1. Getting in S.T.E.P. with Simulations Pamela R. Jeffries DNS, RN, FAAN Debra Spunt Endowed Lecture NLN Education Summit 2007 September 29, 2007

2. Introduction During the past decade, the use of simulations as a teaching-learning intervention in nursing curricula has increased greatly. Nursing students, clinicians, and educators alike appear to be strongly in agreement about the importance of incorporating simulations as a teaching practice because of several factors.

3. Current Situation A movement toward making simulations a part of the clinical practicum, either as a clinical substitute or as an adjunct. Movement arises out of need for: –More clinical sites –More nurse educators –New clinical practice models to prepare 21st century graduates in high-tech, complex environments

4. Current Situation Nursing educational organizations and leaders recognize that incorporating simulations into the nursing curricula is needed, but developing, implementing simulations can be challenging

5. Current Situation Not all nurse educators feel prepared for this type of teaching-learning pedagogy Some educators feel students cannot get adequate experience unless caring for ‘real’ patients

6. Professional Challenge “For all of us to find ways to improve clinical nursing education and address the concerns and hesitation that faculty have to try new educational strategies.”

7. S. imulations T. ake E. ducator P. reparation Today schools purchase equipment and build simulations centers, but the question unanswered is: “How do we prepare the educators for this pedagogy?”

8. Preparation for Educators Material may be purchased for simulators, but not so much for educators Faculty just start experimenting One champion trying to get others on board No standardized preparation for educators Few resources are becoming available Federal funding is increasing for simulation research and the outcomes being obtained

9. Challenges for the Educators Lack of a faculty development plan Administrative Faculty hesitation Resources

10. Administrative Challenges Resources needed for simulations Funding and time for faculty development Adoption by faculty into the curriculum Integrating this clinical model into strategic plan and curriculum Support for innovation, but few champions

11. Faculty Challenges New skill sets and teaching style Obtaining the expertise needed Getting support for innovation Student-centered learning Workload issues Course/class scheduling Resources/equipment

12. Resource Issues Technology –Phones in room –Video capability –Microphones Faculty development dollars Equipment –One way mirrors –Simulators –Props, tools Space

13. Educator Preparation Plan “Steps Needed for Educator Preparation” S = Standardized materials T = Train the trainer E = Encourage the development of a simulation design and integration team P = Plan to coordinate simulation development and implementation

14. Standardized Materials Currently there is no standardized information or training for nurse educators using this pedagogy Second NLN/Laerdal grant: developing online modules for faculty in simulation Different vendors have user group meetings, in- services Professional conferences are increasing the interest and amount of content on simulations

15. Train the Trainer Concept Develop a champion or two, then train others Organize institutes, workshops for faculty, clinical agency partners, workforce development healthcare workers Compile material: teaching tips, resources in one location, e.g. Web site for easy access by all Promote involvement of other faculty members – invite them to see your simulations

16. Simulation Development Team Encourage development of faculty and a appoint a Simulation Development Team Ask a consultant to work with the simulation team to get everyone on board and motivated Use materials available for learning Visit nursing schools and medical centers that use simulations

17. Simulation Development Team Hold phone conferences with other educators who incorporate simulation into their teaching Stay current with the literature – more is coming out at a higher level, but it is slow to come

18. Faculty/Sim Team Development Need buy-in from faculty Start with a ‘champion’ or small cohort of faculty Obtain funding for small projects Seminar development –Designing simulations –Evaluating the use of simulations

19. Faculty/Sim Team Development Initiate a Simulation Interest Group (SIG) for more buy-in and support Attend regional, state, national conferences, e.g., SUN meetings Promote partnerships and collaboration with other schools, clinical partners, nursing organizations, corporations, etc.

20. Strategies to Assist Faculty Select a course to implement simulations: –Ask what experience would you want all students to experience? –Have faculty develop and write scenario (have peer-reviewed) –Conduct a pilot simulation with end- users –Schedule lab and debriefing times

21. Guidelines for Educators Ensure specific objectives match the simulation Set a time limit for the simulation and adhere to it Assign roles to students prior to the simulation to avoid confusion and delay

22. Guidelines for Educators Avoid interrupting students during the simulation experience – use debriefing time to correct mistakes Ideally limit to 2-6 students in a simulation Develop simulation in authentic, realistic manner Ensure faculty who implement a simulation know how to conduct one

23. Plan for Coordination Work smart and efficient; work in teams, determine what scenarios are priority Don’t duplicate efforts; if working in a system school or with a clinical partner, assign specific scenarios to faculty, then compile the scenarios for all to share Partner with other schools, clinical agency educators, and other healthcare professionals

24. Roles to Re-shape Paradigm Join organizations and task forces. Get involved at the regional and national level to shape trends and policies Conduct nursing research Evaluate learning outcomes. Obtain evidence and findings that reflect meeting desired outcomes

25. Roles to Re-shape Paradigm Send in abstracts to speak, disseminate, and participate in conferences Serve on national panels, focus groups where nursing education decisions are being made, e.g., NLN, HRSA, NCSBN, AHRQ, AACN Integrate this pedagogy into better practices, better patient outcomes, and improved care and safe environments

26. Field-Tested Strategies Ensure objectives match the designed simulation Provide information/objectives prior to simulation Assign student roles. Limit them to only nursing-type roles or family members. Don’t ask students to play a health professional role out of their scope of practice.

27. Field-Tested Strategies Set a time limit and honor that time with students Have your scenarios peer-reviewed; use clinical agency partners to do this Conduct a practice or pilot run-through before implementing your simulations with students

28. Summary Perhaps the most important reason to adopt this pedagogy is its ability to create environments that present students with problem-solving encounters that require real-time assessment and interventions for a clinical problem and which they can use to learn how to make decisions based on the knowledge and skills learned in their nursing courses.

29. Conclusions This type of experience can often ‘bridge’ the gap between academe and practice

30. Conclusions Overall, students have found simulation experiences rewarding and helpful in increasing their self-confidence prior to entering a clinical unit Nevertheless, challenges remain –How much will clinical practicum experiences change? –To what extent will simulations be adopted by nurse educators?

31. Conclusions With the national call for the use of innovative clinical models, nurse educators need to be encouraged, developed, and supported in designing and implementing innovations such as simulations in the nursing curriculum.

32. Questions? Pamela R. Jeffries DNS, RN, FAAN prjeffri@iupui.edu