1. Getting in S.T.E.P. with Simulations
Pamela R. Jeffries DNS, RN, FAAN
Debra Spunt Endowed Lecture
NLN Education Summit 2007
September 29, 2007

2. Introduction
During the past decade, the use of simulations as a teaching-learning intervention in nursing curricula has increased greatly.
Nursing students, clinicians, and educators alike appear to be strongly in agreement about the importance of incorporating simulations as a teaching practice because of several factors.

3. Current Situation
A movement toward making simulations a part of the clinical practicum, either as a clinical substitute or as an adjunct.
Movement arises out of need for:
More clinical sites
More nurse educators
New clinical practice models to prepare 21st century graduates in high-tech, complex environments

4. Current Situation
Nursing educational organizations and leaders recognize that incorporating simulations into the nursing curricula is needed, but developing, implementing simulations can be challenging

5. Current Situation
Not all nurse educators feel prepared for this type of teaching-learning pedagogy
Some educators feel students cannot get adequate experience unless caring for ‘real’ patients

6. Professional Challenge
“For all of us to find ways to improve clinical nursing education and address the concerns and hesitation that faculty have to try new educational strategies.”

7. S.imulations T.ake E.ducator P.reparation
Today schools purchase equipment and build simulations centers, but the question unanswered is:
“How do we prepare the educators for this pedagogy?”

8. Preparation for Educators
Material may be purchased for simulators, but not so much for educators
Faculty just start experimenting
One champion trying to get others on board
No standardized preparation for educators
Few resources are becoming available
Federal funding is increasing for simulation research and the outcomes being obtained

9. Challenges for the Educators
Lack of a faculty development plan
Administrative
Faculty hesitation
Resources

10. Administrative Challenges
Resources needed for simulations
Funding and time for faculty development
Adoption by faculty into the curriculum
Integrating this clinical model into strategic plan and curriculum
Support for innovation, but few champions

11. Faculty Challenges New skill sets and teaching style
Obtaining the expertise needed
Getting support for innovation
Student-centered learning
Workload issues
Course/class scheduling
Resources/equipment

12. Resource Issues Technology Faculty development dollars Equipment Space
Phones in room
Video capability
Microphones
Faculty development dollars
Equipment
One way mirrors
Simulators
Props, tools
Space

13. Educator Preparation Plan
“Steps Needed for Educator Preparation”
S = Standardized materials
T = Train the trainer
E = Encourage the development of a simulation
design and integration team
P = Plan to coordinate simulation development
and implementation

14. Standardized Materials
Currently there is no standardized information or training for nurse educators using this pedagogy
Second NLN/Laerdal grant: developing online modules for faculty in simulation
Different vendors have user group meetings, in-services
Professional conferences are increasing the interest and amount of content on simulations

15. Train the Trainer Concept
Develop a champion or two, then train others
Organize institutes, workshops for faculty, clinical agency partners, workforce development healthcare workers
Compile material: teaching tips, resources in one location, e.g. Web site for easy access by all
Promote involvement of other faculty members – invite them to see your simulations

16. Simulation Development Team
Encourage development of faculty and a appoint a Simulation Development Team
Ask a consultant to work with the simulation team to get everyone on board and motivated
Use materials available for learning
Visit nursing schools and medical
centers that use simulations

17. Simulation Development Team
Hold phone conferences with other educators who incorporate simulation into their teaching
Stay current with the literature – more is coming out at a higher level, but it is slow to come

18. Faculty/Sim Team Development
Need buy-in from faculty
Start with a ‘champion’ or small cohort of faculty
Obtain funding for small projects
Seminar development
Designing simulations
Evaluating the use of simulations

19. Faculty/Sim Team Development
Initiate a Simulation Interest Group (SIG) for more buy-in and support
Attend regional, state, national conferences, e.g., SUN meetings
Promote partnerships and collaboration with other schools, clinical partners, nursing organizations, corporations, etc.

20. Strategies to Assist Faculty
Select a course to implement simulations:
Ask what experience would you want all students to experience?
Have faculty develop and write scenario (have peer-reviewed)
Conduct a pilot simulation with end-users
Schedule lab and debriefing times

21. Guidelines for Educators
Ensure specific objectives match the simulation
Set a time limit for the simulation and adhere to it
Assign roles to students prior to the simulation to avoid confusion and delay

22. Guidelines for Educators
Avoid interrupting students during the simulation experience – use debriefing time to correct mistakes
Ideally limit to 2-6 students in a simulation
Develop simulation in authentic, realistic manner
Ensure faculty who implement a simulation know how to conduct one

23. Plan for Coordination
Work smart and efficient; work in teams, determine what scenarios are priority
Don’t duplicate efforts; if working in a system school or with a clinical partner, assign specific scenarios to faculty, then compile the scenarios for all to share
Partner with other schools, clinical agency educators, and other healthcare professionals

24. Roles to Re-shape Paradigm
Join organizations and task forces. Get involved at the regional and national level to shape trends and policies
Conduct nursing research
Evaluate learning outcomes. Obtain evidence and findings that reflect meeting desired outcomes

25. Roles to Re-shape Paradigm
Send in abstracts to speak, disseminate, and participate in conferences
Serve on national panels, focus groups where nursing education decisions are being made, e.g., NLN, HRSA, NCSBN, AHRQ, AACN
Integrate this pedagogy into better practices, better patient outcomes, and improved care and safe environments

26. Field-Tested Strategies
Ensure objectives match the designed simulation
Provide information/objectives prior to simulation
Assign student roles. Limit them to only nursing-type roles or family members. Don’t ask students to play a health professional role out of their scope of practice.

27. Field-Tested Strategies
Set a time limit and honor that time with students
Have your scenarios peer-reviewed; use clinical agency partners to do this
Conduct a practice or pilot run-through before implementing your simulations with students

28. Summary
Perhaps the most important reason to adopt this pedagogy is its ability to create environments that present students with problem-solving encounters that
require real-time assessment and interventions for a clinical problem and which they can use to learn how to make decisions based on the knowledge and skills learned in their nursing courses.

29. Conclusions
This type of experience can often ‘bridge’ the gap between academe and practice

30. Conclusions
Overall, students have found simulation experiences rewarding and helpful in increasing their self-confidence prior to entering a clinical unit
Nevertheless, challenges remain
How much will clinical practicum experiences change?
To what extent will simulations be adopted by nurse educators?

31. Conclusions
With the national call for the use of innovative clinical models, nurse educators need to be encouraged, developed, and supported in designing and implementing innovations such as simulations in the nursing curriculum.

32. Pamela R. Jeffries DNS, RN, FAAN
Questions?
Pamela R. Jeffries DNS, RN, FAAN