Simulation Integration Beth Fentress Hallmark PhD RN Belmont University College of Health Sciences Introduction Beth Hallmark PhD RN Belmont University Director of Simulation Gordon E Inman College of Health Sciences and Nursing ID: 481952
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Slide1
Taking Your First Steps
Simulation Integration
Beth Fentress Hallmark, PhD, RN
Belmont University College of Health SciencesSlide2
Introduction:
Beth Hallmark, PhD, RNBelmont UniversityDirector of Simulation, Gordon E. Inman College of Health Sciences and Nursing
Laerdal Center of Educational ExcellenceDirector Tennessee Simulation AllianceSlide3
Objectives:
Identify the benefits, challenges and emerging trends in the use of simulationIdentify what is driving simulation education
Discover ways to integrate simulation into nursing curriculumIdentify courses where simulation may help you reach curricular objectives.Verbalize training resources for your schoolSlide4
Belmont University
Nashville, Tennessee
7,000 + students
College of Health Sciences
Inter-professional EducationNursing
Accelerated, Fast track and Traditional BSN
FNP, DNP
Social Work (BSW)
Physical Therapy (
DOT)
Occupational Therapy (
DPT/MSOT)
Pharm DSlide5
Belmont’s Integration:
May 2006 – Gordon E. Inman College of Health Sciences and Nursing
August 2006 – Simulation Coordinator named
Spring 2007 – Faculty development activities
Fall 2010 McWhorter Center
Established one physical space for COHSSlide6
Belmont University
Nashville, Tennessee
2- Eight bed Adult Health laboratories
8 bed “Acute care” lab
6 bed Peds lab
8 bed Health Assessment/OB lab
4 Inter-professional private patient roomsSlide7
Inman Center
77,000 square feet
Designed to house Nursing, Occupational Therapy, and Social WorkConference Center on 4th
floorPlanning for building began Spring 2004Groundbreaking October 2004, moved in May 18, 2006Slide8
Adult Health Nursing Lab
Functioning headwalls (compressed air/suction)
Lift equipment
“Storage” converted to “clean utility room” – materials managementSlide9
McWhorter Hall
Designed to house Pharmacy, PT, (Chem
labs)90,000 square feetRetail PharmacyHealth Services Clinic4 Sim
Rooms/SPand mannequinsSlide10
MISSION & VISION
Mission of the Health Care Simulation Center is to provide high quality experiential education through innovative simulation based teaching and inter-professional collaboration to enhance clinical reasoning and safe practices in health care.
Vision for the Future: National Leaders in interprofessional healthcare simulation.Slide11
Belmont’s SON Goals
Prepare the novice nurse for clinical practice
Link Concepts & Critical Thinking to Practice Progressive ComplexityTheoretical SupportSlide12
Why Integrate Simulation?
The true value of simulation lies in its ability to offer experiences throughout the educational process that provide students with opportunities for:
Repetitionpattern recognition, and faster decision making.”
Doyle & Leighton, 2010Slide13
Why Integrate Simulation?
Bridging the gap between education and practice“90% of nurse educators
think their graduates are ready to safely practice VS. 10% of hospital administrators”
JONA , November 2008Slide14
Transition from student to RN
Research shows new grads experience:FearLack of confidence
Communication deficits Complex decision makingContradictory informationIssues 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.Slide15
New Graduates say:
They feel uncomfortable with: IV skills
Physical AssessmentCare of the dying patientCaring 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).Slide16
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 d
ifficulty
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).Slide17
Simulation TrainingSlide18
Adult Learner: self direction“High fidelity team simulation combined with reflective debriefing teaches learners to monitor and question their mental models and practice behaviors”
“Vivid experiences in simulation stimulates the ‘need to know’ that motivates adult learner”
Experiential Learning and SimulationSlide19
The Shifting Paradigm
OLD
Didactic
See one do oneSilos
Practice on patientsLearn from mistakes on LIVE patients
NEW
Self-directed
Practice to pre-defined standards or competency using simulators
Learn from your mistakes on SIMULATED patients
Team Training
ReflectionSlide20
Risk Management
Most serious medical errors are committed bycompetent, caring people doing what other competent, caring people would do.”
-Donald M. Berwick, MD, MPPNot just about the people, it is about the design:
System, medical devices, procedures, policesHuman Factors: safeguard in the design“making it difficult for people to do the wrong thing”Slide21
Environmental Organizational
IndividualTeam Patient Related
Factors that increase risk of errorSlide22
Root Cause Information for Medication Error Events
Reviewed by The Joint
Commission(Resulting in death or permanent loss of function)
2004 through 2011 (N=333)
The majority of events have multiple root causes
Medication Use 292
Leadership 248
Communication 242
Human Factors 239
Assessment 138
Information Management 127
Physical Environment 63
Continuum of Care 33
Care Planning 32
Patient Education Slide23
Realistic Learning Experience• Medical issues
• Legal issues• Patient relation issues• Ethical issues
Identification of Potential System FailuresRepair System FailuresTest New SystemsTeam SimulationEmployee Satisfaction and Retention
Student and Patient SatisfactionRisk Reduction$$$$$$ Savings
Advantages to using simulationSlide24
“Training multidisciplinary teams using simulation is an effective strategy for reducing surgical errors counts”
Helmreich & Merritt, 1998“Simulation-based training in team coordination process has been found to be an effective tool for improving team coordination process in high performance teams in the Navy”
Cannon-Bowers & Salas, 1998Slide25
How can you use simulation?
Crisis Management
FlexibilityUse factual knowledge
Critical thinkingTeam interactionResponse time
Communication SkillsPlanningStrategy Multiple DecisionsCollaborationSlide26
Clinical timeState by State regulations in nursing education
Lab timeOrientationIn situRemediation
What areas do you have difficulties in clinical placement? OB? PEDS? PYSCH? EMR/MEDS?High Risk Lo Volume incidents
Where can you use simulation?Slide27
Why do we plan?
“If simulation is instituted in a curriculum prior to completion of evaluation planning, the potential for pedagogic improvement may be jeopardized”.
Schlairet, 2011. Slide28
Why Integrate Simulation?
Deliberate practice Healthcare Technologies
Team trainingQuality and safetyDelegationTherapeutic communication/Inter-professional Clinical Judgment/Decision-MakingSlide29
What can simulation do?
Help promote teamwork and collaborationFoster effective and safe communications
DelegationSafe practices/Quality ImprovementCultural awarenessEvidence based practicePatient centered careSlide30
Advantages of Simulation
Safe practice arenaHands onExposure to rare/high risk events
Practice cognitive and psychomotor skillsTransfer to clinical settingImmediate feedbackReflective learningSlide31
Where to start?
Seropian et al. (2004) recommended eight steps to institute a simulation program:
Develop a vision to show what is to be achieved, who will be involved, and how the laboratory will be used.Generate a
business plan to outline initial and annual fiscal obligations.Identify and seek support from stakeholders
.Construct the facility or laboratory, as defined in the vision and the business plan, including the equipment purchase.
Provide
training
for all individuals who will be involved.
Develop
the curriculum.
Faculty training
.
Determine
policies and procedures
.
Collect Data!Slide32
Vision/Mission/Goals
Spend time working on this before you jump in head first to simulation..if you did not do it in this order..BACK UP!Slide33
Business Plan
SustainabilityPlanningShow ROIBudget 3, 5 years out
StaffingSlide34
Other
Maintain a working lab group to create change.
Strengthen partnerships with local medical centersDevelop relationships with vendorsProvide consistent and timely communications between the lab group, faculty and administration.
Maintain records to identify areas of needed improvementHire faculty and staff that are qualified to support our visionSlide35
Other
Manage the financial resources to provide the most sophisticated equipment available.Develop simulation within every course in the curriculum.
Benchmark through electronic resources and by developing relationships with experts in the field.Inventory managementMaintenance of Capital equipment.Slide36
Stakeholders!
Who?Why?Where ?What can they do for you?
What can you do for them?Slide37
Curriculum Development
PLANPLAN PLAN!!Slide38
Lab/Simulation Committee
Lab Committee/simulation groupLab coordinatorChampions
Share with faculty new standards (ie: SBAR, QSEN)Map skills throughout curriculum (“lets do blood now”)Develop a written plan
Mission and visionGoalsSlide39
Learning Domains
Cognitive: “involves knowledge and the development of intellectual skills. This includes the recall or recognition of specific facts, procedural patterns, and concepts that serve in the development of intellectual abilities and skills”
In Nursing Education; what falls in the cognitive domain?http://www.nwlink.com/~donclark/hrd/bloom.htmlSlide40
Learning Domains
Affective: “manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes”.
In Nursing education what falls in the affective domain?http://www.nwlink.com/~donclark/hrd/bloom.htmlSlide41
Learning Domains
Psychomotor: “includes physical movement, coordination, and use of the motor-skill areas. Development of these skills requires practice and is measured in terms of speed, precision, distance, procedures, or techniques in execution”.
What falls in the psychomotor domain?http://www.nwlink.com/~donclark/hrd/bloom.htmlSlide42
Traditional Nursing Education
DidacticLabClinicalOrientation at workplace
CEUsSlide43
New Strategies
Simulation as a Teaching StrategySimulation as an Evaluation ToolHigh stakes?Slide44
Types of Simulation
Case StudyRole-playingStandardized patientsPartial vs. Complex Task Trainers
Static and Computerized Integrated Simulators (HPS)Virtual Simulation/OnlineSlide45
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.Slide46
Simulation: Theory
Active LearningReflective ThinkingConstructivismSlide47Slide48
Curricular Changes
Examine where simulation naturally fitsOutline a plan based on each semesterBuild simulations upon one another
Simple to complexStudents need exposure early in the programUse for remediation and clinical makeupSlide49
Connecting the dots in courses:
LabsDidacticCourses in same semesterHow 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?Slide50
Standards
Identify your programs outcomes based on standards.BSN Essentials
QSENIOMJoint CommissionNCLEXCore
Competencies for Interprofessional Collaborative PracticeSlide51
How do I overcome:
Faculty ResistanceTimeResourcesTechnology assistance, equipment
PayAdministrative AssistanceSkillsSchedulingSlide52
What do I need?
CHAMPIONAdministrative Buy InMoney: GrantsStaff
SpaceFaculty Development PlanPolicies Mission VisionStakeholdersSlide53
What do I need?
ChampionOne 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 ideasLead simulation committee/groupSlide54
What do I need?
Administrative Buy In How to accomplish this?
Bring in experts/consultantsTake them with you to meetingsShare with them what you learn at conferencesShow them student evaluations
Demonstrate how simulation worksPeer pressureSlide55
What do I need? MONEY…..
MONEY…..Grants State Federal
Local community organizationsNational Private Funding groupsSlide56
What do I need?
StaffSimulation DirectorFaculty: Simulation Committee GroupTechnical Support: IT and Network specialist
Supply specialistScheduling Slide57
What do I need?
SpaceSTORAGE, STORAGE, and still MORE STORAGE!!
Preparation AreaSimulation LabsPartitions?Observation/Control RoomDebriefing roomSlide58
What do I need?
Faculty Development PlanConferencesLunch and Learn
SIRC.NLN.orgList servesINACSLSSiHNLN
AACNInvite them to play a partSlide59
Components to a Simulation
Student PreparationObjectivesReportActual Simulation
DebriefingEvaluationSlide60
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 SummativeCase Study versus procedural prepSlide61
Objectives
Need to fit with curricular objectives and course objectivesCase by case General safety and communication
So many moreSlide62
Report
One example of integrationStudents need to learn how to receive and give reportUse SBAR or other communication rubrics
Ask practice partners for the system they useSlide63
Simulation
ScenariosPre programmed Make it your ownValidate with practice partners
Faculty script/training Reality: suspendFiction ContractSlide64
Debriefing
ReflectionTRAIN faculty/methodLearner uses previous knowledge to build uponBad Habits develop if not addressed
Video tapingDASH model for training faculty Slide65
Evaluation
MUST be based on your objectives!Remember to link your simulation objectives to your course..to your program..to the college..etcFormative or Summative Evaluation
Evaluation rubric Slide66
Where can you use clinical sims?Slide67
What can we examine in acute care?
Patient SafetyTeamCommunicationSlide68
Nursing Education
ConfidenceSelf-EfficacySkillsCommunication
Test scoresNLN: High StakesNCSBN: Clinical ReplacementSlide69
Your curricular objectives should dictate what simulators, what information and what simulation you need
Team simulationSkills are a small percentage of the trainingProcess oriented simulationLeadership is essential
Effective communication is a must componentEducation should be universal, pro-active and non-punitive?HIGH STAKES?
Examine CurriculumSlide70
Clinical Skills integrated in a summative simulationSterile procedure:
foley, dressing changeMedication administration: insulin, Flu, pain medVitals/assessmentClamp NG
Introduction to NursingSlide71
Severe dehydrationBowel ObstructionIV fluid bolus
OxygenZofran
Adult Health OneSlide72
Post Partum bleedAntepartum: Hyperemesis, PIH, pre- term labor
Mega Sim Scenario: Doctors office early labor delivery code and postpartum
ObstetricsSlide73
DepressionSchizophrenia: Neuroleptic
Malignant SyndromeAlcohol withdrawal
PsychiatricSlide74
PEDS
RespiratoryALLSkillsSlide75
Adult Health Two
End of LifeCodesBlood Slide76
Leadership
DelegationNurse practice ActSlide77
Other Disciplines
OT and PT lines acute carePharm medication dosage
InterprofessionalSlide78
Nursing EducationMedical Education
Literature reviewSlide79
Support: Find a Network
Tennessee Simulation Alliance (www.tnsim.org)INACSL (www.inacsl.org)SSiH (
www.SSiH.org)NLN SIRC (www.sirc.nln.org)
Simulation Users Network (SUN)Slide80
Questions?