This document outlines a framework for integrating simulation in nursing education, emphasizing a shift from a teaching to a learning paradigm to enhance student engagement and clinical reasoning. It provides insights on the scheduling and resources needed for large class simulations, along with lessons learned for improving the effectiveness of such educational experiences. Key references and theoretical models are presented to support the application of simulation as a teaching strategy in a nursing curriculum.

2. Breaking the mold:
Large class simulation in a day
Lori Lioce, DNP, CRNP
Clinical Assistant Professor
University of Alabama Huntsville

3. SIMULATION CENTERS

4. Objectives
1. Audience will be able to understand
theoretical and curriculum integration
framework for simulation
2. Audience will be able to discuss a rotation
schedule for a large class
3. Audience will be able to explain resources to
facilitate simulation large class
4. Lessons Learned

5. 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

6. 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

7. Simulation Literature Review
Source Finding
NLN, 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 learners
Jeffries, 2007 offers students the ability to participate in patient care, testing
their decision-making and clinical reasoning skills in real time
Dewey (1933) learner’s reflective observation about an experience is essential
& Kolb (1984) in the long term learning process

8. 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

9. 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.

10. Armstrong’s Curriculum
Planning Framework
 Reinforces student centered learning
 Learners may be kinesthetic, auditory, or
visual and succeed within this framework
UAB GEC, 2011.

11. Blended Kolb
1. Activate 3. Try out
2. Add new 4. Use new
prior new
knowledge knowledge
knowledge knowledge
& Armstrong

12. Types of Evaluation
 Formative
ongoing gives students feedback, addresses gaps
 Summative
end of term – how competent - grade

13. Tanner’s Clinical Judgment Model
2006

15. METI METI
SIM D
LAYOUT Neonatal
D
SIM
D NEWB NOELLE
D

17. Critical Care Suite

20. Framework

22. PEDS

23. Overview

25. Setting
up for
success

26. 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

27. 128
students
64 64 Each group of
32 32 32
• 8 - METI 1
16
• 8:00-10:00 • 12:30-2:30
• 8 - METI 2 • 8- SimNew B
• 8- Noelle
32 32
• 10:00-12:00 • 3:00-5:00 16

28. ONE 2 HOUR = 4 Groups of 8
• 8 - METI 1
16
• 8 - METI 2 • 8- SimNew B
• 8- Noelle
16

29. Clinical
Group
Division

30. Resources
 4 Simulators
 Sim Coordinator/Faculty Expert
 4 Faculty
 9 hours
 Supplies
 Preparation Time

31. 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

32. 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

33. Rotation Schedule Examples

35. Audience Discussion

36. 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

37. SUCCESSFUL SIMS
 Scenario/Didactic
 Faculty Preparation
 Integrate Standardized Case Study
 EBP Article
 Rigor/Consistency
 Reliability/Validity
 Continuous Consistent Evaluation & Planning

38. Not everything that counts,
can be counted and
Not everything that can be
counted, counts.
Albert Einstein

39. References
Arundell, 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.aspx
Jeffries, 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.com
Paulson, 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.htm
Rance-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.

40. QUESTIONS

43. 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

44. Thinking like a nurse: a research-based
model 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.

45. 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

46. 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?

47. UNDERPINNINGS OF CJ RESEARCH
 OUTCOMES DRIVE LEARNING STRATEGIES
AND EVALUATION
 THEORY PRACTICE GAP STILL EXISTS
(CARNEGIE FOUNDATION BENNER
PROFESSIONAL PREPARATION)
 LEARNER CENTERED

48. UNDERPINNINGS OF CJ RESEARCH
 OUTCOMES DRIVE LEARNING STRATEGIES
AND EVALUATION
 THEORY PRACTICE GAP STILL EXISTS
(CARNEGIE FOUNDATION BENNER
PROFESSIONAL PREPARATION)
 LEARNER CENTERED

49. 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

50. 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

51. National Research Council, 1999. “How People
Learn” downloaded on July 17,2011 from
http://www.pkal.org/documents/HowPeopleL
earn1999Page16.cfm