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

2. Faculty Disclosure –
No disclosures or conflicts of interest to report

3. 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….

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

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

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

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

13. 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!

14. 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.

15. 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

16. 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

18. Response Options
Already happening

19. Response Options
Already happening Good Start

20. Response Options
Already happening Good Start Considering it

21. Response Options
Already happening Good Start Considering it Very Challenging

22. Response Options
Already happening Good Start Considering it Very Challenging

23. Faculty members are prepared using INACSL Standards of Best Practice: Simulation

24. We are using a tool that evaluates simulation based learning experiences

25. Faculty are prepared to create a learning environment that encourages active learning, repetitive practice, and reflection and to provide appropriate support throughout each activity.

26. The program utilizes a standardized method of debriefing using a Socratic methodology.

27. the effectiveness of the facilitator.

28. the effectiveness of the simulation experience.

29. The school has created a framework that provides adequate resources (fiscal, human, and material) to support the simulation program.

30. Policies and procedures are in place to ensure quality-consistent simulation experiences for the students.

31. The program has job descriptions for simulation faculty members/facilitators.

32. The program has a plan for orienting simulation faculty members to their roles.

33. Citations NCSBN National Simulation Study (Hayden et al., 2014)
NCSBN Simulation Guidelines (Alexander et al., 2015)
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