., & Wynaden, D (2006). Male nurses’ experiences of providing intimate care for women clients. Journal of Advanced Nursing, 55 (5), 559-567. Keogh, B. & Gleeson, M.(2006). Caring for female patients: the experiences of male nurses. British Journal of Nursing, 15 (11), 604-607. O’Lynn, C (2004). Gender-based barriers for male students in nursing education programs; prevalence and perceived importance. Journal of Nursing Education, 43 ( ), 229-236. Patterson, B. & Morin, K (2002). Perceptions of the maternal-child clinical rotation: The male student nurse experience. Journal of Nursing Education, 41 (6), 266-272. Routasalo, P (1999). Physical touch in nursing studies: a literature review. Journal of Advanced Nursing, 30 (4). Selected References

  25. Billings, D.M., & Halstead, J.A. (2005). Teaching in nursing: A guide for faculty. Philadelphia: W.B. Saunders. Bradshaw, M. (2001). Philosophical approaches to clinical instruction. In Lowenstein, A. & Bradshaw, J. Fuszard’s innovative teaching strategies in nursing (3rd ed.). Gaithersburg, Maryland: Aspen Publishers, Inc. Childs, J. (2002). Clinical resource centers in nursing programs. Nurse Educator, 27 (5), 232-235. Cook, L. (2005). Inviting teaching behaviors of clinical faculty and nursing students’ anxiety. Journal of Nursing Education, 44(4), 156-161. Dearman, C., Lazenby, R., Faulk, D., & Coker, R. (2001). Simulated clinical scenarios Nurse Educator, 26 (4), 167-169. De Young, S. (2003). Teaching strategies for nurse educators. Upper Saddle River, NJ: Prentice Hall. Feingold, C., Calaluce, M., & Kallen, M. (2004). Computerized patient model and simulated clinical experiences: Evaluation with baccalaureate nursing students. Journal of Nursing Education, 43 (4), 156-163. Gaberson, K., & Oermann, M. (1999). Clinical teaching strategies in nursing. New York: Springer. Selected References

  26. Infante, M. (1975). The clinical laboratory in nursing education. New York: John Wiley & Sons, Inc. Johnson, J., Johnson, J., &Theis, S. (1999). Clinical simulation laboratory, an adjunct to clinical teaching. Nurse Educator, 24 (5), 37-41. Letizia, M. & Jennnrich, J. (1998). Development and testing of the clinical post-conference learning environment survey. Journal of Professional Nursing, 14 (4), 206-213 McCausland, L., Curran, C., & Cataldi, P. (2004). Use of a human simulator for undergraduate nurse education. International Journal of Nursing Education Scholarship, 1 (1), 1-17. O’Conner, A. (2001). Clinical instruction and evaluation: A teaching resource. Sudbury, MA: Jones and Bartlett. Tanner, C. (2002). Clinical education, Circa 2010. Journal of Nursing Education, 41, 51-52. Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45 (6), 204-211. Selected References

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