Presentation on theme: "Alamo Colleges Simulation in Nursing Education: Creating a Quality Simulation Yvette Baxter MSN, RN."— Presentation transcript:
Alamo Colleges Simulation in Nursing Education: Creating a Quality Simulation Yvette Baxter MSN, RN
Faculty Development in the Effective Use of Simulation Objectives: Identify factors in the educational and practice environment which have contributed to the use of simulation in nursing education. Identify advantages to incorporating simulation as a clinical teaching strategy. Discuss strategies for maximizing simulation effectiveness and student learning outcomes. Identify the key goals of debriefing Identify the key goals of debriefing.
Academic and Healthcare Environment Shortages of clinical faculty and clinical sites. Limited exposure to high risk, low volume clinical events Complexity of the healthcare environment Emphasis on patient safety Technological advances offering sophisticated and realistic clinical experiences in the laboratory setting Need to better prepare new nurses for working in a complex and technologically rich health care environment
Clinical Gaps IOM (2003): hospital leaders, health plans, and practice sites reported increasing skills deficits in new graduates reported 65-75% of new-to-practice nurses did not meet entry-level competencies for clinical judgment (Ulrich et al., 2010) The Future of Nursing: Focus on Education (2011) – the current nursing educational system inadequate to prepare nurses with the necessary competencies to provide high-quality care in increasingly complex healthcare environment
Implications Medical Error: Greater risk for errors in clinical practice Increased Turnover: Gaps between preparation and practice requirements results in stress and increased potential to leave the field The percentage of turnover of new graduates is estimated as 17.7% within one year, 33.4% within two years, and 46.3% by the third year (Cho, Lee, Mark, & Yun, 2012)
The Deficits Competencies in which new-to-practice nurses scored lowest included: Interpretation of assessment data Decision-making & application of nursing process Identification of changes in patient status Timely & appropriate follow-up Initiative in management of care Saintsing, Gibson, and Pennington (2011)
Clinical Simulation A technique, not a technology Immersion of the learner with enough realism to suspend disbelief Environment to develop knowledge, skills, and clinical reasoning A concept- based learning experience
Self-confidence Learn from mistakes without risk to patient safety Practice high risk, low incidence patient events Identify gaps in knowledge /skills Diverse learning Real time/immediate feedback Promotes critical thinking and decision-making skills Safety, teamwork, communication, collaborative learning Benefits of Simulation
Components for Creating a Quality Simulation Faculty/Student Preparation Scenario Selection, Writing, and Testing Fidelity/Realism Debriefing
Simulation Effectiveness “The patient simulation is only as effective as the faculty who are using it. The creativity, clinical knowledge, teaching expertise, and technological abilities of the faculty are highly influential in the effective use of patient simulation" (Durham and Alden, 2008, p ).
Faculty Preparation Requires: Student-centered approach Preparation and comfort with scenarios and equipment Understanding of the goals/objectives Creativity, flexibility, & recognition of learning opportunities Participation in the design process/evaluation
Faculty Preparation Understanding that mistakes will be made Minimize competition Small groups Roles assignment and assumption of roles Close observation of actions, interactions, and decisions MINDSET!!!
Learner Preparation Understanding of simulation guidelines, objectives, & means of evaluation Establishment of confidentiality, trust, &consent Pre-scenario study guide Orientation to simulation environment What is to be simulated Once in the simulation, students should function as they would in the clinical environment
Clinical Scenario Defined “ The plan of an expected and potential course of events for a simulated clinical experience. The clinical scenario provides the context for the simulation and can vary in length and complexity, depending on the objectives ” (International Nursing Association for Clinical Simulation and Learning [INACSL], 2011).
Steps in Scenario Development Selection of topic and template Identification of learning objectives Story Writing (determination of concepts, cues, and critical events) Peer review/Validation Pilot
Knowledge level of student Goals and purpose of the simulation Level of complexity and fidelity Number of participants/length of time Experience and comfort level of facilitator Availability of content expert Setting and equipment needed Considerations for Scenario Selection
Safety and identified concepts/competencies Evidence based practice and standards of care Institutional policies and procedures References What Should be Incorporated in My Scenario?
Writing the Story Beginning: Description of the patient, event, setting, participants Information to be provided Middle: Plot progression and contingencies Expected actions & timelines Cues Flexibility of facilitator Ending: Logical and realistic transition maximizes fidelity
Validation & Piloting Validation: Evidence –based : current journals, clinical guidelines, and textbooks Checked for accuracy and believability Reviewed by content expert for validity and revised as needed Piloting: Piloted with small group of targeted learners Feedback enables scenario revision for maximum effectiveness Information regarding timeline, areas where learners get derailed, or aspects of the scenario learners find confusing
Fidelity The degree to which simulators and simulations mimic reality Simulation experiences should be as realistic as possible Realism of scenario, staging, props enhance the simulation experience
Realism “The realism of any simulation depends upon multiple factors, including the fidelity of the simulator, the environment, props, and the description of the scenario…as realism is enhanced, the effectiveness of the scenario as a learning tool is increased” (Durham & Alden, 2008, p ).
Debriefing: “a conversation among two or more people to review a simulated event or activity in which participants explore, analyze and synthesize their actions and thought processes, emotional states and other information to improve performance in real situations” (Center for Medical Simulation, 2009, p. 1).
Reaction – opportunity to decompress and discuss emotional response to the simulation experience Analysis - provides a time for reflection, understanding, and discussion of what went well and what didn’t Summary/Closure – a summary of the experience is provided and evaluation of the simulation as a learning experience Phases of the Debriefing Process
Role of Facilitator in Debriefing Create a safe and trusting learning environment Provide support Permit opportunity for defusing emotions Guide the reflective process Provide feedback/observations Assist in assimilating new knowledge
Texas Board of Nursing (BON) Position Statement on Simulation In 2010 the BON put forth a position statement to clarify the role and limitations of simulation in order to provide educators with guidelines for making simulation educationally sound and meaningful.
Texas Board of Nursing (BON) Position Statement on Sim ulation Simulation provides a valuable adjunct to traditional clinical learning. To be effective the simulation must challenge learners to use problem solving and critical thinking skills. Each simulation experience should have clearly stated objectives that are presented to learners PRIOR to engaging in the experience.
Texas Board of Nursing (BON) Position Statement on Simulation Learners are required to prepare for a clinical simulation experience in the same manner they would a hospital clinical experience. An orientation to the simulation technology and environment is required. The educator should act as a facilitator providing cues when needed, but not as an active participant. Unless an end of life scenario, the simulation should end with a viable patient.
Acknowledgements The Alamo Colleges wishes to extend a special thanks to San Antonio College nursing students Lori Hannasch, Renee Howard, & Sylvia Muniz for lending their time and services in the making of this project!!!
References Ackermann, A.D. (2011, September 26). Standards of best practice: Simulation. International Nursing Association for Clinical Simulation and Learning. Retrieved from: 20Ackermann%20.pdf 20Ackermann%20.pdf 20Ackermann%20.pdf Arafeh, J.M.R., Hansen, S.S., & Nichols, A. (2010). Debriefing in simulated-based learning. Facilitating a reflective discussion. The Journal of Perinatal and Neonatal Nursing, 24(4), Aschenbrenner, D.S., Milgrom, L.B., Settles,J. (2012). Designing simulation scenarios to promote learning. In P.R. Jeffries (Ed.). Simulation in nursing education: From conceptualization to evaluation (43-74). New York, NY: National League for Nursing Buerhaus, P.I., Auerbach, D.I., & Staiger, D.O. (2009). The recent surge in nurse employment: Causes and implications. Health Affairs, 28(4), w657-w668. doi: /hlthaff.28.4.w657 Childs, J.C. & Sepples, S. (2006). Clinical teaching by simulation. Lessons learned from a complex patient care scenario. Nursing Education Perspectives, 27(3), Cho, S.H., Lee, J.Y., Mark, B.A., & Yun, S.C. (2012). Turnover of new graduate nurses in their first job using survival analysis. Journal of Nursing Scholarship, 44(1), doi: /j Cohen, E.R., Feinglass, J., Barsuk, J.H., Barnard, C., O'Donnell, A., McGoghie, W.C., & Wayne, D.B. (2010). Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Society for Simulation in Healthcare, 5(2), doi: //sUG,0b013e3181bc8304 /
References Dreifuerst, K.T., & Decker, S.I. (2012). Debriefing: An essential component for learning in simulation pedagogy. In P.R. Jeffries (Ed.). Simulation in nursing education: From conceptualization to evaluation ( ). New York, NY: National League for Nursing Duchscher, J.B. (2008). A process of becoming: The stages of new nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10), Durham, C.F., & Alden, K.R. (2008). Enhancing patient safety in nursing education through patient simulation. In R.G. Hughes (Ed), Patient safety and quality: An evidence-based handbook for nurses (AHRQ Publication No ). Retrieved from: Fanning, R.M., & Gaba, D.M. (2007). The role of debriefing in simulation-based learning. Society for Simulation in Healthcare, 2(2), doi: /SIH/0b013e Friedman, M.I., Cooper, A.H., Click, E., & Fitzpatrick, J.J. (2011). Specialized new graduate RN critical care orientation: Retention and financial impact. Nursing Economics, 29(1), Giddens, J., Brady, D., Brown, P., Wright, M., Smith, D., & Harris, J. (2008). A new curriculum for a new era of nursing education. Nursing Education Perspectives, 29(4), Institute of Medicine (2003). Health professions education. A bridge to quality. Washington, D.C.: National Academy Press.
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References Pelayo, L.W. (2008). Responding to the nursing shortage – a new paradigm. Unpublished manuscript, Department of Nursing, Alamo Colleges, San Antonio, Texas Rothgeb, M.K. (2008). Creating a nursing simulation laboratory: A literature review. Journal of Nursing Education, , Saintsing, D. Gibson, L.M., & Pennington, A.W. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19, doi: /j x Scheckel, M. (2009). Selecting learning experiences to achieve curriculum outcomes. In D.M. Billings & J.A. Halstead (Eds.), Teaching in nursing. A guide for faculty (pp ). St. Louis, Missouri: Saunders Elsevier. Sportsman, S., Bolton, C., Bradshaw, P., Close, D., Lee, M., Townley, N, & Watson, M.N. (2009). A regional simulation center partnership: Collaboration to improve staff and student competency. The Journal of Continuing Education in Nursing, 40(2), Texas Board of Nursing (2012). Texas Board of Nursing Position Statements. Retrieved from:
References Ulrich, B., Krozek, C., Early, S., Ashlock, C.H., Africa, L.M., & Carman, M.L. (2010) Improving retention, confidence, and competence of new graduate nurses: Results from a 10- year longitudinal database. Nursing Economics, 28(6), Waxman, K. T. (2010). The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators. Journal of Nursing Education, 49(1), doi: /