Mary Cato MSN, RNOregon Health & Science University

Laerdal SUN meetingDallas TexasOctober 2009

“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

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.

Effective medical learning stems from learner engagement in deliberate practice with clinical problems and devices in simulated settings in addition to patient care experience.

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

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

Cognitive: mental skills (Knowledge)

Affective: growth in feelings or emotional areas (Attitude)

Psychomotor: manual or physical skills (Skills)

ORIGINAL TERMINOLOGY REVISED TERMINOLOGY

Because simulation is experiential learning, objectives can be higher level

Creating and evaluating, for example, rather than simply understanding or remembering

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

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

High, mid, and low fidelity manikins Standardized patients and

participants Role-playing Computer simulation Virtual reality

Give students opportunities to make decisions

Reinforce important concepts Teach and practice clinical judgment Practice professional communication Reflect on case

An Integrative Model of Clinical Judgment

Noticing Interpreting Responding

Expectations

Initial Grasp

Reasoning PatternsAnalytic Intuitive

NarrativeAction

OutcomesReflection on action andClinical Learning

ContextBackgroundRelationship

Reflecting

Reflection on Action

Tanner, CA (2006) Thinking like a nurse: A research-based model of clinical judgment. Journal of Nursing Education, , 45(6), 204-211

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

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)

Occurs after the simulation session

Reflective journaling

Use of rubric

Individual learning – availability of faculty outside of simulation session if needed

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?

Organizations INACSL SSiH NLN

Courses Workshops Apprenticeships Graduate courses

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

“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

Jeffries Simulation Framework

Simulation Innovation Resource CenterSimulation Innovation Resource Center

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

Use of standardized patients Use of hybrid simulations Increased focus on management,

delegation, and leadership Integration of Electronic Medical Record Interprofessional activities Graduate programs