1. Joanie Selman, MSN, RN Med-Surg Course Coordinator DeWitt School of Nursing Stephen F. Austin State University

2. DeWitt School of Nursing at Stephen F. Austin State University Nacogdoches, Texas Joanie Selman, Med-Surg Instructor  9,000 square foot simulation lab opened Jan. 2010 *10 room Med-Surg lab *4 room OB/pedi lab and Nursery *ER with 12 gurney spaces *Assessment lab with 10 exam tables *14-station control room  5-3Gs, 1-SimMan, 1-SimNewB,2-SimBaby, 17 VitalSims, 6-Virtual IVs, SimMom,SimKid

4.  Shortage of clinical opportunities  Many schools competing same clinical sites/times  Limited cases in smaller hospitals Few deliveries No NICU No neuro, head trauma  Faculty shortage, students/instructor  No patients with diseases you want your students to experience

5. Up to 30% of students are Tactile/Kinesthetic learners. Simulation Enhances Learning  Lecture is not enough, Reading is not enough  Case studies are not enough

6. Control  Instructor has control over what disease patient exhibits  What complications the patient develops  Which student practices with that patient

7.  Practically All Collaborate with other courses Basic courses in beginning semester(s)  Health assessment  Basic Med-Surg  Pharmacology Scenario……..Elderly man s/p surg after he fell and broke his hip needs assessment of surgical incision, inhaler, repositioning, IS, PO antibiotics and teaching about proper protein intake for proper healing.

8.  Mid-way Courses  OB/PEDI  Med-Surg  Mental Health Scenario…. Schizophrenic pregnant woman with a 2 year old child brought to ER after a MVA. She has a broken leg and is awaiting surgery.

9.  Last semester courses  Critical Care  Community Health  Leadership/Management Scenario…..Shortage of nurses in ICU, manager must delegate & prioritize pt assignments then take the most critical patient herself for the day. s/p major stroke with paralysis and concussion from fall. Wife has meeting with home health nurse to discuss at home care after discharge.

10.  If you can only do limited simulation…. Med-Surg and Pedi/OB courses are your best bet b/c you can incorporate concepts from other courses into the scenario.

11.  Laerdal  Conferences  Book  Visit other schools  Get ideas from others  SIRC- Simulation Innovation Resource Center http://sirc.nln.org/  SUN website http://www.laerdal.com/us/SUN  NLN scenarios  Scenarios from textbook publishers  Case studies Simulation in Nursing Education Author: Pamela Jeffries

12. Start simple. Do not overwhelm yourself.  Only one scenario the first semester you start  Common scenario from your practice. Choose problem that is it crucial students know Not readily available in your area

13.  Lecture on the topic  Help students prepare  Assignment to complete on topic before the sim  article in a journal  case study  Worksheet  “dress rehearsal” with other students or faculty Before simulation day

14. During simulation  Make room and mannequin as realistic as possible  Pre-brief students  a learning exercise not a punitive evaluation  act exactly like a real life setting  give them report – like at a hospital  Give a few minutes after report for them to plan as a team before starting scenario  As mannequin voice give “hints” if student is really struggling.

15. After simulation  De-brief immediately  Identify gaps in knowledge  Praise students for positive interventions  Redirect students away from poor choices.  Post-scenario assignment to re-enforce clinical concepts covered  Care plan  Assessment values with nurse notes  Taking and writing telephone orders on order sheet

16.  First person to convince is your  Director or Dean of the nursing school.  As a group  present a video-taped scenario  Have students share their experience  Discuss the benefits  Teamwork  Delegation  Communication  Decision-making  Time management  Critical thinking  Med administration  Infection control  Assessment  Physician orders

17.  Individual courses  meet with the team  have them “attend” one of your simulations.  Offer to assist them in developing a simulation.  Tell them you will “run” the first one with them  Share your ideas, forms, etc

18. General for all scenarios Example…Student demonstrates appropriate infection control techniques. ….Student identifies client with two identifiers Specific for individual scenario Example….Student assesses blood pressure before administering nitroglycerin tablet. http://www.laerdal.com/us/SUN

19.  Faculty Objectives for SIM Failure rate will decrease. Does SIM help students learn the important concepts in my course? Since SIM the failure rate in the Med-Surg I teach dropped from an average of 10% to 6%.

20. Very important to survey the students Question DisagreeNo opinion Agree 1. I understand the purpose and objectives of the simulation. 0.00% 100.00% 2. The scenario(s) resembled a real-life situation.1.33%0.00%98.67% 3. The simulation provided a variety of ways to learn the material. 0.00%5.33%94.67% 4. I had a chance to work with my peers during the simulation. 0.00%5.33%94.67% 5. The simulation helped me learn to prioritize.0.00%1.33%98.67% 6. The debriefing session was helpful as a learning activity.1.33%0.00%98.67% 7. I was able to participate in the debriefing session.1.33% 97.33% 8. The feedback was constructive.0.00%2.67%97.33% 9. The simulation will help me better care for healthcare clients. 0.00% 100.00% 10. The simulation made me feel more confident in caring for healthcare clients. 2.67%4.00%93.33%

21.  Have a free text comment section on the evaluation. Actual student comments……. I really enjoy SIMs and I always learn a lot from them. I wish we had more and I will continue to learn and feel more comfortable when entering a patient's room. I always learn things that I know I won’t forget. It is good to have these simulations because we don't always come across some of these situations when we are actually in clinicals. Because of these simulations, I know i will be prepared when I come across the same problems.. The feedback in the debriefing session was very informative without being condemning. Good job !

22.  Short answer --- IT’S WORTH IT !!  To the instructor  To the students  To the future employer  To the client

24. Contact information Joanie Selman, MSN, RN selmand@sfasu.edu 936-674-7896 DeWitt School of Nursing Stephen F. Austin State University Nacogdoches, Texas