Lori Lioce, DNP, CRNP

Clinical Assistant Professor

University of Alabama Huntsville

Breaking the mold: Large class simulation in a day

SIMULATION CENTERS

Objectives

1. Audience will be able to understand theoretical and curriculum integration framework for simulation

2. Audience will be able to discuss a rotation schedule for a large class

3. Audience will be able to explain resources to facilitate simulation large class

4. Lessons Learned

HISTORICAL PERSPECTIVE

1ST SIMULATION FRAMEWORK PUBLISHED IN 2005 NLN JEFFRIES

FRAMEWORKS 23 CONSTRUCTS OF 3 ECLECTIC

THEORIES LEARNING THEORIES, GRAND &

MIDDLE RANGE THEORIES TANNER 2006 HOW TO THINK LIKE A

NURSE

Systematic Review

“ concludes most nursing faculty approach simulation from a teaching paradigm rather than a learning paradigm. For simulation to foster student learning there must be a fundamental shift from a teaching paradigm to a learning paradigm and a foundational learning theory to design and evaluate simulation should be used”. Kaakinen, Joanna and Arwood,

Ellyn, 2009

Simulation Literature ReviewSource Finding

NLN, 2006 “students engaged in high-fidelity simulation reported higher satisfaction scores in their learning experience and an increased confidence rating. …students given paper/pencil case study did not perceive as many problem solving features as students actively involved in high-fidelity simulation”.

Conner, 2006

offers learning for all: visual learners, auditory learners, and tactile learners

Jeffries, 2007

offers students the ability to participate in patient care, testing their decision-making and clinical reasoning skills in real time

Dewey (1933) & Kolb (1984)

learner’s reflective observation about an experience is essential in the long term learning process

Simulation requires students activate prior knowledge in order to

construct new knowledge active engagement in real-time

learning to revise their thinking and try out

new ideas by applying them and reflecting on the impact of those decisions

the student to utilize meta-cognition or “to know what they know” National Research

Council, 1999

Experiential Learning (Kolb) Learner Centered Learning Learning styles in a multi-

dimensional format Perception (grasping) and processing

(transformation) 4 ASPECTS:

providing a concrete experience reflective observation conceptualization active experimentation.

Armstrong’s Curriculum Planning Framework

Reinforces student centered learning Learners may be kinesthetic,

auditory, or visual and succeed within this framework

UAB GEC, 2011.

Blended Kolb

& Armstrong

Types of Evaluation

Formative ongoing gives students feedback,

addresses gaps

Summative end of term – how competent - grade

2006

Tanner’s Clinical Judgment Model

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Setting up for success

128 Students 9 hours 4 high-fidelity simulators

128 students

Each group of 32

ONE 2 HOUR = 4 Groups of 8

Clinical Group

Division

Resources

4 Simulators Sim Coordinator/Faculty Expert 4 Faculty 9 hours Supplies Preparation Time

Consistent Repetitive Format Introduction to simulation/simulator Pre-test Scenario Overview-Observers/Participants

assigned Scenario #1 Debriefing with video review Scenario #2 Debriefing with video review Post Test Evaluations of facilitator and experience

Course Manager/Liason

Meeting with simulation coordinator at the beginning/end of each semester

Connecting the didactic portions of course to clinical simulation

Selecting the appropriate case scenarios with coordinator (reservation form must be completed)

Reserving LRC equipment and rooms through the LRC Director

Selecting an evaluation method Coordinating clinical group rotation for simulation Completion of evaluations and tests Documents are maintained at LRC in simulation

filing cabinet and data entered by GTA

Rotation Schedule Examples

Audience Discussion

Lessons Learned Clinical Attire = Clinical Performance = Uniforms ALL Faculty Training + Student Trust Set up for Success Post student learner documents for scenario 1-2 weeks prior EBP article information 1-2 weeks prior Do not “assign” roles – limits their thinking to only their

assignment Recording (no student) Card reader Data Storage Management Process /flow Academic Teaching Preferences Post Evaluation & Debriefing Method Agreement Team training Continuous Assessment Increasing Reliability and Validity Plan

SUCCESSFUL SIMS

Scenario/Didactic Faculty Preparation Integrate Standardized Case Study EBP Article Rigor/Consistency Reliability/Validity Continuous Consistent Evaluation &

Planning

Not everything that counts,

can be counted andNot everything that can

be counted, counts.

Albert Einstein

ReferencesArundell, F., & Cioffi, J. (2005). Using a simulation strategy: An educator’s experience. Nurse Education in Practice, 5.

Brown, J. S., Collins, A., & Duguid, S. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32-42.

Byrne, D. (1985). Simulation work with large classes. English Teachers’ Journal 32, 26-33.

Gaba, D. M. (2007). The future vision of simulation in healthcare. Simulation in Healthcare, 2.

Gordon, J. (2004). High fidelity patient simulation: A revolution in medical education. In W.L. Dunn (Ed.), Simulators in critical care and beyond (pg 3 6). U.S.A.: Des Plaines, IL.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Jeffries, P. (2007). Simulation in Nursing Education: From Conceptualization to Evaluation. National League of Nursing.

Kaakinen, J., & Arwood, E. (2009). Systematic review of nursing simulation literature for use of learning theory. International Journal of Nursing Education Scholarship, (6)1.

Larew, C., Lessons, S., Spunt, D., Foster, D., & Covington, B. (2006). Innovations in clinical simulation: Application of Benner’s theory in an interactive patient care simulation. Nursing Education Perspectives, 27(1). National League for Nursing, New York.

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503.

Lashley, M. (2005). Teaching health assessment in the virtual classroom. Journal of Nursing Education, 44(8), 348-350.

Lave, J., & Wenger, E. (1990). Situated learning: Legitimate peripheral participation. Cambridge, UK: Cambridge University Press. Retrieved from www.learning-Theories.com

Paulson, D., & Faust, J. (2011). Learning for the college classroom. Center for Research on Learning and Teaching: The Regents of the University of Michigan. Retrieved from http://www.calstatela.edu/dept/chem/chem2/Active/main.htm

Rance-Roney, J. (2010). Reconceptualizing interactional groups: Grouping schemes for maximizing language learning. English Teaching Forum, 48, 20-26.

Rauen, C. (June 2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care Nurse, 24(3), 46-51.

Shoemaker, M., Beasley, J., Cooper, M., Perkins, R., Smith, J., & Swank, C. (2011). A method for providing high-volume inter-professional simulation encounters in physical and occupational therapy education programs. Journal of Allied Health Professionals. (40)1 15-21.

Tuller, M., Gonzalez, M., and Rice, J. (2009). Using simulation as an effective teaching strategy: A faculty guide. University of Texas Health Science Center: San Antonio School of Nursing.

Waldner, M., & Olson, J. (2007). Taking the patient to the classroom: Applying theoretical frameworks to simulation in nursing education. International Journal of Nursing Education Scholarship, (4)1.

Weiner, E. (2008). Supporting the integration of technology into contemporary nursing education. Nursing Clinics of North America, 43, 497-506.

QUESTIONS

Jeffries 2007

Synthesize knowledge Make mistakes, learn from their mistakes,

and immediately correct mistakes Integrate evidence Work in Collaboration Provide ethical and safe care Allows for clinical reasoning Practice decision making skills Reflections on their skills and decision

making Develop self-confidence Develops leadership and delegation skills

Thinking like a nurse: a research-based model of clinical judgment in nursing.(1) Clinical judgments are more influenced by what nurses

bring to the situation than the objective data about the situation at hand;

(2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns;

(3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit;

(4) Nurses use a variety of reasoning patterns alone or in combination; and

(5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning.

Tanner, CA J Nurs Educ. 2006 Jun;45(6):204-11.

Implementation proposal for simulation

Four domains of clinical judgment: Noticing Interpreting Responding Reflecting

Provides an evaluation tool in which educators may benchmark progress and implement goal setting with students

Chris Tanner’s Clinical Judgment Model

C.J. PROMPTS

What did you notice about your patient when you walked into the room?

What you expected to see? You assessed... What did you make of

those findings? What were your initial priorities? How did they change? Your patient said “.....” What do you

think was important to her/him at this time?

UNDERPINNINGS OF CJ RESEARCH OUTCOMES DRIVE LEARNING

STRATEGIES AND EVALUATION THEORY PRACTICE GAP STILL EXISTS

(CARNEGIE FOUNDATION BENNER PROFESSIONAL PREPARATION)

LEARNER CENTERED

UNDERPINNINGS OF CJ RESEARCH OUTCOMES DRIVE LEARNING

STRATEGIES AND EVALUATION THEORY PRACTICE GAP STILL EXISTS

(CARNEGIE FOUNDATION BENNER PROFESSIONAL PREPARATION)

LEARNER CENTERED

Lassater Rubric

Clinical reasoning process into common language that will help us all

Identify a developmental scale that students could see themselves on

Use to set goals for themselves and identify next steps

Uses the 4 aspects of Tanner & adds dimension (words across top descriptors)

Goal accomplished level before they leave program

Developmental = does not equivalate to grades

Change the setting goes back to beginning level

Topics to Consider

MORE LEVELS THAN PASS FAIL—RIGHT NOW ALMOST ALL PASS CLINICAL

HOW WELL DO THEY UNDERSTAND THE BACKGROUND TO FOCUS THEIR ASSESSMENT

WHAT DO YOU DO WITH STUDENTS WHO DON’T HAVE A GOOD GRASP

WHAT DOES PATIENT/NURSE BRING TO SITUATION

ARE THEY CAPABLE OF APPLYING INFORMATION TO MULTIPLE SOURCES?

Utilize NCLEX TEST PLAN, QSEN, JCAHO ex: recommends use memory aid – for report etc

National Research Council, 1999. “How People Learn” downloaded on July 17,2011 from http://www.pkal.org/documents/HowPeopleLearn1999Page16.cfm