Transcript Taking Your First Steps

Taking Your First Steps
Simulation Integration
Beth Fentress Hallmark, PhD, RN
Belmont University College of Health Sciences
Objectives:
• Learn the benefits, challenges and
emerging trends in the use of
simulation
• Ways to integrate simulation into
nursing curriculum
• Identify courses where simulation may
help you reach curricular objectives.
• Verbalize training resources for your
school
Introduction:
• Beth Hallmark, PhD, RN
– Belmont University
– Director of Simulation, Gordon E. Inman
College of Health Sciences and Nursing
– Laerdal Center of Educational Excellence
– Director Tennessee Simulation Alliance
Belmont University
Nashville, Tennessee
• 7,000 + students
College of Health Sciences
Inter-professional Education
• Nursing
– Accelerated, Fast track and Traditional BSN
– FNP
•
•
•
•
Social Work (BSW)
Physical Therapy (DOT)
Occupational Therapy (DPT/MSOT)
Pharm D
Belmont’s Integration:
• May 2006 – Gordon E. Inman College of
Health Sciences and Nursing
• August 2006 – Simulation Coordinator
named
• Spring 2007 – Faculty development
activities
• Fall 2010 McWhorter Center
• Established one physical space for COHS
Belmont University
Nashville, Tennessee
•
•
•
•
•
2- Eight bed Adult Health laboratories
8 bed “Acute care” lab
4 bed Peds lab
8 bed Health Assessment/OB lab
4 Inter-professional private patient rooms
Belmont’s Goals
• Prepare the novice nurse for clinical
practice
• Link Concepts & Critical Thinking to
Practice
• Progressive Complexity
• Theoretical Support
Transition from student to RN
Research shows new grads experience:
• 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.
Why Integrate Simulation?
• The true value of simulation lies in its
ability to offer experiences throughout
the educational process that provide
students with opportunities for
repetition, pattern recognition, and
faster decision making.”
• Doyle & Leighton, 2010
Why Integrate Simulation?
Bridging the gap between education and
practice
• “90% of nurse educators think their
graduates are ready to safely practice
VS. 10% of hospital administrators”
• JONA , November 2008
Why do we plan?
• “If simulation is instituted in a
curriculum prior to completion of
evaluation planning, the potential for
pedagogic improvement may be
jeopardized”.
• Schlairet, 2011.
Why Integrate Simulation?
•
•
•
•
•
•
Deliberate practice
Healthcare Technologies
Team training
Quality and safety
Delegation
Therapeutic communication/Interprofessional
• Clinical Judgment/Decision-Making
New Graduates say:
• They feel uncomfortable with:
– IV skills
– Physical Assessment
– Care of the dying patient
– Caring for patients with changing care
needs
–
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
•
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).
What can simulation do?
•
•
•
•
•
•
•
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
•
•
•
•
•
•
•
Safe practice arena
Hands on
Exposure to rare/high risk events
Practice cognitive and psychomotor skills
Transfer to clinical setting
Immediate feedback
Reflective learning
Where to start?
• Seropian et al. (2004) recommended eight
steps to institute a simulation program:
– Develop a vision to show what is to be achieved, who will
be involved, and how the laboratory will be used.
– Generate a business plan to outline initial and annual fiscal
obligations.
– Identify and seek support from stakeholders.
– Construct the facility or laboratory, as defined in the vision
and the business plan, including the equipment purchase.
– Provide training for all individuals who will be involved.
– Develop the curriculum.
– Faculty training.
– Determine policies and procedures.
Vision/Mission/Goals
• Spend time working on this before you
jump in head first to simulation..if you
did not do it in this order..BACK UP!
Business Plan
• Sustainability
• Planning
Stakeholders!
•
•
•
•
•
Who?
Why?
Where ?
What can they do for you?
What can you do for them?
Curriculum Development
• PLAN
• PLAN
• PLAN!!
Lab/Simulation Committee
– Lab Committee/simulation group
– Lab coordinator
– Champions
– Share with faculty new standards (ie:
SBAR, QSEN)
– Map skills throughout curriculum (“lets do
blood now”)
– Develop a written plan
– Mission and vision
– Goals
Lab Goals
•
•
•
•
•
•
•
•
•
•
•
Maintain a working lab group to create change.
Strengthen partnerships with local medical centers
Develop relationships with vendors
Provide consistent and timely communications between the
lab group, faculty and administration.
Maintain records to identify areas of needed improvement
Hire faculty and staff that are qualified to support our vision
Manage the financial resources to provide the most
sophisticated equipment available.
Develop simulation within every course in the curriculum.
Benchmark through electronic resources and by developing
relationships with experts in the field.
Inventory management
Maintenance of Capital equipment.
Learning Domains
• Cognitive: “involves knowledge and the
development of intellectual skills. This
includes the recall or recognition of
specific facts, procedural patterns, and
concepts that serve in the development
of intellectual abilities and skills”
• In Nursing Education; what falls in the
cognitive domain?
http://www.nwlink.com/~donclark/hrd/bloom.html
Learning Domains
• Affective: “manner in which we deal
with things emotionally, such as
feelings, values, appreciation,
enthusiasms, motivations, and
attitudes”.
• In Nursing education what falls in the
affective domain?
http://www.nwlink.com/~donclark/hrd/bloom.html
Learning Domains
• Psychomotor: “includes physical
movement, coordination, and use of the
motor-skill areas. Development of these
skills requires practice and is measured
in terms of speed, precision, distance,
procedures, or techniques in execution”.
• What falls in the psychomotor domain?
http://www.nwlink.com/~donclark/hrd/bloom.html
Traditional Nursing Education
•
•
•
•
•
Didactic
Lab
Clinical
Orientation at workplace
CEUs
New Strategies
• Simulation as a Teaching Strategy
• Simulation as an Evaluation Tool
Types of Simulation
•
•
•
•
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
• Examine where simulation naturally fits
– Outline a plan based on each semester
• 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:
•
•
•
•
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?
•
•
•
•
•
•
•
•
•
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
•
•
•
•
•
•
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
• One example of integration
• 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
Faculty script/training
Reality: suspend
Fiction Contract
Debriefing
• Reflection
• TRAIN faculty/method
• Learner uses previous knowledge to
build upon
• Bad Habits develop if not addressed
• Video taping
Evaluation
• MUST be based on your objectives!
• Remember to link your simulation
objectives to your course..to your
program..to the collge..etc
• Formative or Summative Evaluation
Support: Find a Network
• Tennessee Simulation Alliance
(www.tnsim.org)
• INACSL (www.inacsl.org)
• SSiH (www.SSiH.org)
• NLN SIRC (www.sirc.nln.org)
• Simulation Users Network (SUN)
Questions?