Presentation on theme: "Integrating Simulation into Nursing Education"— Presentation transcript:
1 Integrating Simulation into Nursing Education The International Nursing Association for Clinical Simulation & LearningIntegrating Simulation into Nursing Education
2 Presenter and Disclaimer Andrea D. Ackermann, PhD, RN, CNEVP Finance, INACSL Board of DirectorsMember of Editorial Board for Clinical Simulation in NursingProfessor and Chair of Nursing Division, Mount Saint Mary College, Newburgh, NYAdjunct faculty member, Excelsior College, Albany, NY
3 ObjectivesBy the end of the learning session the participant will be able to:Discuss drivers for the introduction of simulationIdentify courses within your nursing curriculum to best leverage simulationLocate tools and resources for quick successes.Create buy-in with faculty and / or other health care specialtiesDefine measurable objectives for success
4 What drives Simulation Education in Nursing? Lack of learning experiences and resourcesIOM initiatives, Joint Commission, NCSBN, QSENCurriculumStudent characteristicsHigh risk/Low frequency situationsDeveloping professional demeanor, inter-professional collaboration, attitudes, communicationActive and experiential learningReflective learning
5 How do you fit Simulation Education into Curriculum? Program needsStudents learning needsDeveloping objectivesFacilitation ofsimulationEvaluation ofDebriefing
6 Guided by program assessment NCLEX pass rates Standardized testing Program needsGuided by program assessmentNCLEX pass ratesStandardized testingAvailable clinical experiences in the communityCurriculum assessment
7 Student and Faculty Needs Guided byStudent levelWhat do the students say they need?CommunicationAssessmentDealing with familiesCultural considerationsWhat do I do if somethinggoes wrong?What do the faculty say they need?Areas where the students are “weak”Areas where the students are not getting practiceSafetyTesting
8 Overall purpose of the simulation Student learning needs and level Objectives/OutcomesGuided by:Simulation standardsOverall purpose of the simulationStudent learning needs and levelRealistic and measurableIdentify the appropriate environment, fidelity, prompting, etc.Foundation for simulation facilitationBasis for assessment and evaluation
10 Evaluation Guided by: Simulation Standards Assessment/formative evaluationSummative evaluationEstablished Objectives/OutcomesThree domains of learningCognitiveAffectivePsychomotorValid and Reliable tools
11 Debriefing Guided by: Simulation Standards Evidence based debriefing methodologiesPromoting reflective thinkingSkills of the debrieferObjectives/outcomesConfidentiality, trustand opencommunication
12 Standardized patients Virtual experiences Tools and ResourcesSimulatorsTask trainersStandardized patientsVirtual experiencesStandards of Best Practice: SimulationINACSL Board of Directors, (August, 2011). Standards of best practice: Simulation. Clinical Simulation in Nursing, 7(4 Supplement). S1-S20. Available at
13 Development of INACSL Standards 2 YearsSurvey to INACSL MembershipCommittee DraftPeer ReviewFinal DraftPublication – Summer 2011
14 Standards of Best Practice TerminologyProfessional Integrity of ParticipantParticipant ObjectivesFacilitation MethodsSimulation FacilitatorThe Debriefing ProcessEvaluation of Expected Outcomes
15 Standard One: Terminology Statement:Consistent terminology provides guidance, clear communication, and reflects shared values in simulation experiences, research, and publications.
16 Standardized terminology: RationaleStandardized terminology:Enhances understanding and communication among planners, participants and others involved in simulation experiencesPromotes consistency in the development, implementation, evaluation and publication of or about simulated clinical experiences or research studies for use in education and practice
18 Standard 2: 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.
19 RationaleFailure of the participants to maintain professional integrity related to simulation and lack of respect or professionalism could undermine the benefits of this pedagogySharing of confidential information of any kind before, during or after the simulation experience can alter the experience
20 Upholding professional integrity promotes a safe learning environment OutcomesThis standard offers the opportunity for similar learning experiences to all participantsUpholding professional integrity promotes a safe learning environmentTo achieve the desired outcomes, the facilitator must address key areas during the simulation
21 Standard Three: Participant Objectives Statement: The simulation experience should focus on the participant objectives and experience level.
22 RationaleParticipant objectives are the guiding tools for simulation and essential to achieve the outcomesIdentification of appropriate scenario, fidelity, instructor prompting/facilitating, and environment is crucial for best experiences and meeting the participant objectives
23 OutcomesThe focus of simulation is on the outcome to be achieved and on participant learning-Know your participantsShould facilitate the development of clinical judgment in order to deliver high quality and safe nursing care that is holistic and includes cultural awarenessObjectives should be:Achievable within an appropriate time frameIncorporate evidence-based practiceAddress domains of learningAppropriate to the participant ‘s level of learning and congruent with overall program outcomesSee Standard I: Terminology for Nursing Skill Development and Clinical Judgment Model
24 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.
25 RationaleFacilitation methodology should vary because participants bring cultural and individual differences that affect their knowledge, skills, attitudes (KSAs), and behaviorFacilitation assists the learner to meet the objectives by incorporating learner’s needs and experience into the planning and implementation of a simulated clinical experience
26 OutcomesFacilitation revolves around engaging participants within the scenario by assisting them to meet the objectives of the clinical scenarioEffective facilitation requires using the facilitation method and personnel/faculty indicated by participant objectives and expected outcomes
27 Standard Five: Simulation Facilitator Statement: A proficient facilitator is required to manage the complexity of all aspects of simulation.
28 The facilitator is the key to participant learning: RationaleThe facilitator is the key to participant learning:Guides and supports participants to understand and achieve the objectivesEngages the participants to search for evidence-based practice solutions to develop participant’s skill development and clinical judgmentAdjusts simulations to meet objectives based on participant’s actions or lack of actionsLeads the participants in identifying the positive actions and changes
29 OutcomesFacilitator promotes and assists with achieving the desired outcomes of a simulated experience by utilizing various methods
30 Standard Six: The Debriefing Process Statement: All simulated experiences should include a planned debriefing session aimed toward promoting reflective thinking.
31 RationaleLearning is dependent upon the integration of experience and reflectionReflection is the conscious consideration of the meaning and implication of an actionThe skills of the debriefer are important to ensure the best possible learningLearners report the debriefing session is the most important component of a simulated learning experience
32 The integration of the process of debriefing into simulation: OutcomesThe integration of the process of debriefing into simulation:Enhances learningHeightens self-confidence for the learnerIncreases understandingPromotes knowledge transferIdentifies best practicesPromotes safe, quality patient carePromotes life-long learning
33 Outcomes (Continued)To achieve the desired outcomes, the effective debriefing process should:Be facilitated by individual competent in debriefing that observed the simulationUse evidence-based debriefing methodologiesBe based on a structured framework for debriefingBe based on objectives, the learners, & the outcomesBe conducted in an environment that supports confidentiality, trust, open communication, self-analysis & reflection
34 Standard Seven: Evaluation of Expected Outcomes Statement: This standard addresses summative evaluation as opposed to formative assessment.
35 RationaleSimulation is an acceptable method of evaluating the three domains of learning:Cognitive (knowledge)Affective (attitude)Psychomotor (skills)
36 OutcomesThe participant’s achievement of expected outcomes of a simulation experience should be based on valid and reliable instrumentation, tools, and methodologies in the evaluation processTo achieve valid and reliable evaluation results, the simulation used for the purpose of assessment and particularly high-stakes evaluation must follow certain aspects.
37 Creating Buy-InDetermine your organizational ‘needs’ and ‘problems’ and provide solutions through the use of simulationShare data / evidenceInvite others to the sim labPlan Open Houses and awareness eventsCollect user satisfaction data and share it with othersDesign ‘evidence-based’ simulation scenariosUtilize the Standards
38 Defining Measureable Objectives for Success CognitiveStandardized ExamsCourse ExamsPsychomotor SkillsChecklistsGlobal Rating ScalesAffectiveConfidenceSelf-EfficacySatisfactionAACN, November 29, 2011
39 CognitiveBased upon Scenario ContentInstructor Made TestsProprietary Tests
41 Psychomotor – Global Rating Scale Assessment❑ 1 Unsatisfactory❑ 2❑ 3❑ 4❑ 5 Satisfactory❑ 6❑ 7❑ 8❑ 9 Superior
42 Visual Analog Scale (VAS) – 100 mm line Affective DomainNLN ToolsJournalingVisual Analog Scale (VAS) – 100 mm linePlace a mark on the line below to indicate your level of confidence in your ability to insert and IV catheter__________________________________________________________No Confidence Highly Confident
43 Examples of Validated Tools NLNSimulation Design ScaleEducational Practice QuestionnaireStudent Satisfaction and Confidence in LearningLasater Clinical Judgment RubricBased upon Tanner’s workCreighton Simulation Evaluation ToolANTS (Team Evaluation)
44 Evaluation of the 3 Domains of Learning Lasater (2007)Herm, et al (2007)Rhadakrishnan, et al (2007)Todd, et al (2008)
45 Evaluation of the Scenario RationaleCQISupport for future activitiesDevelopmentSupport for StaffElementsDemographic informationWhat do you want to know?
46 Simulation Evaluation (Howard, 2010) StronglyDisagreeAgreeStrongly Agree4. The simulation experience helped me tobetter understand nursing concepts.12345. The simulations were a valuable learningexperience.6. The simulations helped to stimulate criticalthinking abilities.7. The simulation was realistic.8. The knowledge gained through thesimulation experiences can be transferred tothe clinical setting.9. I was nervous during the simulation10. Because of the simulation experience, I willbe less nervous in the clinical setting whenproviding care for similar patients.11. Simulation experiences can be a substitutefor clinical experiences in the hospital.12. Simulation experiences should be included inour undergraduate education.Please share any additional thoughts at this time: