1. Taking Your First Steps Simulation Integration Beth Fentress Hallmark, RN, MSN, PhD(c) Tiffany L. Holmes, D.C.

2. Objectives: Learn the benefits, challenges and emerging trends in the use of simulation How to integrate simulation into nursing curriculum.

3. Who are we: Beth Hallmark –Belmont University –Gordon E. Inman College of Health Sciences and Nursing –Laerdal Center of Educational Excellence Tiffany L. Holmes –University of Texas at Arlington –College of Nursing Smart Hospital™ –Laerdal Center of Educational Excellence

4. UT Arlington College of Nursing (UTACON) Ranked in the top 15 largest schools of nursing in U.S. 126 faculty, (102 FTEs) Over 4,000 students in BSN, RN-to-BSN, MSN, Post-MSN, DNP and PhD programs Graduates 200 BSN students annually 70-80 MSN and Post-Masters Nurse Practitioners (NP) graduates who assume advanced roles as NPs, administrators, and educators.

5. UTACON’s Integration: 2003 – Smart Hospital™ Concept started 2004 – Simulation Coordinator named 2005 – Faculty development activities 2006 – Simulation Technician hired Jun. 2007 – Moved to new Smart Hospital building

6. Transition from student to RN Research shows new grads experience: Fear Lack of confidence Communication Deficits Complex decision making Contradictory information Issues working with peers Dyess, S., & Sherman, R.. (2009). The first year of practice: New graduate nurses' transition and learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-10. doi: 1864764661.

7. New Graduates say: They feel uncomfortable with: – IV skills –Physical Assessment –Care of the dying patient –Caring for patients with changing care needs –Marshburn, D., Engelke, M., & Swanson, M.. (2009). Relationships of New Nurses' Perceptions and Measured Performance-Based Clinical Competence. The Journal of Continuing Education in Nursing, 40(9), 426-32. Retrieved November 2, 2009, from ProQuest Medical Library. (Document ID: 1864764651).

8. Practice Partners Say: Students Fail to perform relevant nursing actions relating to specific disease states Lack the ability to prioritize Give incomplete or irrelevant information to PCP Have difficulty giving rationale for nursing actions Do not know laboratory values Burns, P., & Poster, E.. (2008). Competency Development in New Registered Nurse Graduates: Closing the Gap Between Education and Practice. The Journal of Continuing Education in Nursing, 39(2), 67-73. Retrieved November 2, 2009, from ProQuest Medical Library. (Document ID: 1423354581).

9. Traditional Nursing Education Didactic Lab Clinical Orientation at workplace

10. What can simulation do? Help promote teamwork and collaboration Foster effective and safe communications Delegation Safe practices/Quality Improvement Cultural awareness Evidence based practice Patient centered care

11. Advantages of Simulation Safe practice arena Hands on Exposure to rare/high risk events Practice cognitive and psychomotor skills Transfer to clinical setting Immediate feedback Reflective learning

12. New Strategies Simulation: Teaching Strategy Simulation: Evaluation Tool

13. Types of Simulation Case Study Role-playing Standardized patients Partial vs. Complex Task Trainers –Static and Computerized Integrated Simulators (HPS)

14. Types of Simulators Fidelity Low Fidelity: Task Trainers. Medium Fidelity: non-responsive in terms of physiological signs but can have heart and lung sounds, etc. High Fidelity: physiologically responsive to students actions or lack of action.

15. Simulation: Theory Active Learning Reflective Thinking Constructivism

16. Curricular Changes Examine where simulation naturally fits Build simulations upon one another Simple to complex Students need exposure early in the program Use for remediation and clinical makeup

17. Connecting the dots in courses: Labs Didactic Courses in same semester How can we “marry” the content and reiterate in simulation? How can we re-frame the content we are teaching in labs and didactic within simulation?

18. Standards Identify your programs outcomes based on standards. –BSN Essentials –QSEN –IOM –Joint Commission –NCLEX Not just the standards that are r/t technology….i.e.: safety and communication

19. How do I overcome: Faculty Resistance –Time –Resources Technology assistance, equipment –Pay –Administrative Assistance –Skills –Scheduling

20. What do I need? CHAMPION Administrative Buy In Money: Grants Staff Space Faculty Development Plan Policies Mission Vision Stakeholders

21. What do I need? Champion One or two people who are interested in this new pedagogy. Train the champions then bring back info to the rest of faculty Champion can send information to others in form of literature and conference ideas Lead simulation committee/group

22. What do I need? Administrative Buy In How to accomplish this? Bring in experts/consultants Take them with you to meetings Share with them what you learn at conferences Show them student evaluations Demonstrate how simulation works Peer pressure

23. What do I need? MONEY….. MONEY….. Grants State Federal Local community organizations National Private Funding groups

24. What do I need? Staff Simulation Director Faculty: Simulation Committee Group Technical Support: IT and Network specialist Supply specialist Scheduling

25. What do I need? Space STORAGE, STORAGE, and still MORE STORAGE!! Preparation Area Simulation Labs Partitions? Observation/Control Room Debriefing room

26. What do I need? Faculty Development Plan Conferences Lunch and Learn SIRC.NLN.org List serves –INACSL –SSiH NLN AACN Invite them to play a part

27. Components to a Simulation Student Preparation Objectives Report Actual Simulation Debriefing Evaluation

28. Student Preparation How does a student prepare for a simulation? Do you give them the case prior to the simulation? What are the objectives of the simulations? Formative or Summative Case Study versus procedural prep

29. Objectives Need to fit with curricular objectives and course objectives Case by case General safety and communication

30. Report Students need to learn how to receive and give report Use SBAR or other communication rubrics Ask practice partners for the system they use

31. Simulation Scenarios –Pre programmed –Make it your own Validate with practice partners Reality: suspend Fiction Contract

32. Debriefing Reflection Learner uses previous knowledge to build upon Bad Habits develop if not addressed Video taping

33. Evaluation Formative or Summative Evaluation

34. Support: Find a Network Tennessee Simulation Alliance INACSL (www.inacsl.org) SSiH (www.SSiH.org)www.SSiH.org NLN SIRC (www.sirc.nln.org)www.sirc.nln.org Simulation Users Network (SUN)

35. Questions?