Integrating Simulation into Nursing Education The International Nursing Association for Clinical Simulation & Learning Integrating Simulation into Nursing Education

Presenter and Disclaimer Andrea D. Ackermann, PhD, RN, CNE VP Finance, INACSL Board of Directors Member of Editorial Board for Clinical Simulation in Nursing Professor and Chair of Nursing Division, Mount Saint Mary College, Newburgh, NY Adjunct faculty member, Excelsior College, Albany, NY

Objectives By the end of the learning session the participant will be able to: Discuss drivers for the introduction of simulation Identify courses within your nursing curriculum to best leverage simulation Locate tools and resources for quick successes. Create buy-in with faculty and / or other health care specialties Define measurable objectives for success

What drives Simulation Education in Nursing? Lack of learning experiences and resources IOM initiatives, Joint Commission, NCSBN, QSEN Curriculum Student characteristics High risk/Low frequency situations Developing professional demeanor, inter-professional collaboration, attitudes, communication Active and experiential learning Reflective learning

How do you fit Simulation Education into Curriculum? Program needs Students learning needs Developing objectives Facilitation of simulation Evaluation of Debriefing

Guided by program assessment NCLEX pass rates Standardized testing Program needs Guided by program assessment NCLEX pass rates Standardized testing Available clinical experiences in the community Curriculum assessment

Student and Faculty Needs Guided by Student level What do the students say they need? Communication Assessment Dealing with families Cultural considerations What do I do if something goes wrong? What do the faculty say they need? Areas where the students are “weak” Areas where the students are not getting practice Safety Testing

Overall purpose of the simulation Student learning needs and level Objectives/Outcomes Guided by: Simulation standards Overall purpose of the simulation Student learning needs and level Realistic and measurable Identify the appropriate environment, fidelity, prompting, etc. Foundation for simulation facilitation Basis for assessment and evaluation

Facilitation Guided by: Simulation standards Simulation plan Simulation implementation Participant engagement Scheduling Facilitator Preparation Prompting Establish safe learning environment Guides the learning

Evaluation Guided by: Simulation Standards Assessment/formative evaluation Summative evaluation Established Objectives/Outcomes Three domains of learning Cognitive Affective Psychomotor Valid and Reliable tools

Debriefing Guided by: Simulation Standards Evidence based debriefing methodologies Promoting reflective thinking Skills of the debriefer Objectives/outcomes Confidentiality, trust and open communication

Standardized patients Virtual experiences Tools and Resources Simulators Task trainers Standardized patients Virtual experiences Standards of Best Practice: Simulation INACSL Board of Directors, (August, 2011). Standards of best practice: Simulation. Clinical Simulation in Nursing, 7(4 Supplement). S1-S20. Available at http://www.nursingsimulation.org/issues?issue_key=S1876-1399(11)X0005-1

Development of INACSL Standards 2 Years Survey to INACSL Membership Committee Draft Peer Review Final Draft Publication – Summer 2011

Standards of Best Practice Terminology Professional Integrity of Participant Participant Objectives Facilitation Methods Simulation Facilitator The Debriefing Process Evaluation of Expected Outcomes

Standard One: Terminology Statement: Consistent terminology provides guidance, clear communication, and reflects shared values in simulation experiences, research, and publications.

Standardized terminology: Rationale Standardized terminology: Enhances understanding and communication among planners, participants and others involved in simulation experiences Promotes consistency in the development, implementation, evaluation and publication of or about simulated clinical experiences or research studies for use in education and practice

Nursing Skill Development & Judgment Model

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.

Rationale Failure of the participants to maintain professional integrity related to simulation and lack of respect or professionalism could undermine the benefits of this pedagogy Sharing of confidential information of any kind before, during or after the simulation experience can alter the experience

Upholding professional integrity promotes a safe learning environment Outcomes This standard offers the opportunity for similar learning experiences to all participants Upholding professional integrity promotes a safe learning environment To achieve the desired outcomes, the facilitator must address key areas during the simulation

Standard Three: Participant Objectives Statement: The simulation experience should focus on the participant objectives and experience level.

Rationale Participant objectives are the guiding tools for simulation and essential to achieve the outcomes Identification of appropriate scenario, fidelity, instructor prompting/facilitating, and environment is crucial for best experiences and meeting the participant objectives

Outcomes The focus of simulation is on the outcome to be achieved and on participant learning-Know your participants Should facilitate the development of clinical judgment in order to deliver high quality and safe nursing care that is holistic and includes cultural awareness Objectives should be: Achievable within an appropriate time frame Incorporate evidence-based practice Address domains of learning Appropriate to the participant ‘s level of learning and congruent with overall program outcomes See Standard I: Terminology for Nursing Skill Development and Clinical Judgment Model

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.

Rationale Facilitation methodology should vary because participants bring cultural and individual differences that affect their knowledge, skills, attitudes (KSAs), and behavior Facilitation assists the learner to meet the objectives by incorporating learner’s needs and experience into the planning and implementation of a simulated clinical experience

Outcomes Facilitation revolves around engaging participants within the scenario by assisting them to meet the objectives of the clinical scenario Effective facilitation requires using the facilitation method and personnel/faculty indicated by participant objectives and expected outcomes

Standard Five: Simulation Facilitator Statement: A proficient facilitator is required to manage the complexity of all aspects of simulation.

The facilitator is the key to participant learning: Rationale The facilitator is the key to participant learning: Guides and supports participants to understand and achieve the objectives Engages the participants to search for evidence-based practice solutions to develop participant’s skill development and clinical judgment Adjusts simulations to meet objectives based on participant’s actions or lack of actions Leads the participants in identifying the positive actions and changes

Outcomes Facilitator promotes and assists with achieving the desired outcomes of a simulated experience by utilizing various methods

Standard Six: The Debriefing Process Statement: All simulated experiences should include a planned debriefing session aimed toward promoting reflective thinking.

Rationale Learning is dependent upon the integration of experience and reflection Reflection is the conscious consideration of the meaning and implication of an action The skills of the debriefer are important to ensure the best possible learning Learners report the debriefing session is the most important component of a simulated learning experience

The integration of the process of debriefing into simulation: Outcomes The integration of the process of debriefing into simulation: Enhances learning Heightens self-confidence for the learner Increases understanding Promotes knowledge transfer Identifies best practices Promotes safe, quality patient care Promotes life-long learning

Outcomes (Continued) To achieve the desired outcomes, the effective debriefing process should: Be facilitated by individual competent in debriefing that observed the simulation Use evidence-based debriefing methodologies Be based on a structured framework for debriefing Be based on objectives, the learners, & the outcomes Be conducted in an environment that supports confidentiality, trust, open communication, self-analysis & reflection

Standard Seven: Evaluation of Expected Outcomes Statement: This standard addresses summative evaluation as opposed to formative assessment.

Rationale Simulation is an acceptable method of evaluating the three domains of learning: Cognitive (knowledge) Affective (attitude) Psychomotor (skills)

Outcomes The participant’s achievement of expected outcomes of a simulation experience should be based on valid and reliable instrumentation, tools, and methodologies in the evaluation process To achieve valid and reliable evaluation results, the simulation used for the purpose of assessment and particularly high-stakes evaluation must follow certain aspects.

Creating Buy-In Determine your organizational ‘needs’ and ‘problems’ and provide solutions through the use of simulation Share data / evidence Invite others to the sim lab Plan Open Houses and awareness events Collect user satisfaction data and share it with others Design ‘evidence-based’ simulation scenarios Utilize the Standards

Defining Measureable Objectives for Success Cognitive Standardized Exams Course Exams Psychomotor Skills Checklists Global Rating Scales Affective Confidence Self-Efficacy Satisfaction AACN, November 29, 2011

Cognitive Based upon Scenario Content Instructor Made Tests Proprietary Tests

Psychomotor-Checklist

Psychomotor – Global Rating Scale Assessment ❑ 1 Unsatisfactory ❑ 2 ❑ 3 ❑ 4 ❑ 5 Satisfactory ❑ 6 ❑ 7 ❑ 8 ❑ 9 Superior

Visual Analog Scale (VAS) – 100 mm line Affective Domain NLN Tools Journaling Visual Analog Scale (VAS) – 100 mm line Place a mark on the line below to indicate your level of confidence in your ability to insert and IV catheter __________________________________________________________ No Confidence Highly Confident

Examples of Validated Tools NLN Simulation Design Scale Educational Practice Questionnaire Student Satisfaction and Confidence in Learning Lasater Clinical Judgment Rubric Based upon Tanner’s work Creighton Simulation Evaluation Tool ANTS (Team Evaluation)

Evaluation of the 3 Domains of Learning Lasater (2007) Herm, et al (2007) Rhadakrishnan, et al (2007) Todd, et al (2008)

Evaluation of the Scenario Rationale CQI Support for future activities Development Support for Staff Elements Demographic information What do you want to know?

Simulation Evaluation (Howard, 2010)   Strongly Disagree Agree Strongly Agree 4. The simulation experience helped me to better understand nursing concepts. 1 2 3 4 5. The simulations were a valuable learning experience. 6. The simulations helped to stimulate critical thinking abilities. 7. The simulation was realistic. 8. The knowledge gained through the simulation experiences can be transferred to the clinical setting. 9. I was nervous during the simulation 10. Because of the simulation experience, I will be less nervous in the clinical setting when providing care for similar patients. 11. Simulation experiences can be a substitute for clinical experiences in the hospital. 12. Simulation experiences should be included in our undergraduate education. Please share any additional thoughts at this time:

Stakeholder Evaluations Faculty Students / Participants Outside Users Regional Healthcare Providers Patients