NCSBN Study & NCSBN Guidelines Mary K Fey PhD, RN, CHSE

Faculty Disclosure – No disclosures or conflicts of interest to report

50% is the end… in the beginning What is often lost in talking about this study is what went into creating it. Because not only is this critical to the quality of the study, perhaps it’s also a model for how nursing education can be improved in all areas: clinical, sim, and classroom….

3 Questions; 2 Parts Does amount of simulation affect program outcomes? course-by-course outcomes & perception of learning needs being met? NCLEX pass rates? Part I – Nursing program Part II – 1st 6 months of practice Outcomes: knowledge, clin comp, CT, Readiness for Pract

High Quality Simulation Experiences INACSL Standards of Best Practice: Simulation NLN/Jeffries Simulation Framework/Theory Debriefing for Meaningful Learning Debriefing Assessment for Simulation in Healthcare Terminology Professional Integrity of Participant(s) Participant Objectives Facilitation Facilitator Debriefing Process Participant Assessment and Evaluation Simulation Enhanced Interprofessional Education (Sim-IPE) Simulation Design

The Schools Call for participants; 23 applicants 10 undergraduate nursing schools across the US – rural, urban, suburban Fall 2011 – Spring 2013 Randomized incoming students to: Control < 10% simulation 25% simulation 50% simulation N=666 5 AND 5 BSN – all had at least 600 hours in the curriculum

The Teachers Dedicated study teams: faculty and staff – decrease variability in teaching 3 full days of training: NLN/Jeffries Framework & DML Trained using SIMULATION Trained to use evaluation instruments Ongoing evaluation using DASH

The Simulations Standardized curriculum – published, validated cases If none available – call to INACSL members, new sims vetted All sims given to programs; they selected what would meet their learning outcomes Standardized programming and supplies (including meds)

RECAP INACSL Standards of Best PracticeSM Validated simulations Development of select faculty Ongoing assessment of faculty Validation of processes Evidence based teaching strategies Purposeful faculty development….imagine that… Ongoing assessment of competence Something about taking these techniques across the curriculum

The Outcomes Knowledge ATI Comprehensive Predictor – no difference ATI Content Mastery Series - 50% group better in: med/surg, maternal/newborn, peds, mental health

The Outcomes Clinical Competency – no differences Creighton Competency Evaluation Instrument New Graduate Nurse Performance Survey Global Assessment of Clinical Competency and Readiness for Practice

The Outcomes NCLEX – no differences Critical Thinking – no differences Critical Thinking Diagnostic Learning Needs Comparison – no differences Clinical Learning Environment Comparison Survey

Results Substantial evidence that substituting high quality simulation experiences for up to half of traditional clinical hours produces comparable end of program education outcomes and new graduates that are ready for clinical practice Follow INACSL Standards Faculty trained in simulation pedagogy Adequate number of faculty to support students Subject matter experts who conduct theory-based debriefing Equipment and supplies to create a realistic environment About tx to practice: many of us remember a study from the 90’s in which 90%/10% (Del Bueno). That was a wake up call – note that in this study, overall, the new grads were deemed ready to practice by preceptors & managers – we’ve fixed something!

Guidelines Guidelines developed to . . . assist BON in assessing nursing simulation programs. Inform nursing program directors and faculty to prepare and plan for using simulation successfully in their nursing programs.

Faculty preparation Dedicated simulation faculty vs. teaching everyone (included in workload) Faculty preparation including training on INACSL Standards of Best Practice: SimulationSM Planned and documented orientation policy Ongoing continuing education and CV documentation Formalized debriefing training and use of a debriefing methodology Evaluation (i.e. learner acquisition of KSAs, program, effectiveness of facilitator, debriefing) Sharing of information with clinical faculty

Program prep Institutional commitment to the simulation program Long range plan documented for simulation usage Appropriate facilities to conduct simulation Educational and technological resources and equipment for simulation Qualified faculty and personnel to conduct simulation

Response Options Already happening

Response Options Already happening Good Start

Response Options Already happening Good Start Considering it

Response Options Already happening Good Start Considering it Very Challenging

Response Options Already happening Good Start Considering it Very Challenging

Faculty members are prepared using INACSL Standards of Best Practice: Simulation https://www.polleverywhere.com/multiple_choice_polls/awgAjxdv6VBn9Ej

We are using a tool that evaluates simulation based learning experiences https://www.polleverywhere.com/multiple_choice_polls/NfR99M4Yjp1K4Hu

Faculty are prepared to create a learning environment that encourages active learning, repetitive practice, and reflection and to provide appropriate support throughout each activity. https://www.polleverywhere.com/multiple_choice_polls/zppDQ2kwWn2SVLO

The program utilizes a standardized method of debriefing using a Socratic methodology. https://www.polleverywhere.com/multiple_choice_polls/sr4qjdQqvn10qFD

the effectiveness of the facilitator. https://www.polleverywhere.com/multiple_choice_polls/p9IxYWGgIBBvswy

the effectiveness of the simulation experience. https://www.polleverywhere.com/multiple_choice_polls/4MPk4FHzsZVZXFl

The school has created a framework that provides adequate resources (fiscal, human, and material) to support the simulation program. https://www.polleverywhere.com/multiple_choice_polls/A2i8ZWmiMmDc9b3

Policies and procedures are in place to ensure quality-consistent simulation experiences for the students. https://www.polleverywhere.com/multiple_choice_polls/RAordBwXwGEHl2M

The program has job descriptions for simulation faculty members/facilitators. https://www.polleverywhere.com/multiple_choice_polls/7gDfLZtYcFpjWY2

The program has a plan for orienting simulation faculty members to their roles. https://www.polleverywhere.com/multiple_choice_polls/ic2LI2pPrBu5Lqj

Citations NCSBN National Simulation Study (Hayden et al., 2014) https://www.ncsbn.org/5644.htm NCSBN Simulation Guidelines (Alexander et al., 2015) http://www.journalofnursingregulation.com/article/S2155- 8256(15)30783-3/pdf