Pamela R. Jeffries

Getting in S.T.E.P. with simulations: simulations take educator preparation.

PAMELA R. JEFFRIES, DNS, RN, FAAN, ANEF, delivered the first Debra L. Spunt Endowed Lecture at the NLN Education Summit 2007 on September 29 in Phoenix, Arizona. This article is adapted from her presentation. The NLN Foundation for Nursing Education and Laerdal Medical Corporation established this annual presentation in appreciation for the leadership of Debra L. Spunt, DNP,, RN, FAAN, who died on March 9, 2007. DR. SPUNT, an assistant professor and director of the clinical simulation laboratories at the University of Maryland School of Nursing, led the University of Marylands participation in the three-year NLN/Laerdal Simulation Study that culminated in the book Simulation in Nursing Education: From Conceptualization to Evaluation. Dr. Jeffries, associate professor of nursing at Indiana University School of Nursing, Indianapolis, was project director. Janet L. Grady, DrPH, RN, will present the second Debra L. Spunt Endowed Lecture at the NLN Education Summit 2008 in San Antonio. THE USE OF SIMULATIONS as a teaching-learning intervention in nursing curricula has increased greatly during the past decade. Nursing students, clinicians, and educators are in strong agreement about the importance of this effort. Typically, nursing students are taught theory in one course and clinical skills in others, such as fundamentals. They are assigned to clinical settings to apply what they have learned and to think on their feet while caring for real patients. This traditional model does not provide opportunities to practice skills and think critically in a safe environment. On clinical units, students are expected to recognize alterations and deterioration of patients and to intervene quickly, even though they have not had sufficient practice (1). The Current Situation The move toward making simulations a part of nursing curricula, either as a clinical enhancement, substitute, or adjunct, is arising for several reasons: There is an increased need for clinical sites and instructors as more schools of nursing are established. Across the nation there is a need for more nurse educators in all types and levels of nursing programs. With the educator shortage, nurse leaders and professional nursing organizations are calling for new clinical models and encouraging schools and universities to seek innovative approaches to traditional nursing education (2,3). Concerns about patient safety have led to calls for lower student-faculty ratios that ultimately will increase the need for more clinical sites and increase the cost of clinical education. Many schools of nursing have responded to calls to prepare nurse graduates for work in high-tech, complex health care environments by purchasing patient simulators. However, equipment is often purchased with the expectation that faculty will embrace the new technology, when the reality is that many faculty are not prepared for this type of teaching. Simulations Take Educator Preparation: The Professional Challenge How are faculty best prepared for this paradigm shift in clinical education? Too often they are not properly prepared; they must experiment with simulations by trial and error. Certain materials and programs can be purchased, but there is no standardized curriculum for simulation nor set of competencies that will prepare nurse educators for this pedagogy. Fortunately, federal funding agencies are beginning to notice that faculty development is needed for using advanced technologies, and calls for federally funded grants are focusing more on faculty proposals. The challenges faculty face as they adopt this new pedagogy and clinical teaching model are found primarily in the areas of administration, resources, and faculty development. ADMINISTRATIVE CHALLENGES Deans and directors must recognize that the use of this new clinical model and teaching pedagogy requires administrative support as well as funds for various resources. Faculty must be able to attend regional and national nursing education conferences and educational symposia to learn more about the pedagogy and affiliated research, and to be able to network with other educators who are using this teaching-learning method. …

Constructing Maternal-Child Learning Experiences Using Clinical Simulations

Clinical simulations are gaining more attention in the field of maternal-child health and allow nursing programs and service organizations to assess competency of students and staff in key patient safety situations. Nursing and midwifery programs, orientations, and yearly reaccreditation modules commonly include simulation on postpartum hemorrhage, placenta abruption, shoulder distocia, and other high-risk, low-incidence emergency events. This article describes the use of simulations by educators and managers as teaching or professional development strategies.

NCSBN Simulation Guidelines for Prelicensure Nursing Programs

The National Council of State Boards of Nursing (NCSBN) published the results of the largest, most comprehensive study to date concerning the use of simulation as a substitute for traditional clinical experience. Results of the study, which were published in 2014, demonstrated that high-quality simulation experiences could be substituted for up to 50% of traditional clinical hours across the prelicensure nursing curriculum. An expert panel convened by NCSBN evaluated the data gathered through this study, examined previous research and the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: SimulationSM, and used their collective knowledge to develop national simulation guidelines for prelicensure nursing programs. This article presents those guidelines, evidence to support the use of simulation, and information for faculty and program directors on preparation and planning for using simulation successfully in their nursing programs.

Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial

BACKGROUND Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available. DESIGN A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA. METHODS Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool. RESULTS More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p < 0.001]; and defibrillation: [C: 157(140-254) vs. 6M: 138(107-158) vs. 3M: 115(101-119) vs. 2M: 109(98-129); p < 0.001]. A composite outcome of key priorities, compressions within 20s, defibrillation within 180 s and use of a backboard, revealed improvement with more frequent training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p < 0.001]. CONCLUSION Results revealed short in-situ training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA.

Creating Simulation Communities of Practice: An International Perspective

&NA; A three‐year National League for Nursing grant aimed at faculty development in the use of simulation as a teaching‐learning strategy to promote and evaluate student learning outcomes was funded in 2007 by the Laerdal Medical Corporation. The focus of the faculty development project was the creation of nine web‐based courses written by nine United States authors with the assistance of eight contributing partners from seven different countries. The process is described from the view of the international participants who worked together with the US experts. The significance of the work, the process, the challenges and barriers, and the benefits and rewards of the work are described. Recommendations for working on a multisite, international collaborative project are also discussed.

Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses.

Abstract Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one‐group pre‐to‐post‐intervention design. Educational interventions included faculty‐led, simulation‐based case presentations using the Harvey® cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer‐based CD‐ROM program. Outcome measures included a 31‐item cognitive written exam, a 13‐item skills checklist used in each of a three‐station objective structured clinical exam, learner self‐efficacy and satisfaction survey, instructor satisfaction and self‐efficacy survey, and a participant logbook to record practice time using the self‐learning materials. Thirty‐six students who received the simulation‐based training showed statistically significant pre‐to‐post‐test improvement in cognitive knowledge and cardiovascular assessment skills.

A Clinical Academic Practice Partnership: A Clinical Education Redesign

The clinical academic practice partnership (CAPP), a clinical redesign based on the dedicated education unit concept, was developed and implemented by large, private school of nursing in collaboration with 4 clinical partners to provide quality clinical education, to explore new clinical models for the future, and to test an innovative clinical education design. An executive steering committee consisting of nursing leaders and educators from the school of nursing and the clinical institutions was established as the decision-making and planning components, with several collaborative task forces initiated to conduct the work and to accomplish the goals. This article will describe methods to initiate and to organize the key elements of this dedicated education unit-type clinical model, providing examples and an overview of the steps and elements needed as the development proceeded. After 18 months of implementation in 4 different nursing programs in 4 different clinical institutions, the clinical redesign has shown to be a positive initiative, with students actively requesting CAPP units for their clinical experiences. Preliminary findings and outcomes will be discussed, along with nursing education implications for this new clinical redesign.

The National League for Nursing Project to Explore the Use of Simulation for High-Stakes Assessment: Process, Outcomes, and Recommendations.

AIM This project was designed to explore the feasibility of using simulation for high‐stakes assessment in pre‐licensure RN programs. METHOD A think tank of experts recommended simulation scenarios suitable for assessing students at the end of their program. Two teams were formed: one to design the simulations, the other to develop the evaluation plan. Scenarios were piloted and refined, then sent to schools across the country. Student performances on video recordings were scored by raters. RESULTS Essential elements of simulation design, implementation, evaluation tools, and processes were found. CONCLUSION Well‐designed and facilitated scenarios, delivered in the controlled environment of the simulation center, can be a reliable and valid tool for evaluating the clinical skills of students.

Faculty Development When Initiating Simulation Programs: Lessons Learned From the National Simulation Study

Nursing programs are seeking guidance from boards of nursing about how much simulation can be substituted for traditional clinical practice. To address this question and to assess educational outcomes when simulation is substituted for clinical time, the National Council of State Boards of Nursing (NCSBN) conducted a study using 10 nursing schools across the United States.This article focuses on the faculty development needed to maintain fidelity in the intervention, implementation, and evaluation processes of initiating simulation programs. Lessons learned from preparing faculty for the NCSBN simulation study are shared and may be applicable to schools seeking to educate faculty in teaching simulation.

Increasing Faculty Capacity: Findings from an Evaluation of Simulation Clinical Teaching

AIM To compare how the use of different “doses” of simulation in undergraduate clinical teaching affect faculty capacity. BACKGROUND Since 2008, the NYU College of Nursing has used a “high dose” of simulation to substitute for 50 percent of the clinical hours in core medical‐surgical courses to address a shortage of faculty and clinical sites. Johns Hopkins University School of Nursing has used limited, “low‐dose” simulation hours to supplement clinical hours. METHOD The evaluation included program data and surveys and qualitative interviews with faculty and students in each program. RESULTS Implementing “high‐dose” clinical simulation resulted in a nearly 50 percent increase in faculty capacity at NYU, expanding undergraduate enrollment from 613 students in 2007 to 900 in 2012, with no negative impacts on faculty work life or student outcomes. CONCLUSION Substituting simulation for traditional clinical hours can be a sustainable and educationally sound option to increase faculty capacity.