Using Simulation as a Capstone Experience in a Nursing Residency Program A Collaborative effort between Academia and Practice Arlene Coughlin MSN, CNE, RN J. Cedar Wang MSN, RN Lori Podlinski MSN, MBA, RN Barbara Blackwell EdD, RN-BC There is no financial relationship or conflict of interest with any product or class of products discussed in this educational activity.

Nurse Residency Program

• Form collaborative relationships • Transition student into the professional role • Ease reality shock

Nurse Residency

• Institute of Medicine (IOM) • Increase skill attainment through the use of simulation • Enhance patient safety through reinforcing critical thinking skills

Clinical Simulation Reinforces Adult Learning Theories

Experiential Learning Reflective Learning Transformational Learning Clinical simulation finds support in educational literature as a critical component of experiential learning (Dreifuerst, 2009

).

Experiential Learning

Kolb (1984) states: “Knowledge is derived from and tested out in experiences of the learner. The knowledge and skill that is acquired in one experience becomes the foundation by which the learner adapts to new experiences” (p.27).

REFLECTIVE LEARNING

Kolb (1984) proposes “learning occurs when an event is followed by reflection and then critical discourse after which the learner modifies their actions” (p.21

).

Transformational Learning

Daloz (1999) states that “mentors are a key part on our transformation reminding us that we can indeed survive the terror of our journey and undergo transformation by moving through not around our fears” (p.18).

Nurse Residency Simulation Objective

The nursing resident will integrate theory into practice by using the metacognitive skills of critical thinking and problem solving to determine priority nursing actions in two clinical simulations.

Planning Process

Identifying Objectives

8 weeks prior to simulation • Faculty & Staff Development meet to identify learning objectives

Writing & Programming

8 weeks prior to simulation • Faculty review learning objectives and write 2 scenarios • Medium fidelity mannequins are programmed to simulate scenarios • Additional roles are identified and assigned

Testing of Scenarios

2 weeks prior to simulation • Faculty meet to test simulators • “Live” run through • Simulated medical records are written and compiled • Final meeting with Staff Development to assign roles and to review scenarios

Collaborative Effort

deliver autonomous self-directed primary care to a group of clients.

provides educational and clinical support to RN residents.

devises simulation scenarios as RN residents’ capstone experience.

Resident Capstone Event

Scenario Objectives • • • • • • Accurate assessment and identification of client problems Safety measures including standard of care Therapeutic communication Effective communication with interdisciplinary team Prioritize and implement appropriate interventions Evaluate client’s response to treatment

Resident Simulation Day VitalSim Scenario 1

Resident Simulation Day VitalSim Scenario 2

Equipment & Facility

• • Laerdal Anne ® Vitals ™ with medium fidelity Nursing 2 simulated acute care bedsides (oxygen, suction equipment, cardiac monitoring, IV pump, telephone, patient chart, simulated medications)

Resident Simulation Day Schedule

E-26: Pat Trick 9:00 – 9:30AM

RN 1

9:30 – 10:00AM 10:00 – 10:30AM

RN 3 RN 2 Observer 1

E-28: Vincent Brody

RN 2 Observer 2 Observer 3 RN 4 Observer 4 Observer 2 RN 1 (previously observer 1) Observer 1

10:30 – 11:00AM

RN 4 Observer 4 RN 3 Observer 3 • 2 Scenarios • 2 Roles for each resident – RN – Observer (silent) • Faculty and staff development roles – Mannequin controller – – – Family member at the bedside Physician Respiratory therapist

• • •

Facilitation Strategies

Partial facilitator prompting Reflective learning Formative assessment

Debriefing/Guided Reflection

• • • • • • How did you feel during the simulation experience?

What did you learn about interacting with family members?

What did you learn about collaborating with interdisciplinary healthcare team members?

What do you think you did correctly?

What do you think you could have done differently?

What would you change about this experience?

Additional Resources in Scenario Development • NLN, (2009). Chronic Obstructive

Pulmonary Disease – Oxygen Therapy

VitalSim Scenario. Laerdal Medical Corporation. • Debriefing/Guided Reflection Questions Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing education: Learner volume. (p. 431). Philadelphia, PA: F.A. Davis Company

Lessons Learned

Run simulation earlier in the Residency Program Use simulation as a formative assessment that factors into summative evaluation process

Lessons Learned

Include simulation throughout the student’s academic career to assess achievement of higher level skills and better prepare the graduate nurse for practice (Bensfield, Horsley, & Leann, 2012).

Simulation provides an effective means to evaluate practitioner safety and competency (Beyea, van Reyn, & Slattery, 2008)

Lessons Learned

Preparation is a key ingredient to enhancing the fidelity of a simulation – – – Participant Scenario Environment

Lessons Learned

Effective debriefing is essential to the learning process (Dreifuerst, 2009).

Future Implications-Education

• Integration of simulation into all areas of school curriculum to enhance attainment of metacognitive, communication, and psychomotor skills • Introduce simulation as means of formative assessment • Use simulation as a summative assessment of clinical skills

Future Implications-Practice Use simulation as a means to validate skill attainment and competency in the new graduate and experienced RN

New Graduate Orientation

• • • Classic New Nurse Orientation Paid Orientation – $15,460 or $32.21/hour Time investment – 12 weeks orientation  Time added as necessary Educational Benefit – Variability in content – Reality Shock

Return on Investment New Graduate Orientation

Nurse Residency

• • • • No orientation after residency completed Lower Salary – $9,600 or $20/hour – No paid benefits Time investment – 12 weeks Educational Benefit – – Close theory-practice gap Consistency in orientation practice

References

Beyea, S. C., van Reyn, S., & Slattery, M. J. (2008). A nurse residency program for competency development using human patient simulation. Journal for Nurses in Staff Development, 23(2), 77-82.

Bensfield, L. A., Olech, M. J., & Horsley, T. L. (2012). Simulation for high-stakes evaluation in nursing. Nurse Educator March/April, 37(2), 71-74.

Daloz, L.A. (1999). Mentor: Guiding the Journey of Adult Learners. San Francisco, CA: Jossey-Bass.

Dreifuerst, K. (2009). The essentials of debriefing in simulation learning: A concept analysis. Nursing Education Perspective 30, (2).

References

Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing education: Learner Volume. Philadelphia, PA: F.A. Davis Company.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.

NLN, (2009). Chronic Obstructive Pulmonary Disease – Oxygen Therapy VitalSim Scenario. Laerdal Medical Corporation.

Tanner, C. (2009). The Case for Cases: A Pedagogy for Developing Habits of Thought. Journal of Nursing Education, 48(6), 299. Taylor, E.W. (1998). The theory and practice of transformational learning: A critical review. Columbus, Ohio.