1. Advance Practice Nursing Simulation: Lessons Taught and Lessons Learned
Barbara Hollie, PhD, ANP-BC, Youvalanda Frencher DNP, WHNP-BC, Hiba Wehbe-Alamah, PhD, FNP-BC, CTN-A
Enrollment in the University of Michigan-Flint DNP program has progressively increased. The expansion required increased clinical sites and visits; however, a need for summative evaluation visits remained. To meet this need, simulation was undertaken to evaluate skill acquisition and clinical decision-making.
Use of simulation in APRN education has been gradual, in part due to:
the level of competencies required (AACN, 2006)
the lack of common definitions for “competence” and “competency” (Lauzon Clabo, 2016)
the lack of common measurable competencies, which creates a dearth of simulation learning tools and practice-ready materials (Lauzon Clabo, 2016)
INTRODUCTION
A clinical skill evaluation checklist was completed and reviewed with each student.
Student Satisfaction Survey evaluations were completed anonymously and identified high satisfaction with simulation sessions.
Among the highest rated items were:
Students acknowledged amazement that they were able to obtain additional knowledge and confidence while being evaluated
Students agreed the simulation session provided an opportunity to comfortably display skill acquisition
EVALUATION
Lessons learned by students
Increased confidence
Re-enforcement of skills acquisition
Emotional disclosures related to visible and invisible disabilities and integration of cultural sensitivity
Lessons learned by faculty
Awareness of simulation time allotments, workload and cost implications
Identified outcome gaps, unknown impact on actual patient care.
Identified need to adapt acute care high fidelity simulation center into out-patient (OP) setting
Identified need to augment available OP setting with suitable simulation equipment.
CONCLUSION
The INACSL Standards (2016) guided the simulation design with integration of ethics, cultural awareness, integrity and confidentiality. Students and standardized patients (SPs) were filmed with consent.
Pre-Brief Session - Reviewed simulation objectives, process, and desired outcomes.
Two simulation approaches were utilized:
Faculty-developed scenarios with SPs
H&P including pelvic and breast exam performed
Wet mount prepared and examined with microscope
Clinical decision making & documentation completed
Faculty Developed Simulation Stations with SPs
3 Simulation stations (Breast & Pelvic Exam, Wet mount Prep & Exam)
Students rotated through stations
De-brief Session: SPs shared what experiences were appreciated and what could be improved. Filmed interactions were reviewed with peer and instructor feedback provided.
The following reflective questions were presented to students:
What comes to mind about your experience?
What did you do well?
What do you wish you had done better?
How will this experience change your clinical education practice, current work practice, and future NP practice?
METHODOLOGY
To provide opportunity for students to demonstrate and be evaluated on the following:
Utilization of effective communication
Performance of breast and pelvic examinations
Preparation and examination of vaginal wet mounts
Clinical reasoning and decision making
Provision of culturally congruent care
OBJECTIVES
INACSL standards of best practice: Simulation design (2016). Clinical Simulation in Nursing , 12(S), S5-S12
Lauzon Clabo, L. M. (2016). National Council of State Board of Nursing (NCSBN) APRN Roundtable Panel, Chicago, IL
REFERENCES
Thank you to M. Andrews, PhD, RN, FAAN, Interim Dean University of Michigan-Flint School of Nursing, C. Creech, EdD, MSN, RN, ANP-BC, Director of Graduate Nursing Affairs, and L. Pagano-Lawrence, Administrative Assistant, University of Michigan-Flint VBSN
ACKNOWLEDGEMENTS