Alamo Colleges

Simulation in Nursing Education: Creating a Quality Simulation

Yvette Baxter MSN, RN

Faculty Development in the Effective Use of Simulation

Objectives:

Identify factors in the educational and practice environment which have contributed to the use of simulation in nursing education.

Identify advantages to incorporating simulation as a clinical teaching strategy.

Discuss strategies for maximizing simulation effectiveness and student learning outcomes.

Identify the key goals of debriefing.

Academic and Healthcare Environment

Shortages of clinical faculty and clinical sites.

Limited exposure to high risk, low volume clinical events

Complexity of the healthcare environment

Emphasis on patient safety

Technological advances offering sophisticated and realistic clinical experiences in the laboratory setting

Need to better prepare new nurses for working in a complex and technologically rich health care environment

Clinical Gaps

IOM (2003): hospital leaders, health plans, and practice sites reported increasing skills deficits in new graduates reported

65-75% of new-to-practice nurses did not meet entry-level competencies for clinical judgment (Ulrich et al., 2010)

The Future of Nursing: Focus on Education (2011) – the current nursing educational system inadequate to prepare nurses with the necessary competencies to provide high-quality care in increasingly complex healthcare environment

ImplicationsMedical Error: Greater risk for errors in clinical practice

Increased Turnover: Gaps between preparation and practice

requirements results in stress and increased potential to leave the field

The percentage of turnover of new graduates is estimated as 17.7% within one year, 33.4% within two years, and 46.3% by the third year (Cho, Lee, Mark, & Yun, 2012)

The Deficits

Competencies in which new-to-practice nurses scored lowest included:

Interpretation of assessment data Decision-making & application of nursing

process Identification of changes in patient status Timely & appropriate follow-up Initiative in management of care

Saintsing, Gibson, and Pennington (2011)

Clinical Simulation

A technique, not a technology

Immersion of the learner with enough realism to suspend disbelief

Environment to develop knowledge, skills, and clinical reasoning

A concept- based learning experience

Self-confidence

Learn from mistakes without risk to patient safety

Practice high risk, low incidence patient events

Identify gaps in knowledge /skills

Diverse learning

Real time/immediate feedback

Promotes critical thinking and decision-making skills

Safety, teamwork, communication, collaborative learning

Benefits of Simulation

Components for Creating a Quality Simulation

Faculty/Student Preparation

Scenario Selection, Writing, and Testing

Fidelity/Realism Debriefing

Simulation Effectiveness

“The patient simulation is only as effective as the faculty who are using it. The creativity, clinical knowledge, teaching expertise, and

technological abilities of the faculty are highly influential in the effective use of patient

simulation" (Durham and Alden, 2008, p. 3-237).

Faculty PreparationRequires: Student-centered approach

Preparation and comfort with scenarios and equipment

Understanding of the goals/objectives

Creativity, flexibility, & recognition of learning opportunities

Participation in the design process/evaluation

Faculty Preparation Understanding that mistakes will

be made

Minimize competition

Small groups

Roles assignment and assumption of roles

Close observation of actions, interactions, and decisions

MINDSET!!!

Learner Preparation

Understanding of simulation guidelines, objectives, & means of evaluation

Establishment of confidentiality, trust, &consent

Pre-scenario study guide

Orientation to simulation environment

What is to be simulated

Once in the simulation, students should function as they would in the clinical environment

Clinical Scenario Defined

“The plan of an expected and potential course of events for a simulated clinical experience. The clinical

scenario provides the context for the simulation and can vary in length and

complexity, depending on the objectives”

(International Nursing Association for Clinical Simulation and Learning [INACSL], 2011).

Steps in Scenario Development

Selection of topic and template Identification of learning objectives Story Writing (determination of

concepts, cues, and critical events) Peer review/Validation Pilot

Idea Generation Course objectives Identified practice gaps Staff/student survey perceived

learning needs/clinical challenges

Clinical experiences Case studies Legal cases

Topic Selection

Pre-programmed/purchased

Created by faculty/educators

On-line pre-written scenarios

Books

Source of Scenarios

Free On-line Resources

Healthy Simulation http://healthysimulation.com/2018/free-nursing-scenarios/

Kansas State Board of Nursing http://www.ksbn.org/cne/SimulationScenarioLibrary.htm

Massachusetts Nursing Initiative- Simulation Scenario Library http://www.mass.edu/currentinit/Nursing/Sim/Scenarios.asp

Knowledge level of student Goals and purpose of the

simulation Level of complexity and fidelity Number of participants/length of

time Experience and comfort level of

facilitator Availability of content expert Setting and equipment needed

Considerations for Scenario Selection

Safety and identified concepts/competencies

Evidence based practice and standards of care

Institutional policies and procedures

References

What Should be Incorporated in My

Scenario?

Writing the Story

Beginning: Description of the patient, event, setting,

participants Information to be providedMiddle: Plot progression and contingencies Expected actions & timelines Cues Flexibility of facilitatorEnding: Logical and realistic transition maximizes

fidelity

Validation & Piloting

Validation: Evidence –based : current journals, clinical

guidelines, and textbooks Checked for accuracy and believability Reviewed by content expert for validity and

revised as needed

Piloting: Piloted with small group of targeted

learners Feedback enables scenario revision for

maximum effectiveness Information regarding timeline, areas

where learners get derailed, or aspects of the scenario learners find confusing

Fidelity

The degree to which simulators and simulations mimic reality

Simulation experiences should be as realistic as possible

Realism of scenario, staging, props enhance the simulation experience

Realism

“The realism of any simulation depends upon multiple factors, including the

fidelity of the simulator, the environment, props, and the

description of the scenario…as realism is enhanced, the

effectiveness of the scenario as a learning tool is increased”

(Durham & Alden, 2008, p. 3-234).

Staging

Staging

Debriefing

Debriefing:“a conversation among two or more people to review a simulated event or activity in which participants explore, analyze and synthesize their actions and thought processes, emotional states and other information to improve performance in real situations”

(Center for Medical Simulation, 2009, p. 1).

Evaluate whether learning objectives met

Build on prior learning

Self-reflection/assessment

Communication/different perceptions/attitudes

Reinforce teaching points

Identify/ correct gaps in knowledge, skills, attitudes

Improve future performance

Goals of Debriefing

Reaction – opportunity to decompress and discuss emotional response to the simulation experience

Analysis - provides a time for reflection, understanding, and discussion of what went well and what didn’t

Summary/Closure – a summary of the experience is provided and evaluation of the simulation as a learning experience

Phases of the Debriefing Process

Role of Facilitator in Debriefing

Create a safe and trusting learning environment

Provide support Permit opportunity for defusing

emotions Guide the reflective process Provide feedback/observations Assist in assimilating new knowledge

Texas Board of Nursing (BON) Position Statement

on Simulation

In 2010 the BON put forth a position statement to clarify the role and limitations of simulation in order to provide educators with guidelines for making simulation educationally sound and meaningful.

Texas Board of Nursing (BON) Position Statement

on Simulation Simulation provides a valuable adjunct to traditional clinical learning.

To be effective the simulation must challenge learners to use problem solving and critical thinking skills.

Each simulation experience should have clearly stated objectives that are presented to learners PRIOR to engaging in the experience.

Texas Board of Nursing (BON) Position Statement

on Simulation Learners are required to prepare for a

clinical simulation experience in the same manner they would a hospital clinical experience.

An orientation to the simulation technology and environment is required.

The educator should act as a facilitator providing cues when needed, but not as an active participant.

Unless an end of life scenario, the simulation should end with a viable patient.

Acknowledgements

The Alamo Colleges wishes to extend a special thanks to San

Antonio College nursing students Lori Hannasch, Renee Howard, &

Sylvia Muniz for lending their time and services in the making of this

project!!!

Questions?

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