Simulation: Integrating interactive learning experiences...

Simulation: Integrating interactive learning experiences into the

nursing curriculum

Suzanne H. Campbell, PhD, RN, IBCLC

Associate Professor, UBC School of Nursing,

University of British Columbia, Vancouver, BC, Canada

HiOA Norway Faculty Workshop 05 March 2018 SHCampbell

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Welcome!

HiOA Norway Faculty Workshop 05 March 2018

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Photo Credit: http://www.traveltop.net/wp-content/uploads/2012/05/banff-national-park-alberta-canada1.jpg

DisclosureSuzanne Hetzel Campbell PhD, RN, IBCLC

• Royalties Springer Publishers, Inc. Co-editor Simulation Scenarios for Nursing Educators: Making it Real 3rd Ed., 2018.

• Royalty Jones & Bartlett Learning, Co-editor Core Curriculum for Interdisciplinary Lactation Care, 2018.

• Sit on Editorial Board of Clinical Simulation in Nursing

• Sit on Advisory Board of LiquidGoldConcept, Inc.

• Sit on Board of Directors of CanHealth International

• Canadian Association of Schools of Nursing (CASN/ACESI) Course Instructor, Canadian Simulation Nurse Educator Certification Program (Modules 2 & 3)

• I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation

HiOA Norway Faculty Workshop 05 March 2018

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Objectives

• Share a “state-of-the-science” perspective to identify synergies for your program planning

• Differentiate the use of simulation for technical and non-technical learning: clinical skill, teamwork, conflict resolution, leadership and role development;

• Review health professional educations use of simulation;

• Analyze the substitution of clinical practice with other methods of learning (on-campus vs off-campus);

• Examine how simulation is being standardized and evaluated; and

• Compare and contrast the advantages and challenges of integrating simulation into the curriculum.


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The 2010 Lancet Commission Report:

Blueprints for 21th Century Health Professional Education

INSTITUTE OF MEDICINE of the National Academies HiOA Norway Faculty Workshop 05 March

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Education of Health Professionals for

the 21st Century (2010)

Health Professionals for a New Century: Transforming Education to Strengthen Health

Systems in an Interdependent World*A Global Independent Commission

• Educate all health professionals:

– as members of interdisciplinary teams,

– emphasizing evidence-based practice,

– quality improvement approaches, and

– informatics*Julio Frenk and Lincoln Chen. "Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World." The Lancet 376, (Dec 4, 2010): 1923-1958.


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Top 10 Changes in Nursing in last ½ Century! (Barron McBride, 2011, p. 166-167)

1. Nursing not one kind of job (leadership not discipline specific)2. Growing global acceptance that nursing leadership is necessary

for development of safe practice environments, quality care3. Informatics revolution – practice, research, education – not time or place

bound4. Emphasis now on OUTCOMES (rather than process) – decision making

requires data5. Centers of nursing excellence -> consortium arrangements across

institutional boundaries6. Research base of nursing visible – doctoral programs, post-doctoral

training, institutes of nursing research, research societies7. Advanced-practice nursing established at graduate level – accepted by

public, specialties, and certification8. Nursing students – diverse age, gender, race, learning style --- better

reflecting the population served9. Articulation across levels of nursing increasingly possible and user-friendly10.Nursing literature and infrastructure greatly expanded – journals,

standards, competencies, and policy statements


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Paradigm Shift in Nursing Education

• Effective use of nurses based on their levels of

– Knowledge

– Education

– Skills

• Configuration of the nursing workforce –succession planning

• Enhancing the knowledge base of nursing to bring it in line with other professions (BSN)


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WHO Collaborative Practice Learning

Domains• Teamwork

• Roles and responsibilities

• Communication

• Learning and critical reflection

• Relationships with and recognizing the needs of

the patient

• Ethical practice


World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Care. Geneva, World Health Organization. Retrieved from http://www.who.int/hrh/resources/framework_action/en/

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http://www.who.int/hrh/resources/framework_action/en/

Evolving Use of Simulation

Across industries, simulation technologies have evolved from World War I (wooden horse

simulator) to latest aircraft simulators being used by NASA


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• Photo wooden horse simulator & NASA

Modern era of simulation technology in health care – 1960’s Norway!

• Bjorn Lind – a Norwegian anesthesiologist persuaded Asmund Laerdal, to make Resusci-Anne – CPR mannequin (1960s)

• Earlier 1874 advocates for use of skeletons in Schools of Nursing

• 1906 – Mrs. Chase (Hartford Hospital, SoN, Connecticut US) full-body static mannequin for practicing injections/procedures


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Prevalence of Simulation Globally

Courtesy Foisy-Doll & Leighton, SCORS presentation 2017, slide 6our text here

Simulation Statistics• NCSBN Study - NCSBN conducted a landmark, national,

multi-site, longitudinal study of simulation use in prelicensure nursing programs throughout the country. Collaborating with learning institutions across the U.S., NCSBN embarked on a research initiative exploring the role and outcomes of simulation in pre-licensure clinical nursing education.

• The study provides substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses under conditions comparable to those described in the study.

https://www.ncsbn.org/685.htm


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https://www.ncsbn.org/685.htm

Simulation vs Case-Based Learning

• Similarities:– Identify objectives for learning

– Provide a beginning “story” with key information

– Focus on critical thinking

– Fluid/dynamic process – no “right” answer

• Differences: Simulation/Health care scenarios– A method of teaching for unpredictable future events

– Variety of confounding variables & quick timeframe

– More individually focused vs. system/organization

– Prioritization of actions – misstep = adverse event


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Flexible Learning Opportunities

• Web-based instruction enhanced - modules with interactive learning and testing options

• Hybrid Simulation

• Outside preparation that augments class

• Classroom – small and large groups, individual response systems for interactive learning (clickers, PollEverywhere, Zoom)

• Clinical/lab = High-stakes testing/Capstones

• Virtual reality – HMD, examine patient, clinic, etc


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Identifying Curricular Fit

• Curriculum – concept-based, specialty-specific

• Key experiences –

– Technical skills: asthma, hemorrhage, CPR, hypoglycemia, deteriorating patient

– Non-technical skills: communication, team-work, therapeutic relationship – power-sharing, empathy, and trust/rapport building

• Reality-based: faculty expertise, lab resources, time management, substitution for clinical hours


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Assessing Organizational Readiness

• SCORS – Simulation Cultural Organizational Readiness Survey (Foisy-Doll & Leighton, 2017) https://sites.google.com/site/scorsfile/home

• Faculty buy-in and professional development – identification of champions

• Student request - expectations


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https://sites.google.com/site/scorsfile/home

Assessing Program Objectives

• Mission & Vision of your school, fit with university and community

• Describe what your graduate will look like

• Identify theoretical frameworks underlining your approach to teaching and clinical practice

• Outline professional development

• List outcome competencies for program –match with country Registered Nurse licensing


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Theories Guiding Simulation Case Development

• Blooms Taxonomy – to guide objective development (transition over time)

• Bandura’s Theory of Self-efficacy – to increase confidence for skill development

• Benner’s (1984) – Novice to Expert (here)• Kolb’s (1984) Experiential Learning Theory (here)• Schön’s reflection-in-action/reflection-on action (1983)• NLN/Jeffries Simulation Framework• Daley & Campbell’s Framework for Simulation Learning

in Nursing Education © - to provide knowledge translation & mobilization for theory into practice

• (17 years, average time for best practices to translate into hospital practice)


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http://www.health.nsw.gov.au/nursing/projects/Documents/novice-expert-benner.pdf

http://www.simplypsychology.org/learning-kolb.html

http://infed.org/mobi/donald-schon-learning-reflection-change/

Evolution: Comparison of Bloom’s Original (1956) and Bloom’s Revised (2001)

Taxonomies with QSEN KSAs


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Domains of Learning

• Original Bloom’s Taxonomy (1956)

• Cognitive

• Psychomotor

• Affective

Knowledge Dimension

•Revised Bloom’s Taxonomy (2001)

•Factual knowledge

•Conceptual Knowledge

•Procedural knowledge

•Metacognitive knowledge

QSEN Competencies

• The Quality and Safety Education for Nurses (QSEN) Project (2005 – 2012)

• Knowledge

• Skills

• Attitudes

Anderson & Krathwohl, 2011; Bloom, 1956; Cronenwett et al., 2007

Clinical Judgment

Critical Thinking Problem SolvingPsychomotor

SkillsClinical

Reasoning

Nursing skill development and clinical judgment model (International Nursing Association for Clinical Simulation and

Learning)

The Experiential Learning Cycle*(here)

• Kolb's experiential learning style theory is typically represented by a four stage learning cycle in which the learner 'touches all the bases':


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“Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38).

http://www.simplypsychology.org/learning-kolb.html

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CultureIndividual

Experiences

Learner brings to learning:

Framework for Simulation Learning in Nursing Education

Digital culture

Improved

Outcomes

Translation to

practice

Think Critically

Communicate

Effectively

Intervene

TherapeuticallyS

Foundational

Knowledge

Vigilance

Learning to learn

Human dimension

Integration Application

Caring

Failure to

Rescue

Feed-

back

loop

Translation

to practice

Improved

Outcomes

Safety

Excellence

Reflective

Practice

© Daley & Campbell

(2008) Framework for

simulation learning in

nursing education.

HiOA Norway Faculty Workshop 05

March 2018 SHCampbell

Examples of simulation pedagogy

integration for IPE• Integration throughout the curriculum

– Multiple opportunities for IPE – passport; medication reconciliation; patient-handovers; teamwork in trauma scenarios

– Health mentor model

• Competency-based testing at various points– Use to assess student competencies individually with evaluation criteria

and student goals focused on IPE

• Concept-based across the curriculum– Develop scenarios which can be used to bring together concepts that fit

many specialty areas and levels of students (e.g. medication reconciliation, ethics, informatics, communication, cultural humility)

• Scherer et al (2013) found IP simulation fostered collaboration between nursing & medical students on 3 subscales of the Readiness for Interprofessional Learning Scale: teamwork & collaboration, professional identity, & roles & responsibilities


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Postpartum Hemorrhage Still Leading Cause of

Maternal Death

35%

18%9%

8%1%

11%

18%

CAUSES OF MATERNAL DEATH

Haemorrhage Hypertension Unsafe abortion Sepsis

Embolism Other direct Indirect


Source: http://www.countdown2015mnch.org/documents/2012Report/2012-Complete.pdf

• Leading cause of maternal

mortality: 35% of all maternal

deaths

• About 14 million women around

the world suffer from PPH every

year

• Maternal Mortality Ratio (MMR)

has roughly halved between 1990

(400 per 100,000 live births) and

2010 (210 per 100,000 live births)

• However, MMR is

disproportionately high in

developing countries (240 per

100,000 live births) than

developed countries (16 per live

births)

http://www.who.int/medicines/areas/priority_medicines/BP6_16PPH.pdf

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Undergraduate NursingSimulation Scenario Prep


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Identifying Simulation Scenarios

4.3 kg infant of a

diabetic mother is

experiencing

hypoglycemia and

respiratory distress,

potentially life-

threatening. (photo)

Adolescent that was

admitted with the

diagnosis of recurrent

leukemia, for which

there was no curative

treatment (photo)

Post-partum

hemorrhage –

high maternal

mortality rates.(photo)

1st trimester bleeding –

spontaneous abortion,

gestational trophoblastic

disease; three emergency

deliveries, high risk of

maternal and/or fetal

mortality (photo)HiOA Norway Faculty Workshop 05 March

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http://www.redbubble.com/people/mtheuer/works/8475201-newborn-in-a-blanket-drawing

http://doodlealladay.blogspot.ca/2008/10/generic-teenager-ii.html

http://pixshark.com/hospital-room-sketch.htm

http://www.webcomicsnation.com/dirktiede/sketchbook-dt/series.php?view=archive&chapter=5737#strip3

Gaps in Nursing Simulation Research

Mariani & Doolen (2016)* identified the following gaps:

(a) outcomes,

(b) simulation design/setting,

(c) participants/facilitators, and

(d) research rigor.

Greatest obstacles: Time, resources, and support • Mariani, B., & Doolen, J. (2016, January). Nursing simulation research: What are the perceived gaps? Clinical Simulation in

Nursing, 12(1), 30-36. http://dx.doi.org/10.1016/j.ecns.2015.11.004.


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The Elephant in the Room

• Faculty Professional Development

– Lack of time release – added on content

– Fee structures – do not support lab resources and IT, lab staff support

– How are we working with faculty to prepare them?

• Continuing Education

• Competency requirements

• Evaluation


http://www.funicebreaker.com/wp-content/uploads/2012/12/elephant_copy_animal-1969px.png

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http://www.funicebreaker.com/wp-content/uploads/2012/12/elephant_copy_animal-1969px.png

Models for Integrating Simulation in the curriculum

• Map out curriculum identifying key competencies

• Create climate for faculty professional development – identify “Champions”

• Develop scenarios according to INACSL Best Practice StandardsSM

• Identify combination of teaching strategies use according to programs context


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Standard IX: Simulation DesignTo achieve optimal outcomes, simulation design should consider the following elements:1. Needs assessment2. Measurable objectives3. Format of simulation4. Clinical scenario or case5. Fidelity6. Facilitator/Facilitative approach7. Briefing8. Debriefing and/or feedback9. Evaluation10. Participant preparation11. Test of the design (Lioce et al., 2015, p. 310).


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Scenario Development

• Working in teams

• Focusing outcomes – clinical, team, leadership

• Coordinating the event – date, time, place, participants

• Small scale: in situ – e.g. Code in ER, PPH code in OB

• Large scale: disaster planning – include first responders, government, health care practitioners, and students


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Evidence-based practice (EBP) baseline for simulation scenario development

During simulation – Use current Evidence-Based Practice (EBP) guidelines

• Introduce EBP guidelines (or evidence-informed guidelines)

• Implement EBP guidelines throughout the scenario (incorporate as part of assessment check-list)

• Reinforce EBP guidelines during de-briefing or second-run of the scenario

• Assess for transfer to clinical skills by assessing on clinical evaluation tools

• Enhance synergy between classroom & clinical practiceHiOA Norway Faculty Workshop 05

March 2018 SHCampbell

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Future of Health Care Professional Education

• Simulation

• Web Based Learning - Virtual Simulation – Virtual Clinical Excursions TM (VCE) Elsevier

– Serious Gaming – e-Baby TM Serious Game

– Multiplayer Virtual Worlds

– Single User Products: CliniSpace TM (here); TINA TM; Second Life TM; ArchieMD TM

• Virtual RealityHiOA Norway Faculty Workshop 05 March 2018 SHCampbell

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https://evolve.elsevier.com/education/nursing/virtual-clinical-excursions/

http://www.scielo.br/scielo.php?pid=S0034-71672015000100013&script=sci_arttext&tlng=en

http://virtualsimcenter.clinispace.com/

Virtual Simulation – Future?


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• Photo of virtual reality glasses

Digital technology: VR, AR, Green-screen

• Green-screen technology: static photo or dynamic video as backdrop for illusion (e.g. car accident scene, University of Johannesburg)


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Photos: SHCampbell, University of Johannesburg, South Africa 9/20/2017


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Photos: SHCampbell, University of Johannesburg, South Africa 9/20/2017

Standardization Process

Contributing factors:• INACSL Best Practice Standards: Simulation SM

(2016)– Increased confidence in reliability of scenarios,

facilitation, teaching, and evaluation methods– NLN-INACSL Debriefing Across the Curriculum

• Society for Simulation in Healthcare (SSIH) Dictionary– Importance of speaking the same language

• Repository of Instruments Used in Simulation Research INACSL


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http://www.inacsl.org/i4a/pages/index.cfm?pageID=3407

http://www.nln.org/docs/default-source/about/nln-vision-series-(position-statements)/nln-vision-debriefing-across-the-curriculum.pdf?sfvrsn=0

http://www.ssih.org/Dictionary

http://www.inacsl.org/i4a/pages/index.cfm?pageID=3496

Next steps

I. Many opportunities to bridge the education- practice gap

and create innovative learning: need standardization,

assessment, evaluation

II. Critical Reflection of Learning – Debriefing depends on

initial objectives

III. Proceed with caution and use of theory in the

development of policies around clinical hours/

substitution – focus on competencies and measurable

learning outcomes

IV. Integrate incrementally – combine methodologies for best

return on investment


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Tell me more about your toolkit!

Thank you!

Contact Information:

[email protected]


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References - IPEInterprofessional Education - Key papers:

• A National Interprofessional Competency Framework. Canadian Interprofessional Health Collaborative, 2010. http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

• Core competencies for interprofessional collaborative practice: Report of an expert panel. Interprofessional Education Collaborative, 2011. http://www.aacn.nche.edu/education-resources/IPECReport.pdf

• World Health Organization (WHO). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization, 2010. Retrieved June 20, 2011 from: http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf


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http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

http://www.aacn.nche.edu/education-resources/IPECReport.pdf

http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf

References-IPE• IPEC (2011). Core Competencies for Interprofessional Collaborative Practice: Report of an Expert

Panel. Retrieved from http://www.aacn.nche.edu/education-resources/ipecreport.pdf.

• Frenk, J. and Chen, L. "Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World." The Lancet 376, (Dec 4, 2010): 1923-1958.

• Maxfield, D., Grenny, J., McMillan, R., Patterson, K. & Switzler, A. (2005). Silence Kills: The Seven Crucial Conversations in Healthcare. Retrieved from http://www.aacn.org/aacn/pubpolcy.nsf/Files/SilenceKillsExecSum

• A National Interprofessional Competency Framework. Canadian Interprofessional Health Collaborative, 2010. http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

• Quality and Safety education for Nurses: QSEN. Retrieved December 1st, 2011 from http://www.qsen.org/about_qsen.php

• World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Care. Geneva, World Health Organization. Retrieved from http://www.who.int/hrh/resources/framework_action/en/


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http://www.aacn.nche.edu/education-resources/ipecreport.pdf

http://www.aacn.org/aacn/pubpolcy.nsf/Files/SilenceKillsExecSum

http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

http://www.qsen.org/about_qsen.php

http://www.who.int/hrh/resources/framework_action/en/

References - Simulation• Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulation for

novice nursing students: Communication, confidence, clinical judgment. Nursing

Education Perspectives, 30, 79-82.

• Barrett, H.C. (2006). Researching and evaluating digital storytelling as a deep learning

tool. In C. Crawford et al. (Eds.), Proceedings of Society for Information Technology & Teacher

Education International Conference 2006, (pp. 647-654), Chesapeake, VA: AACE.

• Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo

Park: Addison-Wesley, pp. 13-34.

• Campbell, S.H. (2010). Chapter 8, Clinical simulation. In K.B. Gaberson and M.H.

Oermann, Clinical teaching strategies in nursing (3rd ed). (pp. 151-181). New York: Springer

Publishing Company.

• Campbell, S.H. (2013). Chapter 14 Obstetric Emergency: Post-partum hemorrhage. In

S.H. Campbell & K. Daley (eds) Simulation Scenarios for Nurse Educators: Making it REAL

(2nd Ed). (pp. 137-148). New York, N.Y.: Springer Publishing Company, Inc.

• Campbell, S.H. & Daley, K. Eds. (2018). Simulation scenarios for nursing educators: Making it

real. (3rd ed). New York, N.Y.: Springer Publishing, Inc.

• Clapper, T. C., & Ng, G. M. (2013, August). Why your TeamSTEPPS program may not

be working. Clinical Simulation in Nursing, 9(8), e287-e292.

doi:10.1016/j.ecns.2012.03.007.HiOA Norway Faculty Workshop 05 March

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References - Simulation• Daley, K. & Campbell, S.H. (2018). Chapter 44 Framework for Simulation Learning in

Nursing education. In S.H. Campbell & K. Daley (eds) Simulation Scenarios for Nursing

Educators: Making it real. (3rd Ed) (pp. 13-18). New York, N.Y.: Springer Publishing

Company, Inc.

• Decker S. I., Anderson M., Boese T., Epps C., McCarthy J., Motola I., Palaganas J., Perry

C., Puga F., Scolaro K., & Lioce L. (2015, June). Standards of best practice: Simulation

standard VIII: Simulation-enhanced interprofessional education (sim-IPE). Clinical

Simulation in Nursing, 11(6), 293-297. http://dx.doi.org/10.1016/j.ecns.2015.03.010.

• Jeffries, P. (2005). A framework for designing, implementing, and evaluating: Simulations

used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103.

• Kaakinen, J., & Arwood, E. (2009). Systematic review of nursing simulation literature for

use of learning theory. International Journal of Nursing Education Scholarship, 6, 1.

• Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C. (2010). A review of currently

published evaluation instruments for human patient simulation. Clinical Simulation in

Nursing, 6(1), e25-35. doi: 0.1016/j.ecns.2009.08.004

• Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development

(Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.


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http://dx.doi.org/10.1016/j.ecns.2015.03.010

References - Simulation• Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015, June). Standards

of best practice: Simulation standard IX: simulation design. Clinical Simulation in Nursing, 11(6),

309-315. http://dx.doi.org/10.1016/j.ecns.2015.03.005.

• Mariani, B., & Doolen, J. (2016, January). Nursing simulation research: What are the perceived

gaps? Clinical Simulation in Nursing, 12(1), 30-36. http://dx.doi.org/10.1016/j.ecns.2015.11.004.

• Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., Sando, C. R., & Borum, J.

C. (2013, June). Standards of Best Practice: Simulation Standard I: Terminology. Clinical

Simulation in Nursing, 9(6S), S3-S11. http://dx.doi.org/10.1016/j.ecns.2013.04.001.

• Mikasa, A. W., Cicero, T. F., & Adamson, K. A. (2013). Outcome-Based Evaluation Tool to

Evaluate Student Performance in High-Fidelity Simulation. Clinical Simulation in Nursing, 9(9),

e361-367. doi: 10.1016/j.ecns.2012.06.001

• Murdoch, N. L., Bottorff, J. L., & McCullough, D. (2013). Simulation Education Approaches to

Enhance Collaborative Healthcare: A Best Practices Review. International Journal of Nursing

Education Scholarship, 11, 307. doi: 10.1515/ijnes-2013-0027

• Pagano, M., O’Shea, E., Campbell, S., Currie, L., Chamberlin, E., & Pates, C. (2015). Validating

the Health Communication Assessment Tool (HCAT). Clinical Simulation in Nursing, 11, 402-410.

• Scherer, Y. K., Myers, J., O’Connor, T. D., & Haskins, M. (2013, March). Interprofessional

simulation to foster collaboration between nursing and medical students. Clinical Simulation in

Nursing, Vol(X), xx-xx. http://dx.doi.org/10.1016/j.ecns.2013.03.001.

• Young, P.K. (2004). Trying something new: Reform as embracing the possible, the familiar, and

the at-hand. Nursing Education Perspectives, 25, 124-30.HiOA Norway Faculty Workshop 05 March 2018 SHCampbell

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