Expanding a Simulation Program

1. Expanding a Simulation Program The Experience at Quinnipiac University Mary Ann Cordeau PhD, RN

2. Presentation Outcomes • From participating in this presentation the participant should be able to: • Discuss the process of starting a clinical simulation program • Discuss the process of setting up a simulation laboratory • Discuss the process of expanding a clinical simulation program • Discuss the process of starting an interdisciplinary clinical simulation program

3. What we learned at Quinnipiac University Moving from a Simulation Room To a simulation suite

4. Getting started: Mount Carmel Campus (2006) • One Mannequin • One patient room with a control room • One instructor • One scenario • Eighty students!!!!! • Number for HELP desk • Number for Laerdal Some assembly necessary!!!

5. Expanding Clinical Simulation • Interested faculty member • Supportive Leadership • Curriculum plan for incorporating clinical simulation • Space • Funding • Mannequin • Faculty Expert(s) (Novice to Expert) • Fidelity Environment • Accessories • Faculty Buy-in • Faculty Education • Technological Support • Maintenance of Lab equipment • Management of student experiences • Selling the Program • Interprofessional use • Director of Clinical Simulation

6. Supportive Leadership • Department – Chairperson who supports clinical simulation as a teaching learning strategy • 2005 Janice Thompson decided to purchase a SimMan for the Department and build a simulation lab. • 2008 Plans for move to North Haven and Simulation Suite with 5 simulation rooms • School – Dean who supports clinical simulation • University – Understanding of the potential of clinical simulation as a teaching/learning strategy

7. Introduction of Clinical Simulation • Finding a framework to guide the process • Orientation • No practice sessions • Simulation outcomes • Began in spring semester in our first medical/surgical course with the care of a postoperative client • Wrote a scenario which included scenario outcomes • Created grading rubric • Scenario was related to NU 303 as an add on assignment, Pass/Fail • After the second year, I presented a potential plan for incorporating clinical simulation into all courses • Research on the Experience of Clinical Simulation

8. Plan for incorporating clinical simulation into curriculum • Look to the literature for information on best practices for clinical simulation • Examine program/course outcomes to determine how clinical simulation will be used to meet outcomes • The use of clinical simulation needs to be examined for each course • Number and type of experiences • Use of clinical simulation in the class room • Teaching content, Practice, Nursing experience, Team work, Evaluation • Attach % points, Pass/Fail, Letter, number grade

9. Plan for incorporating clinical simulation into curriculum • Start with a written scenario: Laerdal, International Nursing Association for Clinical Simulation and Learning (INACSL), Colleague • Start with one course • Conduct a Pilot study • Uncover what needs to be changed Don’t jump into the water unless you know what is there!!

10. Plan for incorporating clinical simulation into curriculum • Current Use: • Fundamentals Course – Fall Junior Year • Therapeutic communication, Client Safety • Medical/surgical Course – Spring Junior Year • Post-operative assessment, Medication Administration • Maternity Course – Spring Junior Year • Assessment • Medical/surgical Course – Fall Senior year • Mock Codes, Chest Tubes • Leadership Course – Spring Senior Year • Working as a team, Being the nurse • SNUAC – Post operative assessment of a client with a C-section, Teaching, New born Assessment

11. Plan for incorporating clinical simulation into curriculum • Future Use • New Curriculum • Integrated Lab - more course objectives could be met using clinical simulation • Streaming from sim lab to classroom for most courses • Integration of Electronic Health Record

12. Space • What space is available for setting up a clinical simulation lab? • Renovate existing space • Create a space for a clinical simulation suite • Faculty need to work closely with technology to describe technological needs for running a clinical simulation Move to North Haven

13. Space • One control room for each simulation room • Use of desk microphones • Debriefing immediately after simulation • If using desk microphones do not have rooms set up with patient rooms back to back, sound from one room interfere with sound from other room

14. Deciding on Mannequin(s) • Budget • Program/course objectives

15. Fidelity and environment • Fidelity depends on learning outcomes • A realistic environment as possible is necessary for simulating a patient care scenario and the promotion of clinical reasoning • Cost and Waste What is essential for learning?

16. Funding • Grants, School budget, University budget • Cost of mannequin (40-60K) • Cost of room construction • Cost of AV equipment (20K) • Cost of related equipment (bed, etc) • Cost of maintenance • Cost of training • Cost of staff 100,000.00 WOW!!!!!

17. Faculty Expert(s) • At least one faculty must develop expertise • Nursing knowledge • Teaching knowledge • Simulation knowledge • Technology knowledge • Literature • SUN conferences • Laerdal Training • Other institutions • Practice, Practice, Practice!!! Super Clinical Simulation Educator

18. Faculty buy-in You cannot do it alone!! • Faculty education -Expert should educate faculty on potential of clinical simulation • Literature • Demonstration • Student testimony • Outcome measurement • Institutional Research

19. Faculty Education • Laerdal • SUN Conferences • Mentoring • Discussion • Technology • Scenarios • Role play • Demonstration • Return demonstration • Technology Support Gonna fly now

20. Management of student experiences • Began with 80 juniors • 140 juniors • 45 minute session fall • 45 minutes session spring • Maternity experience spring • 50 SNUAC students • 1 hour session • 140 seniors • Mock codes in fall • Capstone simulation

21. Management of students • Where is clinical simulation placed in the curriculum • Lab, Course, Clinical • Is it used in place of clinical time? • How is credit for preparation and successful meeting of objectives given? • How is faculty time managed, credits? • How does clinical simulation affect faculty work load? • Will full-time and/or adjunct faculty be used for teaching • Will simulation technicians be used to run programmed scenarios?

22. Management of student experiences • Clinical Simulation Policy (should be included in syllabus or handbook • Stick to policy unless unusual circumstances • Orientation process (video, hands on) • Number of practice sessions • Limited, unlimited • Evaluation - Number of times student will be allowed repeat experience • How will this affect grade/passing of course or course component • Remediation • Opportunities for practice, mandatory/voluntary • Single or group/team experiences • Objectives, faculty resources, technology • Length of experience • Objectives, type of scenario • Number of instructors needed to meet program needs • Scheduling • Wiki

23. Selling the Program • University Administration • Students are asking about clinical simulation during open house • Parents impressed with simulation as teaching/learning strategy • Health care facilities recognize significance of clinical simulation experiences • Getting the word out to other departments in the University

24. Interdisciplinary Use • Began with nursing • Individuals in other departments (OT, PT) contacted Nursing • Physician Assistant students • Who will set up faculty training sessions and be responsible for training • Once faculty are oriented, nursing signs off

25. Interdisciplinary Use • Concerns – Scheduling • Determining departmental needs from all departments • Extra workload on current Laboratory Coordinator • Need for Development of a Laboratory Manager who is responsible for training, student orientation, troubleshooting, budgeting, scheduling and simulation set up for all departments • Approved for 5 extra rooms Roles develop over time To meet needs

26. Faculty Experience • Dr. Barrere

27. If I can do it, you can do it… prospect.rsc.org

28. Brings Classroom, Skills Lab, & Clinical Together calstate.fullerton.edu augusta.va.gov

29. A Flare for the Dramatic… 7starspress.com

30. The Most Challenging Part…