Simulation: Integrating interactive learning experiences into the nursing curriculum

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1 Simulation: Integrating interactive learning experiences into the nursing curriculum Suzanne H. Campbell, PhD, RN, IBCLC Associate Professor, UBC School of Nursing, University of British Columbia, Vancouver, BC, Canada 1

2 Welcome! Photo Credit: SHCampbell 2

3 Disclosure Suzanne Hetzel Campbell PhD, RN, IBCLC Royalties Springer Publishers, Inc. Co-editor Simulation Scenarios for Nursing Educators: Making it Real 3 rd Ed., Royalty Jones & Bartlett Learning, Co-editor Core Curriculum for Interdisciplinary Lactation Care, Sit on Editorial Board of Clinical Simulation in Nursing Sit on Advisory Board of LiquidGoldConcept, Inc. Sit on Board of Directors of CanHealth International Canadian Association of Schools of Nursing (CASN/ACESI) Course Instructor, Canadian Simulation Nurse Educator Certification Program (Modules 2 & 3) I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation 2018 SHCampbell 3

4 Objectives Share a state-of-the-science perspective to identify synergies for your program planning Differentiate the use of simulation for technical and nontechnical learning: clinical skill, teamwork, conflict resolution, leadership and role development; Review health professional educations use of simulation; Analyze the substitution of clinical practice with other methods of learning (on-campus vs off-campus); Examine how simulation is being standardized and evaluated; and Compare and contrast the advantages and challenges of integrating simulation into the curriculum. 4

5 The 2010 Lancet Commission Report: Blueprints for 21 th Century Health Professional Education INSTITUTE OF MEDICINE of the National Academies HiOA Norway Faculty Workshop 05 5 March

6 Education of Health Professionals for the 21 st Century (2010) Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World* A Global Independent Commission Educate all health professionals: as members of interdisciplinary teams, emphasizing evidence-based practice, quality improvement approaches, and informatics *Julio Frenk and Lincoln Chen. "Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World." The Lancet 376, (Dec 4, 2010):

Top 10 Changes in Nursing in last ½ Century! (Barron McBride, 2011, p. 166-167) 1. Nursing not one kind of job (leadership not discipline specific) 2.

7 Top 10 Changes in Nursing in last ½ Century! (Barron McBride, 2011, p ) 1. Nursing not one kind of job (leadership not discipline specific) 2. Growing global acceptance that nursing leadership is necessary for development of safe practice environments, quality care 3. Informatics revolution practice, research, education not time or place bound 4. Emphasis now on OUTCOMES (rather than process) decision making requires data 5. Centers of nursing excellence -> consortium arrangements across institutional boundaries 6. Research base of nursing visible doctoral programs, post-doctoral training, institutes of nursing research, research societies 7. Advanced-practice nursing established at graduate level accepted by public, specialties, and certification 8. Nursing students diverse age, gender, race, learning style --- better reflecting the population served 9. Articulation across levels of nursing increasingly possible and user-friendly 10.Nursing literature and infrastructure greatly expanded journals, standards, competencies, and policy statements 7

8 Paradigm Shift in Nursing Education Effective use of nurses based on their levels of Knowledge Education Skills Configuration of the nursing workforce succession planning Enhancing the knowledge base of nursing to bring it in line with other professions (BSN) 8

9 WHO Collaborative Practice Learning Teamwork Domains Roles and responsibilities Communication Learning and critical reflection Relationships with and recognizing the needs of the patient Ethical practice World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Care. Geneva, World Health Organization. Retrieved from 9

10 Evolving Use of Simulation Photo wooden horse simulator & NASA Across industries, simulation technologies have evolved from World War I (wooden horse simulator) to latest aircraft simulators being used by NASA 10

11 Modern era of simulation technology in health care 1960 s Norway! Bjorn Lind a Norwegian anesthesiologist persuaded Asmund Laerdal, to make Resusci- Anne CPR mannequin (1960s) Earlier 1874 advocates for use of skeletons in Schools of Nursing 1906 Mrs. Chase (Hartford Hospital, SoN, Connecticut US) full-body static mannequin for practicing injections/procedures 11

12 Prevalence of Simulation Globally Courtesy Foisy-Doll & Leighton, SCORS presentation 2017, slide 6our text here

13 Simulation Statistics NCSBN Study - NCSBN conducted a landmark, national, multi-site, longitudinal study of simulation use in prelicensure nursing programs throughout the country. Collaborating with learning institutions across the U.S., NCSBN embarked on a research initiative exploring the role and outcomes of simulation in pre-licensure clinical nursing education. The study provides substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses under conditions comparable to those described in the study. 13

14 Simulation vs Case-Based Learning Similarities: Identify objectives for learning Provide a beginning story with key information Focus on critical thinking Fluid/dynamic process no right answer Differences: Simulation/Health care scenarios A method of teaching for unpredictable future events Variety of confounding variables & quick timeframe More individually focused vs. system/organization Prioritization of actions misstep = adverse event 14

15 Flexible Learning Opportunities Web-based instruction enhanced - modules with interactive learning and testing options Hybrid Simulation Outside preparation that augments class Classroom small and large groups, individual response systems for interactive learning (clickers, PollEverywhere, Zoom) Clinical/lab = High-stakes testing/capstones Virtual reality HMD, examine patient, clinic, etc 15

16 Identifying Curricular Fit Curriculum concept-based, specialty-specific Key experiences Technical skills: asthma, hemorrhage, CPR, hypoglycemia, deteriorating patient Non-technical skills: communication, team-work, therapeutic relationship power-sharing, empathy, and trust/rapport building Reality-based: faculty expertise, lab resources, time management, substitution for clinical hours 16

17 Assessing Organizational Readiness SCORS Simulation Cultural Organizational Readiness Survey (Foisy-Doll & Leighton, 2017) Faculty buy-in and professional development identification of champions Student request - expectations 17

18 Assessing Program Objectives Mission & Vision of your school, fit with university and community Describe what your graduate will look like Identify theoretical frameworks underlining your approach to teaching and clinical practice Outline professional development List outcome competencies for program match with country Registered Nurse licensing 18

19 Theories Guiding Simulation Case Development Blooms Taxonomy to guide objective development (transition over time) Bandura s Theory of Self-efficacy to increase confidence for skill development Benner s (1984) Novice to Expert (here) Kolb s (1984) Experiential Learning Theory (here) Schön s reflection-in-action/reflection-on action (1983) NLN/Jeffries Simulation Framework Daley & Campbell s Framework for Simulation Learning in Nursing Education - to provide knowledge translation & mobilization for theory into practice (17 years, average time for best practices to translate into hospital practice) 19

20 Evolution: Comparison of Bloom s Original (1956) and Bloom s Revised (2001) Taxonomies with QSEN KSAs Domains of Learning Original Bloom s Taxonomy (1956) Cognitive Psychomotor Affective Knowledge Dimension Revised Bloom s Taxonomy (2001) Factual knowledge Conceptual Knowledge Procedural knowledge Metacognitive knowledge QSEN Competencies The Quality and Safety Education for Nurses (QSEN) Project ( ) Knowledge Skills Attitudes Anderson & Krathwohl, 2011; Bloom, 1956; Cronenwett et al., 2007 Clinical Judgment Critical Thinking Problem Solving Psychomotor Skills Clinical Reasoning Nursing skill development and clinical judgment model (International Nursing Association for Clinical Simulation and Learning) 20

The Experiential Learning Cycle*(here) Kolb's experiential learning style theory is typically represented by a four stage learning cycle in which the

21 The Experiential Learning Cycle*(here) Kolb's experiential learning style theory is typically represented by a four stage learning cycle in which the learner 'touches all the bases': Learning is the process whereby knowledge is created through the transformation of experience (Kolb, 1984, p. 38). 21

22 Framework for Simulation Learning in Nursing Education Learner brings to learning: Individual Experiences Culture Digital culture Learning to learn Feedback loop Foundational Knowledge Think Critically Human dimension Integration Communicate Effectively S Intervene Therapeutically Application Translation to to practice Caring Improved Outcomes Daley & Campbell (2008) Framework for simulation learning in nursing education. Safety Vigilance Excellence HiOA Norway Faculty Workshop 05 March Reflective Practice Failure to Rescue 22

23 Examples of simulation pedagogy integration for IPE Integration throughout the curriculum Multiple opportunities for IPE passport; medication reconciliation; patient-handovers; teamwork in trauma scenarios Health mentor model Competency-based testing at various points Use to assess student competencies individually with evaluation criteria and student goals focused on IPE Concept-based across the curriculum Develop scenarios which can be used to bring together concepts that fit many specialty areas and levels of students (e.g. medication reconciliation, ethics, informatics, communication, cultural humility) Scherer et al (2013) found IP simulation fostered collaboration between nursing & medical students on 3 subscales of the Readiness for Interprofessional Learning Scale: teamwork & collaboration, professional identity, & roles & responsibilities 23

Postpartum Hemorrhage Still Leading Cause of Maternal Death

deaths About 14 million women around the world suffer from

halved between 1990 (400 per 100,000 live births) and 2010

disproportionately high in developing countries (240 per

births) CAUSES OF MATERNAL DEATH 18% 35% 11% 1% 8% 9% 18%

24 Postpartum Hemorrhage Still Leading Cause of Maternal Death Leading cause of maternal mortality: 35% of all maternal deaths About 14 million women around the world suffer from PPH every year Maternal Mortality Ratio (MMR) has roughly halved between 1990 (400 per 100,000 live births) and 2010 (210 per 100,000 live births) However, MMR is disproportionately high in developing countries (240 per 100,000 live births) than developed countries (16 per live births) CAUSES OF MATERNAL DEATH 18% 35% 11% 1% 8% 9% 18% Haemorrhage Hypertension Unsafe abortion Sepsis Embolism Other direct Indirect Source: 24

25 Undergraduate Nursing Simulation Scenario Prep 25

and respiratory distress, potentially lifethreatening.

(photo) Adolescent that was admitted with the diagnosis of

(photo) 1 st trimester bleeding spontaneous abortion,

26 Identifying Simulation Scenarios 4.3 kg infant of a diabetic mother is experiencing hypoglycemia and respiratory distress, potentially lifethreatening. (photo) Post-partum hemorrhage high maternal mortality rates. (photo) Adolescent that was admitted with the diagnosis of recurrent leukemia, for which there was no curative treatment (photo) 1 st trimester bleeding spontaneous abortion, gestational trophoblastic disease; three emergency deliveries, high risk of maternal and/or fetal mortality (photo) 26

27 Gaps in Nursing Simulation Research Mariani & Doolen (2016)* identified the following gaps: (a) outcomes, (b) simulation design/setting, (c) participants/facilitators, and (d) research rigor. Greatest obstacles: Time, resources, and support Mariani, B., & Doolen, J. (2016, January). Nursing simulation research: What are the perceived gaps? Clinical Simulation in Nursing, 12(1),

The Elephant in the Room Faculty Professional Development Lack of time release added on content Fee structures do not support lab resources and IT, lab staff support How are we

28 The Elephant in the Room Faculty Professional Development Lack of time release added on content Fee structures do not support lab resources and IT, lab staff support How are we working with faculty to prepare them? Continuing Education Competency requirements Evaluation 28

29 Models for Integrating Simulation in the curriculum Map out curriculum identifying key competencies Create climate for faculty professional development identify Champions Develop scenarios according to INACSL Best Practice StandardsSM Identify combination of teaching strategies use according to programs context 29

30 Standard IX: Simulation Design To achieve optimal outcomes, simulation design should consider the following elements: 1. Needs assessment 2. Measurable objectives 3. Format of simulation 4. Clinical scenario or case 5. Fidelity 6. Facilitator/Facilitative approach 7. Briefing 8. Debriefing and/or feedback 9. Evaluation 10. Participant preparation 11. Test of the design (Lioce et al., 2015, p. 310). 30

31 Scenario Development Working in teams Focusing outcomes clinical, team, leadership Coordinating the event date, time, place, participants Small scale: in situ e.g. Code in ER, PPH code in OB Large scale: disaster planning include first responders, government, health care practitioners, and students 31

32 Evidence-based practice (EBP) baseline for simulation scenario development During simulation Use current Evidence-Based Practice (EBP) guidelines Introduce EBP guidelines (or evidence-informed guidelines) Implement EBP guidelines throughout the scenario (incorporate as part of assessment check-list) Reinforce EBP guidelines during de-briefing or second-run of the scenario Assess for transfer to clinical skills by assessing on clinical evaluation tools Enhance synergy between classroom & clinical practice HiOA Norway Faculty Workshop 05 March 32

33 Future of Health Care Professional Education Simulation Web Based Learning - Virtual Simulation Virtual Clinical Excursions TM (VCE) Elsevier Serious Gaming e-baby TM Serious Game Multiplayer Virtual Worlds Single User Products: CliniSpace TM (here); TINA TM ; Second Life TM ; ArchieMD TM Virtual RealityHiOA Norway Faculty Workshop 05 March 33

34 Virtual Simulation Future? Photo of virtual reality glasses 34

35 Digital technology: VR, AR, Green-screen Green-screen technology: static photo or dynamic video as backdrop for illusion (e.g. car accident scene, University of Johannesburg) Photos: SHCampbell, University of Johannesburg, South Africa 9/20/

36 Photos: SHCampbell, University of Johannesburg, South Africa 9/20/

Standardization Process Contributing factors: INACSL Best Practice Standards: Simulation SM (2016) Increased confidence in reliability of scenarios, facilitation, teaching, and evaluation methods

37 Standardization Process Contributing factors: INACSL Best Practice Standards: Simulation SM (2016) Increased confidence in reliability of scenarios, facilitation, teaching, and evaluation methods NLN-INACSL Debriefing Across the Curriculum Society for Simulation in Healthcare (SSIH) Dictionary Importance of speaking the same language Repository of Instruments Used in Simulation Research INACSL 37

Next steps I. Many opportunities to bridge the education- practice gap and create innovative learning: need standardization, assessment, evaluation II.

38 Next steps I. Many opportunities to bridge the education- practice gap and create innovative learning: need standardization, assessment, evaluation II. Critical Reflection of Learning Debriefing depends on initial objectives III. Proceed with caution and use of theory in the development of policies around clinical hours/ substitution focus on competencies and measurable learning outcomes IV. Integrate incrementally combine methodologies for best return on investment 38

39 Tell me more about your toolkit! Thank you! Contact Information: 39

40 References - IPE Interprofessional Education - Key papers: A National Interprofessional Competency Framework. Canadian Interprofessional Health Collaborative, Core competencies for interprofessional collaborative practice: Report of an expert panel. Interprofessional Education Collaborative, World Health Organization (WHO). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization, Retrieved June 20, 2011 from: ng.pdf 40

41 References-IPE IPEC (2011). Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Retrieved from Frenk, J. and Chen, L. "Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World." The Lancet 376, (Dec 4, 2010): Maxfield, D., Grenny, J., McMillan, R., Patterson, K. & Switzler, A. (2005). Silence Kills: The Seven Crucial Conversations in Healthcare. Retrieved from A National Interprofessional Competency Framework. Canadian Interprofessional Health Collaborative, Quality and Safety education for Nurses: QSEN. Retrieved December 1st, 2011 from World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Care. Geneva, World Health Organization. Retrieved from 41

42 References - Simulation Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nursing Education Perspectives, 30, Barrett, H.C. (2006). Researching and evaluating digital storytelling as a deep learning tool. In C. Crawford et al. (Eds.), Proceedings of Society for Information Technology & Teacher Education International Conference 2006, (pp ), Chesapeake, VA: AACE. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp Campbell, S.H. (2010). Chapter 8, Clinical simulation. In K.B. Gaberson and M.H. Oermann, Clinical teaching strategies in nursing (3rd ed). (pp ). New York: Springer Publishing Company. Campbell, S.H. (2013). Chapter 14 Obstetric Emergency: Post-partum hemorrhage. In S.H. Campbell & K. Daley (eds) Simulation Scenarios for Nurse Educators: Making it REAL (2 nd Ed). (pp ). New York, N.Y.: Springer Publishing Company, Inc. Campbell, S.H. & Daley, K. Eds. (2018). Simulation scenarios for nursing educators: Making it real. (3 rd ed). New York, N.Y.: Springer Publishing, Inc. Clapper, T. C., & Ng, G. M. (2013, August). Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing, 9(8), e287-e292. doi: /j.ecns

43 References - Simulation Daley, K. & Campbell, S.H. (2018). Chapter 44 Framework for Simulation Learning in Nursing education. In S.H. Campbell & K. Daley (eds) Simulation Scenarios for Nursing Educators: Making it real. (3 rd Ed) (pp ). New York, N.Y.: Springer Publishing Company, Inc. Decker S. I., Anderson M., Boese T., Epps C., McCarthy J., Motola I., Palaganas J., Perry C., Puga F., Scolaro K., & Lioce L. (2015, June). Standards of best practice: Simulation standard VIII: Simulation-enhanced interprofessional education (sim-ipe). Clinical Simulation in Nursing, 11(6), Jeffries, P. (2005). A framework for designing, implementing, and evaluating: Simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), Kaakinen, J., & Arwood, E. (2009). Systematic review of nursing simulation literature for use of learning theory. International Journal of Nursing Education Scholarship, 6, 1. Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C. (2010). A review of currently published evaluation instruments for human patient simulation. Clinical Simulation in Nursing, 6(1), e doi: /j.ecns Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall. HiOA Norway Faculty Workshop 05 43March

44 References - Simulation Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015, June). Standards of best practice: Simulation standard IX: simulation design. Clinical Simulation in Nursing, 11(6), Mariani, B., & Doolen, J. (2016, January). Nursing simulation research: What are the perceived gaps? Clinical Simulation in Nursing, 12(1), Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., Sando, C. R., & Borum, J. C. (2013, June). Standards of Best Practice: Simulation Standard I: Terminology. Clinical Simulation in Nursing, 9(6S), S3-S11. Mikasa, A. W., Cicero, T. F., & Adamson, K. A. (2013). Outcome-Based Evaluation Tool to Evaluate Student Performance in High-Fidelity Simulation. Clinical Simulation in Nursing, 9(9), e doi: /j.ecns Murdoch, N. L., Bottorff, J. L., & McCullough, D. (2013). Simulation Education Approaches to Enhance Collaborative Healthcare: A Best Practices Review. International Journal of Nursing Education Scholarship, 11, 307. doi: /ijnes Pagano, M., O Shea, E., Campbell, S., Currie, L., Chamberlin, E., & Pates, C. (2015). Validating the Health Communication Assessment Tool (HCAT). Clinical Simulation in Nursing, 11, Scherer, Y. K., Myers, J., O Connor, T. D., & Haskins, M. (2013, March). Interprofessional simulation to foster collaboration between nursing and medical students. Clinical Simulation in Nursing, Vol(X), xx-xx. Young, P.K. (2004). Trying something new: Reform as embracing the possible, the familiar, and the at-hand. Nursing Education Perspectives, HiOA Norway 25, Faculty Workshop 05 March 44

Integrated Learning in Simulation: Theoretic Foundations Based on Carper s Patterns of Knowing

St. Catherine University SOPHIA Master of Arts/Science in Nursing Scholarly Projects Nursing 12-2015 Integrated Learning in Simulation: Theoretic Foundations Based on Carper s Patterns of Knowing Shannon