Taking Your First StepsSimulation IntegrationBeth Fentress Hallmark, RN, MSN, PhD(c)

Tiffany L. Holmes, D.C.

Objectives:

• Learn the benefits, challenges and emerging trends in the use of simulation

• How to integrate simulation into nursing curriculum.

Who are we:

• Beth Hallmark– Belmont University– Gordon E. Inman College of Health

Sciences and Nursing– Laerdal Center of Educational Excellence

• Tiffany L. Holmes– University of Texas at Arlington– College of Nursing Smart Hospital™– Laerdal Center of Educational Excellence

UT Arlington College of Nursing (UTACON)

• Ranked in the top 15 largest schools of nursing in U.S.

• 126 faculty, (102 FTEs)• Over 4,000 students in BSN, RN-to-BSN, MSN,

Post-MSN, DNP and PhD programs• Graduates 200 BSN students annually• 70-80 MSN and Post-Masters Nurse Practitioners

(NP) graduates who assume advanced roles as NPs, administrators, and educators.

UTACON’s Integration:

• 2003 – Smart Hospital™ Concept started• 2004 – Simulation Coordinator named• 2005 – Faculty development activities• 2006 – Simulation Technician hired• Jun. 2007 – Moved to new Smart Hospital

building

Transition from student to RN

Research shows new grads experience:

• Fear• Lack of confidence• Communication Deficits • Complex decision making• Contradictory information• Issues working with peers

Dyess, S., & Sherman, R.. (2009). The first year of practice: New graduate nurses' transition and learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-10. doi: 1864764661.

New Graduates say:

• They feel uncomfortable with:– IV skills– Physical Assessment– Care of the dying patient– Caring for patients with changing care

needs

– Marshburn, D., Engelke, M., & Swanson, M.. (2009). Relationships of New Nurses' Perceptions and Measured Performance-Based Clinical Competence. The Journal of Continuing Education in Nursing, 40(9), 426-32.  Retrieved November 2, 2009, from ProQuest Medical Library. (Document ID: 1864764651).

Practice Partners Say:

Students • Fail to perform relevant nursing actions

relating to specific disease states• Lack the ability to prioritize• Give incomplete or irrelevant

information to PCP• Have difficulty giving rationale for

nursing actions• Do not know laboratory values• Burns, P., & Poster, E.. (2008). Competency Development in New Registered Nurse Graduates: Closing the Gap Between Education and

Practice. The Journal of Continuing Education in Nursing, 39(2), 67-73.  Retrieved November 2, 2009, from ProQuest Medical Library. (Document ID: 1423354581).

Traditional Nursing Education

• Didactic• Lab• Clinical• Orientation at workplace

What can simulation do?

• Help promote teamwork and collaboration• Foster effective and safe communications• Delegation• Safe practices/Quality Improvement• Cultural awareness• Evidence based practice• Patient centered care

Advantages of Simulation

• Safe practice arena• Hands on• Exposure to rare/high risk events• Practice cognitive and psychomotor skills• Transfer to clinical setting• Immediate feedback• Reflective learning

New Strategies

• Simulation: Teaching Strategy• Simulation: Evaluation Tool

Types of Simulation

• Case Study• Role-playing• Standardized patients• Partial vs. Complex Task Trainers

– Static and Computerized • Integrated Simulators (HPS)

Types of Simulators

Fidelity

Low Fidelity: Task Trainers.

Medium Fidelity: non-responsive in terms of physiological signs but can have heart and lung sounds, etc.

High Fidelity: physiologically responsive to students actions or lack of action.

Simulation: Theory

• Active Learning• Reflective Thinking• Constructivism

Curricular Changes

• Examine where simulation naturally fits• Build simulations upon one another• Simple to complex• Students need exposure early in the

program• Use for remediation and clinical

makeup

Connecting the dots in courses:

• Labs• Didactic• Courses in same semester• How can we “marry” the content and

reiterate in simulation?• How can we re-frame the content we

are teaching in labs and didactic within simulation?

Standards

Identify your programs outcomes based on standards.– BSN Essentials– QSEN– IOM– Joint Commission– NCLEX

• Not just the standards that are r/t technology….i.e.: safety and communication

How do I overcome:

• Faculty Resistance– Time– Resources

• Technology assistance, equipment

– Pay– Administrative Assistance– Skills– Scheduling

What do I need?

• CHAMPION• Administrative Buy In• Money: Grants• Staff• Space• Faculty Development Plan• Policies • Mission Vision• Stakeholders

What do I need?

Champion• One or two people who are interested

in this new pedagogy.• Train the champions then bring back

info to the rest of faculty• Champion can send information to

others in form of literature and conference ideas

• Lead simulation committee/group

What do I need?

Administrative Buy In • How to accomplish this?• Bring in experts/consultants• Take them with you to meetings• Share with them what you learn at

conferences• Show them student evaluations• Demonstrate how simulation works• Peer pressure

What do I need? MONEY…..

MONEY…..• Grants • State • Federal• Local community organizations• National Private Funding groups

What do I need?

Staff• Simulation Director• Faculty: Simulation Committee Group• Technical Support: IT and Network

specialist• Supply specialist• Scheduling

What do I need?

Space• STORAGE, STORAGE, and still MORE STORAGE!!

• Preparation Area• Simulation Labs• Partitions?• Observation/Control Room• Debriefing room

What do I need?

Faculty Development Plan• Conferences• Lunch and Learn• SIRC.NLN.org• List serves

– INACSL– SSiH

• NLN• AACN• Invite them to play a part

Components to a Simulation

• Student Preparation• Objectives• Report• Actual Simulation• Debriefing• Evaluation

Student Preparation

• How does a student prepare for a simulation?

• Do you give them the case prior to the simulation?

• What are the objectives of the simulations?

• Formative or Summative• Case Study versus procedural prep

Objectives

• Need to fit with curricular objectives and course objectives

• Case by case • General safety and communication

Report

• Students need to learn how to receive and give report

• Use SBAR or other communication rubrics

• Ask practice partners for the system they use

Simulation

• Scenarios– Pre programmed – Make it your own

• Validate with practice partners• Reality: suspend• Fiction Contract

Debriefing

• Reflection• Learner uses previous knowledge to

build upon• Bad Habits develop if not addressed• Video taping

Evaluation

• Formative or Summative Evaluation

Support: Find a Network

• Tennessee Simulation Alliance• INACSL (www.inacsl.org)• SSiH (www.SSiH.org)• NLN SIRC (www.sirc.nln.org)• Simulation Users Network (SUN)

Questions?