Breaking the mold:Large class simulation in a dayLori Lioce, DNP, CRNPClinical Assistant ProfessorUniversity of Alabama Hu...
SIMULATION CENTERS
Objectives1. Audience will be able to understand   theoretical and curriculum integration   framework for simulation2. Aud...
HISTORICAL PERSPECTIVE 1ST SIMULATION FRAMEWORK PUBLISHED  IN 2005 NLN JEFFRIES FRAMEWORKS   23 CONSTRUCTS OF 3 ECLECTI...
Systematic Review“ concludes most nursing faculty approach  simulation from a teaching paradigm rather  than a learning pa...
Simulation Literature ReviewSource           FindingNLN, 2006        “students engaged in high-fidelity simulation reporte...
Simulation requires students activate prior knowledge in order to construct  new knowledge active engagement in real-tim...
Experiential Learning (Kolb) Learner Centered Learning Learning styles in a multi-dimensional format Perception (graspi...
Armstrong’s Curriculum         Planning Framework Reinforces student centered learning Learners may be kinesthetic, audi...
Blended Kolb1. Activate                 3. Try out              2. Add new                 4. Use new   prior             ...
Types of Evaluation Formative  ongoing gives students feedback, addresses gaps Summative  end of term – how competent - ...
Tanner’s Clinical Judgment Model                           2006
METI      METI  SIM        DLAYOUT                     Neonatal                                D             SIM         D...
Critical Care Suite
Framework
PEDS
Overview
Setting up forsuccess
128 Students 9 hours       4  high-fidelity simulators  64              64 32              32 • 8:00-10:00    • 12:30-2:30...
128students 64    64                         Each group of32              32                32                            ...
ONE 2 HOUR = 4 Groups of 8  • 8 - METI 1                        16  • 8 - METI 2   • 8- SimNew B                 • 8- Noel...
Clinical GroupDivision
Resources 4 Simulators Sim Coordinator/Faculty Expert 4 Faculty 9 hours Supplies Preparation Time
Consistent Repetitive Format Introduction to simulation/simulator Pre-test Scenario Overview-Observers/Participants  as...
Course Manager/Liason Meeting with simulation coordinator at the beginning/end    of each semester   Connecting the dida...
Rotation Schedule Examples
Audience Discussion
Lessons Learned   Clinical Attire = Clinical Performance = Uniforms ALL   Faculty Training + Student Trust Set up for Su...
SUCCESSFUL SIMS Scenario/Didactic Faculty Preparation Integrate Standardized Case Study EBP Article Rigor/Consistency...
Not everything that counts,   can be counted andNot everything that can be      counted, counts.              Albert Einst...
ReferencesArundell, F., & Cioffi, J. (2005). Using a simulation strategy: An educator’s experience. Nurse Education in Pra...
QUESTIONS
Jeffries 2007 Synthesize knowledge Make mistakes, learn from their mistakes, and    immediately correct mistakes   Inte...
Thinking like a nurse: a research-basedmodel of clinical judgment in nursing.(1) Clinical judgments are more influenced by...
Chris Tanner’s        Clinical Judgment Model Implementation proposal for simulation Four domains of clinical judgment: ...
C.J. PROMPTS What did you notice about your patient when    you walked into the room?   What you expected to see?   You...
UNDERPINNINGS OF CJ RESEARCH OUTCOMES DRIVE LEARNING STRATEGIES  AND EVALUATION THEORY PRACTICE GAP STILL EXISTS  (CARNE...
UNDERPINNINGS OF CJ RESEARCH OUTCOMES DRIVE LEARNING STRATEGIES  AND EVALUATION THEORY PRACTICE GAP STILL EXISTS  (CARNE...
Lassater Rubric Clinical reasoning process into common language that    will help us all   Identify a developmental scal...
Topics to Consider MORE LEVELS THAN PASS FAIL—RIGHT NOW ALMOST    ALL PASS CLINICAL   HOW WELL DO THEY UNDERSTAND THE   ...
National Research Council, 1999. “How People Learn” downloaded on July 17,2011 from http://www.pkal.org/documents/HowPeopl...
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
HPSN 2012: Large Class Simulation
Upcoming SlideShare
Loading in …5
×

HPSN 2012: Large Class Simulation

970 views

Published on

Human Patient Simulator Network 2012 Presentation: Large Class Simulation in a day
How to successfully design a schedule and perform 2 simulations and debriefings for 120+ senior nursing students with 4 faculty and 4 simulators in a nine hour day.

Published in: Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
970
On SlideShare
0
From Embeds
0
Number of Embeds
13
Actions
Shares
0
Downloads
38
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • Background
  • >125 yet little research on LARGE Class Simulation
  • UNCLEAR : TIME SIM, DEBRIEIFING, FORMAT
  • SIMULATION AS ACTIVE LEARNING STRATEGY WAS AMAZINGFIRST SIMULATIONS ABLE TO WATCH STUDENTSBEGINNNING TO END OF PATIENT (NOT ON FLOOR)ENGAGED IN ACTIVE LEARNING WHERE I COULD WATCH THEM –SEE WHERE THEY DON’T UNDERSTAND THINGSSTUDENTS WERE SEEING ASSESSMENT AS SOMETHING YOU CHECK OFF AND YOUR DONEFOSTERING REFLECTION OFFERS HUGEPOTENTIAL FOR LEARNING OPPORTUNITIES (PROCESS AND LEARN FROM EXPERIENCES- REINFORCES LEARNING (ESP QUICK TIMEFRAME – NEED A LITTLE TIME TO PROCESS WHAT THEY ARE SEEING AND DOING
  • Not
  • Not a quick fix to evaluate clinical competency, all so frustrated with trying to grade students clinical thinking
  • NOT THE NURSING PROCESSUSES A NOT SO LINEAR WAY OF THINKINGLED BY WHAT NURSE BRINGS TO SITUATION Tanner 2006 Think Like a Nurse
  • (max. of 8 = 4 participants/4 observers evaluating)
  • Goal ot an evaluation instrument for simulation
  • This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.
  • Dissertation research, looked at critical thinking construct to consider, literature didn’t agree on critical thinking in nursing, even though it was an accreditation criterion and in every syllabus and objective for years.Asking instructors how to evaluate critical thinking: “I know what it is and you don’t have it…..”Rubric considers what life experiences these students bring. Epidemiologist, air-force pilots (calm & confident skill already there – didn’t mean she knew what she was talking about but I would have followed her anywhere because the manner in which she performed)Skillful last dimension added to rubric – start an IV drip and came out crying because the patient talked to her – Benner- head heart & the hands cant separate them outDrove
  • Words across the top are descriptors
  • HPSN 2012: Large Class Simulation

    1. 1. Breaking the mold:Large class simulation in a dayLori Lioce, DNP, CRNPClinical Assistant ProfessorUniversity of Alabama Huntsville
    2. 2. SIMULATION CENTERS
    3. 3. Objectives1. Audience will be able to understand theoretical and curriculum integration framework for simulation2. Audience will be able to discuss a rotation schedule for a large class3. Audience will be able to explain resources to facilitate simulation large class4. Lessons Learned
    4. 4. HISTORICAL PERSPECTIVE 1ST SIMULATION FRAMEWORK PUBLISHED IN 2005 NLN JEFFRIES FRAMEWORKS  23 CONSTRUCTS OF 3 ECLECTIC THEORIES LEARNING THEORIES, GRAND & MIDDLE RANGE THEORIES TANNER 2006 HOW TO THINK LIKE A NURSE
    5. 5. Systematic Review“ concludes most nursing faculty approach simulation from a teaching paradigm rather than a learning paradigm. For simulation to foster student learning there must be a fundamental shift from a teaching paradigm to a learning paradigm and a foundational learning theory to design and evaluate simulation should be used”. Kaakinen, Joanna and Arwood, Ellyn, 2009
    6. 6. Simulation Literature ReviewSource FindingNLN, 2006 “students engaged in high-fidelity simulation reported higher satisfaction scores in their learning experience and an increased confidence rating. …students given paper/pencil case study did not perceive as many problem solving features as students actively involved in high-fidelity simulation”.Conner, 2006 offers learning for all: visual learners, auditory learners, and tactile learnersJeffries, 2007 offers students the ability to participate in patient care, testing their decision-making and clinical reasoning skills in real timeDewey (1933) learner’s reflective observation about an experience is essential& Kolb (1984) in the long term learning process
    7. 7. Simulation requires students activate prior knowledge in order to construct new knowledge active engagement in real-time learning to revise their thinking and try out new ideas by applying them and reflecting on the impact of those decisions the student to utilize meta-cognition or “to know what they know” National Research Council, 1999
    8. 8. Experiential Learning (Kolb) Learner Centered Learning Learning styles in a multi-dimensional format Perception (grasping) and processing (transformation) 4 ASPECTS:  providing a concrete experience  reflective observation  conceptualization  active experimentation.
    9. 9. Armstrong’s Curriculum Planning Framework Reinforces student centered learning Learners may be kinesthetic, auditory, or visual and succeed within this framework UAB GEC, 2011.
    10. 10. Blended Kolb1. Activate 3. Try out 2. Add new 4. Use new prior new knowledge knowledgeknowledge knowledge & Armstrong
    11. 11. Types of Evaluation Formative ongoing gives students feedback, addresses gaps Summative end of term – how competent - grade
    12. 12. Tanner’s Clinical Judgment Model 2006
    13. 13. METI METI SIM DLAYOUT Neonatal D SIM D NEWB NOELLE D
    14. 14. Critical Care Suite
    15. 15. Framework
    16. 16. PEDS
    17. 17. Overview
    18. 18. Setting up forsuccess
    19. 19. 128 Students 9 hours 4 high-fidelity simulators 64 64 32 32 • 8:00-10:00 • 12:30-2:30 32 32 • 10:00-12:00 • 3:00-5:00
    20. 20. 128students 64 64 Each group of32 32 32 • 8 - METI 1 16• 8:00-10:00 • 12:30-2:30 • 8 - METI 2 • 8- SimNew B • 8- Noelle32 32• 10:00-12:00 • 3:00-5:00 16
    21. 21. ONE 2 HOUR = 4 Groups of 8 • 8 - METI 1 16 • 8 - METI 2 • 8- SimNew B • 8- Noelle 16
    22. 22. Clinical GroupDivision
    23. 23. Resources 4 Simulators Sim Coordinator/Faculty Expert 4 Faculty 9 hours Supplies Preparation Time
    24. 24. Consistent Repetitive Format Introduction to simulation/simulator Pre-test Scenario Overview-Observers/Participants assigned Scenario #1 Debriefing with video review Scenario #2 Debriefing with video review Post Test Evaluations of facilitator and experience
    25. 25. Course Manager/Liason Meeting with simulation coordinator at the beginning/end of each semester Connecting the didactic portions of course to clinical simulation Selecting the appropriate case scenarios with coordinator (reservation form must be completed) Reserving LRC equipment and rooms through the LRC Director Selecting an evaluation method Coordinating clinical group rotation for simulation Completion of evaluations and tests Documents are maintained at LRC in simulation filing cabinet and data entered by GTA
    26. 26. Rotation Schedule Examples
    27. 27. Audience Discussion
    28. 28. Lessons Learned Clinical Attire = Clinical Performance = Uniforms ALL Faculty Training + Student Trust Set up for Success Post student learner documents for scenario 1-2 weeks prior EBP article information 1-2 weeks prior Do not “assign” roles – limits their thinking to only their assignment Recording (no student) Card reader Data Storage Management Process /flow Academic Teaching Preferences Post Evaluation & Debriefing Method Agreement Team training Continuous Assessment Increasing Reliability and Validity Plan
    29. 29. SUCCESSFUL SIMS Scenario/Didactic Faculty Preparation Integrate Standardized Case Study EBP Article Rigor/Consistency Reliability/Validity Continuous Consistent Evaluation & Planning
    30. 30. Not everything that counts, can be counted andNot everything that can be counted, counts. Albert Einstein
    31. 31. ReferencesArundell, F., & Cioffi, J. (2005). Using a simulation strategy: An educator’s experience. Nurse Education in Practice, 5.Brown, J. S., Collins, A., & Duguid, S. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32-42.Byrne, D. (1985). Simulation work with large classes. English Teachers’ Journal 32, 26-33.Gaba, D. M. (2007). The future vision of simulation in healthcare. Simulation in Healthcare, 2.Gordon, J. (2004). High fidelity patient simulation: A revolution in medical education. In W.L. Dunn (Ed.), Simulators in critical care and beyond (pg 3-6). U.S.A.: Des Plaines, IL.Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Reports/2010/The-Future-of- Nursing-Leading-Change-Advancing-Health.aspxJeffries, P. (2007). Simulation in Nursing Education: From Conceptualization to Evaluation. National League of Nursing.Kaakinen, J., & Arwood, E. (2009). Systematic review of nursing simulation literature for use of learning theory. International Journal of Nursing Education Scholarship, (6)1.Larew, C., Lessons, S., Spunt, D., Foster, D., & Covington, B. (2006). Innovations in clinical simulation: Application of Benner’s theory in an interactive patient care simulation. Nursing Education Perspectives, 27(1). National League for Nursing, New York.Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503.Lashley, M. (2005). Teaching health assessment in the virtual classroom. Journal of Nursing Education, 44(8), 348-350.Lave, J., & Wenger, E. (1990). Situated learning: Legitimate peripheral participation. Cambridge, UK: Cambridge University Press. Retrieved from www.learning-Theories.comPaulson, D., & Faust, J. (2011). Learning for the college classroom. Center for Research on Learning and Teaching: The Regents of the University of Michigan. Retrieved from http://www.calstatela.edu/dept/chem/chem2/Active/main.htmRance-Roney, J. (2010). Reconceptualizing interactional groups: Grouping schemes for maximizing language learning. English Teaching Forum, 48, 20- 26.Rauen, C. (June 2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care Nurse, 24(3), 46-51.Shoemaker, M., Beasley, J., Cooper, M., Perkins, R., Smith, J., & Swank, C. (2011). A method for providing high-volume inter-professional simulation encounters in physical and occupational therapy education programs. Journal of Allied Health Professionals. (40)1 15-21.Tuller, M., Gonzalez, M., and Rice, J. (2009). Using simulation as an effective teaching strategy: A faculty guide. University of Texas Health Science Center: San Antonio School of Nursing.Waldner, M., & Olson, J. (2007). Taking the patient to the classroom: Applying theoretical frameworks to simulation in nursing education. International Journal of Nursing Education Scholarship, (4)1.Weiner, E. (2008). Supporting the integration of technology into contemporary nursing education. Nursing Clinics of North America, 43, 497-506.
    32. 32. QUESTIONS
    33. 33. Jeffries 2007 Synthesize knowledge Make mistakes, learn from their mistakes, and immediately correct mistakes Integrate evidence Work in Collaboration Provide ethical and safe care Allows for clinical reasoning Practice decision making skills Reflections on their skills and decision making Develop self-confidence Develops leadership and delegation skills
    34. 34. Thinking like a nurse: a research-basedmodel of clinical judgment in nursing.(1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand;(2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns;(3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit;(4) Nurses use a variety of reasoning patterns alone or in combination; and(5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. Tanner, CA J Nurs Educ. 2006 Jun;45(6):204-11.
    35. 35. Chris Tanner’s Clinical Judgment Model Implementation proposal for simulation Four domains of clinical judgment:  Noticing  Interpreting  Responding  Reflecting Provides an evaluation tool in which educators may benchmark progress and implement goal setting with students
    36. 36. C.J. PROMPTS What did you notice about your patient when you walked into the room? What you expected to see? You assessed... What did you make of those findings? What were your initial priorities? How did they change? Your patient said “.....” What do you think was important to her/him at this time?
    37. 37. UNDERPINNINGS OF CJ RESEARCH OUTCOMES DRIVE LEARNING STRATEGIES AND EVALUATION THEORY PRACTICE GAP STILL EXISTS (CARNEGIE FOUNDATION BENNER PROFESSIONAL PREPARATION) LEARNER CENTERED
    38. 38. UNDERPINNINGS OF CJ RESEARCH OUTCOMES DRIVE LEARNING STRATEGIES AND EVALUATION THEORY PRACTICE GAP STILL EXISTS (CARNEGIE FOUNDATION BENNER PROFESSIONAL PREPARATION) LEARNER CENTERED
    39. 39. Lassater Rubric Clinical reasoning process into common language that will help us all Identify a developmental scale that students could see themselves on Use to set goals for themselves and identify next steps Uses the 4 aspects of Tanner & adds dimension (words across top descriptors) Goal accomplished level before they leave program Developmental = does not equivalate to grades Change the setting goes back to beginning level
    40. 40. Topics to Consider MORE LEVELS THAN PASS FAIL—RIGHT NOW ALMOST ALL PASS CLINICAL HOW WELL DO THEY UNDERSTAND THE BACKGROUND TO FOCUS THEIR ASSESSMENT WHAT DO YOU DO WITH STUDENTS WHO DON’T HAVE A GOOD GRASP WHAT DOES PATIENT/NURSE BRING TO SITUATION ARE THEY CAPABLE OF APPLYING INFORMATION TO MULTIPLE SOURCES? Utilize NCLEX TEST PLAN, QSEN, JCAHO  ex: recommends use memory aid – for report etc
    41. 41. National Research Council, 1999. “How People Learn” downloaded on July 17,2011 from http://www.pkal.org/documents/HowPeopleL earn1999Page16.cfm

    ×