Needs Assessment as Foundation for Effective Simulation-based Experiences: Applying INACSL Simulation Standard IX: Simulation Design

Transcription

1 Needs Assessment as Foundation for Effective Simulation-based Experiences: Applying INACSL Simulation Standard IX: Simulation Design Maureen Tremel, MSN, ARNP, CNE, CHSE-A, ANEF Nursing Professor; Leader, Experiential Learning/Simulation; Seminole State College of Florida Jennifer Savey Former Intern, Community College Undergraduate Research Initiative, Seminole State College of Florida Student Nurse, Daytona State College HPSN World 2016, Tampa, Florida 1

2 Facilitators Maureen Tremel Image: Collection of Maureen Tremel, Seminole State College of Florida Jennifer Savey 2

3 Purpose The purpose of this session is to present an example of how an evidenced based needs assessment addressing underlying causes of a concern input from stakeholders and outcome data from pilot testing led to the creation and sustaining of a successful, capstone course complex team simulation. Image: Collection of Maureen Tremel, Seminole State College of Florida 3 3

4 Learning Goals Utilize INACSL Simulation Standard IX: Simulation Design to develop effective simulation-based experiences (SBE) Conduct needs assessment to establish learner goals and objectives of SBEs Plan evaluation strategies and revisions of SBEs based on established needs. 4

5 International Nursing Association for Clinical Simulation and Learning 5

6 INACSL Standards of Best Practice: Simulation 1 st Ed. in 2011: Initial Seven Standards Standard I: Terminology Standard II: Professional Integrity of Participant(s) Standard III: Participant Objectives Standard IV: Facilitation Standard V: Facilitator Standard VI: Debriefing Process Standard VII: Participant Assessment and Evaluation 2 nd Ed. in 2013: Initial Seven Standards Reviewed/Revised Amended in 2015: Two New Standards Standard VIII: Simulation Enhanced Interprofessional Education Standard IX: Simulation Design 3 rd Ed. Projected for 2017 Sittner, B., Aebersold, M., Paige, J., Graham, L., Schram, A., Decker, S., & Lioce, L. (2015). INACSL standards of best practice for simulation: Past, present, and future. Nursing Education Perspectives, 36(5),

7 Standard IX: Simulation Design Key elements to be incorporated into each simulation experience Needs assessment Measurable objectives Simulation format Participant preparation Clinical scenario or case Fidelity Facilitator/facilitation approach Briefing Debriefing and/or feedback Evaluation Sittner, B., Aebersold, M., Paige, J., Graham, L., Schram, A., Decker, S., & Lioce, L. (2015). INACSL standards of best practice for simulation: Past, present, and future. Nursing Education Perspectives, 36(5),

8 Needs Assessment Standard Statement Simulation-based experiences (SBEs) should be purposefully designed to meet identified objectives Foundational evidence guides the designer in developing an overarching goal or broad objective development of simulation-specific participant objectives Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015). Standards of best practice: Simulation standard IX: Simulation design. Clinical Simulation in Nursing, 11(6),

9 Needs Assessment: May include Underlying causes of a concern root cause gap analysis Organizational analysis Strengths, Weaknesses, Opportunities and Threats (SWOT) Surveys stakeholders participants clinicians Educators Outcome data pilot testing previous SBE s aggregate health care data Standards certifying bodies rules and regulations practice guidelines Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015). Standards of best practice: Simulation standard IX: Simulation design. Clinical Simulation in Nursing, 11(6),

10 Example from Literature #1 New Zealand Journal of Physiotherapy Image retrieved: 10

11 Develop a simulation-based intensive care unit training programme for physiotherapists Online survey establish most appropriate curriculum for a simulationbased intensive care training programme for junior physiotherapists. Perceptions were compared between intensive care-naive 'novice group of rotational physiotherapists from a single tertiary teaching hospital in Melbourne, Australia 'expert' group of senior intensive care physiotherapists from across Australia Question 1 Rank assessment topics for perceived training importance from 1 (greatest) to 6 (least) Question 2 Select which treatment topics from a list (total 15) they felt important for further training Seller, D. R., O'Brien, R., & Brock, K. (2014). Learning needs analysis comparing novice and expert opinion, to develop a simulation-based intensive care unit training programme. New Zealand Journal of Physiotherapy, 42(3),

12 How would you classify the types of needs assessments conducted? Underlying causes of a concern root cause gap analysis Organizational analysis Strengths, Weaknesses, Opportunities and Threats (SWOT) Surveys stakeholders participants clinicians educators Outcome data pilot testing previous SBE s aggregate health care data Standards certifying bodies rules and regulations practice guidelines Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015). Standards of best practice: Simulation standard IX: Simulation design. Clinical Simulation in Nursing, 11(6),

13 Example from Literature #2 Nursing Education Perspectives Image retrieved: 13

14 Give nursing students opportunity to care for patient/family when the condition quickly progresses from stable to critical/terminal American Association of Colleges of Nursing (AACN, 1998) Recommended competencies and curricular guidelines Report (Schlairet, 2009) Statewide survey in Georgia; over 50% of nurses perceived themselves inadequate with EOL care. Report (Smith-Stoner, Hall-Lord, Hedelin, & Petzäll, 2011) Undergraduate nursing students in California experienced greater anxiety about death than counterparts in Sweden Report (Wells,2003) Deans and directors from accredited nursing schools in US Only 3 % offered courses dedicated to EOL care in curricula 40 % would like to increase such content. Lippe, M. & Becker, H. (2015). Improving attitudes and perceived competence in caring for dying patients: An end-of-life simulation. Nursing Education Perspectives, 36(6),

15 How would you classify the types of needs assessments conducted? Underlying causes of a concern root cause gap analysis Organizational analysis Strengths, Weaknesses, Opportunities and Threats (SWOT) Surveys stakeholders participants clinicians educators Outcome data pilot testing previous SBE s aggregate health care data Standards certifying bodies rules and regulations practice guidelines Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015). Standards of best practice: Simulation standard IX: Simulation design. Clinical Simulation in Nursing, 11(6),

16 Develop multi-patient team simulation to prepare students for capstone practicum experience and decrease academic/practice gap Image: Collection of Maureen Tremel, Seminole State College of Florida 16

17 Needs Assessment for Capstone Course Simulation Underlying causes of a concern root cause gap analysis Organizational analysis strengths, weaknesses, opportunities and threats (SWOT) Surveys stakeholders participants clinicians educators Outcome data pilot testing previous SBE s aggregate health care data Standards certifying bodies rules and regulations practice guidelines Lioce L., Meakim C. H., Fey M. K., Chmil J. V., Mariani B., & Alinier G. (2015). Standards of best practice: Simulation standard IX: Simulation design. Clinical Simulation in Nursing, 11(6),

18 Informal Verbal Surveys 2008/09 Educators Stakeholders Nursing Advisory Board Image retrieved: stock-photo-aerial-view-people-working-sharing-connection-conference-table jpg 18

19 National Research Survey 2008/09 Nursing Executive Center and The Advisory Board Company 36 New Graduate Nurse Critical Competencies 6 Categories/6 Competencies Clinical Knowledge Technical Skills Critical Thinking Communication Professionalism Management of Responsibilities Surveyed Nurse Executives (Stakeholders) Frontline Nurse Leaders/Managers (Clinicians) Academic Nurse Educators (Educators) Berkow, S., Virkstis, K., Stewart, J., & Conway, L. (2009). Assessing new graduate nurse performance. Nurse Educator, 34(1),

20 Which two competency areas do you think nurse managers rated lowest? Clinical Knowledge Technical Skills Critical Thinking Communication Professionalism Management of Responsibilities 20

21 National Research Survey 2008/09 Nursing Executive Center and The Advisory Board Company Stakeholders Clinicians Educators Ability to Work as Part of a Team 37% Nursing Executive Center. (2008). Bridging the preparation-practice gap, volume i: Quantifying new graduate nurse improvement needs. Washington, DC: Advisory Board Company. Printed with permission 21

22 National Research Survey 2008/09 Nursing Executive Center and The Advisory Board Company Stakeholders Clinicians Compliance with Legal/Regulatory Issues Recognition of Unsafe Practice by Self/Others Know Pharmacological Implications of Meds 30% 28% 28% Educators Interpretation of Physician s Orders Communication with Physicians Decision Making Based on the Nursing Process Nursing Executive Center. (2008). Bridging the preparation-practice gap, volume i: Quantifying new graduate nurse improvement needs. Washington, DC: Advisory Board Company. 23% 20% 25% Printed with permission 22

23 National Research Survey 2008/09 Nursing Executive Center and The Advisory Board Company Stakeholders Clinicians Recognition of changes in patient status Conducting appropriate follow-up Interpretation of assessment data Ability to take initiative 19% 19% 18% 18% Critical Thinking Management of Responsibilities Critical Thinking Management of Responsibilities Educators Ability to keep track of multiple responsibilities Conflict resolution Ability to anticipate risk Ability to prioritize Delegation of tasks 12% 12% 11% 11% 10% Nursing Executive Center. (2008). Bridging the preparation-practice gap, volume i: Quantifying new graduate nurse improvement needs. Washington, DC: Advisory Board Company. Management of Responsibilities Communication Critical Thinking Management of Responsibilities Management of Responsibilities Printed with permission 23

24 Informal Verbal Surveys 2009/10 Clinicians/ Corporate Educators Academic Educators/Partners Images: Collection of Maureen Tremel, Seminole State College of Florida 24

25 Pilot/Revisions

26 Pilot/Revisions Pre/Post Tests Scantron 5 point Likert scale Institutional Research Insignificant change Web course survey tool 10 point Likert scale Better data Pretest Posttest 26

27 Participant Interviews Simulation #1 Simulation #2 Images: Collection of Maureen Tremel, Seminole State College of Florida 27

28 Data Analysis Participant Surveys 2013 Present Permission from the Nurse Advisory Board Original 6-point Likert scale was expanded to a 10-point scale To compare to national study Scale recoded for categorical data 7 to 10 = confident or very confident Revised tool tested with pilot data Good internal consistency Cronbach alpha coefficient of.96 28

29 Question 1 How does self-rating of the ability to perform thirty-six critical nurse competencies in their first employment by nursing students following participation in a complex clinical simulation in their last clinical course compare to frontline nurse managers ratings on new graduate performance in a nationally published study? Chi-square goodness-of-fit test 29

30 Question 1 Know Pharmacological Implications of Meds 80% 28% Utilization of Clinical Technologies 81% 27% 30

31 Question 1 Ability to anticipate risk 85% 11% Communication with Physicians 79% 23% 31

32 Question 1 Ability to Work as Part of a Team 96% 37% Delegation of tasks 95% 10% 32

33 Question 2 What effect does participation in a complex clinical simulation have on the self-confidence of nursing students in their last clinical course to perform thirty-six critical nurse competencies in their first employment? Paired t test 33

34 Question 2 Pharmacological Implications of Meds

35 Question 2 Recognition of changes on patient status Communication with Physicians

36 Question 2 Delegation of Tasks

37 Question 3 What effect does participation in a complex clinical simulation have on the comfort level of nursing students in their last clinical course to participate in an end of program preceptor based practicum experience? 37

38 Question

39 Discussion Pharmacological Implications of Meds (2) Utilization of Clinical Technologies Ability to anticipate risk Communication with Physicians (2) Ability to Work as Part of a Team Delegation of tasks (2) Recognition of changes on patient status 39

40 Assessments - Future Plans Repeat post-test at end of practicum experience Course faculty review Pre/Post test data for trends Qualitative content analysis for application to practicum simulation experience Review literature for additional new graduate surveys Ballem, A., & MacIntosh, J. (2014). A Narrative Exploration: Experienced Nurses' Stories of Working With New Graduates. Western Journal of Nursing Research, 36(3), Theisen, J. L., & Sandau, K. E. (2013). Competency of New Graduate Nurses: A Review of Their Weaknesses and Strategies for Success. Journal of Continuing Education In Nursing, 44(9), Zamanzadeh, V., Roshangar, F., Fathi-Azar, E., Valizadeh, L., & Kirkwood, J. (2014). Experiences of Newly Graduated Nurses on Strategies of Gaining Self-Confidence During Their Initial Work: A Qualitative Study. Journal of Nursing Research, 22(4), Rice, E. (2015). Predictors of Successful Clinical Performance in Associate Degree Nursing Students. Nurse Educator, 40(4), National Council of State Boards of Nursing (NCSBN) 2014 RN Nursing Knowledge Survey 2014 RN Practice Analysis 40

41 Questions and Answers THANK-YOU Images: Collection of Maureen Tremel, Seminole State College of Florida 41