1. MOVING SIMULATION OUT OF THE LAB AND INTO MAINSTREAM NURSING EDUCATION PRACTICES Coffey, S., Graham, L., de la Rocha, A., Chorney, D., Cummings, K., Papaconstantinou, E., Mairs, S., Zitzelsberger, H., Vogel, E., & Sproul, S.

2. SIMULATION FOR TEACHING- LEARNING Simulation is becoming a critical teaching-learning strategy in nursing education High quality simulation experiences occur across a full range of modalities: high-fidelity medium-fidelity low-fidelity Evaluation using simulation now includes: Summative Formative High stakes remedial

3. SIMULATION FOR TEACHING- LEARNING As a result, learners are able to acquire and demonstrate the knowledge and skills necessary for safe and competent nursing practice Simulation provides real-time opportunities for students to work through complex patient-care situations Simulation is playing an essential role in supporting educators to facilitate nursing students’ learning of complex concepts and skills (CASN, 2007; Rickets, 2011) In clinical settings, the shift to higher acuity and increased complexity of patients demands higher levels of decision-making This cycle of increasing complexity further necessitates increased (and unprecedented) competency and confidence among nursing students and program graduates

4. SIMULATION FOR TEACHING- LEARNING A number of studies demonstrate the advantages of simulation in enhancing nursing students’ knowledge, competence, confidence, and satisfaction, while readying students for clinical practice Cant & Cooper, 2010 Norman, 2012 Rickets, 2011 As nursing programs increasingly turn to simulation as direct clinical replacement in the context of increased student enrolment and dwindling clinical placements, consideration must be given to: standardized evaluation Faculty expertise Enhanced integration of simulation beyond “laboratory” settings

5. SIMULATION FOR TEACHING- LEARNING “Simulation makes visible what we have suspected but could not see in clinical: Some of our students are not safe” (Kardong-Edgren et al., 2011, p. 23)

6. CREATING OPPORTUNITIES FOR WIDESPREAD SIMULATION USE As a result, faculty within the University of Ontario Institute of Technology (UOIT) and Durham College (DC) Collaborative Bachelor of Science in Nursing Program created a multi-faceted plan to promote active teaching- learning using enhanced simulation opportunities Key activities included: Development of a simulation-specific strategic plan for the Nursing Program Enhancing faculty skill sets in relation to simulation, including offering professional development Review of curriculum for simulation opportunities beyond typical laboratory settings Creation of a simulation satellite room for easy access to simulation facilities within steps of teaching space

7. LAYING THE GROUNDWORK Infrastructure requirements included space and capital investment Successful proposals for both were based on Nursing Program success, internal and external recognition of faculty cutting edge expertise, and student feedback Partnering with IT within the University setting supported a process for problem-solving around technical issues (e.g., how to create live streaming from the simulation satellite room to nearby classrooms) Creating small work groups to develop enhanced, cutting edge simulation development skills increased the visibility of simulated learning within the educational agenda in the Nursing Program

8. SITUATING SIMULATION WITHIN EXPERIENTIAL LEARNING Most importantly, a significant philosophical shift was initiated, in which simulation as a teaching-learning methodology was rightly situated within the structure of experiential learning, rather than its current association with ‘technical learning’ in lab settings This resulted in a re-orientation of simulation to make mastery of technology less prominent, while teaching-learning skill more critical Ultimately, it supports the movement of simulation out of the lab and into mainstream education, making it accessible to both more faculty and more learners

9. EARLY OUTCOMES Creation of a simulation satellite room, which can be used for: One-on-one teaching Remediation Small group clinically focused learning Live-streaming of simulated learning events, with a small number of learners involved in the simulation and the rest of the class watching nearby and fully participating in a debriefing after the event Integration of simulation into both clinically oriented courses, as well as theory courses Nursing and health sciences research that involves a wide range of foci

10. EARLY OUTCOMES Exponential faculty development Faculty now are considered “experts in the field” Cutting edge simulation development, with increased focus on context within the situation Curricular revision Increased redesign of existing courses to include simulation foci Development of new elective and core courses which focus on integration of simulation opportunities

11. SUMMING UP Re-examining how simulation was both conceived of and integrated within our nursing program at UOIT-DC enabled us to make critically important changes to: How we use simulation within a broad range of nursing courses How we evaluate all elements of simulation (the scenario itself, rubrics, facilitators, student learning, etc.) How we teach and assumptions we may have had about how students learn How simulation can be used to support research and continuing professional development within nursing and health sciences

12. REFERENCES Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing, 66(1), 3-15. DOI:10.1111/j.1365- 2648.2009.05240.x CASN. (2007). CASN/ACESI Clinical placement projects, Project 3: Inventory of the use of simulated clinical learning experiences and evaluation of their effectiveness. Ottawa, ON: Author. Kardong-Edgren, S., Hanberg, A. D., Keenan, C., Ackerman, A., & Chambers, K. C. (2011). A discussion of high-stakes testing: An extension of a 2009 INACSL conference roundtable. Clinical Simulation in Nursing, 7(1), e19-e24. DOI:10.1016/j.ecns.2010.02.002 Norman, J. (2012). Systematic review of the literature on simulation in education. ABNF Journal, 23 (2), 24-28. Ricketts, B. (2011). The role of simulation for learning within pre-registration nursing education - a literature review. Nurse Education Today, 31, 650-654. DOI:10.1016/j.nedt.2010.10.029