1. Standards of Best Practice: Simulation
The International Nursing Association for Clinical Simulation and Learning (INACSL)
Standards of Best Practice: Simulation
2011
Pearson Faculty Development March 23, 2012 Fort Lauderdale

2. Presenters and Disclosures
Laura Gonzalez PhD, ARNP, CNE
INACSL Chair of Education
Assistant Professor of Nursing, University of Central Florida
Disclosure: Pearson Faculty Consultant & Contributor
Pearson Faculty Development March 23, 2012 Fort Lauderdale

3. Mission and Vision Statements
The Mission of INACSL is to promote research and disseminate evidence based practice standards for clinical simulation methodologies and learning environments
The Vision Statement: Nursing’s portal to the world of clinical simulation pedagogy and learning environments
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4. Development of Standards
2 Years
Survey to INACSL Membership
Committee Draft
Peer Review
Final Draft
Publication – Summer 2011
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5. Special Thanks to the 2009-2011 INACSL BOD
Teri Boese, MSN, RN
Jimmie Borum, MSN, RN
Janis Childs, PhD, RN
Sharon Decker, PhD, RN, ANEF
Jana Faragher, ND, CNS, RN
Cheryl Feken, MSN, RN
Teresa Gore, DNP, APRN
Nicole Harder, PhD, MPA, RN
Beverly Hewett, PhD, RN
Valerie Howard, EdD, RN
Kim Leighton, PhD, CNE, RN
Colleen Meakim, MSN, RN
Meg Meccariello, MS, RN
Patricia Ravert, PhD, RN, CNE, ANEF
Leland (Rocky) Rockstraw, PhD, RN
Carol Sando, PhD, CNE, RN
Renee Schnieder, MSN, RN
Marianne Schubert, MSN-Ed, CEN, MICP, RN
Special thanks to the INACSL Board of Directors for developing initial standards draft
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6. Special Thanks
Standards Committee for their continued work on revisions and peer-review process
Jana Faragher, ND, CNS, RN-Chair
Sharon Decker, PhD, RN, ANEF
Teri Boese, MSN, RN
Carol Sando, PhD, RN, CNE
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7. Standards of Best Practice
Terminology
Professional Integrity of Participant
Participant Objectives
Facilitation Methods
Simulation Facilitator
The Debriefing Process
Evaluation of Expected Outcomes
INACSL Board of Directors, (August, 2011). Standards of best practice: Simulation. Clinical Simulation in Nursing, 7(4 Supplement). S1-S20. Available at
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8. Standard One: Terminology
Statement:
Consistent terminology provides guidance, clear communication, and reflects shared values in simulation experiences, research, and publications.
Terminology has not been standardized until this point.
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9. Rationale Standardized terminology:
Enhances understanding and communication among planners, participants and others involved in simulation experiences
Promotes consistency in the development, implementation, evaluation and publication of or about simulated clinical experiences or research studies for use in education and practice
Clinical Scenario:
The plan of an expected and potential course of events for a simulated clinical experience.
-provides the context for the simulation and can vary in length and complexity, depending on the objectives.
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10. Nursing Skill Development & Judgment Model
This model shows the progression from psychomotor skills to clinical judgment
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11. Standard Two: Professional Integrity of Participants
Statement: The simulation learning and testing environment will be one of clear expectations for the attitudes and behavior of each participant and an area where mutual respect is supported. Professional integrity related to confidentiality of the performances, scenario content, and participant experience is expected to be upheld during a simulation experience. These performances in simulation experience may be live, recorded, and/or virtual.
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12. Rationale
Failure of the participants to maintain professional integrity related to simulation and lack of respect or professionalism could undermine the benefits of this pedagogy
Sharing of confidential information of any kind before, during or after the simulation experience can alter the experience
Sharing of Information can:
Interfere with learning outcomes
Bias an individual’s performance
Alter perception of a safe learning environment (psychological safety)
Modify group dynamics
Negatively alter the future participants’ learning experience
This standard offers the opportunity for similar learning experiences to all participants.
Upholding professional integrity promotes a safe learning environment where:
Formative assessment and/or summative evaluation can occur.
Simulation participants will consider their performance and the performance of others as confidential interactions.
Violation of professional integrity may be viewed as an honor code/ethical violation, eliciting similar consequences.
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13. Outcomes
This standard offers the opportunity for similar learning experiences to all participants
Upholding professional integrity promotes a safe learning environment
To achieve the desired outcomes, the facilitator must address key areas during the simulation
Upholding Professional Integrity Promotes a Safe Learning Environment where:
Formative assessment and/or summative evaluation can occur
Participants consider performances confidential interactions. Performances include self and others in the simulation
Violation of professional integrity may be viewed as an honor code or ethical violation and may elicit consequences invoked by honor code or ethical issues
Facilitator must address these:
Ensure a safe learning environment
Ensure steps are taken to protect the content of the scenario & simulation
Provide clear direction to the participants: expectations of the simulation environment, learning or testing
Demonstrate professional & ethical behavior
Role model constructive feedback during simulation and debriefing
Monitor for unprofessional participant behavior during simulation and take steps to abate it
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14. Standard Three: Participant Objectives
Statement: The simulation experience should focus on the participant objectives and experience level.
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15. Rationale
Participant objectives are the guiding tools for simulation and essential to achieve the outcomes
Identification of appropriate scenario, fidelity, instructor prompting/facilitating, and environment is crucial for best experiences and meeting the participant objectives
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16. Outcomes
The focus of simulation is on the outcome to be achieved and on participant learning-Know your participants
Should facilitate the development of clinical judgment in order to deliver high quality and safe nursing care that is holistic and includes cultural awareness
Objectives should be:
Achievable within an appropriate time frame
Incorporate evidence-based practice
Address domains of learning
Appropriate to the participant ‘s level of learning and congruent with overall program outcomes
See Standard I: Terminology for Nursing Skill Development and Clinical Judgment Model
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17. Standard Four: Facilitation Methods
Statement: Multiple methods of facilitation are available, and use of a specific method is dependent upon the learning needs of the participant(s) and the expected outcomes.
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18. Rationale
Facilitation methodology should vary because participants bring cultural and individual differences that affect their knowledge, skills, attitudes (KSAs), and behavior
Facilitation assists the learner to meet the objectives by incorporating learner’s needs and experience into the planning and implementation of a simulated clinical experience
Multiple methods should be used to meet the participant objectives and expected outcomes
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19. Outcomes
Facilitation revolves around engaging participants within the scenario by assisting them to meet the objectives of the clinical scenario
Effective facilitation requires using the facilitation method and personnel/faculty indicated by participant objectives and expected outcomes
Level of Facilitation:
Facilitator Prompting
Partial Facilitator Prompting
No Facilitator Prompting
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20. Standard Five: Simulation Facilitator
Statement: A proficient facilitator is required to manage the complexity of all aspects of simulation.
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21. Rationale The facilitator is the key to participant learning:
guides and supports participants to understand and achieve the objectives
Engages the participants to search for evidence-based practice solutions to develop participant’s skill development and clinical judgment
Adjusts simulations to meet objectives based on participant’s actions or lack of actions
Leads the participants in identifying the positive actions and changes
The facilitator assists the participants with identifying actions that could have been changed to promote better patient outcomes and how the actions could have been changed to meet the learning objectives, if these objectives are not met
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22. Outcomes
Facilitator promotes and assists with achieving the desired outcomes of a simulated experience by utilizing various methods
Clearly communicate and ensure understanding of objectives, goals, and expected outcomes
Create a safe learning environment
Promote maintenance of fidelity in the simulated environment
Recognize and use appropriate facilitation method(s)
Identify & evaluate individual and group performance as it relates to the acquisition of knowledge, skills, appropriate attitudes & behaviors
Demonstrate professional and ethical behaviors
Foster enthusiasm & support for simulation as a learning modality
Establish methods for obtaining meaningful feedback from participants, observers, & other facilitators/instructors re: effectiveness of facilitator
Demonstrate role modeling when assuming a role in the simulation
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23. Standard Six: The Debriefing Process
Statement: All simulated experiences should include a planned debriefing session aimed toward promoting reflective thinking.
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24. Rationale
Learning is dependent upon the integration of experience and reflection
Reflection is the conscious consideration of the meaning and implication of an action
The skills of the debriefer are important to ensure the best possible learning
Learners report the debriefing session is the most important component of a simulated learning experience
Reflection: assimilation of knowledge, skills, and attitudes (KSAs) with pre-existing knowledge and can lead to new interpretations by the learner
Reflective thinking does not happen automatically, but it can be taught; it requires time, active involvement in realistic experience, and guidance by an effective trainer/facilitator (coach).
Learning without guidance could lead to the learner repeating mistakes, focusing only on the negative, or developing fixations
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25. Outcomes The integration of the process of debriefing into simulation:
Enhances learning
Heightens self-confidence for the learner
Increases understanding
Promotes knowledge transfer
Identifies best practices
Promotes safe, quality patient care
Promotes life-long learning
Debriefing and reflection are essential determinants of professional development at all levels and are linked to professional nurse competencies
Encourage reflective learning:
Provides an opportunity to discuss the process, outcome, and application of scenario to clinical practice
Enables the facilitator to review relevant teaching points
Promotes reflective thinking
The debriefing should be facilitated by an individual who has observed the simulated experience; based on a structured framework for debriefing; based on standard III, in a safe learning environment
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26. Outcomes (Continued)
To achieve the desired outcomes, the effective debriefing process should:
Be facilitated by individual competent in debriefing that observed the simulation
Use evidence-based debriefing methodologies
Be based on a structured framework for debriefing
Be based on objectives, the learners, & the outcomes
Be conducted in an environment that supports confidentiality, trust, open communication, self-analysis & reflection
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27. Standard Seven: Evaluation of Expected Outcomes
Statement: This standard addresses summative evaluation as opposed to formative assessment.
Formative Assessment
Assessment wherein the facilitator’s focus is on the participant’s progress towards goal attainment.
Summative Evaluation
Evaluation occurring at the end of a learning period where participants are provided feedback about their achievement of outcome criteria.
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28. Rationale
Simulation is an acceptable method of evaluating the three domains of learning:
Cognitive (knowledge)
Affective (attitude)
Psychomotor (skills)
The participant outcomes should include, but are not limited to:
Safe patient care and/or decision-making abilities
Skill performance
Critical thinking/reasoning
Knowledge level of the participant
In addition, self-confidence & satisfaction with the experience can be assessed
When these domains interact in the context of a novel simulation experience, problem-solving and analytical skills can be evaluated in terms of the achievement of identified outcomes.
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29. Outcomes
The participant’s achievement of expected outcomes of a simulation experience should be based on valid and reliable instrumentation, tools, and methodologies in the evaluation process
To achieve valid and reliable evaluation results, the simulation used for the purpose of assessment and particularly high-stakes evaluation must follow certain aspects.
Simulation used for assessment and high-stakes evaluation:
Be explained to the participant prior to the start
Conducted in a familiar environment on previously tested evidence-based content
Be standardized in format and in scoring method
Use appropriate fidelity level
Be accompanied by specific participant objectives
Use pre-established guidelines for responses/prompting if any
Have predetermined parameters for terminating the scenario
Include the participant’s self-assessment of performance as part of the evaluation.
Pearson Faculty Development March 23, 2012 Fort Lauderdale

30. Resources
International Nursing Association for Clinical Simulation and Learning (INACSL):
Society for Simulation in Healthcare (SSH):
Simulation Innovation Resource Center (SIRC)
METI: Human Patient Simulation Network (HPSN)
Laerdal: Simulation User Network (SUN)
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31. Evaluation Tools
Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C. (2010, January). A review of currently published evaluation instruments for human patient simulation. Clinical Simulation in Nursing, VOL(6), e25-e35. doi: /j.ecns
METI Simulation Effectiveness Tool and Educational Material
NLN and Laerdal Simulation Study Evaluation Tools
Other tools are available
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32. What Can I Do With the Standards?
Curricular Integration
Evidence Based Practice in Education
Administrative Support
Faculty Buy-In
Research Opportunities
Funding Opportunities
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33. Saddle up for Simulation: Rope in the Best Ideas
INACSL Conference
11th Annual International Nursing Simulation/Learning Resource Centers Conference:
Saddle up for Simulation: Rope in the Best Ideas
Pre-conference: June 20, 2012
Conference: June
San Antonio Marriott Rivercenter
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34. How to Obtain Standards of Best Practice: Simulation
Initial publication of the Supplement to Clinical Simulation in Nursing was made possible by an educational grant from METI
Will be printed and mailed to current members of INACSL
Available through the official journal of INACSL: Clinical Simulation in Nursing
Journal access is just one benefit of membership in INACSL
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35. Conclusion Thank you for attending this presentation
Question and Answer Session
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