Details - Texas Organization for Associate Degree Nursing

Alamo Colleges
Simulation in Nursing Education:
Creating a Quality Simulation
Yvette Baxter MSN, RN
Faculty Development in the
Effective Use of Simulation
Identify factors in the educational and practice environment
which have contributed to the use of simulation in nursing
Identify advantages to incorporating simulation as a clinical
teaching strategy.
Discuss strategies for maximizing simulation effectiveness and
student learning outcomes.
Identify the key goals of debriefing.
Academic and Healthcare
Shortages of clinical faculty and clinical sites.
Limited exposure to high risk, low volume clinical events
Complexity of the healthcare environment
Emphasis on patient safety
Technological advances offering sophisticated and realistic
clinical experiences in the laboratory setting
Need to better prepare new nurses for working in a complex
and technologically rich health care environment
Clinical Gaps
IOM (2003): hospital leaders, health plans, and practice sites
reported increasing skills deficits in new graduates reported
65-75% of new-to-practice nurses did not meet entry-level
competencies for clinical judgment (Ulrich et al., 2010)
The Future of Nursing: Focus on Education (2011) – the current
nursing educational system inadequate to prepare nurses with the
necessary competencies to provide high-quality care in increasingly
complex healthcare environment
Medical Error:
 Greater risk for errors in clinical practice
Increased Turnover:
 Gaps between preparation and practice requirements results in
stress and increased potential to leave the field
 The percentage of turnover of new graduates is estimated as
17.7% within one year, 33.4% within two years, and 46.3% by
the third year (Cho, Lee, Mark, & Yun, 2012)
The Deficits
Competencies in which new-to-practice nurses
scored lowest included:
Interpretation of assessment data
Decision-making & application of nursing process
Identification of changes in patient status
Timely & appropriate follow-up
Initiative in management of care
Saintsing, Gibson, and Pennington (2011)
Clinical Simulation
A technique, not a technology
Immersion of the learner with enough realism to
suspend disbelief
Environment to develop knowledge, skills, and
clinical reasoning
A concept- based learning experience
Benefits of Simulation
Learn from mistakes without risk to patient safety
Practice high risk, low incidence patient events
Identify gaps in knowledge /skills
Diverse learning
Real time/immediate feedback
Promotes critical thinking and decision-making skills
Safety, teamwork, communication, collaborative learning
Components for Creating a
Quality Simulation
 Faculty/Student
 Scenario Selection, Writing, and
 Fidelity/Realism
 Debriefing
Simulation Effectiveness
“The patient simulation is only as effective as
the faculty who are using it. The creativity,
clinical knowledge, teaching expertise, and
technological abilities of the faculty are highly
influential in the effective use of patient
(Durham and Alden, 2008, p. 3-237).
Faculty Preparation
Student-centered approach
Preparation and comfort with scenarios and equipment
Understanding of the goals/objectives
Creativity, flexibility, & recognition of learning
Participation in the design process/evaluation
Faculty Preparation
Understanding that mistakes will be made
Minimize competition
Small groups
Roles assignment and assumption of roles
Close observation of actions, interactions, and
Learner Preparation
Understanding of simulation guidelines, objectives, & means
of evaluation
Establishment of confidentiality, trust, &consent
Pre-scenario study guide
Orientation to simulation environment
What is to be simulated
Once in the simulation, students should function as they
would in the clinical environment
Clinical Scenario Defined
“The plan of an expected and potential course of events
for a simulated clinical experience. The clinical
scenario provides the context for the simulation and
can vary in length and complexity, depending on the
(International Nursing Association for Clinical Simulation and
Learning [INACSL], 2011).
Steps in Scenario Development
Selection of topic and template
Identification of learning objectives
Story Writing (determination of concepts, cues, and
critical events)
Peer review/Validation
Topic Selection
Idea Generation
 Course objectives
 Identified practice gaps
 Staff/student survey perceived learning
needs/clinical challenges
 Clinical experiences
 Case studies
 Legal cases
Source of Scenarios
Created by faculty/educators
On-line pre-written scenarios
Free On-line Resources
Healthy Simulation
Kansas State Board of Nursing
Massachusetts Nursing Initiative- Simulation Scenario
Considerations for Scenario
Knowledge level of student
Goals and purpose of the simulation
Level of complexity and fidelity
Number of participants/length of time
Experience and comfort level of facilitator
Availability of content expert
Setting and equipment needed
What Should be Incorporated in
My Scenario?
Safety and identified concepts/competencies
Evidence based practice and standards of care
Institutional policies and procedures
Writing the Story
 Description of the patient, event, setting, participants
 Information to be provided
 Plot progression and contingencies
 Expected actions & timelines
 Cues
 Flexibility of facilitator
 Logical and realistic transition maximizes fidelity
Validation & Piloting
 Evidence –based : current journals, clinical guidelines, and
 Checked for accuracy and believability
 Reviewed by content expert for validity and revised as needed
 Piloted with small group of targeted learners
 Feedback enables scenario revision for maximum effectiveness
 Information regarding timeline, areas where learners get
derailed, or aspects of the scenario learners find confusing
The degree to which simulators and simulations mimic
Simulation experiences should be as realistic as
Realism of scenario, staging, props enhance the
simulation experience
“The realism of any simulation depends upon multiple
factors, including the fidelity of the simulator, the
environment, props, and the description of the
scenario…as realism is enhanced, the effectiveness of
the scenario as a learning tool is increased”
(Durham & Alden, 2008, p. 3-234).
“a conversation among two or more people to review a
simulated event or activity in which participants explore,
analyze and synthesize their actions and thought
processes, emotional states and other information to
improve performance in real situations”
(Center for Medical Simulation, 2009, p. 1).
Goals of Debriefing
Evaluate whether learning objectives met
Build on prior learning
Communication/different perceptions/attitudes
Reinforce teaching points
Identify/ correct gaps in knowledge, skills, attitudes
Improve future performance
Phases of the Debriefing
Reaction – opportunity to decompress and discuss emotional
response to the simulation experience
Analysis - provides a time for reflection, understanding, and
discussion of what went well and what didn’t
Summary/Closure – a summary of the experience is provided
and evaluation of the simulation as a learning experience
Role of Facilitator in Debriefing
Create a safe and trusting learning environment
 Provide support
 Permit opportunity for defusing emotions
 Guide the reflective process
 Provide feedback/observations
 Assist in assimilating new knowledge
Texas Board of Nursing (BON)
Position Statement on
In 2010 the BON put forth a position statement to clarify
the role and limitations of simulation in order to
provide educators with guidelines for making
simulation educationally sound and meaningful.
Texas Board of Nursing (BON)
Position Statement on Simulation
Simulation provides a valuable adjunct to traditional clinical
To be effective the simulation must challenge learners to use
problem solving and critical thinking skills.
Each simulation experience should have clearly stated
objectives that are presented to learners PRIOR to engaging in
the experience.
Texas Board of Nursing (BON)
Position Statement on Simulation
Learners are required to prepare for a clinical simulation
experience in the same manner they would a hospital clinical
An orientation to the simulation technology and environment is
The educator should act as a facilitator providing cues when
needed, but not as an active participant.
Unless an end of life scenario, the simulation should end with a
viable patient.
The Alamo Colleges wishes to extend a
special thanks to San Antonio College
nursing students Lori Hannasch, Renee
Howard, & Sylvia Muniz for lending their
time and services in the making of this
Ackermann, A.D. (2011, September 26). Standards of best practice: Simulation. International Nursing
Association for Clinical Simulation and Learning. Retrieved from:
Arafeh, J.M.R., Hansen, S.S., & Nichols, A. (2010). Debriefing in simulated-based learning. Facilitating a
reflective discussion. The Journal of Perinatal and Neonatal Nursing, 24(4), 302-309.
Aschenbrenner, D.S., Milgrom, L.B., Settles,J. (2012). Designing simulation scenarios to promote learning.
In P.R. Jeffries (Ed.). Simulation in nursing education: From conceptualization to evaluation (43-74). New
York, NY: National League for Nursing
Buerhaus, P.I., Auerbach, D.I., & Staiger, D.O. (2009). The recent surge in nurse employment: Causes and
implications. Health Affairs, 28(4), w657-w668. doi: 10.1377/hlthaff.28.4.w657
Childs, J.C. & Sepples, S. (2006). Clinical teaching by simulation. Lessons learned from a complex patient
care scenario. Nursing Education Perspectives, 27(3), 154-158.
Cho, S.H., Lee, J.Y., Mark, B.A., & Yun, S.C. (2012). Turnover of new graduate nurses in their first job
using survival analysis. Journal of Nursing Scholarship, 44(1), 63-70. doi: 10.1111/j.1547-5069.2011.01
Cohen, E.R., Feinglass, J., Barsuk, J.H., Barnard, C., O'Donnell, A., McGoghie, W.C., & Wayne, D.B.
(2010). Cost savings from reduced catheter-related bloodstream infection after simulation-based education
for residents in a medical intensive care unit. Society for Simulation in Healthcare, 5(2), 98-102. doi:
Dreifuerst, K.T., & Decker, S.I. (2012). Debriefing: An essential component for learning in
simulation pedagogy. In P.R. Jeffries (Ed.). Simulation in nursing education: From
conceptualization to evaluation (105-129). New York, NY: National League for Nursing
Duchscher, J.B. (2008). A process of becoming: The stages of new nursing graduate
professional role transition. The Journal of Continuing Education in Nursing, 39(10), 441-450.
Durham, C.F., & Alden, K.R. (2008). Enhancing patient safety in nursing education through
patient simulation. In R.G. Hughes (Ed), Patient safety and quality: An evidence-based
handbook for nurses (AHRQ Publication No. 08-0043). Retrieved from:
Fanning, R.M., & Gaba, D.M. (2007). The role of debriefing in simulation-based learning.
Society for Simulation in Healthcare, 2(2), 115-125. doi: 10.1097/SIH/0b013e3180315539
Friedman, M.I., Cooper, A.H., Click, E., & Fitzpatrick, J.J. (2011). Specialized new graduate
RN critical care orientation: Retention and financial impact. Nursing Economics, 29(1), 7-14.
Giddens, J., Brady, D., Brown, P., Wright, M., Smith, D., & Harris, J. (2008). A new
curriculum for a new era of nursing education. Nursing Education Perspectives, 29(4), 200-204.
Institute of Medicine (2003). Health professions education. A bridge to quality. Washington,
D.C.: National Academy Press.
Institute of Medicine (2011). The future of nursing. Leading change, advancing health.
Retrieved from:
The International Nursing Association for Clinical Simulation and Learning (2011). Scenario
development [PowerPoint slides]. Retrieved from:
Jeffries, P.R. (2005). A framework for designing, implementing, and evaluating simulations
used as teaching strategies in nursing. Nursing Educational Perspectives, 26(2), 96-103.
Jeffries, P.R., & Rizzolo, M.A. (2006). Designing and implementing models for the innovative
use of simulation to teach nursing care of ill adults and children: A national, multi-site, multimethod study. National League for Nursing. Retrieved from:
Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds). (2000). To err is human: building a
safer health care system. Retrieved from:
Massy, K. (2011). Identifying and analyzing professional practice gaps. The HIS Primary
Care Provider, 36(3), 39-55. Retrieved from:
Pelayo, L.W. (2008). Responding to the nursing shortage – a new paradigm. Unpublished
manuscript, Department of Nursing, Alamo Colleges, San Antonio, Texas
Rothgeb, M.K. (2008). Creating a nursing simulation laboratory: A literature review. Journal
of Nursing Education, 47 911 0, 489-494.
Saintsing, D. Gibson, L.M., & Pennington, A.W. (2011). The novice nurse and clinical
decision-making: How to avoid errors. Journal of Nursing Management, 19, 354-359. doi:
Scheckel, M. (2009). Selecting learning experiences to achieve curriculum outcomes. In D.M.
Billings & J.A. Halstead (Eds.), Teaching in nursing. A guide for faculty (pp.154-172). St.
Louis, Missouri: Saunders Elsevier.
Sportsman, S., Bolton, C., Bradshaw, P., Close, D., Lee, M., Townley, N, & Watson, M.N.
(2009). A regional simulation center partnership: Collaboration to improve staff and student
competency. The Journal of Continuing Education in Nursing, 40(2), 67-73.
Texas Board of Nursing (2012). Texas Board of Nursing Position Statements. Retrieved from:
Ulrich, B., Krozek, C., Early, S., Ashlock, C.H., Africa, L.M., & Carman, M.L. (2010)
Improving retention, confidence, and competence of new graduate nurses: Results from a 10year longitudinal database. Nursing Economics, 28(6), 363-374.
Waxman, K. T. (2010). The development of evidence-based clinical simulation scenarios:
Guidelines for nurse educators. Journal of Nursing Education, 49(1), 29-35. doi:

similar documents