9/28/2015. To This: USING SIMULATION TO BRIDGE THE GAP BETWEEN NOVICE AND EXPERT WHAT IS SIMULATION? SIMULATION

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1 USING SIMULATION TO BRIDGE THE GAP BETWEEN NOVICE AND EXPERT Kevin V. Stevens, MSN, RN, CHSE Director, Center of Excellence in Clinical Performance and Simulation WSU College of Nursing SIMULATION I hear and I forget. I see and I remember. I do and I understand. -Confucius Something we have always done that has evolved from this: WHAT IS SIMULATION? To This: DEFINITION INTERNATIONAL NURSING ASSOCIATION FOR CLINICAL SIMULATION AND LEARNING (INACSL) Defines simulation as: A pedagogy utilizing one or more typologies to promote, improve, and/or validate the progression from skills attainment through clinical judgement. Purpose: to replicate some or nearly all of the essential aspects of a clinical situation so that the situation may be more readily understood and managed when it occurs for real in clinical practice. (Morton, 1995) 1

2 WHAT ARE THE ADVANTAGE S TO USING SIMULATION? Provide experiences High risk, low volume: Codes, PPH, shoulder dystocia Standardized for all staff Team work emphasized Controlled environment--set objectives Foster clinical judgment, critical thinking Immediate feedback to participants by Debriefing ature=player_embedded HISTORY : Mrs. Chase low fidelity life size manikin used at Hartford hospital to teach basic nursing skills - Task trainers developed for catheter insertion, wound care, ng tubes s: Resusci Anne (Laerdal) - Late 1990s: Intro of affordable Human Patient Simulators : High Fidelity- SimMan SIMULATION IN NURSING EDUCATION -Widely accepted as a valuable educational tool - National nursing shortage - Growth of nursing programs - Shortage of clinical sites -Defined as: Patient care scenario, participants, a manikin, Standardized Patient, or Hybrid -Followed by reflective Debriefing -scenario deconstructed, analyzed -Feedback given to participants 3G, Meti integrity Man caring altruism social justice maximizing human potential PREVALENCE IN NURSING EDUCATION NCSBN survey (2010) 1729 mailed to prelicensure nursing programs 62% response rate from every state: colleges, universities, tech schools 87% used high or midfidelity simulation 54% used simulation in 5 or more nursing courses NCSBN NATIONAL SIMULATION STUDY Highlighted currently known best practices in simulation use Evaluated the learning occurring with various amounts of simulation substituted for clinical hours Established key simulation standards and learning experiences Evaluated new graduates ability to translate educational experiences into the workplace 2

3 RESEARCH DESIGN Large scale 847 students WSU-72 Multi-site 10 schools Longitudinal Randomized Controlled Follow-up component Control Group 25% Group 50% Group STUDY GROUPS Traditional clinical experiences as usual (up to 10% simulation) 25% of clinical time spent in simulation 75% spent in traditional clinical 50% clinical time spent in simulation 50% of time traditional clinical RESEARCH QUESTIONS PHASE II 1. Does substituting clinical hours with 25% and 50% simulation impact educational outcomes (knowledge, clinical competency, critical thinking and readiness for practice) assessed at the end of the undergraduate nursing program? 2. Are there course by course differences in nursing knowledge, clinical competency, and perception of learning needs among undergraduate students when traditional clinical hours are substituted with 25% and 50% simulation? 3. Are there differences in first-time NCLEX pass rates between students that were randomized into a control group, 25% and 50% of traditional clinical substituted with simulation? PHASE III CLINICAL PRACTICE IN THE WORKPLACE 1. Are there differences in clinical competency, critical thinking and readiness for practice among new graduate nurses from the 3 study groups? 2. Are there differences among new graduates from the 3 study groups in acclimation to the role of the professional nurse? CONCLUSIONS 1. Up to 50% simulation was effectively substituted for traditional clinical experience in all core courses across the prelicensure nursing curriculum. 2. Comparable outcomes were achieved by the 3 study groups from 10 educational programs which consisted of students from ADN and BSN programs, in urban and rural communities across the country. 3. Up to 50% simulation was effectively substituted for traditional clinical experience without affecting NCLEX pass rates. 3

4 CONCLUSIONS 4. All 3 groups were equally prepared for entry into practice as a new graduate RN. 5. Policy decisions regarding the use and amount of simulation in nursing needs to be dependent upon the utilization of best practices in simulation. Can replicate a clinical situation/more realistic Low volume, High risk Enhances acquisition/ retention of knowledge Sharpens critical thinking/psychomotor skills Allows for critical analysis of actions Job satisfaction WHY USE SIMULATION? WHY USE SIMULATION? JCAHO 2004 Sentinel Event Alert: Preventing Infant death and injury during delivery Communication top cause of identified root causes Recommend team training Clinical drills for SD, PPH, emerg Csec and NRP to prepare staff IOM recommends simulation as method of teaching effective responses to complex/high risk situations AHRQ supports simulation as a method to improve patient safety and patient outcomes WHY USE SIMULATION? L & D units are high risk, high cost environments Rural hospitals challenging Staff must be prepared to handle challenges that are high risk, low volume Need practice interventions Maintain skill levels/clinical competency Nurse satisfaction/retention TYPES OF SIMULATION Emergency drills PPH, Shoulder dystocia, Emergency section Daily tasks Labor assessments for admit FHR strip assessments Other competencies Interdisciplinary Team training Why would an OB emergency be any different than a code scenario? WHY USE SIMULATION TO BRIDGE THE GAP? Benners Novice to Expert Theory Stages of Clinical Competence Novice...New graduate, no experience Advanced Beginner yrs experience Competent years Proficient... 3 plus years Expert... 4 plus years in that same field 4

5 HOW WILL SIMULATION BRIDGE THE GAP? Enables learners to practice necessary skills in an environment that allows for errors and professional growth without risking patient safety Can cover a large amount of knowledge required to get to a Competent level in a short amount of time Transforms protocols into real practice Builds trust/teamwork between experienced nurse and novice nurse as well as entire care team USING SIMULATION TO BRIDGE THE GAP Provide initial simulation training to new nurses (many will have sim experience) NSVD High risk, low volume: PPH, SD, emerg C-sec Consider monthly quarterly drills Repetition builds confidence, knowledge retention In-situ sims Experiential learning Interprofessional opportunities Teambuilding, trust, competence IN SITU SIMULATION Occurs on the workday, should be done on all shifts Use on duty clinical providers/nurses Avoid scheduling on days off Avoid having to backfill Allows for reinforcement of skills in the actual environment Allows for identification of system issues SIMULATION MORE EFFECTIVE THAN DIDACTIC INSTRUCTION TO TRAIN CRISIS MANAGEMENT SKILLS IN L & D TEAMS Nurses and OB residents <5yrs experience Management for shoulder dystocia and preeclampsia Didactic group and Simulation group Pre and post test Simulation drill performance test 1 mo post training Results: No Statistical significance on pre and post test scores BUT statistically significant higher scores for the sim group on performance testing for shoulder dystocia and preeclampsia Daniels, K. et al Prospective Randomized Trial Simulation Versus Didactic Teaching for Obstetrical Emergencies HOW DO I GET STARTED? Start low, go slow Low budget options Parto pants Hybrid sim Practice protocols in place Resources: California Maternal Quality Care Collaborative toolkit AWHONN toolkit ACOG tools Perinatalweb.org LOW BUDGET OPTIONS Parto pants Half body manikins Laerdal Mamma Natalie 5

6 DEBRIEFING WHERE THE RUBBER MEETS THE ROAD Simulation is an excuse to debrief Enables students to think through and discuss what went on in the simulation Assists in knowledge retention Process reactions and feelings related to the simulation DEBRIEFING What went well? What would you do differently next time? What can you take away or forward into your practice? On a scale of 1-10, how comfortable were you with caring for this patient before the simulation and how comfortable are you now? g4&feature=player_embedded Questions? TO SUM IT UP: Simulation can pave the path between formal education and professional practice for experiences that can be difficult to find, but are essential for progressing to the level of competence and beyond kvstevens@wsu.edu HM

7 MAKING IT REAL: A POSTPARTUM HEMORRHAGE SIMULATION DEMONSTRATION Kevin V. Stevens, MSN, RN, CHSE Director, Center of Excellence in Clinical Performance and Simulation WSU College of Nursing WHERE TO START? With the end in mind Identify Outcomes/what do you want to accomplish? Space In Situ/Classroom/Dedicated sim area Manikin Static/Low/High fidelity/hybrid/live body Equipment IV pumps/infant warmer/pph cart Supplies Meds/fluids/O2/pads/gloves/foley Moulage Hybrid /Pg9OQiwvi7k Parto Pants High/Low fidelity manikins SIMULATION OPTIONS HYBRID SIMULATION PARTO PANTS 7

8 PARTO PANTS KIT MAMA NATALIE r_embedded FULL MANIKIN Noelle birthing PPH SET UP Scenario California Maternal Quality Care Collaborative toolkit AWHONN toolkit ACOG tools Perinatalweb.org Patient Manikin: low or high fidelity Real person/hybrid Moulage: clots, blood, fundus Set up Supplies: IV, fluids, meds, peri pads, chux Space: sim area or in Situ? CLOTS 8

9 EASY AS PIE! 9

10 MOULAGE Questions? 10

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