Laerdal SUN meeting
Dallas Texas
October 2009
Mary Cato MSN, RN
Oregon Health & Science University
Where
to go
for help
How to
integrate?
Why
integrate?
VALUE OF SIMULATION INTEGRATION
“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

ISSENBERG
25% of studies cite integration of simulationbased 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.
WHY INTEGRATE SIMULATION?
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
WHERE IS IMPROVEMENT NEEDED?
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
MULTIPLE DOMAINS

Cognitive: mental skills (Knowledge)

Affective: growth in feelings or emotional
areas (Attitude)

Psychomotor: manual or physical skills (Skills)
ORIGINAL TERMINOLOGY
Evaluation
REVISED TERMINOLOGY
Creating
Synthesis
Evaluating
Analysis
Analyzing
Application
Applying
Comprehension
Understanding
Knowledge
Remembering
BLOOM’S TAXONOMY
EXPERIENTIAL LEARNING


Because simulation is
experiential learning,
objectives can be
higher level
Creating and evaluating,
for example, rather than
simply understanding or
remembering
Where
to go for
help
How to
integrate?
Why
integrate?
DETERMINE GOAL OF SIMULATION
Demonstrate
Evaluate
Practice
DEMONSTRATION

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
PRACTICE
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
POSSIBILITIES FOR PRACTICE
High, mid, and low fidelity manikins
 Standardized patients and participants
 Role-playing
 Computer simulation
 Virtual reality

WHY PRACTICE IN SIMULATION?
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
Context
Background
Relationship
Responding
Interpreting
Expectations
Initial Grasp
Reflection on action and
Clinical Learning
Reasoning Patterns
Analytic
Intuitive
Narrative
Reflection on
Action
Action
Outcomes
Reflecting
Tanner, CA (2006) Thinking like a nurse: A research-based model of clinical judgment.
Journal of Nursing Education, , 45(6), 204-211
DETERMINE TYPES OF EXPERIENCES




Who are the client case exemplars?
Common situations


Highly prevalent nursing practice situations
What students will most likely see in clinical



Lack of clinical experiences
Apply previously learned content
“Spiral up” the curricular content


Faculty & content experts
Space & equipment
High risk, low frequency situations
Resources available
LEVELING SCENARIO
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)

WHEN CAN THE OBJECTIVES BE MET?
Student
Prep
During
Simulation
Debriefing
Reflection
on
Learning
PREPARATION


Participant Handout
 Sent prior to simulation
 Policy/procedure review
 Skill review
 Role review
 Evidence-knowledge
review
Benefits
 Promotes self-directed
learning
 Promotes accountability
 Increases confidence
through preparation
 Identifies expectations
DURING THE SCENARIO
DURING THE DEBRIEFING
REFLECTION ON LEARNING
Occurs after the simulation session

Reflective journaling

Use of rubric

Individual learning – availability of faculty
outside of simulation session if needed
EVALUATION

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?
CONSEQUENCES OF PARTICIPATION
Practice
Evaluation
Deliberate
You pass
You fail
Learning
A, A-, B+,
B, B-
Where to
go for help
How to
integrate?
Why
integrate?
RESOURCES FOR FACULTY

Organizations
 INACSL
 SSiH
 NLN

Courses
 Workshops
 Apprenticeships
 Graduate
courses
SOURCES FOR SCENARIOS
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

SOURCES FOR SCENARIOS: PUBLICATIONS
“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
THE SIRC
Simulation Innovation Resource Center
SIRC COMPONENTS: TEMPLATE
RESEARCH QUESTIONS
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

FUTURE OF SIMULATION
Use of standardized patients
 Use of hybrid simulations
 Increased focus on management, delegation,
and leadership
 Integration of Electronic Medical Record
 Interprofessional activities
 Graduate programs
