There is no financial relationship or conflict of interest with any product or class of products discussed in this educational activity. Arlene Coughlin MSN, CNE, RN J. Cedar Wang MSN, RN Lori Podlinski MSN, MBA, RN Barbara Blackwell EdD, RN-BC

Form collaborative relationships Transition student into the professional role Ease reality shock

Institute of Medicine (IOM) Increase skill attainment through the use of simulation Enhance patient safety through reinforcing critical thinking skills

Experiential Learning Reflective Learning Transformational Learning Clinical simulation finds support in educational literature as a critical component of experiential learning (Dreifuerst, 2009).

Kolb (1984) states: “Knowledge is derived from and tested out in experiences of the learner. The knowledge and skill that is acquired in one experience becomes the foundation by which the learner adapts to new experiences” (p.27).

Kolb (1984) proposes “learning occurs when an event is followed by reflection and then critical discourse after which the learner modifies their actions” (p.21).

Daloz (1999) states that “mentors are a key part on our transformation reminding us that we can indeed survive the terror of our journey and undergo transformation by moving through not around our fears” (p.18).

The nursing resident will integrate theory into practice by using the metacognitive skills of critical thinking and problem solving to determine priority- nursing actions in two clinical simulations.

8 weeks prior to simulation Identifying Objectives Faculty & Staff Development meet to identify learning objectives 8 weeks prior to simulation Writing & Programming Faculty review learning objectives and write 2 scenarios Medium fidelity mannequins are programmed to simulate scenarios Additional roles are identified and assigned 2 weeks prior to simulation Testing of Scenarios Faculty meet to test simulators “Live” run through Simulated medical records are written and compiled Final meeting with Staff Development to assign roles and to review scenarios

Resident Capstone Event

Accurate assessment and identification of client problems Safety measures including standard of care Therapeutic communication Effective communication with interdisciplinary team Prioritize and implement appropriate interventions Evaluate client’s response to treatment

Laerdal ® Vitals ™ with medium fidelity Nursing Anne 2 simulated acute care bedsides (oxygen, suction equipment, cardiac monitoring, IV pump, telephone, patient chart, simulated medications)

E-26: Pat TrickE-28: Vincent Brody 9:00 – 9:30AM RN 1 Observer 1 RN 2Observer 2 9:30 – 10:00AM RN 3 Observer 3 RN 4Observer 4 10:00 – 10:30AM RN 2Observer 2 RN 1 (previously observer 1) Observer 1 10:30 – 11:00AM RN 4 Observer 4 RN 3Observer 3 2 Scenarios 2 Roles for each resident – RN – Observer (silent) Faculty and staff development roles – Mannequin controller – Family member at the bedside – Physician – Respiratory therapist

Partial facilitator prompting Reflective learning Formative assessment

How did you feel during the simulation experience? What did you learn about interacting with family members? What did you learn about collaborating with interdisciplinary healthcare team members? What do you think you did correctly? What do you think you could have done differently? What would you change about this experience?

NLN, (2009). Chronic Obstructive Pulmonary Disease – Oxygen Therapy VitalSim Scenario. Laerdal Medical Corporation. Debriefing/Guided Reflection Questions Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing education: Learner volume. (p. 431). Philadelphia, PA: F.A. Davis Company

Run simulation earlier in the Residency Program Use simulation as a formative assessment that factors into summative evaluation process

Include simulation throughout the student’s academic career to assess achievement of higher level skills and better prepare the graduate nurse for practice (Bensfield, Horsley, & Leann, 2012).

Simulation provides an effective means to evaluate practitioner safety and competency (Beyea, van Reyn, & Slattery, 2008)

Preparation is a key ingredient to enhancing the fidelity of a simulation – Participant – Scenario – Environment

Effective debriefing is essential to the learning process (Dreifuerst, 2009).

Integration of simulation into all areas of school curriculum to enhance attainment of metacognitive, communication, and psychomotor skills Introduce simulation as means of formative assessment Use simulation as a summative assessment of clinical skills

Use simulation as a means to validate skill attainment and competency in the new graduate and experienced RN

Classic New Nurse Orientation Paid Orientation – $15,460 or $32.21/hour Time investment – 12 weeks orientation  Time added as necessary Educational Benefit – Variability in content – Reality Shock

No orientation after residency completed Lower Salary – $9,600 or $20/hour – No paid benefits Time investment – 12 weeks Educational Benefit – Close theory-practice gap – Consistency in orientation practice Nurse Residency

Beyea, S. C., van Reyn, S., & Slattery, M. J. (2008). A nurse residency program for competency development using human patient simulation. Journal for Nurses in Staff Development, 23(2), Bensfield, L. A., Olech, M. J., & Horsley, T. L. (2012). Simulation for high-stakes evaluation in nursing. Nurse Educator March/April, 37(2), Daloz, L.A. (1999). Mentor: Guiding the Journey of Adult Learners. San Francisco, CA: Jossey-Bass. Dreifuerst, K. (2009). The essentials of debriefing in simulation learning: A concept analysis. Nursing Education Perspective 30, (2).

Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing education: Learner Volume. Philadelphia, PA: F.A. Davis Company. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall. NLN, (2009). Chronic Obstructive Pulmonary Disease – Oxygen Therapy VitalSim Scenario. Laerdal Medical Corporation. Tanner, C. (2009). The Case for Cases: A Pedagogy for Developing Habits of Thought. Journal of Nursing Education, 48(6), 299. Taylor, E.W. (1998). The theory and practice of transformational learning: A critical review. Columbus, Ohio.