Mary Cato MSN, RN Oregon Health & Science University Laerdal SUN meeting Dallas Texas October 2009.
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Transcript of Mary Cato MSN, RN Oregon Health & Science University Laerdal SUN meeting Dallas Texas October 2009.
Mary Cato MSN, RNOregon Health & Science University
Laerdal SUN meetingDallas TexasOctober 2009
“The true value of simulation lies in its ability to offer experiences throughout the educational process that provide students with opportunities for repetition, pattern recognition, and faster decision making.”
Doyle & Leighton, 2010
25% of studies cite integration of simulation-based exercises into the curriculum as an essential feature of their effective use.
Simulation-based education should not be an extra-ordinary activity, but must be grounded in the ways learner performance is evaluated, and should be built into learners’ normal training schedule.
Effective medical learning stems from learner engagement in deliberate practice with clinical problems and devices in simulated settings in addition to patient care experience.
90% of nurse educators think their graduates are ready to safely practice
10% of hospital and health system executives think graduates are ready to safely practice
JONA November 2008
Mainly NOT in “motor skills” New graduates often have little
experience in: Delegation Taking “a full load” Utilizing resources (for themselves and
their clients) Interprofessional communication
Cognitive: mental skills (Knowledge)
Affective: growth in feelings or emotional areas (Attitude)
Psychomotor: manual or physical skills (Skills)
ORIGINAL TERMINOLOGY REVISED TERMINOLOGY
Because simulation is experiential learning, objectives can be higher level
Creating and evaluating, for example, rather than simply understanding or remembering
Classroom or lecture Techniques of assessment Effects of a drug (use monitor) Role model communication
Skills lab Demonstrate procedure Increase realism by doing procedure in
context of patient care
Utilize as clinical hours? Impact of increasing fidelity
Able to provide context to situation Encourage use of clinical judgment,
communication, resource management, “thinking on your feet,” teaching skills, management of emotional situations
High, mid, and low fidelity manikins Standardized patients and
participants Role-playing Computer simulation Virtual reality
Give students opportunities to make decisions
Reinforce important concepts Teach and practice clinical judgment Practice professional communication Reflect on case
An Integrative Model of Clinical Judgment
Noticing Interpreting Responding
Expectations
Initial Grasp
Reasoning PatternsAnalytic Intuitive
NarrativeAction
OutcomesReflection on action andClinical Learning
ContextBackgroundRelationship
Reflecting
Reflection on Action
Tanner, CA (2006) Thinking like a nurse: A research-based model of clinical judgment. Journal of Nursing Education, , 45(6), 204-211
Who are the client case exemplars? Common situations
Highly prevalent nursing practice situations What students will most likely see in clinical
High risk, low frequency situations Lack of clinical experiences Apply previously learned content “Spiral up” the curricular content
Resources available Faculty & content experts Space & equipment
Objectives need to be attainable Tasks should be appropriate Consider “just manageable” situations – (the experience is challenging enough
to move the learner to a higher level, but not so difficult that the learner becomes frustrated or discouraged) (Bransford, Brown and Cocking, 2000)
Occurs after the simulation session
Reflective journaling
Use of rubric
Individual learning – availability of faculty outside of simulation session if needed
Formative vs summative or “high stakes”
Clarity of objectives, what is being tested Participants need to know what the stakes
are How will the results be communicated to
the participants?
Organizations INACSL SSiH NLN
Courses Workshops Apprenticeships Graduate courses
Laerdal Nursing Scenarios SIRC (NLN/Laerdal Medical) has 2
samples in Designing & Developing a simulation course
MedEdPORTAL (Association of American Medical Colleges)
STORC OB Safety Initiative PNCI
“Real Nursing Simulations,” (2009) Pearson Education Inc.
“Simulation Scenarios for Nurse Educators,” (2009) Campbell and Daley: Springer Publishing
"High-Fidelity Patient Simulation and Nursing Education," (2009)Nehring and Lashley: Jones and Bartlett
Jeffries Simulation Framework
Simulation Innovation Resource CenterSimulation Innovation Resource Center
What do students need in real-world clinical practice and what can we simulate
How much, How often When What aspects are most important for learning Does simulation make a difference to patient
safety Does simulation improve patient care
outcomes
Use of standardized patients Use of hybrid simulations Increased focus on management,
delegation, and leadership Integration of Electronic Medical Record Interprofessional activities Graduate programs