Presentation on theme: "Integrating Simulation into Nursing Curriculum: Creative Solutions"— Presentation transcript:
1 Integrating Simulation into Nursing Curriculum: Creative Solutions Laerdal SUN meetingDallas TexasOctober 2009Integrating Simulation into Nursing Curriculum: Creative SolutionsAMary Cato MSN, RNOregon Health & Science University
2 Why integrate?How to integrate?Where to go for help
3 Value of simulation integration “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
4 Issenberg25% of studies cite integration of simulation-based exercises into the curriculum as an essential feature of their effective use.Simulation-based education should not be an extra-ordinary activity, but must be grounded in the ways learner performance is evaluated, and should be built into learners’ normal training schedule.
5 Effective medical learning stems from learner engagement in deliberate practice with clinical problems and devices in simulated settings in addition to patient care experience.
6 Why integrate simulation? 90% of nurse educators think their graduates are ready to safely practice10% of hospital and health system executives think graduates are ready to safely practiceWhat is it that accounts for this variation in perception?JONA November 2008
7 Where is improvement needed? Mainly NOT in “motor skills”New graduates often have little experience in:DelegationTaking “a full load”Utilizing resources (for themselves and their clients)Interprofessional communicationOther ideas, from service, of what our new grads need to know?
8 Multiple domains Cognitive: mental skills (Knowledge) Affective: growth in feelings or emotional areas (Attitude)Psychomotor: manual or physical skills (Skills)-We can think about simulation as useful for learning in multiple domains-All three can be incorporated into simulation case. Beneficial to know where students are at in theory course, skills lab, and include that content into simulation scenario. Use of a realistic patient adds the affective domain. (need to deal with patient anger, or emotions at end-of-life, or frustration with member of the team, for instance.)
9 Bloom’s Taxonomy Original Terminology Revised Terminology Evaluation SynthesisAnalysisApplicationComprehensionKnowledgeCreatingEvaluatingAnalyzingApplyingUnderstandingRememberingCognitive domain important to consider in curricular integration of simulationThinking beyond the skills, what else can students practice/demonstrate in simulation?Remembering (1) Recalling information Recognising, listing, describing, retrieving, naming, findingNouns changed to verbs (thinking is active process)The knowledge category was renamed – remembering more accurately describes a category of thinking.Comprehension became understanding and synthesis was renamed creating in order to better reflect the nature of the thinking described by each categoryUnderstanding (2) Explaining ideas or concepts Interpreting, summarising, paraphrasing, classifying, explainingApplying (3) Using information in another familiar situation Implementing, carrying out, using, executing Analysing (4) Breaking information into parts to explore understandings and relationships Comparing, organising, deconstructing, interrogating, finding Evaluating (5) Justifying a decision or course of action Checking, hypothesising, critiquing, experimenting, judging Creating (6) Generating new ideas, products, or ways of viewing things Designing, constructing, planning, producing, inventing Bloom’s Taxonomy
10 Experiential Learning Because simulation is experiential learning, objectives can be higher levelCreating and evaluating, for example, rather than simply understanding or remembering
11 Why integrate?How to integrate?Where to go for help
12 Determine Goal of Simulation DemonstratePracticeEvaluate“high fidelity” = highly realistic. Participants need to treat the manikin or standardized patient “as if” it were a real situation. Requires an engagement in the learning process.
13 Demonstration Classroom or lecture Skills lab Techniques of assessment Effects of a drug (use monitor)Role model communicationSkills labDemonstrate procedureIncrease realism by doing procedure in context of patient care
14 Practice Utilize as clinical hours? Impact of increasing fidelity Able to provide context to situationEncourage use of clinical judgment, communication, resource management, “thinking on your feet,” teaching skills, management of emotional situations
15 Possibilities for practice High, mid, and low fidelity manikinsStandardized patients and participantsRole-playingComputer simulationVirtual reality
16 Why practice in simulation? Give students opportunities to make decisionsReinforce important conceptsTeach and practice clinical judgmentPractice professional communicationReflect on case
17 An Integrative Model of Clinical Judgment NoticingInterpretingRespondingReasoning PatternsAnalyticIntuitiveNarrativeExpectationsContextBackgroundRelationshipActionInitial GraspReflection onActionOutcomesReflection on action andClinical LearningReflectingTanner, CA (2006) Thinking like a nurse: A research-based model of clinical judgment.Journal of Nursing Education, , 45(6),
18 Determine types of experiences Who are the client case exemplars?Common situationsHighly prevalent nursing practice situationsWhat students will most likely see in clinicalHigh risk, low frequency situationsLack of clinical experiencesApply previously learned content“Spiral up” the curricular contentResources availableFaculty & content expertsSpace & equipment
19 Leveling Scenario Objectives need to be attainable Tasks should be appropriateConsider “just manageable” situations –(the experience is challenging enough to move the learner to a higher level, but not so difficult that the learner becomes frustrated or discouraged) (Bransford, Brown and Cocking, 2000)Reflection on Practice is often triggered by a breakdown in clinical judgmentCreate Scenarios that are “Just Manageable Difficulty”Provide Coaching and ScaffoldsDesign Scenarios and Reflective Learning Activity that incorporate various kinds of knowledge that nurses use to make clinical judgments
20 When can the objectives be met? Student PrepDuring SimulationDebriefingReflection on Learning“simulation encounter” may begin before simulation session. Provides multiple opportunities to meet objectives.
25 Evaluation Formative vs summative or “high stakes” Clarity of objectives, what is being testedParticipants need to know what the stakes areHow will the results be communicated to the participants?Discuss conversations at INACSL, roundtable on “Using Simulation for High Stakes Testing.”Many discussions on both sidesCan discuss this controversy over lunch or wine!
29 Sources for Scenarios Laerdal Nursing Scenarios SIRC (NLN/Laerdal Medical) has 2 samples in Designing & Developing a simulation courseMedEdPORTAL (Association of American Medical Colleges)STORC OB Safety InitiativePNCIIncreasing numbers available as schools are putting information online. Google search of nursing simulation scenarios revealed multiple sources through schools of nursing.
30 Sources for Scenarios: Publications “Real Nursing Simulations,” (2009) Pearson Education Inc.“Simulation Scenarios for Nurse Educators,” (2009) Campbell and Daley: Springer Publishing"High-Fidelity Patient Simulation and Nursing Education," (2009)Nehring and Lashley: Jones and Bartlett_Real Nursing Simulations, (has facilitators guide for faculty, website with prep and other activities for students)_Simulation Scenarios for Nurse Educators, step-by-step guide to designing and developing simulated scenarios, includes 17 exemplars of actual scenarios_will contain scenarios
31 Jeffries Simulation Framework Framework comprises 3 spheres.1. faculty & student characteristics and educational practices2. student outcomes (desired)3. simulation design characteristicsNature of the simulation must be determined by the learning needs of the student.Jeffries Simulation Framework
32 Simulation Innovation Resource Center The SIRCSimulation Innovation Resource Center
34 Research QuestionsWhat do students need in real-world clinical practice and what can we simulateHow much, How oftenWhenWhat aspects are most important for learningDoes simulation make a difference to patient safetyDoes simulation improve patient care outcomes
35 Future of simulation Use of standardized patients Use of hybrid simulationsIncreased focus on management, delegation, and leadershipIntegration of Electronic Medical RecordInterprofessional activitiesGraduate programs