Simulation: It Depends Georgia Association of Nursing Deans and Directors June 1-2, 2019 Teresa Gore, PhD, DNP, FNP-BC, FP-C, CHSE-A, FAAN Disclosures Dr. Teresa Gore University of South Florida College of Nursing Associate Professor Assistant Dean of Center for Experiential Learning and
Simulation Past INACSL President Serve as a Reviewer for CHSE-A Applicants for SSiH OBJECTIVES At the conclusion of this educational program, participants will be able to: 1. State the standards of best practice in simulation with manikins, standardized patients, certification, accreditation, and key resources 2. Determine how simulation can be
implemented using best practices 3. Identify strategies for faculty and curriculum development 4. Determine the resources needed for simulationist development, certification, and cost sharing 5. State a debriefing technique used in your institution or one you would like to pilot INACSL Standards of Best Practice: SimulationSM available at www.inacsl.org www.nursingsimulation.org ASPE Standards
https://advancesinsimulation.biomedcentral.com/track/pdf/10.1186/ s41077-017-0043-4 SSH Simulation Dictionary www.ssih.org/dictionary KEY References Certification http://www.ssih.org/Certification Accreditation http://www.ssih.org/Accreditation
IPEC Competencies 2016 https://ipecollaborative.org OSCEs http://mcc.ca/wp-content/uploads/OSCE-Booklet-2014.pdf http://www.oscehome.com/What_is_Objective-Structured-Clinical-Ex amination_OSCE.html NCSBN National Simulation Study (Hayden et al., 2014) https://www.ncsbn.org/5644.htm NCSBN Simulation Guidelines (Alexander et al., 2015) http://www.journalofnursingregulation.com/article/S2155-8256(15)3
Conundrum What is simulation How much simulation is the right amount and map it to curricula Simulation without best practices is worse than no simulation You MUST have a Simulation Champion Practice institutions are sometimes having to take the fear and anxiety away from new graduates related to simulation experiences in academia Levels of Perspective-SD.mp4
Importance of Theory in Simulation Theory provides the foundation of the learning experience Guides the development of the experience Debriefing method grounded in educational theory The NCSBN National Simulation Study and NCSBN Simulation Guidelines state simulation programs, especially debriefing, is based on educational theories associated with simulation in educational theory using subject matter experts and formally trained faculty in simulation pedagogy
For effective learner outcomes the learners need both traditional clinical and simulation experiences that are high quality and educational based Alexandertheory et al, 2015; Hayden et al., 2014; INACSL Standards Committee, 2016, 2017 Nursing Education Pedagogy & Theory Nurse educators need to guide, but not control; know, but not necessarily state; use dialogue without necessarily providing the only or best answer; and follow students when they are on a potentially productive
learning trail (Horsfall, Cleary & Hunt, 2012) Deliberate Practice & Scaffolding (Gonzalez & Kardong-Edgren, 2017) Constructivism Learners process experiences and learn with their environment HFS is closely aligned with constructivism principles, as experiential and inquiry (Parker & Myrick, 2009) NLN Permission to use Constructivism
The constructivist approach to teaching and learning is based on the concept that learners create their own meaning through interaction with the environment Scaffolding experiences Deliberate Practice Learning occurs in a variety of ways Huitt & Hummel (2003); Parker & Myrick, 2009; Powell & Kalina (2009) Image from https://www.tes.com/lessons/Nv5uA9kQCVXl0w/learning-theories
What is Simulation? Healthcare Simulation Dictionary: An educational technique that replaces or amplifies real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. INACSL: An educational strategy in which a particular set of conditions are created or replicated to resemble authentic situations that are possible in real life. Simulation care incorporate one or more
modalities to promote, improve, or validate a participants performance. INACSL Standards Committee, 2016, 2017; Lopreiato et al., 2016) Best Practices INACSL Standards of Best Practice: SimulationSM NCSBN National Simulation Study NCSBN Simulation Guidelines ASPE Standardized Patients Best Practice SSH Certification and Accreditation NCSBN National Simulation Study
Confident that substituting up to 50% simulation promotes outcomes similar to traditional clinical experience across prelicensure nursing curriculum Concern emerged that programs might substitute simulation for clinical without: adequately trained and committed simulation faculty dedicated simulation lab with appropriate resources Use the INACSL Standards and high quality simulations that are appropriate and realistic
faculty trained in debriefing based on a theoretical model (Hayden et al, 2014) NCSBN Simulation Guidelines Institutional commitment to the simulation program Long range plan documented for simulation usage Appropriate facilities to conduct simulation Educational and technological resources and equipment for simulation Qualified faculty and personnel to conduct simulation
Policies and procedures for simulation including job descriptions Alexander et al., 2015 Standard Simulation-based experiences are purposefully designed to meet identified objectives and optimize achievement of expected outcomes. Standard
All simulation experiences should begin with the development of measureable objectives designed to achieve expected outcomes. Standard A facilitator assumes responsibility and oversight for managing the entire simulation experience.
Criteria 1. A facilitator who has specific skills and knowledge in simulation pedagogy. 2. The approach is appropriate to the level of learning, experience, and competency of the participants. 3. Includes preparatory activities and a prebriefing to prepare participants for the simulation-based experience. 4. Involves the delivery of cues (predetermined and/or unplanned) aimed to assist participants in achieving expected outcomes. 5. Facilitation after and beyond the simulation experience aims to support learners
achievement of expected outcomes. Roles and Function Simulation Faculty/Facilitator Simulation Operations Specialist Clinical and Didactic Faculty or Adjuncts Roles Simulation Technician Moulage Artist IT
Technician OPERATIONS SPECIALIST A/V Technologist Operator Operations Manager 20 "Learning is not attained by
chance; it must be sought for with ardor and attended to with diligence. Abigail Adams, 1780 Standard All simulation experiences must include a planned debriefing session aimed at
improving future performance. Criteria 1. Facilitated by a person(s) competent in the process of debriefing. 2. Conducted in an environment that is conducive to learning and supports confidentiality, trust, open communication, self-analysis, feedback, and reection. 3. Facilitated by a person(s) who can devote enough concentrated attention during the simulation.
4. Based on a theoretical framework for debriefing that is structured in a purposeful way. 5. Congruent with the objectives and out comes of the simulation. Facilitators Role for Debriefing & Critical Thinking Establish a safe environment for reection During Reection Be supportive
Conducted in an environment that supports confidentiality, trust, open communication, self-analysis, and reection Encourage and engage group Listen attentively Help participant deal with feelings of ambiguity Monitor and facilitate group dynamics Promote patterns of recognition Facilitate transfer of knowledge Nurture commitment to action Challenge the participant to initiate change Support the participant to act on his/her insights
Debriefing Methods Debriefing for Meaningful Learning Debriefing with Good Judgement PEARLS Plus - Delta Debriefing for Meaningful Learning Uses Socratic question to challenge the taken-for-granted assumptions to uncover thinking associated with actions DML uses six phases for debriefing
that consistently guides the reection Engage Explore Explain Elaborate Evaluate Extend
Dreifuerst, 2015 Challenging Assumptions Right thinking but wrong action Wrong thinking and wrong action Wrong thinking but right action Right thinking and right action Debriefing with Good Judgment Rigorous reection process that guides participants to discover and resolve: Clinical issues in the simulation Behavioral dilemmas in the simulation
Increase the chances the participants will hear and process information from the facilitator during the debriefing Dr. Jenny Rudolph: Basic Assumption React Reset Get Curious Rudolph, Simon, Dufresne, & Ramer, 2006 Debriefing with Good Judgment Promoting Excellence and Reflective Learning in Simulation
(PEARLS) Performance Enhancement via Augmented Reective Learning in Simulation (PEARLS) mixed-methods approach Facilitator select and apply the appropriate debriefing methodology using a decision support aid Combines learner self-assessment, facilitating focused discussion, and providing information by directed feedback Incorporates scripted language to guide debriefing
Eppich & Cheng, 2015 Standard Professional integrity is demonstrated and upheld by all who are involved in simulation experiences. Undergraduate Curriculum and Transitioning to Practice
Map to NCLEX and practice competencies Semester 1 - Communication and vital signs Semester 2 - Medication administration Advanced Medical Surgical Sepsis Transition to practice - Care for Multiple patients In-Situ from a root cause analysis Microsoft Word
Document Adobe Acrobat Document Microsoft Excel Worksheet Graduate Curriculum Scaffolding and deliberate practice Map to Competencies OSCEs
Developing OSCEs Microsoft Word 97 - 2003 Document Microsoft Word Document ASPE Standard Five underlying values
Safety Quality Professionalism Accountability Collaboration Five domains of best practice Safe work environment Case development SP training for role portrayal, feedback, & completion of assessment instruments
Program management Professional development Lewis et al., 2017 Standard All simulation experiences require some form of participant evaluation. Types of Evaluations and Assessments Formative assessment Summative evaluation
High-Stakes Testing Tools to Evaluate The Who Participants ERPT Facilitator and Simulation Staff DASH TOOL https://harvardmedsim.org/debriefing-assessment-for-si mulation-in-healthcare-dash/ Team CCEI (Hayden, Keegan, Kardong-Edgren & Smiley 2014) TeamSTEPPS Review www.teamsteppsportal.org/ for more information on simulation training and evaluation tools
CLECS Dr. Kim Leighton (Leighton, 2015; Leighton, 2018) Contact her for permission to use [email protected] Simulation Design Scale (NLN) Educational Practices in Simulation Scale (EPSS) (NLN) SET-M (Leighton, Ravert, Mudra, & Macintosh, 2015) Evaluation Resources 39
http://caehealthcare.com/eng/resources /documentation/ http://simulation.laerdal.com/forum/file s/default.aspx http://qsen.org/teaching-strategies/simu lation/simulation-evaluation/ http://sirc.nln.org/ http://cdn.laerdal.com/downloads/f1124 /ABDDIGYM/4517_NLNScenario_SS.pdf http://ced505-tobnick.wikispaces.com/fil e/view/Student+Simulation+Evaluation+ Tool.pdf http://www.oscehome.com/links.html
Augmented and Virtual Simulation, and Gaming https://www.simxar.com/ https://youtu.be/567Eb-Gccn8 Fidelity INACSL: The ability to view or represent things as they are to enhance believability. The degree to which a simulated experience approaches reality: as fidelity increases, realism increases. The level of fidelity is determined by the
environment, the tools, and resources used, and many factors associated with the participants. Fidelity can involve a variety of dimensions. Healthcare Simulation Dictionary: The degree to which the simulation replicates the real event and/or workplace; this includes physical, psychological, and environmental elements. Modalities INACSL and Healthcare Simulation Dictionary: A term used to refer to the types of
simulation being used as part of the simulation activity, for example task trainers, manikin based, standardized/simulated patients, computer based, virtual reality, and hybrid. Hybrid Simulation Combination of technology with Standardized Patients, students or manikins https://www.avkin.com/products.html http://www.ventriloscope.com/produc ts.html
https://www.isimulate.com/auris/ Quotes Knowing is not enough; we must apply. Willing is not enough; we must do Ive learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. Johann Wolfgang von Goethe
Maya Angelou (1928 2014) Cost Models Consortium
Partnership Training Formal agreement IPP Simulation Salaries Warranties Standard Simulation enhanced interprofessional education (Sim-IPE) enables participants from different professions to
engage in a simulatedbased experience to achieve shared or linked objectives and outcomes. IPE & IPP & IPE Simulation IPEC Core Competencies Adobe Acrobat Document https://hsc.unm.edu/ipe/resources/ipec2016-core-competencies.pdf Microsoft Word
Document All disciplines in the education, practice, and simulation must be represented in the development, facilitation, debriefing, and evaluation For a task force, committee, etc with identified champion(s) Requires executive leadership support for success Microsoft Word Document Standard
All simulation education programs require systems and infrastructures to support and maintain operations Statement 1. Consistent terminology provides guidance and clear communication and reects shared values in simulation experiences,
research, and publications. 2. Knowledge and ideas are clearly communicated with consistent terminology to advance the science of simulation. Certified Individuals Worldwide as of May 1, 2019 www.ssih.org
CHSE 1392 CHSOS 304 CHSE-A 47 CHSE & CHSOS 37 CHSE-A & CHSOS - 2 Personal Professional credential Enhanced visibility to your employer Self-evaluation process as a result of
completing the certification Recognition by your peers Demonstrates that you meet the Standards Supports consistency in knowledge, processes, and outcomes Supports professional development Improves quality simulation activities, supporting the downstream effects of simulation Practice Exam Available through the application website
Can be taken even without having submitted your application 30 questions written by the same authors Includes rationales for each question that can be reviewed for up to 30 days Can be taken at home or at work Cost is $75 (USD) Preparatory Courses Official SSH courses ($275) 8 hour in-person courses developed by CHSOS Test Prep Subcommittee
0800-1700 schedule Lunch and resources included Much more in-depth preparation, helps you identify areas of need and develop a plan of action Schedule and registration of currently scheduled courses is on the web http://www.ssih.org/Events/CHSE-Pr ep-Workshops Graduate Simulation Certificate Programs List in not all inclusive
NLN Simulation Leadership Program/SIRC Drexel University University of Central Florida Bryan College of Nursing Boise State University INACSL-SSH Regional Workshops HPSN Conference SUN Conference Robert Morris University The Institute for Medical Simulation Program (Harvard) Seminole State College in Florida University of San Francisco University of Miami Simulation Hospital
Master of Healthcare Simulation This list is not inclusive University of Alabama in Birmingham Drexel University University of Essex University of Central Florida
University of San Francisco Questions? Contact Information Teresa Gore [email protected] Office 813-396-2318 Reference available upon request
