1. Integrating Simulation into Nursing Education
The International Nursing Association for Clinical Simulation & Learning
Integrating Simulation into Nursing Education

2. Presenter and Disclaimer
Andrea D. Ackermann, PhD, RN, CNE
VP Finance, INACSL Board of Directors
Member of Editorial Board for Clinical Simulation in Nursing
Professor and Chair of Nursing Division, Mount Saint Mary College, Newburgh, NY
Adjunct faculty member, Excelsior College, Albany, NY

3. Objectives
By the end of the learning session the participant will be able to:
Discuss drivers for the introduction of simulation
Identify courses within your nursing curriculum to best leverage simulation
Locate tools and resources for quick successes.
Create buy-in with faculty and / or other health care specialties
Define measurable objectives for success

4. What drives Simulation Education in Nursing?
Lack of learning experiences and resources
IOM initiatives, Joint Commission, NCSBN, QSEN
Curriculum
Student characteristics
High risk/Low frequency situations
Developing professional demeanor, inter-professional collaboration, attitudes, communication
Active and experiential learning
Reflective learning

5. How do you fit Simulation Education into Curriculum?
Program needs
Students learning needs
Developing objectives
Facilitation of
simulation
Evaluation of
Debriefing

6. Guided by program assessment NCLEX pass rates Standardized testing
Program needs
Guided by program assessment
NCLEX pass rates
Standardized testing
Available clinical experiences in the community
Curriculum assessment

7. Student and Faculty Needs
Guided by
Student level
What do the students say they need?
Communication
Assessment
Dealing with families
Cultural considerations
What do I do if something
goes wrong?
What do the faculty say they need?
Areas where the students are “weak”
Areas where the students are not getting practice
Safety
Testing

8. Overall purpose of the simulation Student learning needs and level
Objectives/Outcomes
Guided by:
Simulation standards
Overall purpose of the simulation
Student learning needs and level
Realistic and measurable
Identify the appropriate environment, fidelity, prompting, etc.
Foundation for simulation facilitation
Basis for assessment and evaluation

9. Facilitation
Guided by:
Simulation standards
Simulation plan
Simulation implementation
Participant engagement
Scheduling
Facilitator
Preparation
Prompting
Establish safe learning environment
Guides the learning

10. Evaluation Guided by: Simulation Standards
Assessment/formative evaluation
Summative evaluation
Established Objectives/Outcomes
Three domains of learning
Cognitive
Affective
Psychomotor
Valid and Reliable tools

11. Debriefing Guided by: Simulation Standards Evidence based debriefing
methodologies
Promoting reflective thinking
Skills of the debriefer
Objectives/outcomes
Confidentiality, trust
and open
communication

12. Standardized patients Virtual experiences
Tools and Resources
Simulators
Task trainers
Standardized patients
Virtual experiences
Standards of Best Practice: Simulation
INACSL Board of Directors, (August, 2011). Standards of best practice: Simulation. Clinical Simulation in Nursing, 7(4 Supplement). S1-S20. Available at

13. Development of INACSL Standards
2 Years
Survey to INACSL Membership
Committee Draft
Peer Review
Final Draft
Publication – Summer 2011

14. Standards of Best Practice
Terminology
Professional Integrity of Participant
Participant Objectives
Facilitation Methods
Simulation Facilitator
The Debriefing Process
Evaluation of Expected Outcomes

15. Standard One: Terminology
Statement:
Consistent terminology provides guidance, clear communication, and reflects shared values in simulation experiences, research, and publications.

16. Standardized terminology:
Rationale
Standardized terminology:
Enhances understanding and communication among planners, participants and others involved in simulation experiences
Promotes consistency in the development, implementation, evaluation and publication of or about simulated clinical experiences or research studies for use in education and practice

17. Nursing Skill Development & Judgment Model

18. Standard 2: Professional Integrity of Participants
Statement:
The simulation learning and testing environment will be one of clear expectations for the attitudes and behavior of each participant and an area where mutual respect is supported. Professional integrity related to confidentiality of the performances, scenario content, and participant experience is expected to be upheld during a simulation experience. These performances in simulation experience may be live, recorded, and/or virtual.

19. Rationale
Failure of the participants to maintain professional integrity related to simulation and lack of respect or professionalism could undermine the benefits of this pedagogy
Sharing of confidential information of any kind before, during or after the simulation experience can alter the experience

20. Upholding professional integrity promotes a safe learning environment
Outcomes
This standard offers the opportunity for similar learning experiences to all participants
Upholding professional integrity promotes a safe learning environment
To achieve the desired outcomes, the facilitator must address key areas during the simulation

21. Standard Three: Participant Objectives
Statement: The simulation experience should focus on the participant objectives and experience level.

22. Rationale
Participant objectives are the guiding tools for simulation and essential to achieve the outcomes
Identification of appropriate scenario, fidelity, instructor prompting/facilitating, and environment is crucial for best experiences and meeting the participant objectives

23. Outcomes
The focus of simulation is on the outcome to be achieved and on participant learning-Know your participants
Should facilitate the development of clinical judgment in order to deliver high quality and safe nursing care that is holistic and includes cultural awareness
Objectives should be:
Achievable within an appropriate time frame
Incorporate evidence-based practice
Address domains of learning
Appropriate to the participant ‘s level of learning and congruent with overall program outcomes
See Standard I: Terminology for Nursing Skill Development and Clinical Judgment Model

24. Standard Four: Facilitation Methods
Statement: Multiple methods of facilitation are available, and use of a specific method is dependent upon the learning needs of the participant(s) and the expected outcomes.

25. Rationale
Facilitation methodology should vary because participants bring cultural and individual differences that affect their knowledge, skills, attitudes (KSAs), and behavior
Facilitation assists the learner to meet the objectives by incorporating learner’s needs and experience into the planning and implementation of a simulated clinical experience

26. Outcomes
Facilitation revolves around engaging participants within the scenario by assisting them to meet the objectives of the clinical scenario
Effective facilitation requires using the facilitation method and personnel/faculty indicated by participant objectives and expected outcomes

27. Standard Five: Simulation Facilitator
Statement: A proficient facilitator is required to manage the complexity of all aspects of simulation.

28. The facilitator is the key to participant learning:
Rationale
The facilitator is the key to participant learning:
Guides and supports participants to understand and achieve the objectives
Engages the participants to search for evidence-based practice solutions to develop participant’s skill development and clinical judgment
Adjusts simulations to meet objectives based on participant’s actions or lack of actions
Leads the participants in identifying the positive actions and changes

29. Outcomes
Facilitator promotes and assists with achieving the desired outcomes of a simulated experience by utilizing various methods

30. Standard Six: The Debriefing Process
Statement: All simulated experiences should include a planned debriefing session aimed toward promoting reflective thinking.

31. Rationale
Learning is dependent upon the integration of experience and reflection
Reflection is the conscious consideration of the meaning and implication of an action
The skills of the debriefer are important to ensure the best possible learning
Learners report the debriefing session is the most important component of a simulated learning experience

32. The integration of the process of debriefing into simulation:
Outcomes
The integration of the process of debriefing into simulation:
Enhances learning
Heightens self-confidence for the learner
Increases understanding
Promotes knowledge transfer
Identifies best practices
Promotes safe, quality patient care
Promotes life-long learning

33. Outcomes (Continued)
To achieve the desired outcomes, the effective debriefing process should:
Be facilitated by individual competent in debriefing that observed the simulation
Use evidence-based debriefing methodologies
Be based on a structured framework for debriefing
Be based on objectives, the learners, & the outcomes
Be conducted in an environment that supports confidentiality, trust, open communication, self-analysis & reflection

34. Standard Seven: Evaluation of Expected Outcomes
Statement: This standard addresses summative evaluation as opposed to formative assessment.

35. Rationale
Simulation is an acceptable method of evaluating the three domains of learning:
Cognitive (knowledge)
Affective (attitude)
Psychomotor (skills)

36. Outcomes
The participant’s achievement of expected outcomes of a simulation experience should be based on valid and reliable instrumentation, tools, and methodologies in the evaluation process
To achieve valid and reliable evaluation results, the simulation used for the purpose of assessment and particularly high-stakes evaluation must follow certain aspects.

37. Creating Buy-In
Determine your organizational ‘needs’ and ‘problems’ and provide solutions through the use of simulation
Share data / evidence
Invite others to the sim lab
Plan Open Houses and awareness events
Collect user satisfaction data and share it with others
Design ‘evidence-based’ simulation scenarios
Utilize the Standards

38. Defining Measureable Objectives for Success
Cognitive
Standardized Exams
Course Exams
Psychomotor Skills
Checklists
Global Rating Scales
Affective
Confidence
Self-Efficacy
Satisfaction
AACN, November 29, 2011

39. Cognitive
Based upon Scenario Content
Instructor Made Tests
Proprietary Tests

40. Psychomotor-Checklist

41. Psychomotor – Global Rating Scale
Assessment
❑ 1 Unsatisfactory
❑ 2
❑ 3
❑ 4
❑ 5 Satisfactory
❑ 6
❑ 7
❑ 8
❑ 9 Superior

42. Visual Analog Scale (VAS) – 100 mm line
Affective Domain
NLN Tools
Journaling
Visual Analog Scale (VAS) – 100 mm line
Place a mark on the line below to indicate your level of confidence in your ability to insert and IV catheter
__________________________________________________________
No Confidence Highly Confident

43. Examples of Validated Tools
NLN
Simulation Design Scale
Educational Practice Questionnaire
Student Satisfaction and Confidence in Learning
Lasater Clinical Judgment Rubric
Based upon Tanner’s work
Creighton Simulation Evaluation Tool
ANTS (Team Evaluation)

44. Evaluation of the 3 Domains of Learning
Lasater (2007)
Herm, et al (2007)
Rhadakrishnan, et al (2007)
Todd, et al (2008)

45. Evaluation of the Scenario
Rationale
CQI
Support for future activities
Development
Support for Staff
Elements
Demographic information
What do you want to know?

46. Simulation Evaluation (Howard, 2010)
Strongly
Disagree
Agree
Strongly Agree
4. The simulation experience helped me to
better understand nursing concepts. 1 2 3 4
5. The simulations were a valuable learning
experience.
6. The simulations helped to stimulate critical
thinking abilities.
7. The simulation was realistic.
8. The knowledge gained through the
simulation experiences can be transferred to
the clinical setting.
9. I was nervous during the simulation
10. Because of the simulation experience, I will
be less nervous in the clinical setting when
providing care for similar patients.
11. Simulation experiences can be a substitute
for clinical experiences in the hospital.
12. Simulation experiences should be included in
our undergraduate education.
Please share any additional thoughts at this time:

47. Stakeholder Evaluations
Faculty
Students / Participants
Outside Users
Regional Healthcare Providers
Patients