Post on 15-Dec-2015
Alamo Colleges
Simulation in Nursing Education: Creating a Quality Simulation
Yvette Baxter MSN, RN
Faculty Development in the Effective Use of Simulation
Objectives:
Identify factors in the educational and practice environment which have contributed to the use of simulation in nursing education.
Identify advantages to incorporating simulation as a clinical teaching strategy.
Discuss strategies for maximizing simulation effectiveness and student learning outcomes.
Identify the key goals of debriefing.
Academic and Healthcare Environment
Shortages of clinical faculty and clinical sites.
Limited exposure to high risk, low volume clinical events
Complexity of the healthcare environment
Emphasis on patient safety
Technological advances offering sophisticated and realistic clinical experiences in the laboratory setting
Need to better prepare new nurses for working in a complex and technologically rich health care environment
Clinical Gaps
IOM (2003): hospital leaders, health plans, and practice sites reported increasing skills deficits in new graduates reported
65-75% of new-to-practice nurses did not meet entry-level competencies for clinical judgment (Ulrich et al., 2010)
The Future of Nursing: Focus on Education (2011) – the current nursing educational system inadequate to prepare nurses with the necessary competencies to provide high-quality care in increasingly complex healthcare environment
ImplicationsMedical Error: Greater risk for errors in clinical practice
Increased Turnover: Gaps between preparation and practice
requirements results in stress and increased potential to leave the field
The percentage of turnover of new graduates is estimated as 17.7% within one year, 33.4% within two years, and 46.3% by the third year (Cho, Lee, Mark, & Yun, 2012)
The Deficits
Competencies in which new-to-practice nurses scored lowest included:
Interpretation of assessment data Decision-making & application of nursing
process Identification of changes in patient status Timely & appropriate follow-up Initiative in management of care
Saintsing, Gibson, and Pennington (2011)
Clinical Simulation
A technique, not a technology
Immersion of the learner with enough realism to suspend disbelief
Environment to develop knowledge, skills, and clinical reasoning
A concept- based learning experience
Self-confidence
Learn from mistakes without risk to patient safety
Practice high risk, low incidence patient events
Identify gaps in knowledge /skills
Diverse learning
Real time/immediate feedback
Promotes critical thinking and decision-making skills
Safety, teamwork, communication, collaborative learning
Benefits of Simulation
Components for Creating a Quality Simulation
Faculty/Student Preparation
Scenario Selection, Writing, and Testing
Fidelity/Realism Debriefing
Simulation Effectiveness
“The patient simulation is only as effective as the faculty who are using it. The creativity, clinical knowledge, teaching expertise, and
technological abilities of the faculty are highly influential in the effective use of patient
simulation" (Durham and Alden, 2008, p. 3-237).
Faculty PreparationRequires: Student-centered approach
Preparation and comfort with scenarios and equipment
Understanding of the goals/objectives
Creativity, flexibility, & recognition of learning opportunities
Participation in the design process/evaluation
Faculty Preparation Understanding that mistakes will
be made
Minimize competition
Small groups
Roles assignment and assumption of roles
Close observation of actions, interactions, and decisions
MINDSET!!!
Learner Preparation
Understanding of simulation guidelines, objectives, & means of evaluation
Establishment of confidentiality, trust, &consent
Pre-scenario study guide
Orientation to simulation environment
What is to be simulated
Once in the simulation, students should function as they would in the clinical environment
Clinical Scenario Defined
“The plan of an expected and potential course of events for a simulated clinical experience. The clinical
scenario provides the context for the simulation and can vary in length and
complexity, depending on the objectives”
(International Nursing Association for Clinical Simulation and Learning [INACSL], 2011).
Steps in Scenario Development
Selection of topic and template Identification of learning objectives Story Writing (determination of
concepts, cues, and critical events) Peer review/Validation Pilot
Idea Generation Course objectives Identified practice gaps Staff/student survey perceived
learning needs/clinical challenges
Clinical experiences Case studies Legal cases
Topic Selection
Pre-programmed/purchased
Created by faculty/educators
On-line pre-written scenarios
Books
Source of Scenarios
Free On-line Resources
Healthy Simulation http://healthysimulation.com/2018/free-nursing-scenarios/
Kansas State Board of Nursing http://www.ksbn.org/cne/SimulationScenarioLibrary.htm
Massachusetts Nursing Initiative- Simulation Scenario Library http://www.mass.edu/currentinit/Nursing/Sim/Scenarios.asp
Knowledge level of student Goals and purpose of the
simulation Level of complexity and fidelity Number of participants/length of
time Experience and comfort level of
facilitator Availability of content expert Setting and equipment needed
Considerations for Scenario Selection
Safety and identified concepts/competencies
Evidence based practice and standards of care
Institutional policies and procedures
References
What Should be Incorporated in My
Scenario?
Writing the Story
Beginning: Description of the patient, event, setting,
participants Information to be providedMiddle: Plot progression and contingencies Expected actions & timelines Cues Flexibility of facilitatorEnding: Logical and realistic transition maximizes
fidelity
Validation & Piloting
Validation: Evidence –based : current journals, clinical
guidelines, and textbooks Checked for accuracy and believability Reviewed by content expert for validity and
revised as needed
Piloting: Piloted with small group of targeted
learners Feedback enables scenario revision for
maximum effectiveness Information regarding timeline, areas
where learners get derailed, or aspects of the scenario learners find confusing
Fidelity
The degree to which simulators and simulations mimic reality
Simulation experiences should be as realistic as possible
Realism of scenario, staging, props enhance the simulation experience
Realism
“The realism of any simulation depends upon multiple factors, including the
fidelity of the simulator, the environment, props, and the
description of the scenario…as realism is enhanced, the
effectiveness of the scenario as a learning tool is increased”
(Durham & Alden, 2008, p. 3-234).
Staging
Staging
Debriefing
Debriefing:“a conversation among two or more people to review a simulated event or activity in which participants explore, analyze and synthesize their actions and thought processes, emotional states and other information to improve performance in real situations”
(Center for Medical Simulation, 2009, p. 1).
Evaluate whether learning objectives met
Build on prior learning
Self-reflection/assessment
Communication/different perceptions/attitudes
Reinforce teaching points
Identify/ correct gaps in knowledge, skills, attitudes
Improve future performance
Goals of Debriefing
Reaction – opportunity to decompress and discuss emotional response to the simulation experience
Analysis - provides a time for reflection, understanding, and discussion of what went well and what didn’t
Summary/Closure – a summary of the experience is provided and evaluation of the simulation as a learning experience
Phases of the Debriefing Process
Role of Facilitator in Debriefing
Create a safe and trusting learning environment
Provide support Permit opportunity for defusing
emotions Guide the reflective process Provide feedback/observations Assist in assimilating new knowledge
Texas Board of Nursing (BON) Position Statement
on Simulation
In 2010 the BON put forth a position statement to clarify the role and limitations of simulation in order to provide educators with guidelines for making simulation educationally sound and meaningful.
Texas Board of Nursing (BON) Position Statement
on Simulation Simulation provides a valuable adjunct to traditional clinical learning.
To be effective the simulation must challenge learners to use problem solving and critical thinking skills.
Each simulation experience should have clearly stated objectives that are presented to learners PRIOR to engaging in the experience.
Texas Board of Nursing (BON) Position Statement
on Simulation Learners are required to prepare for a
clinical simulation experience in the same manner they would a hospital clinical experience.
An orientation to the simulation technology and environment is required.
The educator should act as a facilitator providing cues when needed, but not as an active participant.
Unless an end of life scenario, the simulation should end with a viable patient.
Acknowledgements
The Alamo Colleges wishes to extend a special thanks to San
Antonio College nursing students Lori Hannasch, Renee Howard, &
Sylvia Muniz for lending their time and services in the making of this
project!!!
Questions?
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