CLINICAL SIMULATIONS IN NURSING EDUCATION Chapter 5 Copyright

Roles of Simulation § Traditionally, simulations are used to provide opportunities for students to

Different Types of Simulations § Vary in degree of fidelity or ability of the

Manikin-Based Simulation § Manikins as human patient simulators (HPS) vary in amount and degree

Manikin-Based Simulation (cont) § Decision about level of fidelity is determined by – What

Standardized Patient § Individual who is trained to portray patient with specific condition and

Virtual Simulation § Learners access internet-based, 3 -dimensional simulated environments for an educational experience

Integration Into Curriculum § Simulations should be leveled throughout curriculum, building in complexity and

Debriefing § During debriefing, teachers guide students to reflect on, analyze, and discuss their

Simulation Evaluation § Identify purpose and focus of the evaluation § Select or develop

Participant Performance Evaluation § Simulation offers opportunities for evaluation of learner performance § Create

Research on Simulation § Simulation has been shown to be an effective educational method

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Roles of Simulation § Traditionally, simulations are used to provide opportunities for students to practice patient care in a safe environment § In the current environment of increasing patient acuity and limited clinical placements, simulation has a broader role as an adjunct or replacement for traditional clinical hours § Institute of Medicine cited simulation as critical for producing an adequate number of competent nurses Copyright © Springer Publishing Company, LLC. All Rights Reserved. 2

Different Types of Simulations § Vary in degree of fidelity or ability of the simulation environment to best replicate the actual clinical environment § Fidelity is realism § Allows learner to become engaged within the simulation – On physical, conceptual, emotional, and experiential levels Copyright © Springer Publishing Company, LLC. All Rights Reserved. 3

Manikin-Based Simulation § Manikins as human patient simulators (HPS) vary in amount and degree of technology and fidelity – Fidelity reflects the level of engagement expected of participants in simulation – High, medium, and low fidelity Copyright © Springer Publishing Company, LLC. All Rights Reserved. 4

Manikin-Based Simulation (cont) § Decision about level of fidelity is determined by – What is available – Objectives of experience – Intended learner outcomes § Moulage: use of makeup, dress, and wigs to enhance the patient story and simulation enhancers to simulate injury, disease, aging, and other physical enhancements Copyright © Springer Publishing Company, LLC. All Rights Reserved. 5

Standardized Patient § Individual who is trained to portray patient with specific condition and plays that patient consistently during every simulation – Within simulation, can portray patients but may also function as either teacher or evaluator – Often used to teach and evaluate physical examination and communication Copyright © Springer Publishing Company, LLC. All Rights Reserved. 6

Virtual Simulation § Learners access internet-based, 3 -dimensional simulated environments for an educational experience § Gaming can be incorporated within simulation § Simulation learning objectives should dictate type of simulation Copyright © Springer Publishing Company, LLC. All Rights Reserved. 7

Integration Into Curriculum § Simulations should be leveled throughout curriculum, building in complexity and ambiguity – Use of an unfolding case • Students introduced to particular patient repeatedly at different points in care continuum within a simulation, throughout a course, or throughout the curriculum – Repeat same case but use a modified version § Steps – Creation or selection of simulation scenario – Planning and implementing simulation in a course Copyright © Springer Publishing Company, LLC. All Rights Reserved. 8

Debriefing § During debriefing, teachers guide students to reflect on, analyze, and discuss their thoughts and feelings about the experience § Is a constructivist, reflective teaching strategy – Provide feedback § Debriefing methods – Plus Delta, Debriefing for Meaningful Learning, Advocacy-Inquiry, and Gather-Analyze-Summarize Copyright © Springer Publishing Company, LLC. All Rights Reserved. 9

Simulation Evaluation § Identify purpose and focus of the evaluation § Select or develop appropriate evaluation instrument § Select and train raters to complete the evaluation – Essential to ensure valid and reliable results § Kirkpatrick levels of outcomes can be used for categorizing evaluation strategies Copyright © Springer Publishing Company, LLC. All Rights Reserved. 10

Participant Performance Evaluation § Simulation offers opportunities for evaluation of learner performance § Create and standardize scenarios to evaluate specific skills and behaviors § Allow multiple participants to engage in given scenario or an individual participant to engage in specific scenario multiple times § Allow participant to make errors without endangering a patient Copyright © Springer Publishing Company, LLC. All Rights Reserved. 11

Research on Simulation § Simulation has been shown to be an effective educational method § Deliberate practice used to assist learner to master clinical skill or behavior – Simulation should incorporate deliberate practice – Nine elements § Areas needing research – Lack of valid and reliable evaluation instruments to measure simulation outcomes – Types of simulation scenarios to use for measuring outcomes Copyright © Springer Publishing Company, LLC. All Rights Reserved. 12