presents new way to use simulation and integraete various technology types into simulations

1. Niki Fogg, MS, RN, CPN
Laura Kubin, PhD, RN, CPN, CHES
Texas Woman’s University
T. Boone Pickens Institute of Health Sciences – Dallas Center
Houston J. and Florence A. Doswell College of Nursing

2. Simulation in Education
• Simulation used for years in many disciplines
– Engineering
– Bio sciences
– Military
– Aviation
– Medicine
• Use in nursing steadily increasing and evolving
– Institute of Medicine (IOM) Report
• Problem of limited opportunities for clinical
experience
– QSEN Competencies
• Patient-Centered Care, Teamwork &
Collaboration, Safety
– National Council of State Boards of Nursing (NCSBN)
• Looking at use of simulation as % of clinical hours

3. Group vs. Individual Sim
Group Simulation Individual Simulation
• Large groups • Must rely upon individual
• Group dynamics knowledge and abilities
• Difficulty evaluating • Each student must
individual performances participate
• Faculty involvement • Faculty can easily
evaluate each student’s
individual performance
• Faculty involvement is
minimal and controlled

4. "A Season for Simulation"
• Set in the pediatric ER
• Diagnoses related to current season
• Each simulation increases in degree of
difficulty
– Cystic fibrosis hyponatremia → near drowning
– Diabetic shock → anaphylaxis
– Asthma attack → medication poisoning
– Minor head injury → severe head injury
– Sunburn → burn
– Focus of each simulation changes
– Allows for assessment of individual
student

5. Overview
• Each student is assigned to one
simulated patient
• Each patient is equipped with:
– Video report
– Background information related
to the patient
– Relevant chart information
– Useful resources relevant to the
case
• Students have 30 minutes
– Assess individual patients
– Give report (using SBAR) to
faculty or video
• Students debrief in groups of 5
– Report on individual patients to
each other
– Prioritize all 5 patients from
highest to lowest priority
• Faculty debrief key concepts

6. Foci of Simulations
First Simulation Focus Second Simulation Focus
• Report • Report
• Assessment • Assessment
– Recognition of abnormal – Analysis of data
findings – Planning care
• SBAR • SBAR
• Prioritization of multiple • Prioritization of multiple
patients patients
+ Identifying priority problems
and interventions
+ Family interaction;
therapeutic communication

7. Third Simulation
• Evolving scenario where the situation
changes
– Assessment
– Intervention
– Evaluate
– Alter intervention to changing status
• Debriefing
– Faculty & Peer Feedback

8. Student viewing computer information
• Low-fidelity simulator

9. Students assessing patients
• Medium-fidelity simulator

10. Students assessing patients
• High-fidelity simulator

11. Patient’s Electronic Medical Record
• PowerPoint
• Video
• Audio

13. Assessment/Evaluation
• Student self-assessment (reflection)
• Peer Assessment (peer review)
• Faculty Assessment & Feedback
– Video Recordings
• Student giving SBAR report
• Group prioritization discussion
– Pilot testing Lasater Clinical Judgment
Rubric

14. Lasater Clinical Judgment Rubric
• Effective noticing
• Effective interpreting
• Effective responding
• Effective reflecting

15. Simulation Across Disciplines
• Simulation used in:
– Architecture
– Business
– Civil Engineering
– Geography
– History
– Law
– Marketing
– Mechanical
– Medical Education
– Military Training
– Psychology
– Sociology
• Concepts can be applied across disciplines

16. Application to Other Disciplines
• Business/Customer Service
– Group of customers with varying issues
– Each participant given a different
customer
• Role play/dialogue
• Intervene
– Debriefing
• Discuss scenarios
• Prioritize/escalate as needed
• Peer feedback
• Revise approach

17. Resources
• Baldwin, K. B. (2007). Friday night in the pediatric
emergency department: A simulated exercise to
promote clinical reasoning in the classroom. Nurse
Educator, 32(1):24-29.
• Lasater, K. (2007). Clinical judgment development:
Using simulation to create an assessment rubric.
Journal of Nursing Education, 46(11), 496-503.
• McMillan, L. R. (2011). Utilizing SBARR: Using peer
reviewers in a low-fidelity lab exercise. Retrieved
from
http://www.qsen.org/teachingstrategy.php?id=153

18. Questions?