Clinical Simulation & McMaster Nursing: Where Are We, How Did We Get Here, & Where Are We Going?

Transcription

1 Clinical Simulation & McMaster Nursing: Where Are We, How Did We Get Here, & Where Are We Going? Janet Landeen, RN, PhD Assistant Dean, Undergraduate Nursing Education Associate Professor, School of Nursing

2 Outline for Talk Brief history of medical simulation Range of clinical simulation McMaster s simulation experience Educational initiatives in nursing Current state of research Summary of positives and negatives & next steps

3 Academic Leaders Stanford University University of Florida-led to development of METI company Harvard University University of Pittsburg (WISER)

4 Range of Simulation (Typology) Partial task trainers Peer-to-peer learning Screen-based computer simulations Virtual reality Haptic systems Standardized patients Full-scale simulation (Decker, Sportsman, Puetz, & Billings, 2008)

5 McMaster Story Problem-based learning-active learning based in clinical scenarios Standardized Patients Clinical Learning Centre Ministry of Health & Long Term Care Funding (2005/6)

6 Establishment of Clinical Learning Centres MOHLTC call early December 2004 with 6 week deadline Conestoga funding $600,000 in 2005 McMaster & Mohawk funding at $600,000 each in 2006 All monies to purchase equipment, no operating or overhead expenses

7 Interprofessional Centre for Simulation Based Learning Decision for interprofessional centre Identification of space & renovation plans Anesthesia using Sim-Man for anesthesia resident training Unpacking & beginning understanding of equipment Faculty attendance at workshops, conferences, & site visits Dr. Dave Musson hired by FHS & Anesthesia

8 Nursing First Steps Provincial Evaluation of Implementation-2005 (McMaster, Western, & UOIT) Evaluation of experience-tba (King & Andrysucizm) Faculty & student perceptions-focus groups-tba (Stanyon & Sproul) Faculty & student perceptions-q-sort (Akhtar-Danesh, Baxter, Valaitis, Stanyon & Sproul, 2009) Spring 2007: RCT comparing high & low fidelity simulation on confidence & competence in 4 th year nursing students (Baxter, Akhtar-Danesh, Landeen, & Norman, submitted)

9 Create a buzz Ruth Chen completing PhD on pediatric simulation-in HRM Geoff Norman, supervisor Post-RN student completes clinical in simulation lab-drop in sessions mixing all level students with different roles-brenda Leonard & Elaine Shuhaibar

10 Need for sustainable support Successful submission for Centre for Leadership & Learning Departmental Grant-to implement clinical simulation $100,000 over 3 years-implemented Spring 2008 Faculty Lead in Simulation: Joanna Pierazzo Project Coordinator: Brenda Leonard Some funds for faculty development

11 Where are we now Simulation activities for Levels 2-optional (shock), 3-acute placement (angina), and 4-all students 4 hours clinical time (Cardiac, Peds respiratory, & Documentation Peds code) & Basic Accelerated RPN to BScN Transition Course Winter 09, lab based clinical course using combination high fidelity simulation, standardized patients, & scenarios Drop-in remediation with Vital Sims & Clinical Assistants

12 McMaster Student Feedback Feedback mostly positive** Need for better preparation pre-experience** Positive value of debriefing** Initial intimidation of observation & videotaping** Desire for group sizes of 2 students (vs. 4) **Consistent with student satisfaction research literature (Jeffries, 2007; Leigh, 2008)

13 Theoretical approaches to simulation integration Benner s model of competence specificity of prompts in scenarios (Larew, Lessans, Spunt, Foster, & Covington, 2006) level of complexity of scenario (novice to competent) (Waldner & Olson, 2007) SIMBaLL (Simulation Based on Language Learning) model for scaffolding conceptual learning sensory-motor, preoperational, concrete, & formal (Arwood & Kaakinen, 2009)

14 Sample of Research Literature Uptake of simulation Survey of METI HPS usage-34 schools 7 6 sim centres (Nehring & Lashley, 2004) Outcome evaluation Clinical practice parameters-safety (patient id) & assessment (vital signs)- METI HPS vs. instruction as usual (Radhakrishnan, Roche, & Cunningham, 2007) Self-efficacy-including confidence & self-assessment (Leigh, 2008)

15 Where is the promise? Standardization of experiences-rare, highly complex and/or clinical acuity-students can intervene Competence & familiarity of setting-reinforce hand washing, how to maneuver in clinical area, practice on task trainers Increasing confidence in high risk scenarios Replacement of clinical time

16 Promise cont d. Prompt critical thinking & reflection-video taping critical for debriefing Emotional arousal/engagement in learning Intra and interprofessional team trainingdecrease time to code response, standardization of language Development of best-practices for measuring change, designing scenarios, choosing strategies for different types of learners

17 Positives and Negatives of Simulation Pros Standardization of experience (high risk but rare situations) Prompts reflection & critique Student engagement in learning Augmentation of clinical experience Increasing knowledge of how and when to use Cons Costs- equipment, technician, faculty training, additional personnel Time for scenario development & testing Evaluation mostly student satisfaction vs. outcome evaluation (Hravnak, Beach, & Tuite, 2007; Kardon- Edgren,Starkweather, & Ward, 2008;Jeffries, 2007; Landeen & Jeffries, 2008)

18 Next Steps Careful integration into curriculum Increase faculty comfort in using teaching strategies Systematize supports Evaluate & modify approach as we move forward (debriefing, complexity) Integrate into other courses-possibly early for engagement; mid for skill acquisition, assessment, critical thinking; senior for interprofessional, team work, critical thinking

19 References Akhtar-Danesh, N, Baxter, P, Valaitis, R.K., Stanyon, W. & Sproul, S. (2009). Nurse faculty perceptions of simulation use in nursing education. Western Journal of Nursing Research, 31, Arwood, E. & Kaakinen, J. (2009). SIMulation based on language and learning (SIMBaLL): The model. International Journal of Nursing Education Scholarship, 6(1) article 9. DOI: / X Baxter, P., Akhtar-Danesh, N., Landeen, J., Norman, G. (Submitted). Teaching critical management skills to senior nursing students: Videotaped or interactive hands-on instruction? Submitted to Nursing Education Perspectives, April Decker, S, Sportsman, S., Puetz, L, & Billings, L. (2008). The evolution of simulation and its contribution to competency. Journal of Continuing Education in Nursing, 39, Hravnak, M., Beach, M., & Tuite, P. (2007). Simulator technology as a tool for education in cardiac care. Journal of Cardiovascular Nursing, 22,

20 References cont d. Jeffries, P.R. (ed.) (2007). Simulation in nursing education: From conceptualization to evaluation. NY: National League for Nursing. Kardon-Edgren, S.E., Starkweather, A.R., & Ward, L.D The integration of simulation in a clinical foundations of nursing course: Student & faculty perspectives. International Journal of Nursing Education Scholarship, 5(1) article 26 DOI: / X Landeen, J. & Jeffries, P. (2008) Guest editorial: Simulation. Journal of Nursing Education, 47, Nehring, W.M. & Lashley, F.R. (2004). Current use and opinions regarding human patient simulators in nursing education: An international survey. Nursing Education Perspectives, 25, Radhakrishnan, K., Roche, J.P., & Cunningham, H. (2007). Measuring clinical practice parameters with human patient simulation: A pilot study. International Journal of Nursing Education Scholarship, 4(1) article 8. DOI: / X Waldner, M.H. & Olson, J.K. (2007). Taking the patient to the classroom: Applying theoretical frameworks to simulation in nursing education. International Journal of Nursing Education Scholarship, 4(1) article 18. DOI: / X.1317.