Transcript Branding in the Digital Age

The International Nursing Association for Clinical Simulation & Learning
Integrating Simulation into Nursing
Education
Presenter and Disclaimer
• Andrea D. Ackermann, PhD, RN, CNE
– VP Finance, INACSL Board of Directors
– Member of Editorial Board for Clinical
Simulation in Nursing
– Professor and Chair of Nursing Division,
Mount Saint Mary College, Newburgh, NY
– Adjunct faculty member, Excelsior College,
Albany, NY
Objectives
By the end of the learning session the participant
will be able to:
1. Discuss drivers for the introduction of
simulation
2. Identify courses within your nursing curriculum
to best leverage simulation
3. Locate tools and resources for quick successes.
4. Create buy-in with faculty and / or other
health care specialties
5. Define measurable objectives for success
What drives Simulation Education in Nursing?
• Lack of learning experiences and resources
• IOM initiatives, Joint Commission, NCSBN,
QSEN
• Curriculum
• Student characteristics
• High risk/Low frequency situations
• Developing professional demeanor, interprofessional collaboration, attitudes,
communication
• Active and experiential learning
• Reflective learning
How do you fit Simulation Education into Curriculum?
Program needs
Students learning needs
Developing objectives
Facilitation of
simulation
• Evaluation of
simulation
• Debriefing
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Program needs
• Guided by program assessment
– NCLEX pass rates
– Standardized testing
– Available clinical experiences in the
community
– Curriculum assessment
Student and Faculty Needs
• Guided by
– Student level
– What do the students say they need?
• Communication
• Assessment
• Dealing with families
• Cultural considerations
• What do I do if something
goes wrong?
– What do the faculty say they need?
• Areas where the students are “weak”
• Areas where the students are not getting practice
• Safety
• Testing
Objectives/Outcomes
• Guided by:
– Simulation standards
– Overall purpose of the simulation
– Student learning needs and level
– Realistic and measurable
– Identify the appropriate environment,
fidelity, prompting, etc.
– Foundation for simulation facilitation
– Basis for assessment and evaluation
Facilitation
• Guided by:
– Simulation standards
– Simulation plan
– Simulation implementation
– Participant engagement
– Scheduling
– Facilitator
• Preparation
• Prompting
• Establish safe learning environment
• Guides the learning
Evaluation
• Guided by:
– Simulation Standards
– Assessment/formative evaluation
– Summative evaluation
– Established Objectives/Outcomes
– Three domains of learning
• Cognitive
• Affective
• Psychomotor
– Valid and Reliable tools
Debriefing
• Guided by:
– Simulation Standards
– Evidence based debriefing
methodologies
– Promoting reflective thinking
– Skills of the debriefer
– Objectives/outcomes
– Confidentiality, trust
and open
communication
Tools and Resources
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Simulators
Task trainers
Standardized patients
Virtual experiences
Standards of Best Practice: Simulation
INACSL Board of Directors, (August, 2011). Standards of best practice:
Simulation. Clinical Simulation in Nursing, 7(4 Supplement). S1-S20.
Available at http://www.nursingsimulation.org/issues?issue_key=S18761399(11)X0005-1
Development of INACSL Standards
• 2 Years
• Survey to INACSL Membership
• Committee Draft
• Peer Review
• Final Draft
• Publication – Summer 2011
Standards of Best Practice
1. Terminology
2. Professional Integrity of Participant
3. Participant Objectives
4. Facilitation Methods
5. Simulation Facilitator
6. The Debriefing Process
7. Evaluation of Expected Outcomes
Standard One: Terminology
Statement:
Consistent terminology provides
guidance, clear communication, and
reflects shared values in simulation
experiences, research, and
publications.
Rationale
• Standardized terminology:
– Enhances understanding and communication
among planners, participants and others
involved in simulation experiences
– Promotes consistency in the development,
implementation, evaluation and publication of or
about simulated clinical experiences or research
studies for use in education and practice
Nursing Skill Development & Judgment Model
Standard 2: Professional Integrity of Participants
Statement:
The simulation learning and testing environment will
be one of clear expectations for the attitudes and
behavior of each participant and an area where
mutual respect is supported. Professional integrity
related to confidentiality of the performances,
scenario content, and participant experience is
expected to be upheld during a simulation
experience. These performances in simulation
experience may be live, recorded, and/or virtual.
Rationale
• Failure of the participants to maintain
professional integrity related to simulation
and lack of respect or professionalism could
undermine the benefits of this pedagogy
• Sharing of confidential information of any
kind before, during or after the simulation
experience can alter the experience
Outcomes
• This standard offers the opportunity for
similar learning experiences to all
participants
• Upholding professional integrity
promotes a safe learning environment
• To achieve the desired outcomes, the
facilitator must address key areas during
the simulation
Standard Three: Participant Objectives
Statement:
The simulation experience should
focus on the participant objectives
and experience level.
Rationale
• Participant objectives are the guiding
tools for simulation and essential to
achieve the outcomes
• Identification of appropriate scenario,
fidelity, instructor prompting/facilitating,
and environment is crucial for best
experiences and meeting the participant
objectives
Outcomes
• The focus of simulation is on the
outcome to be achieved and on
participant learning-Know your
participants
• Should facilitate the development of
clinical judgment in order to deliver high
quality and safe nursing care that is
holistic and includes cultural awareness
Standard Four: Facilitation Methods
Statement:
Multiple methods of facilitation are
available, and use of a specific method
is dependent upon the learning needs
of the participant(s) and the expected
outcomes.
Rationale
• Facilitation methodology should vary because
participants bring cultural and individual
differences that affect their knowledge, skills,
attitudes (KSAs), and behavior
• Facilitation assists the learner to meet the
objectives by incorporating learner’s needs
and experience into the planning and
implementation of a simulated clinical
experience
Outcomes
• Facilitation revolves around engaging
participants within the scenario by assisting
them to meet the objectives of the clinical
scenario
• Effective facilitation requires using the
facilitation method and personnel/faculty
indicated by participant objectives and
expected outcomes
Standard Five: Simulation Facilitator
Statement:
A proficient facilitator is required to
manage the complexity of all aspects of
simulation.
Rationale
• The facilitator is the key to participant
learning:
– Guides and supports participants to understand and
achieve the objectives
– Engages the participants to search for evidence-based
practice solutions to develop participant’s skill
development and clinical judgment
– Adjusts simulations to meet objectives based on
participant’s actions or lack of actions
– Leads the participants in identifying the positive
actions and changes
Outcomes
• Facilitator promotes and assists with
achieving the desired outcomes of a
simulated experience by utilizing various
methods
Standard Six: The Debriefing Process
Statement:
All simulated experiences should
include a planned debriefing session
aimed toward promoting reflective
thinking.
Rationale
• Learning is dependent upon the integration of
experience and reflection
• Reflection is the conscious consideration of the
meaning and implication of an action
• The skills of the debriefer are important to
ensure the best possible learning
• Learners report the debriefing session is the
most important component of a simulated
learning experience
Outcomes
• The integration of the process of
debriefing into simulation:
– Enhances learning
– Heightens self-confidence for the learner
– Increases understanding
– Promotes knowledge transfer
– Identifies best practices
– Promotes safe, quality patient care
– Promotes life-long learning
Outcomes (Continued)
• To achieve the desired outcomes, the effective
debriefing process should:
– Be facilitated by individual competent in debriefing that
observed the simulation
– Use evidence-based debriefing methodologies
– Be based on a structured framework for debriefing
– Be based on objectives, the learners, & the outcomes
– Be conducted in an environment that supports
confidentiality, trust, open communication, selfanalysis & reflection
Standard Seven: Evaluation of Expected Outcomes
Statement:
This standard addresses summative
evaluation as opposed to formative
assessment.
Rationale
• Simulation is an acceptable method of
evaluating the three domains of
learning:
– Cognitive (knowledge)
– Affective (attitude)
– Psychomotor (skills)
Outcomes
• The participant’s achievement of
expected outcomes of a simulation
experience should be based on valid and
reliable instrumentation, tools, and
methodologies in the evaluation process
• To achieve valid and reliable evaluation
results, the simulation used for the
purpose of assessment and particularly
high-stakes evaluation must follow
certain aspects.
Creating Buy-In
• Determine your organizational ‘needs’ and
‘problems’ and provide solutions through the
use of simulation
• Share data / evidence
• Invite others to the sim lab
• Plan Open Houses and awareness events
• Collect user satisfaction data and share it with
others
• Design ‘evidence-based’ simulation scenarios
• Utilize the Standards
Defining Measureable Objectives for Success
• Cognitive
– Standardized Exams
– Course Exams
• Psychomotor Skills
– Checklists
– Global Rating Scales
• Affective
– Confidence
– Self-Efficacy
– Satisfaction
AACN, November 29, 2011
Cognitive
• Based upon Scenario Content
• Instructor Made Tests
• Proprietary Tests
Psychomotor-Checklist
Place a ✔ if the task has been performed correctly
Assessment
❑ Asks patient if he/she is short of breath
❑ HR - Determines heart rate using watch
❑ Pulse - Feels for a radial pulse
❑ BP - Checks blood pressure with cuff on skin (not through gown)
❑ RR - Counts respiratory rate with watch
❑ Breath sounds - listens to breath sounds with stethoscope on the skin (not
through gown)
❑ Reviews bedside chart
❑ Applies and checks pulse oximeter reading
Psychomotor –
Global Rating Scale
Assessment
• ❑ 1 Unsatisfactory
• ❑2
• ❑3
• ❑4
• ❑ 5 Satisfactory
• ❑6
• ❑7
• ❑8
• ❑ 9 Superior
Affective Domain
• NLN Tools
• Journaling
• Visual Analog Scale (VAS) – 100 mm line
Place a mark on the line below to indicate your level of
confidence in your ability to insert and IV catheter
__________________________________________________________
No Confidence
Highly Confident
Examples of Validated Tools
• NLN
– Simulation Design Scale
– Educational Practice Questionnaire
– Student Satisfaction and Confidence in
Learning
• Lasater Clinical Judgment Rubric
– Based upon Tanner’s work
• Creighton Simulation Evaluation Tool
• ANTS (Team Evaluation)
Evaluation of the 3 Domains of Learning
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Lasater (2007)
Herm, et al (2007)
Rhadakrishnan, et al (2007)
Todd, et al (2008)
Evaluation of the Scenario
• Rationale
– CQI
– Support for future activities
– Development
– Support for Staff
• Elements
– Demographic information
– What do you want to know?
Simulation Evaluation (Howard, 2010)
Strongly
Disagree
Disagree
Agree
Strongly
Agree
4.
The simulation experience helped me to
better understand nursing concepts.
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5.
The simulations were a valuable learning
experience.
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The simulations helped to stimulate critical
thinking abilities.
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The simulation was realistic.
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8.
The knowledge gained through the
simulation experiences can be transferred to
the clinical setting.
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9.
I was nervous during the simulation
experience.
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10. Because of the simulation experience, I will
be less nervous in the clinical setting when
providing care for similar patients.
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11. Simulation experiences can be a substitute
for clinical experiences in the hospital.
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12. Simulation experiences should be included in
our undergraduate education.
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Please share any additional thoughts at this time:
Stakeholder Evaluations
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Faculty
Students / Participants
Outside Users
Regional Healthcare Providers
Patients