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Mary Cato MSN, RN Oregon Health & Science University Laerdal SUN meeting Dallas Texas October 2009.

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Presentation on theme: "Mary Cato MSN, RN Oregon Health & Science University Laerdal SUN meeting Dallas Texas October 2009."— Presentation transcript:

1 Mary Cato MSN, RN Oregon Health & Science University Laerdal SUN meeting Dallas Texas October 2009

2 Why integrate? How to integrate? Where to go for help

3 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 25% 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 90% of nurse educators think their graduates are ready to safely practice 10% of hospital and health system executives think graduates are ready to safely practice JONA November 2008

7 Mainly NOT in motor skills New graduates often have little experience in: Delegation Taking a full load Utilizing resources (for themselves and their clients) Interprofessional communication

8 Cognitive: mental skills (Knowledge) Affective: growth in feelings or emotional areas (Attitude) Psychomotor: manual or physical skills (Skills)

9 ORIGINAL TERMINOLOGY REVISED TERMINOLOGY Evaluation Synthesis Analysis Application Comprehension Knowledge Creating Evaluating Analyzing Applying Understanding Remembering

10 Because simulation is experiential learning, objectives can be higher level Creating and evaluating, for example, rather than simply understanding or remembering

11 Why integrate? How to integrate? Where to go for help

12 Demonstrate Practice Evaluate

13 Classroom or lecture Techniques of assessment Effects of a drug (use monitor) Role model communication Skills lab Demonstrate procedure Increase realism by doing procedure in context of patient care

14 Utilize as clinical hours? Impact of increasing fidelity Able to provide context to situation Encourage use of clinical judgment, communication, resource management, thinking on your feet, teaching skills, management of emotional situations

15 High, mid, and low fidelity manikins Standardized patients and participants Role-playing Computer simulation Virtual reality

16 Give students opportunities to make decisions Reinforce important concepts Teach and practice clinical judgment Practice professional communication Reflect on case

17 An Integrative Model of Clinical Judgment NoticingInterpreting Responding Expectations Initial Grasp Reasoning Patterns Analytic Intuitive Narrative Action Outcomes Reflection on action and Clinical Learning Context Background Relationship Reflecting Reflection on Action Tanner, CA (2006) Thinking like a nurse: A research-based model of clinical judgment. Journal of Nursing Education,, 45(6),

18 Who are the client case exemplars? Common situations Highly prevalent nursing practice situations What students will most likely see in clinical High risk, low frequency situations Lack of clinical experiences Apply previously learned content Spiral up the curricular content Resources available Faculty & content experts Space & equipment

19 Objectives need to be attainable Tasks should be appropriate Consider 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)

20 Student Prep During Simulation Debriefing Reflection on Learning




24 Occurs after the simulation session Reflective journaling Use of rubric Individual learning – availability of faculty outside of simulation session if needed

25 Formative vs summative or high stakes Clarity of objectives, what is being tested Participants need to know what the stakes are How will the results be communicated to the participants?

26 Practice DeliberateLearning Evaluation You pass You fail A, A-, B+, B, B-

27 Why integrate? How to integrate? Where to go for help

28 Organizations INACSL SSiH NLN Courses Workshops Apprenticeships Graduate courses

29 Laerdal Nursing Scenarios SIRC (NLN/Laerdal Medical) has 2 samples in Designing & Developing a simulation course MedEdPORTAL (Association of American Medical Colleges) STORC OB Safety Initiative PNCI

30 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

31 Jeffries Simulation Framework

32 Simulation Innovation Resource Center


34 What do students need in real-world clinical practice and what can we simulate How much, How often When What aspects are most important for learning Does simulation make a difference to patient safety Does simulation improve patient care outcomes

35 Use of standardized patients Use of hybrid simulations Increased focus on management, delegation, and leadership Integration of Electronic Medical Record Interprofessional activities Graduate programs

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