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USE OF THEORY IN SIMULATIONCarol Persoon Reid, PhD, MS, RN, CNE, CHSE

OBJECTIVES

1. Identify two theories to guide simulation work.

2. Compare theory use for specific simulations and simulation programs.

3. Apply a theoretical framework to simulation design, facilitation and debriefing.

WHAT IS A THEORY?

Worldview =

knowledge +

environment +

practice

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POLL – DO YOU CURRENTLY USE THEORY?

• Do you currently use a theory as a framework for simulation program?

• Do you currently use theory for specific simulation scenarios or activities?

WHY IS THIS AN IMPORTANT CONVERSATION?

• Lack of evidence that theoretical framework is used in simulation, research, education, etc.

Kaakinen & Arwood, 2009; Pusic, Boutis & McGaghie, 2018

• Variety of theories from several disciplines may be usedPusic, Boutis & McGaghie, 2018

• Challenges abound when considering theory Adamson, 2015

• Program/Activity

• Personal preference

• Knowledge

• Feasibility

WHAT THEORIES ARE YOU USING?

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SELECT THEORIES RELEVANT TO SIMULATION

Behavior Cognitive Constructive Simulation

Classical conditioning(Pavlov, Skinner)

Conditions of Learning(Gagne)

Adult Learning(Knowles)

NLN - Jeffries

Learning Curve(Thurnstone)

Novice to Expert(Benner)

Social Constructivism(Vgyotsky, Bandura)

CPS (Khalili)

Forgetting Curve(Ebbinghaus)

Deliberative Practice(Ericsson)

Reflective Practice(Schön)

Cognitive Load(Sweller)

Clinical Judgment Model(Tanner)

Social Learning(Bandura)

Experiential Learning(Kolb)

Skill Acquisition(Dreyfus)

Situated Learning(Lave & Wenger)

LEARNING AND FORGETTING

Learning Curve Theory Thurstone

• Logistic shaped pattern with increasing time spent practicing results in improved performance

• For example, operation time decreases as skill increases. Continued practice improves performance.

Forgetting Curve TheoryEbbinghaus

• Nonlinear pattern with rapid initial decay

• For example, clinicians lose CPR skills at an exponential rate. Repeated instruction is critical!

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CLASSIC BEHAVIORISM

Pavlov and Skinner

CONSTRUCTIVISM

Previous Knowledge

Previous Experiences

New Experiences

New Knowledge

Piaget; Dewey;

Bruner

ADULT LEARNING THEORY

• Learners are autonomous & self-directed

• Educators are facilitators

• Learning for change

• skill

• behavior

• knowledge

• attitudeKnowles, ; Wittmann-Price & Price, 2015

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NOVICE TO EXPERT (BENNER)

Novice

Advanced Beginner

Competent

Proficient

Expert

Levels of competence in skill acquisition

SKILL ACQUISITION (DREYFUS)

Modified perception of situation

Role change

Paradigm shift

FROM: TANNER, C. A. (2006). THINKING LIKE A NURSE: A RESEARCH-BASED MODEL OF

CLINICAL JUDGMENT IN NURSING. JOURNAL OF NURSING EDUCATION, 45, P. 208.

Clinical Judgment Model (Tanner)

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REFLECTIVE PRACTICE (SCHÖN)

• Important human activity in which people recapture an experience, think about it, mull it over and evaluate it (Boud, Keogh, & Walker, 1985)

• Technique that encourages critical thought, either with self or another individual or group (Whittmann-Price, Rockstraw, & Kirk, 2015)

• Specific process (Scanlon & Chernomas, 1997; Riley-Doucet & Wilson, 1997)

• Awareness

• Critical analysis/appraisal

• Discussion

• Self-awareness

SITUATED LEARNING (LAVEE & WENGER)

Observe Simulate

Do Teach

Learn

CONDITIONS OF LEARNING (GAGNE)

Enhance retention/transfer

Assess performance

Provide feedback

Elicit performance

Guide learning

Present stimulus (teaching)

Recall prior learning

Identify objectives

Gain Attention

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COGNITIVE LOAD THEORY (SWELLER)

Deliberately apportioned to learner

visual auditory

data

data

data

Learning

Key concepts

EXPERIENTIAL LEARNING (KOLB)

• Knowledge is created through the transformation of experience

• Concrete experience

• Abstract conceptualization

• Reflective observation

• Active experimentation

• Experiential learning components

• Providing an experience

• Thinking about the experience

• Identifying improvements

• Planning the learning needed

• Putting the learning into practice

)

DELIBERATIVE PRACTICE (ERICSSON)

Safe Patient Care

Superior Performance

Repetition

Feedback

Learning

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SOCIAL CONSTRUCTIVISM (VYGOTSKY, BANDURA)

• Often called “scaffolding”

• Knowledge of the world is constructed through social interactions

• Responses to client situations vary based on this knowledge

SIMULATION SPECIFIC THEORIES

NLN/JEFFRIES SIMULATION FRAMEWORK

Jeffries, 2012

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NLN-JEFFRIES SIMULATION THEORY

experiential

interactive

collaborativeLearner

centered

Environment of trust

Jeffries 2016

background designSimulation Experience

Dynamic interaction facilitator participant

system

Patient

Participant

KHALILI’S CLINICAL SIMULATION PRACTISE FRAMEWORK (CSP)

Competent, confident, collaborative professional student in real practice

setting

Simulation practice

Learning Env ironment

Scenarios

CSP KEY STRATEGIES AND ASSOCIATED IMPACT

• Providing a non-judgmental and nonthreatening learning environment

• Applying experiential learning along with critical reflection

• Employing scenarios with some degree of fluidity and flexibility

• Replicating the reality of the workplace: a true- to- life simulated clinical setting

• Using interactive, inclusive, interprofessional patient-centered simulated practice

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USING THEORY IN YOUR SIMULATION PROGRAM

• Break into groups

• Pick one theory

• Work as a group to identify how you can incorporate a theory into your simulation program

CHOOSING THE THEORY FOR YOUR SIMULATION PROGRAM

• Single theory approach

• Multi-theory approach

• Incorporate aspects of different theories to create your own

• Choose different theories depending on situation (participants, type of simulation)

• Advantages & Disadvantages of

• Using one theory versus several

• Simulation specific theory versus education or other theories

REFERENCESAyala, F. J., National Academy of Sciences, Institute of Medicine. (2008). Evolution and the nature of

science. Science, Evolution and Creationism, 1st ed. Washington, D.C.: National Academies Press.

Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative edition). Upper Saddle River, NJ: Prentice Hall Health.

Boud, R. K., & Walker, D. (Eds.). (1985). Reflection: Turning experience into learning (pp. 708). London, UK: Kogan.

David L,(2015). Constructivism. Learning Theories, Retrieved from https://www.learning-theories.com/constructivism.html

Goldfarb,R. & Rataner, J. (2008). Theory and models: Terminology through the looking glass. Economics in Practice, 5, 91-108.

Grant & Marden. (1992)

Kaakinen. J., & Arwood, E. (2009). Systematic review of nursing simulation literature for use of learning theory. International Journal of Nursing Education in Scholarship, 6(1), 1-20. doi: 10.2202/1548-923.1688

Khalili, H. (2015). Clinical simulation practise framework. The Clinical Teacher, 12, 32 – 36.

Nehring, W. M. (2010). A synthesis of theory and nursing research using high-fidelity patient simulation. In W. M. Nehring & F. R. Lashley (Eds). High-fidelity patient simulation in nursing education (pp. 26 – 56). Sudbury, MA: Jones & Bartlett.

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REFERENCES

• Pusic, M. V., Boutis, K., McGaghie, W. C. (2018). Role of scientific theory in simulation education research. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 13, S7-S14.

• Riley-Doucet, C. & Wilson, S. (1997). A three-step method of self-reflection using reflective journal writing. Journal of Advanced Nursing, 25, 964-968.

• Scanlon, J. M., & Chernomas, W. M. (1997). Developing the reflective teacher. Journal of Advanced Nursing, 25(5), 1138-1143.

• Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York, NY: Basic Books.

• Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204-211.

• Whittmann-Price, R & Price, S. W. (2015). Educational theories, learning theories, and special concepts. . In L. Wilson & R. A. Whittmann-Price (Eds.). Review manual for the certified healthcare simulation educator (CHSE) exam (pp. 55 – 89). New York, NY: Springer Publishing Company.

• Whittmann-Price, R., Rockstraw, L., Kirk, T. (2015). Debriefing. In L. Wilson & R. A. Whittmann-Price (Eds.). Review manual for the certified healthcare simulation educator (CHSE) exam (pp. 193 – 209). New York, NY: Springer Publishing Company.

CONTACT INFORMATION

• Carol Reid. PhD, RN, CNE, CHSE

• Carol.Reid@metrostate.edu