The Experience at Quinnipiac University Mary Ann Cordeau PhD, RN

 From participating in this presentation the participant should be able to:  Discuss the process of starting a clinical simulation program  Discuss the process of setting up a simulation laboratory  Discuss the process of expanding a clinical simulation program  Discuss the process of starting an interdisciplinary clinical simulation program

Moving from a Simulation Room To a simulation suite

Some assembly necessary!!!  One Mannequin  One patient room with a control room  One instructor  One scenario  Eighty students!!!!!  Number for HELP desk  Number for Laerdal

 Interested faculty member  Supportive Leadership  Curriculum plan for incorporating clinical simulation  Space  Funding  Mannequin  Faculty Expert(s) (Novice to Expert)  Fidelity Environment  Accessories  Faculty Buy-in  Faculty Education  Technological Support  Maintenance of Lab equipment  Management of student experiences  Selling the Program  Interprofessional use  Director of Clinical Simulation

 Department – Chairperson who supports clinical simulation as a teaching learning strategy ◦ 2005 Janice Thompson decided to purchase a SimMan for the Department and build a simulation lab. ◦ 2008 Plans for move to North Haven and Simulation Suite with 5 simulation rooms  School – Dean who supports clinical simulation  University – Understanding of the potential of clinical simulation as a teaching/learning strategy

 Finding a framework to guide the process ◦ Orientation ◦ No practice sessions  Simulation outcomes ◦ Began in spring semester in our first medical/surgical course with the care of a postoperative client ◦ Wrote a scenario which included scenario outcomes  Created grading rubric  Scenario was related to NU 303 as an add on assignment, Pass/Fail  After the second year, I presented a potential plan for incorporating clinical simulation into all courses  Research on the Experience of Clinical Simulation

 Look to the literature for information on best practices for clinical simulation  Examine program/course outcomes to determine how clinical simulation will be used to meet outcomes  The use of clinical simulation needs to be examined for each course ◦ Number and type of experiences ◦ Use of clinical simulation in the class room  Teaching content, Practice, Nursing experience, Team work, Evaluation  Attach % points, Pass/Fail, Letter, number grade

Don’t jump into the water unless you know what is there!!  Start with a written scenario: Laerdal, International Nursing Association for Clinical Simulation and Learning (INACSL), Colleague  Start with one course  Conduct a Pilot study ◦ Uncover what needs to be changed

 Current Use:  Fundamentals Course – Fall Junior Year ◦ Therapeutic communication, Client Safety  Medical/surgical Course – Spring Junior Year ◦ Post-operative assessment, Medication Administration  Maternity Course – Spring Junior Year ◦ Assessment  Medical/surgical Course – Fall Senior year ◦ Mock Codes, Chest Tubes  Leadership Course – Spring Senior Year ◦ Working as a team, Being the nurse  SNUAC – Post operative assessment of a client with a C-section, Teaching, New born Assessment

 Future Use  New Curriculum ◦ Integrated Lab - more course objectives could be met using clinical simulation ◦ Streaming from sim lab to classroom for most courses ◦ Integration of Electronic Health Record

Move to North Haven  What space is available for setting up a clinical simulation lab?  Renovate existing space  Create a space for a clinical simulation suite ◦ Faculty need to work closely with technology to describe technological needs for running a clinical simulation

 One control room for each simulation room ◦ Use of desk microphones ◦ Debriefing immediately after simulation  If using desk microphones do not have rooms set up with patient rooms back to back, sound from one room interfere with sound from other room

 Budget  Program/course objectives

What is essential for learning?  Fidelity depends on learning outcomes  A realistic environment as possible is necessary for simulating a patient care scenario and the promotion of clinical reasoning  Cost and Waste

100, WOW!!!!!  Grants, School budget, University budget  Cost of mannequin (40-60K)  Cost of room construction  Cost of AV equipment (20K)  Cost of related equipment (bed, etc)  Cost of maintenance  Cost of training  Cost of staff 

Super Clinical Simulation Educator  At least one faculty must develop expertise ◦ Nursing knowledge ◦ Teaching knowledge ◦ Simulation knowledge ◦ Technology knowledge  Literature  SUN conferences  Laerdal Training  Other institutions  Practice, Practice, Practice!!!

 Faculty education - Expert should educate faculty on potential of clinical simulation ◦ Literature ◦ Demonstration ◦ Student testimony ◦ Outcome measurement ◦ Institutional Research

Gonna fly now  Laerdal  SUN Conferences  Mentoring  Discussion ◦ Technology ◦ Scenarios  Role play  Demonstration  Return demonstration  Technology Support

 Began with 80 juniors  140 juniors ◦ 45 minute session fall ◦ 45 minutes session spring ◦ Maternity experience spring  50 SNUAC students ◦ 1 hour session  140 seniors ◦ Mock codes in fall ◦ Capstone simulation

 Where is clinical simulation placed in the curriculum ◦ Lab, Course, Clinical  Is it used in place of clinical time?  How is credit for preparation and successful meeting of objectives given?  How is faculty time managed, credits?  How does clinical simulation affect faculty work load?  Will full-time and/or adjunct faculty be used for teaching  Will simulation technicians be used to run programmed scenarios?

 Clinical Simulation Policy (should be included in syllabus or handbook ◦ Stick to policy unless unusual circumstances  Orientation process (video, hands on)  Number of practice sessions ◦ Limited, unlimited  Evaluation - Number of times student will be allowed repeat experience ◦ How will this affect grade/passing of course or course component  Remediation ◦ Opportunities for practice, mandatory/voluntary  Single or group/team experiences ◦ Objectives, faculty resources, technology  Length of experience ◦ Objectives, type of scenario  Number of instructors needed to meet program needs  Scheduling ◦ Wiki

 University Administration  Students are asking about clinical simulation during open house  Parents impressed with simulation as teaching/learning strategy  Health care facilities recognize significance of clinical simulation experiences  Getting the word out to other departments in the University

 Began with nursing  Individuals in other departments (OT, PT) contacted Nursing  Physician Assistant students  Who will set up faculty training sessions and be responsible for training  Once faculty are oriented, nursing signs off

Roles develop over timeTo meet needs  Concerns – Scheduling  Determining departmental needs from all departments  Extra workload on current Laboratory Coordinator  Need for Development of a Laboratory Manager who is responsible for training, student orientation, troubleshooting, budgeting, scheduling and simulation set up for all departments  Approved for 5 extra rooms

 Dr. Barrere

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