Winds of change: Donna Ricketts, MSN, RN, CNE, OCN Cindy Frazer, MS, RN-BC, CNE, CMSRN Kristina Petrey, MSN, RN Yalanda Baker-Scalf, MSN, RN A struggle

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Winds of change:Donna Ricketts, MSN, RN, CNE, OCNCindy Frazer, MS, RN-BC, CNE, CMSRNKristina Petrey, MSN, RNYalanda Baker-Scalf, MSN, RN

A struggle to win buy-in and build a strong simulation program1ObjectivesDescribe a process used to ensure that a simulation program was thoughtfully integrated into an ADN curriculum.Discuss the literature regarding the use of simulation in nursing education.Discuss techniques to obtain faculty buy-in for simulation in a nursing education program.Determine specific questions that must be answered regarding development of simulation in a curriculum.

The simulation Task forceDonna Ricketts, MSN, RN, CNE, OCN3Rationale for Task ForceClinical Inconsistency

Limited clinical sites

Recognition of emerging trendsFormulation of Task ForceGrant funding

Simulation Task Force committee members

Choice of clinical release time/overtime pay

Original GoalDepartment Chair envisioned a formal simulation program to start in the Spring of 2011

Task force considering space, faculty & staffing issues, and equipment needed for a simulation center

Changes in FocusProgressed to incorporating simulation into curriculum .

Concepts that may be better taught using simulation

Opportunity for faculty to use simulation to meet student learning outcomesProcess and TimelineSeptember 3: Feedback from colleagues and seek programs to tour

September 17: Literature search and feedback of each level

October 1: Formulate a vision, review student learning outcomesProcess and TimelineOctober 15: First draft of simulation plan, continue to tour facilities

January 2011: Report to faculty

VisionSimulation will be utilized throughout the ADN curriculum to enhance didactic content and as a method to provide equitable client experiences for all students.

Review of the LiteratureCindy Frazer, MS, RN-BC, CNE, CMSRN11Literature Review Method4 independent reviews

Results integratedEach member of the committee independently undertook a review of the literature. That way, we were most likely to end up with the most complete review. The committee then met to integrate the results. We selected the most relevant and useful articles and divided them amongst the committee. Each member reviewed their assigned articles and prepared a summary for the committee. The committee met again to integrate the review. The last page of your handout is a bibliography of the literature that we selected.12Definition of simulationNo one clear definition of simulation

We defined simulation as:the act of imitating a nursing situation or process for the purposes of performance optimization including clinical reasoning, affective processing, and psychomotor skills.

There is no one accepted definition of simulation in nursing education. Several authors did emphasize that simulation is not new and encompasses much more than high-fidelity mannequins. We integrated the definitions and concepts that we found in the literature and defined simulation for our purposes as you see here. We deliberately wanted a very broad definition both to be complete and because we hoped that a broad definition would improve faculty buy-in.13Efficacy of simulation for nursing educationSimulation is effectivemore research neededGains inKnowledgeCritical thinkingConfidenceDebriefing is criticalA systematic review by Cant & Cooper (listed in your bibliography) found that the studies that have been done consistently validate simulation as an effective educational tool, but more research is still needed. The literature has consistently documented that students exposed to teaching by simulation make gains in knowledge, critical thinking, and confidence.The literature is also consistent is acknowledging that the debriefing process is critical to student learning. Faculty who are going to begin using simulation need to learn how to debrief much more that they need to learn how to run SimMan.14Uses of simulation in nursing educationStudents perceptionsIncreased confidenceEnjoy the experience


Amount of simulationNCSBN study

There are quite a few descriptions of specific uses of simulation in the literature that can help when planning a simulation program. There is a thorough consensus that students do like simulation and feel more competent after being exposed to simulation that question has been pretty well-answered. Most of the descriptions do address student learning outcomes in specific situations care of a postpartum patient, for example and there is literature addressing the use of simulation in most nursing specialties but there is no data about specific topics or patient care areas that are best addressed with simulation. Currently there is no information about the optimal amount of simulation or proportion of simulation to traditional clinical placement in a nursing curriculum. A few states mandate maximum amounts of clinical time that can be met through simulation, but most do not. You may be aware that the National Council of State Boards of Nursing is currently investigating this topic. Ten nursing programs ADN and BSN are participating. Students will be randomized to spend up to 10%, 25% or 50% of clinical time in simulation. Student performance will be evaluated using a leveled clinical competency instrument to compare student learning in the different groups. That study will go a long way toward answering that question.15Simulation for evaluationMinimal researchSubjectivityEvaluation may not be equitableHigh-stakes assessment via simulationEmploymentLicensure?

Simulation has not been tested rigorously as an assessment method. There are numerous articles describing rubrics, scales, and checklists, but very limited research on the accuracy and reproducibility of simulation as assessment. Im not aware of any data testing whether simulation accurately predicts real world performance. While it seems common sense that performance in simulation would predict real world performance, it may not be so. My own (very anecdotal) experience suggests that people may be more tuned in during a simulation that is much briefer than actual patient care and during which they know that their performance is being evaluated each moment.

The research that has been done suggests that accurate and equitable evaluation of a students performance during a simulation is difficult due to the subjectivity of the evaluation process and a tendency to evaluate a students performance based on knowledge of that students past performance (Gantt, 2010).

Some programs report using simulation as on part of a students clinical evaluation, instead of as a pass/fail test. The simulated clinical experiences can be used to identify students strengths and weaknesses to assist clinical instructors to plan assignments to better meet students needs and to validate clinical instructors own observations for evaluation purposes.

Despite the lack of evidence, it is predicted that our current students will likely be exposed to high-stakes assessment by simulation. Benner has proposed that simulation be used to determine licensure. While no regulatory agencies have yet made plans to use simulation to assess candidates for licensure, it is likely that our graduates will be exposed to high-stakes assessment via simulation if not for licensure, that quite possibly in the workplace (Hovancsek, 2007). Exposure to simulated learning experiences during pre-licensure education may help prepare graduates for any assessments via simulation they may encounter in the workplace or from certification and regulatory agencies. 16Faculty Buy-inKristina G. Petrey, MSN, RNFaculty Buy-InWhy do you need the faculty on board?

Is it possible to bring in a stray faculty member or group? 18Faculty Buy-InPoll the faculty

Identify the change agents

Know your team members19Faculty Buy-InSome faculty members might say:

I dont want to give up clinical time

I am not good with technology

Students wont value it20Faculty Buy-InExpand the vision of simulation

Gather like minds together

Define simulation

Literature review21Faculty Buy-InExpand the vision of simulation

Pilot simulation in one course

Involve as many faculty in process as possible

22Faculty Buy-In IDEASWhere do I start?

Educate faculty members about simulation

Remind faculty that this is not a new process23Faculty Buy-In IDEASWhere do I start?

Expose faculty to simulation Experiment with faculty during faculty development events 24Faculty Buy-In IDEASAdvertise

Give student success feedback to faculty

Invite faculty members to simulation experiences25Faculty Buy-In IDEASAdvertise

Gather detailed student feedback

Suggest various uses of simulation26What will work for your program?YALANDA BAKER-SCALF, MSN, RNCurriculum GoalsAccomplish student objectivesEnhance patient safetyDevelop critical thinkingPromote communication skillsIncrease emergency experiencesEqualize clinical experiences

To Use for Student Evaluation, or Not?Will the simulation be used for practice sessions only?Will the simulation be used for a graded check-off?

Resources NeededSimulation EquipmentPhysical Space for LabOther Supplies and EquipmentCost of Training of FacultyFaculty Time to Develop ScenariosPre-packaged scenariosObjectivesDescribe a process used to ensure that a simulation program was thoughtfully integrated into an ADN curriculum.Discuss the literature regarding the use of simulation in nursing education.Discuss techniques to obtain faculty buy-in for simulation in a nursing education program.Determine specific questions that must be answered regarding development of simulatio