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Taking Your First Steps

Taking Your First Steps. Simulation Integration. Beth Fentress Hallmark, RN, MSN, PhD(c). Tiffany L. Holmes, D.C. Objectives:. Learn the benefits, challenges and emerging trends in the use of simulation How to integrate simulation into nursing curriculum. Who are we:. Beth Hallmark

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Taking Your First Steps

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  1. Taking Your First Steps Simulation Integration Beth Fentress Hallmark, RN, MSN, PhD(c) Tiffany L. Holmes, D.C.

  2. Objectives: • Learn the benefits, challenges and emerging trends in the use of simulation • How to integrate simulation into nursing curriculum.

  3. Who are we: • Beth Hallmark • Belmont University • Gordon E. Inman College of Health Sciences and Nursing • Laerdal Center of Educational Excellence • Tiffany L. Holmes • University of Texas at Arlington • College of Nursing Smart Hospital™ • Laerdal Center of Educational Excellence

  4. UT Arlington College of Nursing (UTACON) • Ranked in the top 15 largest schools of nursing in U.S. • 126 faculty, (102 FTEs) • Over 4,000 students in BSN, RN-to-BSN, MSN, Post-MSN, DNP and PhD programs • Graduates 200 BSN students annually • 70-80 MSN and Post-Masters Nurse Practitioners (NP) graduates who assume advanced roles as NPs, administrators, and educators.

  5. UTACON’s Integration: • 2003 – Smart Hospital™ Concept started • 2004 – Simulation Coordinator named • 2005 – Faculty development activities • 2006 – Simulation Technician hired • Jun. 2007 – Moved to new Smart Hospital building

  6. Transition from student to RN Research shows new grads experience: • Fear • Lack of confidence • Communication Deficits • Complex decision making • Contradictory information • Issues 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.

  7. New Graduates say: • They feel uncomfortable with: • IV skills • Physical Assessment • Care of the dying patient • Caring 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).

  8. 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 difficulty 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).

  9. Traditional Nursing Education • Didactic • Lab • Clinical • Orientation at workplace

  10. What can simulation do? • Help promote teamwork and collaboration • Foster effective and safe communications • Delegation • Safe practices/Quality Improvement • Cultural awareness • Evidence based practice • Patient centered care

  11. Advantages of Simulation • Safe practice arena • Hands on • Exposure to rare/high risk events • Practice cognitive and psychomotor skills • Transfer to clinical setting • Immediate feedback • Reflective learning

  12. New Strategies • Simulation: Teaching Strategy • Simulation: Evaluation Tool

  13. Types of Simulation • Case Study • Role-playing • Standardized patients • Partial vs. Complex Task Trainers • Static and Computerized • Integrated Simulators (HPS)

  14. 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.

  15. Simulation: Theory • Active Learning • Reflective Thinking • Constructivism

  16. Curricular Changes • Examine where simulation naturally fits • Build simulations upon one another • Simple to complex • Students need exposure early in the program • Use for remediation and clinical makeup

  17. Connecting the dots in courses: • Labs • Didactic • Courses in same semester • How 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?

  18. Standards Identify your programs outcomes based on standards. • BSN Essentials • QSEN • IOM • Joint Commission • NCLEX • Not just the standards that are r/t technology….i.e.: safety and communication

  19. How do I overcome: • Faculty Resistance • Time • Resources • Technology assistance, equipment • Pay • Administrative Assistance • Skills • Scheduling

  20. What do I need? • CHAMPION • Administrative Buy In • Money: Grants • Staff • Space • Faculty Development Plan • Policies • Mission Vision • Stakeholders

  21. What do I need? Champion • One 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 ideas • Lead simulation committee/group

  22. What do I need? Administrative Buy In • How to accomplish this? • Bring in experts/consultants • Take them with you to meetings • Share with them what you learn at conferences • Show them student evaluations • Demonstrate how simulation works • Peer pressure

  23. What do I need? MONEY….. MONEY….. • Grants • State • Federal • Local community organizations • National Private Funding groups

  24. What do I need? Staff • Simulation Director • Faculty: Simulation Committee Group • Technical Support: IT and Network specialist • Supply specialist • Scheduling

  25. What do I need? Space • STORAGE, STORAGE, and still MORE STORAGE!! • Preparation Area • Simulation Labs • Partitions? • Observation/Control Room • Debriefing room

  26. What do I need? Faculty Development Plan • Conferences • Lunch and Learn • SIRC.NLN.org • List serves • INACSL • SSiH • NLN • AACN • Invite them to play a part

  27. Components to a Simulation • Student Preparation • Objectives • Report • Actual Simulation • Debriefing • Evaluation

  28. 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 Summative • Case Study versus procedural prep

  29. Objectives • Need to fit with curricular objectives and course objectives • Case by case • General safety and communication

  30. Report • Students need to learn how to receive and give report • Use SBAR or other communication rubrics • Ask practice partners for the system they use

  31. Simulation • Scenarios • Pre programmed • Make it your own • Validate with practice partners • Reality: suspend • Fiction Contract

  32. Debriefing • Reflection • Learner uses previous knowledge to build upon • Bad Habits develop if not addressed • Video taping

  33. Evaluation • Formative or Summative Evaluation

  34. Support: Find a Network • Tennessee Simulation Alliance • INACSL (www.inacsl.org) • SSiH (www.SSiH.org) • NLN SIRC (www.sirc.nln.org) • Simulation Users Network (SUN)

  35. Questions?

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