Transcript Taking Your First Steps

Taking Your First Steps
Simulation Integration
Beth Fentress Hallmark, RN, MSN, PhD(c)
Tiffany L. Holmes, D.C.
Objectives:
• Learn the benefits, challenges and
emerging trends in the use of
simulation
• How to integrate simulation into nursing
curriculum.
Who are we:
• Beth Hallmark
– Belmont University
– Gordon E. Inman College of Health
Sciences and Nursing
– Laerdal Center of Educational Excellence
• Tiffany L. Holmes
– University of Texas at Arlington
– College of Nursing Smart Hospital™
– Laerdal Center of Educational Excellence
UT Arlington College of Nursing
(UTACON)
• Ranked in the top 15 largest schools of nursing in
U.S.
• 126 faculty, (102 FTEs)
• Over 4,000 students in BSN, RN-to-BSN, MSN,
Post-MSN, DNP and PhD programs
• Graduates 200 BSN students annually
• 70-80 MSN and Post-Masters Nurse Practitioners
(NP) graduates who assume advanced roles as NPs,
administrators, and educators.
UTACON’s Integration:
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2003 – Smart Hospital™ Concept started
2004 – Simulation Coordinator named
2005 – Faculty development activities
2006 – Simulation Technician hired
Jun. 2007 – Moved to new Smart Hospital
building
Transition from student to RN
Research shows new grads experience:
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Fear
Lack of confidence
Communication Deficits
Complex decision making
Contradictory information
Issues working with peers
Dyess, S., & Sherman, R.. (2009). The first year of practice: New graduate nurses' transition and learning needs. The Journal of
Continuing Education in Nursing, 40(9), 403-10. doi: 1864764661.
New Graduates say:
• They feel uncomfortable with:
– IV skills
– Physical Assessment
– Care of the dying patient
– Caring for patients with changing care
needs
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Marshburn, D., Engelke, M., & Swanson, M.. (2009). Relationships of New Nurses' Perceptions and Measured
Performance-Based Clinical Competence. The Journal of Continuing Education in Nursing, 40(9), 426-32. Retrieved
November 2, 2009, from ProQuest Medical Library. (Document ID: 1864764651).
Practice Partners Say:
Students
• Fail to perform relevant nursing actions
relating to specific disease states
• Lack the ability to prioritize
• Give incomplete or irrelevant
information to PCP
• Have difficulty giving rationale for
nursing actions
• Do not know laboratory values
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Burns, P., & Poster, E.. (2008). Competency Development in New Registered Nurse Graduates: Closing the Gap Between Education and
Practice. The Journal of Continuing Education in Nursing, 39(2), 67-73. Retrieved November 2, 2009, from ProQuest Medical Library.
(Document ID: 1423354581).
Traditional Nursing Education
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Didactic
Lab
Clinical
Orientation at workplace
What can simulation do?
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Help promote teamwork and collaboration
Foster effective and safe communications
Delegation
Safe practices/Quality Improvement
Cultural awareness
Evidence based practice
Patient centered care
Advantages of Simulation
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Safe practice arena
Hands on
Exposure to rare/high risk events
Practice cognitive and psychomotor skills
Transfer to clinical setting
Immediate feedback
Reflective learning
New Strategies
• Simulation: Teaching Strategy
• Simulation: Evaluation Tool
Types of Simulation
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Case Study
Role-playing
Standardized patients
Partial vs. Complex Task Trainers
– Static and Computerized
• Integrated Simulators (HPS)
Types of Simulators
Fidelity
Low Fidelity: Task Trainers.
Medium Fidelity: non-responsive in terms of
physiological signs but can have heart and
lung sounds, etc.
High Fidelity: physiologically responsive to
students actions or lack of action.
Simulation: Theory
• Active Learning
• Reflective Thinking
• Constructivism
Curricular Changes
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Examine where simulation naturally fits
Build simulations upon one another
Simple to complex
Students need exposure early in the
program
• Use for remediation and clinical
makeup
Connecting the dots in courses:
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Labs
Didactic
Courses in same semester
How can we “marry” the content and
reiterate in simulation?
• How can we re-frame the content we
are teaching in labs and didactic within
simulation?
Standards
Identify your programs outcomes based
on standards.
– BSN Essentials
– QSEN
– IOM
– Joint Commission
– NCLEX
• Not just the standards that are r/t
technology….i.e.: safety and
communication
How do I overcome:
• Faculty Resistance
– Time
– Resources
• Technology assistance, equipment
– Pay
– Administrative Assistance
– Skills
– Scheduling
What do I need?
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CHAMPION
Administrative Buy In
Money: Grants
Staff
Space
Faculty Development Plan
Policies
Mission Vision
Stakeholders
What do I need?
Champion
• One or two people who are interested
in this new pedagogy.
• Train the champions then bring back
info to the rest of faculty
• Champion can send information to
others in form of literature and
conference ideas
• Lead simulation committee/group
What do I need?
Administrative Buy In
• How to accomplish this?
• Bring in experts/consultants
• Take them with you to meetings
• Share with them what you learn at
conferences
• Show them student evaluations
• Demonstrate how simulation works
• Peer pressure
What do I need? MONEY…..
MONEY…..
• Grants
• State
• Federal
• Local community organizations
• National Private Funding groups
What do I need?
Staff
• Simulation Director
• Faculty: Simulation Committee Group
• Technical Support: IT and Network
specialist
• Supply specialist
• Scheduling
What do I need?
Space
• STORAGE, STORAGE, and still
MORE STORAGE!!
• Preparation Area
• Simulation Labs
• Partitions?
• Observation/Control Room
• Debriefing room
What do I need?
Faculty Development Plan
• Conferences
• Lunch and Learn
• SIRC.NLN.org
• List serves
– INACSL
– SSiH
• NLN
• AACN
• Invite them to play a part
Components to a Simulation
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Student Preparation
Objectives
Report
Actual Simulation
Debriefing
Evaluation
Student Preparation
• How does a student prepare for a
simulation?
• Do you give them the case prior to the
simulation?
• What are the objectives of the
simulations?
• Formative or Summative
• Case Study versus procedural prep
Objectives
• Need to fit with curricular objectives
and course objectives
• Case by case
• General safety and communication
Report
• Students need to learn how to receive
and give report
• Use SBAR or other communication
rubrics
• Ask practice partners for the system
they use
Simulation
• Scenarios
– Pre programmed
– Make it your own
• Validate with practice partners
• Reality: suspend
• Fiction Contract
Debriefing
• Reflection
• Learner uses previous knowledge to
build upon
• Bad Habits develop if not addressed
• Video taping
Evaluation
• Formative or Summative Evaluation
Support: Find a Network
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Tennessee Simulation Alliance
INACSL (www.inacsl.org)
SSiH (www.SSiH.org)
NLN SIRC (www.sirc.nln.org)
Simulation Users Network (SUN)
Questions?