1. Taking Your First Steps Simulation Integration Beth Fentress Hallmark, PhD, RN Belmont University College of Health Sciences

2. Objectives: Learn the benefits, challenges and emerging trends in the use of simulation Ways to integrate simulation into nursing curriculum Identify courses where simulation may help you reach curricular objectives. Verbalize training resources for your school

3. Introduction: Beth Hallmark, PhD, RN –Belmont University –Director of Simulation, Gordon E. Inman College of Health Sciences and Nursing –Laerdal Center of Educational Excellence –Director Tennessee Simulation Alliance

4. Belmont University Nashville, Tennessee 7,000 + students College of Health Sciences Inter-professional Education Nursing –Accelerated, Fast track and Traditional BSN –FNP Social Work (BSW) Physical Therapy (DOT) Occupational Therapy (DPT/MSOT) Pharm D

5. Belmont’s Integration: May 2006 – Gordon E. Inman College of Health Sciences and Nursing August 2006 – Simulation Coordinator named Spring 2007 – Faculty development activities Fall 2010 McWhorter Center Established one physical space for COHS

6. Belmont University Nashville, Tennessee 2- Eight bed Adult Health laboratories 8 bed “Acute care” lab 4 bed Peds lab 8 bed Health Assessment/OB lab 4 Inter-professional private patient rooms

7. Belmont’s Goals Prepare the novice nurse for clinical practice Link Concepts & Critical Thinking to Practice Progressive Complexity Theoretical Support

8. Transition from student to RN Research shows new grads experience: Fear Lack of confidence Communication deficits Complex decision making Contradictory information Issues working with peers Dyess, S., & Sherman, R.. (2009). The first year of practice: New graduate nurses' transition and learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-10. doi: 1864764661.

9. Why Integrate Simulation? The true value of simulation lies in its ability to offer experiences throughout the educational process that provide students with opportunities for repetition, pattern recognition, and faster decision making.” Doyle & Leighton, 2010

10. Why Integrate Simulation? Bridging the gap between education and practice “90% of nurse educators think their graduates are ready to safely practice VS. 10% of hospital administrators” JONA, November 2008

11. Why do we plan? “If simulation is instituted in a curriculum prior to completion of evaluation planning, the potential for pedagogic improvement may be jeopardized”. Schlairet, 2011.

12. Why Integrate Simulation? Deliberate practice Healthcare Technologies Team training Quality and safety Delegation Therapeutic communication/Inter- professional Clinical Judgment/Decision-Making

13. New Graduates say: They feel uncomfortable with: – IV skills –Physical Assessment –Care of the dying patient –Caring for patients with changing care needs –Marshburn, D., Engelke, M., & Swanson, M.. (2009). Relationships of New Nurses' Perceptions and Measured Performance-Based Clinical Competence. The Journal of Continuing Education in Nursing, 40(9), 426-32. Retrieved November 2, 2009, from ProQuest Medical Library. (Document ID: 1864764651).

14. Practice Partners Say: Students Fail to perform relevant nursing actions relating to specific disease states Lack the ability to prioritize Give incomplete or irrelevant information to PCP Have difficulty giving rationale for nursing actions Do not know laboratory values Burns, P., & Poster, E.. (2008). Competency Development in New Registered Nurse Graduates: Closing the Gap Between Education and Practice. The Journal of Continuing Education in Nursing, 39(2), 67-73. Retrieved November 2, 2009, from ProQuest Medical Library. (Document ID: 1423354581).

15. What can simulation do? Help promote teamwork and collaboration Foster effective and safe communications Delegation Safe practices/Quality Improvement Cultural awareness Evidence based practice Patient centered care

16. Advantages of Simulation Safe practice arena Hands on Exposure to rare/high risk events Practice cognitive and psychomotor skills Transfer to clinical setting Immediate feedback Reflective learning

17. Where to start? Seropian et al. (2004) recommended eight steps to institute a simulation program: –Develop a vision to show what is to be achieved, who will be involved, and how the laboratory will be used. –Generate a business plan to outline initial and annual fiscal obligations. –Identify and seek support from stakeholders. –Construct the facility or laboratory, as defined in the vision and the business plan, including the equipment purchase. –Provide training for all individuals who will be involved. –Develop the curriculum. –Faculty training. –Determine policies and procedures.

18. Vision/Mission/Goals Spend time working on this before you jump in head first to simulation..if you did not do it in this order..BACK UP!

19. Business Plan Sustainability Planning

20. Stakeholders! Who? Why? Where ? What can they do for you? What can you do for them?

21. Curriculum Development PLAN PLAN!!

22. Lab/Simulation Committee –Lab Committee/simulation group –Lab coordinator –Champions –Share with faculty new standards (ie: SBAR, QSEN) –Map skills throughout curriculum (“lets do blood now”) –Develop a written plan –Mission and vision –Goals

23. Lab Goals Maintain a working lab group to create change. Strengthen partnerships with local medical centers Develop relationships with vendors Provide consistent and timely communications between the lab group, faculty and administration. Maintain records to identify areas of needed improvement Hire faculty and staff that are qualified to support our vision Manage the financial resources to provide the most sophisticated equipment available. Develop simulation within every course in the curriculum. Benchmark through electronic resources and by developing relationships with experts in the field. Inventory management Maintenance of Capital equipment.

24. Learning Domains Cognitive: “involves knowledge and the development of intellectual skills. This includes the recall or recognition of specific facts, procedural patterns, and concepts that serve in the development of intellectual abilities and skills” In Nursing Education; what falls in the cognitive domain? http://www.nwlink.com/~donclark/hrd/bloom.html

25. Learning Domains Affective: “manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes”. In Nursing education what falls in the affective domain? http://www.nwlink.com/~donclark/hrd/bloom.html

26. Learning Domains Psychomotor: “includes physical movement, coordination, and use of the motor-skill areas. Development of these skills requires practice and is measured in terms of speed, precision, distance, procedures, or techniques in execution”. What falls in the psychomotor domain? http://www.nwlink.com/~donclark/hrd/bloom.html

27. Traditional Nursing Education Didactic Lab Clinical Orientation at workplace CEUs

28. New Strategies Simulation as a Teaching Strategy Simulation as an Evaluation Tool

29. Types of Simulation Case Study Role-playing Standardized patients Partial vs. Complex Task Trainers –Static and Computerized Integrated Simulators (HPS)

30. Types of Simulators Fidelity Low Fidelity: Task Trainers. Medium Fidelity: non-responsive in terms of physiological signs but can have heart and lung sounds, etc. High Fidelity: physiologically responsive to students actions or lack of action.

31. Simulation: Theory Active Learning Reflective Thinking Constructivism

32. Curricular Changes Examine where simulation naturally fits –Outline a plan based on each semester Build simulations upon one another Simple to complex Students need exposure early in the program Use for remediation and clinical makeup

33. Connecting the dots in courses: Labs Didactic Courses in same semester How can we “marry” the content and reiterate in simulation? How can we re-frame the content we are teaching in labs and didactic within simulation?

34. Standards Identify your programs outcomes based on standards. –BSN Essentials –QSEN –IOM –Joint Commission –NCLEX Not just the standards that are r/t technology….i.e.: safety and communication

35. How do I overcome: Faculty Resistance –Time –Resources Technology assistance, equipment –Pay –Administrative Assistance –Skills –Scheduling

36. What do I need? CHAMPION Administrative Buy In Money: Grants Staff Space Faculty Development Plan Policies Mission Vision Stakeholders

37. What do I need? Champion One or two people who are interested in this new pedagogy. Train the champions then bring back info to the rest of faculty Champion can send information to others in form of literature and conference ideas Lead simulation committee/group

38. What do I need? Administrative Buy In How to accomplish this? Bring in experts/consultants Take them with you to meetings Share with them what you learn at conferences Show them student evaluations Demonstrate how simulation works Peer pressure

39. What do I need? MONEY….. MONEY….. Grants State Federal Local community organizations National Private Funding groups

40. What do I need? Staff Simulation Director Faculty: Simulation Committee Group Technical Support: IT and Network specialist Supply specialist Scheduling

41. What do I need? Space STORAGE, STORAGE, and still MORE STORAGE!! Preparation Area Simulation Labs Partitions? Observation/Control Room Debriefing room

42. What do I need? Faculty Development Plan Conferences Lunch and Learn SIRC.NLN.org List serves –INACSL –SSiH NLN AACN Invite them to play a part

43. Components to a Simulation Student Preparation Objectives Report Actual Simulation Debriefing Evaluation

44. Student Preparation How does a student prepare for a simulation? Do you give them the case prior to the simulation? What are the objectives of the simulations? Formative or Summative Case Study versus procedural prep

45. Objectives Need to fit with curricular objectives and course objectives Case by case General safety and communication

46. Report One example of integration Students need to learn how to receive and give report Use SBAR or other communication rubrics Ask practice partners for the system they use

47. Simulation Scenarios –Pre programmed –Make it your own Validate with practice partners Faculty script/training Reality: suspend Fiction Contract

48. Debriefing Reflection TRAIN faculty/method Learner uses previous knowledge to build upon Bad Habits develop if not addressed Video taping

49. Evaluation MUST be based on your objectives! Remember to link your simulation objectives to your course..to your program..to the collge..etc Formative or Summative Evaluation

50. Support: Find a Network Tennessee Simulation Alliance (www.tnsim.org) INACSL (www.inacsl.org) SSiH (www.SSiH.org)www.SSiH.org NLN SIRC (www.sirc.nln.org)www.sirc.nln.org Simulation Users Network (SUN)

51. Questions?