Transcript moving simulation out of the lab and into mainstream

MOVING SIMULATION OUT OF THE LAB
AND INTO MAINSTREAM NURSING
EDUCATION PRACTICES
Coffey, S., Graham, L., de la Rocha, A., Chorney, D., Cummings, K.,
Papaconstantinou, E., Mairs, S., Zitzelsberger, H., Vogel, E., & Sproul, S.
SIMULATION FOR TEACHINGLEARNING
• Simulation is becoming a critical teaching-learning strategy in nursing
education
• High quality simulation experiences occur across a full range of modalities:
• high-fidelity
• medium-fidelity
• low-fidelity
• Evaluation using simulation now includes:
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Summative
Formative
High stakes
remedial
SIMULATION FOR TEACHINGLEARNING
• As a result, learners are able to acquire and demonstrate the knowledge
and skills necessary for safe and competent nursing practice
• Simulation provides real-time opportunities for students to work through
complex patient-care situations
• Simulation is playing an essential role in supporting educators to facilitate
nursing students’ learning of complex concepts and skills (CASN, 2007;
Rickets, 2011)
• In clinical settings, the shift to higher acuity and increased complexity of
patients demands higher levels of decision-making
• This cycle of increasing complexity further necessitates increased (and
unprecedented) competency and confidence among nursing students and
program graduates
SIMULATION FOR TEACHINGLEARNING
• A number of studies demonstrate the advantages of simulation in enhancing
nursing students’ knowledge, competence, confidence, and satisfaction,
while readying students for clinical practice
• Cant & Cooper, 2010
• Norman, 2012
• Rickets, 2011
• As nursing programs increasingly turn to simulation as direct clinical
replacement in the context of increased student enrolment and dwindling
clinical placements, consideration must be given to:
• standardized evaluation
• Faculty expertise
• Enhanced integration of simulation beyond “laboratory” settings
SIMULATION FOR TEACHINGLEARNING
“Simulation makes visible what we
have suspected but could not see in
clinical: Some of our students are not
safe”
(Kardong-Edgren et al., 2011, p. 23)
CREATING OPPORTUNITIES FOR
WIDESPREAD SIMULATION USE
• As a result, faculty within the University of Ontario Institute of Technology
(UOIT) and Durham College (DC) Collaborative Bachelor of Science in
Nursing Program created a multi-faceted plan to promote active teachinglearning using enhanced simulation opportunities
• Key activities included:
• Development of a simulation-specific strategic plan for the Nursing Program
• Enhancing faculty skill sets in relation to simulation, including offering professional
development
• Review of curriculum for simulation opportunities beyond typical laboratory
settings
• Creation of a simulation satellite room for easy access to simulation facilities
within steps of teaching space
LAYING THE GROUNDWORK
• Infrastructure requirements included space and capital investment
• Successful proposals for both were based on Nursing Program success,
internal and external recognition of faculty cutting edge expertise, and
student feedback
• Partnering with IT within the University setting supported a process for
problem-solving around technical issues (e.g., how to create live streaming
from the simulation satellite room to nearby classrooms)
• Creating small work groups to develop enhanced, cutting edge simulation
development skills increased the visibility of simulated learning within the
educational agenda in the Nursing Program
SITUATING SIMULATION WITHIN
EXPERIENTIAL LEARNING
• Most importantly, a significant philosophical shift was initiated, in which
simulation as a teaching-learning methodology was rightly situated within
the structure of experiential learning, rather than its current association with
‘technical learning’ in lab settings
• This resulted in a re-orientation of simulation to make mastery of technology
less prominent, while teaching-learning skill more critical
• Ultimately, it supports the movement of simulation out of the lab and into
mainstream education, making it accessible to both more faculty and more
learners
EARLY OUTCOMES
• Creation of a simulation satellite room, which can be used for:
One-on-one teaching
Remediation
Small group clinically focused learning
Live-streaming of simulated learning events, with a small number of learners
involved in the simulation and the rest of the class watching nearby and fully
participating in a debriefing after the event
• Integration of simulation into both clinically oriented courses, as well as theory
courses
• Nursing and health sciences research that involves a wide range of foci
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EARLY OUTCOMES
• Exponential faculty development
• Faculty now are considered “experts in the field”
• Cutting edge simulation development, with increased focus on context within
the situation
• Curricular revision
• Increased redesign of existing courses to include simulation foci
• Development of new elective and core courses which focus on integration of
simulation opportunities
SUMMING UP
• Re-examining how simulation was both conceived of and integrated within
our nursing program at UOIT-DC enabled us to make critically important
changes to:
• How we use simulation within a broad range of nursing courses
• How we evaluate all elements of simulation (the scenario itself, rubrics,
facilitators, student learning, etc.)
• How we teach and assumptions we may have had about how students learn
• How simulation can be used to support research and continuing professional
development within nursing and health sciences
REFERENCES
• Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education:
systematic review. Journal of Advanced Nursing, 66(1), 3-15. DOI:10.1111/j.13652648.2009.05240.x
• CASN. (2007). CASN/ACESI Clinical placement projects, Project 3: Inventory of the
use of simulated clinical learning experiences and evaluation of their effectiveness.
Ottawa, ON: Author.
• Kardong-Edgren, S., Hanberg, A. D., Keenan, C., Ackerman, A., & Chambers, K. C.
(2011). A discussion of high-stakes testing: An extension of a 2009 INACSL conference
roundtable. Clinical Simulation in Nursing, 7(1), e19-e24.
DOI:10.1016/j.ecns.2010.02.002
• Norman, J. (2012). Systematic review of the literature on simulation in education.
ABNF Journal, 23 (2), 24-28.
• Ricketts, B. (2011). The role of simulation for learning within pre-registration nursing
education - a literature review. Nurse Education Today, 31, 650-654.
DOI:10.1016/j.nedt.2010.10.029