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.
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
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
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
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.
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
Editor's Notes
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