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
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
Academic Leaders Stanford University University of Florida-led to development of METI company Harvard University University of Pittsburg (WISER)
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)
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)
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
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
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)
Create a buzz 2007-2008 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
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
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
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)
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)
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)
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
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
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)
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
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, 312-329. 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: 10.2202/1548-923X.1783. 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 2009. 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, 74-80. Hravnak, M., Beach, M., & Tuite, P. (2007). Simulator technology as a tool for education in cardiac care. Journal of Cardiovascular Nursing, 22, 16-24.
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. 2008. 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: 10.2202/1548-923X.1603. Landeen, J. & Jeffries, P. (2008) Guest editorial: Simulation. Journal of Nursing Education, 47, 487-488. 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, 244-248. 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: 10.2202/1548-923X.1307. 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: 10.2202/1548-923X.1317.