1. Winds of Change: Transforming and Inspiring Caring Practice Through Simulated Learning Experiences Mary Royse MSN, RN, CMSRN Carman Turkelson, MSN, RN, CCRN Mary Royse MSN, RN, CMSRN Carman Turkelson, MSN, RN, CCRN

2. Objectives  Review historical background and traditional learning strategies for practicing nurses in an acute care setting.  Describe the integration of simulated learning experiences in an acute care setting to foster life long learning and professional development for nursing staff.

3. Beaumont Hospital, Royal Oak

4. Surgical Learning Center

5. Our Catalyst  Verification of clinical competency difficult and outdated.  Relevance and connection of key concepts. – Failure to Rescue  Increased emphasis on patient safety in the clinical setting.

6. Our Burning Questions  Can we do this?  Will it work?  How will “they” respond to this?  How do we evaluate this?

7. Our Journey  Orientation  Medical Surgical & Critical Care Residency Programs  Preceptor Workshop  Critical Care Classes  Management Experiences

8. Simulation Design Framework  Objectives  Fidelity – Low fidelity – High fidelity  Problem solving  Support  Reflective Thinking/Debriefing

9. Simulation Design Framework: Progression Outline

10. Simulation Design Framework: Learner Introduction  Preparatory assignment  Introduction to simulation experience  Assignment of roles  Scenario begins to unfold

11. Simulation Design Framework: Preparatory Assignment Example

13. Simulation Design Framework: Role Assignment Example

14. Simulation Design Framework: Observer Checklist Example

15. Our Personal Journey: Simulation Experiences

18. Simulation Design Framework: Debriefing  Immediately follows simulation experience  Examination of what happened and what was learned  General questions to guide discussion – What went well? – What could have gone better? – What would you do differently?

19. Simulation Design Framework: Debriefing Tool Example

20. Simulation Design Framework: Expected Outcomes/Evaluations  Knowledge gained  Skills performed  Learner satisfaction  Critical thinking  Self confidence

21. Our Personal Journey: Participant Feedback  “The simulations were creative, comprehensive and fun!”  “Recognizing my strengths and weaknesses.”  “Being able to discuss with peers rationales”  “Helped bring things together”  “I hope I have the opportunity to do this again!”

22. Our Personal Journey: Educator Feedback  “Time consuming but rewarding in the end”  “Anxiety provoking because you do not know what to expect with each simulation”  “It can be challenging to watch the learner make mistakes”  “You can see the light bulbs go off”  “Each simulation is different and unique”

23. Our Personal Journey: Lessons Learned Our Personal Journey: Lessons Learned  Operational plan  Simulation design  **Instructor development/preparation  Pre-simulation preparatory assignments  Simulation experience  Not everyone will be enthusiastic!

24. Our Journey Continues… 2010 and Beyond…  Research  Publish  Create a “Library” of simulation scenarios –Hemodynamic Multidisciplinary Simulations –In-Situ Multidisciplinary Simulations –Chemo Simulations –Follow Up Simulation Experiences –Life Long Learner- o Simulated Learning Experiences

25. Summary  Simulation as a teaching strategy has several advantages  Nurses can visualize real consequences of their actions in a safe environment

26. Highlights from Our Journey

27. References  Ackermann, A., Kenny, G., & Walker, C. (2007, May/June). Simulator programs for new nurses' orientation. Journal for Nurses in Staff Development, 23(3), pp. 136-139.  Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative ed.). Upper Saddle River, NJ: Prentice Hall Health.  Billings, D. M., & Halstead, J. A. (2005). Teaching in nursing: A guide for faculty (2nd ed.). St. Louis, MO: Elsevier Saunders.  Childs, J., & Sepples, S. (2006, May/June). Clinical teaching by simulation: Lessons learned from a complex patient case scenario. Nursing Education Perspectives, 27(3), pp. 154-158.  Dillon, P., Noble K., & Kaplan L. (2009, March/April). Simulation as a means to foster collaborative interdisciplinary education. Nursing Education Research, 30 (2), pp. 87-90.  Fort, C. (2010, February). So good it’s unreal: The value of simulation education. Nursing Management, 41(2), pp. 22-25.  Jeffries, P. (2005, March/April). Designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), pp. 96-103.

28. References  Jeffries, P. (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National League for Nursing.  Jeffries, P. (2008, March/April). Getting in S.T.E.P. with simulations: Simulations take educator preparation. Nursing Education Perspectives, 29(2), pp. 70-73.  Hughes, L., Romick, P., Sandor, K., Phillips, C. A., Glaister, J., & Levy, K. et al. (2003, January/February). Evaluation of an informal peer group experience on baccalaureate nursing students' emotional well- being and professional socialization. Journal of Professional Nursing, 19(1), pp. 38-48.  Mitchell, N., & Melton, S. (2003). Collaborative testing: An innovative approach to test taking. Nurse Educator, 28(2), pp. 95-97.  Rashotte, J., & Thomas, (2002). Incorporating educational theory into critical care orientation. The Journal of Continuing Education in Nursing, 33(3), pp. 131-7.  Reese, C., Jeffries, P. & Engum, S. (2010, Jan/Feb). Learning together: Using simulations to develop nursing and medical student collaboration. Nursing Education Perspectives, 31 (1), pp. 33-37.  Robinson, D., & Kish, C. (2001). Core concepts in advanced practice nursing. St. Louis, MO: Mosby.

29. Contact Information  Mary Royse MSN, RN, CMSRN – MRoyse@beaumonthospitals.com MRoyse@beaumonthospitals.com  Carman Turkelson MSN, RN, CCRN – Carman.turkelson@beaumonthospitals.com Carman.turkelson@beaumonthospitals.com  Jill Stefaniak – Assistant Director of Education Surgical Learning Center – Jill.Stefaniak@beaumont.edu Jill.Stefaniak@beaumont.edu