you otter know about sim - deanne blach · what you otter know about sim 17th nurse educator...

3/29/2017

1

The Essentials of Simulation

What you otter know about sim

17th Nurse Educator Institute

Molly Bryan, MSN, RN

Director of Simulation

Cox College

April 4, 2017

Learning Objectives

Explore ways to implement simulation best practices into your curriculum

•Demonstrate novice‐beginner level debriefing techniques

•Develop a simulation experience utilizing best practices

•Identify opportunities to incorporate moulage to enhance realism for simulations

NCSBN Simulation study

•Effectiveness of simulation as a replacement strategy for clinical.

•Study consisted of groups where clinical was replaced by sim:• 10%• 25%• 50%

https://www.ncsbn.org/JNR_Simulation_Supplement.pdf

3/29/2017

2

RESULTs of NCSBN STUDY

The study provided substantial evidence that substituting high‐quality** simulation experiences for up to half of traditional clinical hours produces comparable end‐of‐program educational outcomes and new graduates who are ready for clinical practice.

**Under conditions comparable to those described in the study, which include

Dedicated simulation team

Faculty members/facilitators formally trained in simulation pedagogy

Content expertsEquipment and supplies to create a realistic environment

Benefits of Simulation

Simulation has shown to be beneficial in:

Improving confidence

Promoting critical thinking

Improving student/staff satisfaction

Facilitating cognitive development

Image Source: © 2012 www.zazzle.com

Simulation as a Teaching Strategy

Simulation allows students/staff to:

›Bridge theory to Practice› Incorporates all domains of learning (cognitive, affective, and psychomotor

›Practice in a safe environment

•Aspects of Simulation:•Pre‐briefing•Scenario•Debriefing•Evaluation

3/29/2017

3

Other resources

•Kansas State Board of Nursing (KSBN) http://www.ksbn.org/education/Scenario/SimulationScenarioLibrary.htm

•Simulation Innovation Resource Center (SIRC) http://sirc.nln.org/

•Montgomery College https://cms.montgomerycollege.edu/nursingsims/

INACSL Standards of Best Practice: SimulationSM

• SSH (Society of Simulation in Healthcare)

• INACSL (International Nursing Association for Clinical Simulation and Learning) http://www.inacsl.org/i4a/pages/index.cfm?pageid=3407

• SOBP: Simulation IX‐‐Simulation Design

Why best practice?

• INACSL Standards of Best Practice: SimulationSM was developed and designed to:• Advance the science of simulation

• Share best practices• Provide evidence‐based guidelines for implementation and training

• “living documents”

3/29/2017

4

“Purposeful simulation design promotes essential structure, process, and outcomes that are consistent with programmatic goals and/or institutional mission (Lioce et al., 2015, Standard IX paragraph 2)”.

remember! You are developing and facilitating a simulation experience!

Standard IX: SIMULATION DESIGN

1. Needs Assessment

2. Measurable Objectives

3. Format of Simulation

4. Clinical Scenario or case

5. Fidelity

6. Facilitator/Facilitative

Approach

7. Briefing

8. Debriefing and/or feedback

9. Evaluation

10.Participant Preparation

11.Test of the Design

3/29/2017

5

NEEDS ASSESSMENT

• CURRICULUM INTEGRATION

•What gaps do you see in the curriculum? • HESI, ATI, NCLEX exams scores

•What gaps do you see in clinical? • Competency testing; clinical anecdotals; ethical situations

•What clinical experiences are students missing? • OB; Peds; etc

•What gaps exist for Workforce?• High mortality/low frequency events

• RCA (Root Cause Analysis)• Patient Satisfaction scores• Patient Safety trends

SIMULATION DESIGN

1. Needs Assessment




5. Fidelity


Approach

7. Briefing


9. Evaluation



MEASUREABLE OBJECTIVES

OBJECTIVES

DRIVE THE

DESIGN OF

THE

SCENARIO

EXPERIENCE!

BROAD: REFLECT THE PURPOSE OF THE SBE

Demonstrate skills in a safe and therapeutic manner.

SPECIFIC: RELATED TO PARTICIPANT PERFORMANCE MEASURES

Recalls potential adverse effects related to blood administration

3/29/2017

6

Use blooms taxonomy to describe the type of knowledge gained

Incorporate Cognitive, Affective, and Psychomotor learning domains

Include verb and noun

Be clear, concise, and realistic

Guide learning outcomes

ADDRESS THE DOMAINS OF LEARNING

CORRESPOND TO THE PARTICIPANT’S KNOWLEDGE LEVEL AND EXPERIENCE

• BE SPECIFIC• BENNER’S STAGES OF CLINICAL COMPETENCE

• CHALLENGING YET ATTAINABLE• OUR GOAL IS TO TAKE STUDENTS/PARTICIPANTS TO THE EDGE OF WHAT THEY CAN DO

• FEELING SAFE DOES NOT EQUATE TO COMFORT!• INCLUDE COMPONENTS OF PATIENT CARE• DESIGNED TO ELICIT CLINICAL JUDGMENT AND REASONING

REMAIN CONGRUENT WITH OVERALL (PROGRAM) OUTCOMES

•PROMOTE KNOWLEDGE AND APPLICATION TRANSFERENCE

•INCLUDE SKILL PERFORMANCE AND EFFECTIVE MASTERY TO INCREASE SELF‐CONFIDENCE

3/29/2017

7

INCORPORATE EVIDENCE-BASED PRACTICE

CURRENT PRACTICES

QSEN COMPETENCIESHTTP://QSEN.ORG/

OTHER

Time frames are established as part of the simulation design to ensure there is reasonable time to achieve the objectives.

**Students take approximately twice as long as a practicing nurse.

Students/participants are notified of the time frame prior to beginning the scenario—”you have 15 minutes to complete this portion of the scenario”

WHY DO YOU THINK IT IS IMPORTANT THAT THE PARTICIPANTS KNOW THE TIMEFRAME?

BE ACHIEVABLE WITHIN AN APPROPRIATE TIMEFRAME

1. Needs Assessment




5. Fidelity

6. Facilitator/Facilitative Approach

7. Briefing


9. Evaluation



SIMULATION DESIGN

3/29/2017

8

CLINICAL SCENARIO OR CASE

Use a template

Situation or Background

Clinical Progression/CuesCues are used to refocus participants not lead them

Time FramesStudents take 2-3 times longer than you would!

ScriptDeveloped for structure and

consistency/standardization to increase reliability

Identification of Critical Actions/Performance Measures

SCENARIO TEMPLATE

TIPS FOR DEVELOPING AND RUNNING SIMULATION SCENARIOS

Use a Scenario templateLength: 10-15 minutes segments2-3 participants per segment (8-9 participants per

session) Incorporate cues not leading statementsCreate and Maintain realismPatient and Physician NamesVoice of the PatientVoice from Above

Mental moments (time outs) are ok and encouraged

3/29/2017

9

1. Needs Assessment




5. Fidelity


7. Briefing


9. Evaluation



SIMULATION DESIGN

FIDELITY

REALISM

Physical

Conceptual

Psychological

MODALITY

Platform for the simulation based experience

Standardized Patients; Manikins; Confederates

Independent VS Unfolding

FIDELITY VS MODALITY

YOU OTTER BE PREPARED

3/29/2017

10

SIMULATION DESIGN

1. Needs Assessment




5. Fidelity


Approach

7. Briefing


9. Evaluation



SAFE? LEARNING ENVIRONMENT

SAFE TO TAKE RISKS• ERRORS ARE PUZZLES NOT CRIMES

• BOUNDARIES• What is confidential?

• PURPOSES• Summative vs formative

• SHARED AGREEMENTS• During pre brief: “What helps you feel safe?”

• “How do we help each other get better”

• VALUES THINKING PROCESS• “What got in the way that lead to the mistake?”

Pre Briefing

•Prior to scenario• 5‐10 minutes• Establish baseline knowledge and understanding: “Tell me what you know about _______”• ALWAYS allow students/staff to orient to room prior to beginning scenario.• Fiction Contract/Confidentiality Form and Verbal agreement• Clearly Communicate the objectives and expected outcomes.

3/29/2017

11

Protecting the Content of the Scenario and the Simulation

•Confidentiality•What is your process?

•Fiction Contract• Verbal?•Written?

SIMULATION DESIGN

1. Needs Assessment




5. Fidelity


Approach

7. Briefing


9. Evaluation



Participant orientation

3/29/2017

12

PARTICIPANT ORIENTATION

Prep Assignments/Work

• Purpose• Student Accountability

• Knowledge

• Learning

• Remembering

• If students have a readiness to learn‐they understand

• Prepared for application

https://www.softchalkcloud.com/lesson/serve/r1E7Qq3vLkGsuY/html

INACSL Best Practice criterion 10

Provide preparation materials and resources to promote participants’ ability to meet identified objectives and achieve expected outcomes of the simulation‐based experience.

3/29/2017

13

Ideas for Prep Assignments

• Learning objectives• Broad objectives

• 4‐5 per scenario

• Medication• Provide distractors

• Pathophysiology• Skills required• Orders (optional)• Internet searches• Website review and summary (eg. Crash cart)

• Prezi.com (e.g. photos of home environment)

• YouTube videos (procedures)• Develop Patient Education Materials (cultural and health literacy)

• Concept Map

• EMR

• Case studies• Articles

Still need more ideas

• Lab values activities

• http://quizlet.com/

• Protocols from clinical sites

Don’t forget the benefit of discharge planning activities

DocuCare

Moulage=“Setting the Stage”

Production

The SET

Costumes

Characters

Script

Make up

Strike the set

3/29/2017

14

“setting the stage”

PRODUCTION

• Remember—We are providing an Experience!

• Moulage• Adds realism• Engages participants through all the senses

• Suspends disbelief• Supports critical thinking• Improves performance

THE SET

• “Captivate their emotions through environmental surroundings”

• Get well cards in patient rooms

• Flowers • Oxygen and suction• Food items

“SETTING THE STAGE”

COSTUMES

• clothing‐found at local thrift store

• extra hospital gowns• wigs or Halloween color hair spray‐white

• hats/glasses• props: cane, large purses, toys, books

• (tip‐ Velcro is your friend!)• make up: fake vomit, tooth rot, moulage for injuries

CHARACTERS

• Manikins

• Trainers

• Standardized Patients/participants

• Confederates

“SETTING THE STAGE”

SCRIPT

• “To make the scenario come alive”

• Must consider moulage during the design phase

Example: Mild rash reaction, infiltrated iv

Script vs. Cues

MAKE UP

• Enhance the simulation experience and allows for suspension of disbelief.

• Make sure the products you purchase for moulage are compatible for your manikins

• Certain companies will not assume responsibility for any damages/staining that may occur from moulage

3/29/2017

15

Moulage: Getting StartedThings to Consider:

Will this enhance the participant’s experience?

Will this help meet the simulation objectives?

How old is the injury?

What is the pathophysiology of the injury?

THERE IS NOTHING EMBARRASSING ABOUT DEBRIEFING (OTTERS DON’T WEAR UNDERWEAR)

1. Needs Assessment




5. Fidelity


7. Briefing


9. Evaluation



SIMULATION DESIGN

3/29/2017

16

Debriefing is one of the most important aspects of a simulation activity. Debriefing provides students with opportunities to:

› Reflect on performances› Ask questions› Close performance gaps› Synthesize curriculum

content

DEBRIEFING

management4volunteers.wordpress.com

All simulation-based learning experiences should include a PLANNED debriefing session aimed toward promoting reflective thinking.

Did you know? Reflective thinking does not happen automatically, but it can be taught; It requires time

Active involvement in a realistic experience

Guidance by an effective facilitator

STANDARDS OF BEST PRACTICE-SIMULATION: DEBRIEFING

Frames are invisible drivers of behaviorAssumptions

Feelings

Knowledge base

Situation awareness

Influence of context

Goal

Rules CAUTION: Don’t tell participants their frames Goal: Encourage participants to narrate their thinking! If we tell them frames or “connections”-it doesn’t stick!

OUR ROLE IS TO ELICIT FRAMES

3/29/2017

17

PATTERN OF DIALOGUE

TRADITIONAL

PATTERN OF DIALOGUE

FAN

CONTINUED DIALOGUE

NET=GOAL!How do we do this?Boomerang/deflect

questions-send back to person asking or group

What did you see from your perspective?

Allow silence

Recognize contributions of students Feel valued

3/29/2017

18

1. REACTION—Clear the Air!

What are the participants reactions to the scenario?

We want the emotions to come out so learning can begin!

Explore

Discuss and Teach

Generalize

PHASES OF DEBRIEFING

2. ANALYZE

CONTINUED: PHASES OF DEBRIEFING

Distill lessons to go into the future

Take a ways (aha moments)

PLANT A SEED!

REACT

RESET

GET CURIOUS (ASK) Using active questions

Did I do my best to… RESET

GET CURIOUS?

3. SUMMARY

GAS Model (Novice/Beginner)

Plus Delta (Novice/Beginner)

Advocacy Inquiry (Adv Beginner and up)

PEARLS (Competent and up)

DEBRIEFING FORMATS/STYLES

3/29/2017

19

GAS MODEL

+/What went well (+) What could be changed () or ifyou could do it again what wouldyou do differently or change?Advantages: Instructor prompted; learner

drivenEasy to learnMultiple issues identified quickly

LEARNER SELF-ASSESSMENT

www.forbes.com

Plus Delta Gamma

Examples of good action What we would like to change

How would we change it?

What was the outcome? Recognize performance gaps

Strategies to minimize performance gaps

PLUS DELTA (MODIFIED)

3/29/2017

20

ADVOCACY INQUIRY

ADVOCACY IS AN ASSERTION, OBSERVATION, OR STATEMENT.

INQUIRY IS A QUESTION.

“I see…” “I think…” “Tell me more about…” “I understand; however,

tell me about X” “I wonder…”

Share what you were thinking

Based on frames from student, how can we meet them where they are?

TALK ABOUT THE ELEPHANT

www.worldwildlife.org

Organized: Use learning objectives to guide conversation

Sit in circle to facilitate open conversations

We are exploring frames: “I noticed…” “Can you share with me what you were thinking as you…”

Performance Gaps

Not a mini-lecture

Remember silence is good!

TIPS FOR EFFECTIVE DEBRIEFING

3/29/2017

21

Allow students to internalize—if they are being told the “connections” it doesn’t stick!

Ask open questions avoiding yes/no answers

Leave time for “ah ha” moments or takeaways!

Focus on improvement or sustaining excellencePositive patterns of practice!

MORE TIPS FOR DEBRIEFING

Thinking about all the other things I have to do

Lack of interest in what the other person is saying

I already know what they are going to say

Working out what I am going to say next

CAUTION: DO NOT INTERRUPT!

This rushes their thinking and we get incomplete ideas.

BARRIERS TO FEEDBACK/FRAMES

QUICK DEBRIEFING STARTERS

3/29/2017

22

Suppress the teaching urge

Be curious

Understand learners’ frame of reference and thinking

DEBRIEFER CHALLENGES

YOU OTTER BE SIMMIN’

1. Needs Assessment




5. Fidelity


7. Briefing


9. Evaluation



SIMULATION DESIGN

3/29/2017

23

INACSL STANDARD OF BEST PRACTICE IV: FACILITATION

Allow the simulation scenario to progress without interruption, allowing the participants to problem solve independently.

STANDARD OF BEST PRACTICE IV: FACILITATION

Facilitation ENGAGES participants within a simulation-based learning experience—thereby assisting them to meet the objectives.

Facilitation methods occur: Before During After

STANDARD OF BEST PRACTICE V: FACILITATOR

As the facilitator it is your role to:

Create and maintain the safe container

Promote and Maintain Fidelity/Realism

Assess and Evaluate the Acquisition of Knowledge, Skills, Attitudes, and Behaviors

Models Professional Integrity

Debriefing

Evaluation of Experience

3/29/2017

24

APPROPRIATE USE OF CUES

Providing cues to redirect the scenario and guide participants down the path of discovery.

Cues should not distract!

PERFORMANCE GAP

Quality of Perform

ance

Desired

} Assessment

Actual

PERFORMANCE GAP

Identify the gap

Analyze the gap

Close the negative gap-performance gains

Maintain positive gap-promote excellence!

Schedules/plan Sim Experiences

Guides and supports students during QSE to achieve objectives

Creates safe learning environment

THE Content expert

Acts as Voice of patient

Facilitates Pre-Brief and Debrief participants

Prepares Staff Prep assignments

Plans Synthesis assignments

Seeks continued Professional/Simulation Development

WHAT IS MY ROLE? FACILITATOR

3/29/2017

25

Orient participants to the room

Gathering of supplies, equipment, etc.

Set up of scenario

Moulage

Maintain manikins

Assist with Standardized patients

RUN manikins and AV equipment during scenario

Annotate participants interventions

Support activities in SimLab

WHAT IS MY ROLE? SIM TEAM

1. Needs Assessment




5. Fidelity


7. Briefing


9. Evaluation



SIMULATION DESIGN

STUDENT EVALUATION AND FEEDBACK

Evaluates:Prep workExperienceLearning objectivesConfidenceCritical thinkingSafe

environment/containerDebriefingSelf-reflection

3/29/2017

26

SCENARIO EVALUATION

Does it address the needs assessment?

Learning objectives measureable? met or not met?

Report for student-effective? More or less info?

Format appropriate? Manikin? Unfolding? Smooth transition?

Cue appropriate? Reasonable timeframe?

What info throughout the scenario is missing?

DocuCare?

Plan for prep work?

1. Needs Assessment




5. Fidelity


7. Briefing


9. Evaluation



SIMULATION DESIGN

PILOT TESTING

Why?Does it accomplish what we intended?

Does it meet the objectives?

Is it effective for participants?

What elements are:

Confusing

Missing

Underdeveloped

3/29/2017

27

FACILITATION METHODS BEFORE

Writing objectives Preparing the scenario Developing evaluation plan Communicating objectives Orient participants to: Environment Manikins Equipment Provide ground rules Expectations Provide background info Give time for participants to develop plan

FACILITATION METHODS DURING

Allow the simulation scenario to progress without interruption, allowing the participants to problem solve independently.

Observe and monitor scenarios

FACILITATION METHODS AFTER

DEBRIEFING Acknowledge participants feelings and

perspectives Create transparency Explore participants decisions and

actions Encourage participants to evaluate/self-

reflect Provide feedback

3/29/2017

28

Thank you for attending!

Questions ??Please feel free to contact me with any questions:Molly Bryan MSN, RN

Simulation Director, Cox College

Cox College –meeting the educational needs of students and the health care community

[email protected]

Phone: (417) 269‐8524

Mobile: (417) 489‐4555

Alexander, M., Durham, C. , Hooper, J . , Jef fr ies, P. , Goldman, N. , Kardong-Edgren, S. , Kesten, K. , Spector, N. , Tagl iareni , E. , Radtke, B. and Ti l lman, C.(2015). NCSBN Simulation Guidelines for Prel icensure Nursing Programs. Journal of Nursing Regulation 6(3) , 39-42. http://www.journalofnursingregulation.com/article/S2155-8256(15)30783-3/pdf

Hayden, J . , Smiley, R. , Alexander, M., Kardong-Edgren, S. , & Jef fr ies, P. (2014). The NCSBN national s imulation study: A longitudinal, randomized, control led study replacing cl inical hours with s imulation in prel icensure nursing education. Journal of Nursing Regulation, 5 (2) .

https://www.ncsbn.org/JNR_Simulation_Supplement.pdf INACSL Standards of Best Practice: SimulationSM INACSL ( International

Nursing Association for Cl inical Simulation and Learning) http://www.inacsl.org/i4a/pages/index.cfm?pageid=3407

Lavoie, P. , Pepin, J . & Boyer, L. ( ) . Reflective debriefing to promote novice nurses’ c l inical judgment af ter high-fidel ity c l inical s imulation: a pi lot test.

Merica, B. (2012). Medical Moulage: How to Make Your Simulations Come Al ive.

REFERENCES

Rudolph, J., Raemer, D., & Simon, R. (2014). Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 9(6), 339-349.

Rudolph, J., Simon, R., Dufresne, R., & Raemer, D. (2006). There’s no such thing as “Nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55.

Rutherford-Hemming, T., Lioce, L., Kardong-Edgren, S., Jeffries, P. and Sittner, B. (2016). After the National Council of State Boards of Nursing Simulation Study—Recommendations and Next Steps. Clinical Simulation in Nursing, 12(1), 2-7.

REFERENCES

Cox College Student Orientation to Simulation

Revised 1/2017

Why do we do Simulation? We want you to be successfulo Increase their confidence o Decrease their anxiety

o Bridge theory to practice o Safe environment

o If they will use the tools provided they will be successful (practice skills, do prep work, engage in activity, etc?) Getting to know the Manikin

o No pens or ink “Ink Free Zone” o No fluids down the nose or mouth of the manikin o No “ wet” Betadine (use the dry swab on top) or injections: IM/sub injections=Inject Ed; Foley o No cell phones (why) o Review capabilities of manikin as appropriate

BP (monitor vs manual dependent on course-fundamentals manual and some faculty) Blink Pupils dilate (3G) Pulses (have them each find a pulse to see how it feels) IV start-manikin specific (Noelle L, Esse, others). Review supplies and nursing judgement (cathlon size)

• Explain expectation for blood return/patency of IV (demo); 22 g ONLY o Review assessment findings the manikin cannot do-this is when you will hear voice from above

Capillary refill Edema Skin Turgor

Muscle strength PERRLA (3G) VS, Breath sounds (not overhead)

Lifting and moving manikin limitations. Expectations for posterior breath sounds; turning pt; skin integrity etc Realism—reinforce Confidentiality/Fiction Contract “We do all that we can to make this as realistic as possible, our

expectation is that you treat the manikin and confederates as if they are real” You are not “set up “ to be tricked Provide therapeutic touch Open meds, ampules, tubing etc. Oral meds we expect you to come to

the patient and offer water, etc. Refrain from “I would…” IV hooks by sink

We will stop them if they are opening something they should not or will harm our manikin.

Specimens-hallway Body waste-bathroom Blood glucose testing

How to operate the bed (esp crib) Functional O2 and Suction Patient Monitor: Have students demonstrate rather than sim team

BP Temp

HR/RR=EKG Alarm

Pulse ox

Linen room Where items are located **Course specific relay** Discuss resources available if they can’t find/miss supplies.

Dresser Med Cart (outside the room when

in the taped area)

Oxygen supplies Bladder scanner Glucometer

Phone Will always get the operator. Number listed on marker board and outside the room by the phone Located outside the room-explain why and expectation to not talk to other students/patient in the

room DocuCare: may need to acknowledge orders (pending vs active). Frequent refresh (F5) or arrows. Review medication

admin with scanner (scan patient then meds); How to find labs/xray/specimen culture results, etc Simulation Scenario evaluation tool available in debrief room. Also available is the SBAR Observer tool Sound Delay— Validate frustration and explain the sound delay so they know it is unavoidable. “Mental Moment”—opportunity to occasionally take a 30 sec “pause” or “timeout” to huddle and determine new

plan. Occurs very infrequently. Omnicell IV pump—questions or concerns.

SimulationinaNutshell(AreallyBIGnutshell!)MollyBryan,MSN,[email protected]� The following are best practices and tips for facilitating a simulation experience in a nutshell

Remember you are Developing and Facilitating a Simulation Experience!

1. Orientation to Simulation (this is how we orient students at Cox College)

a. Sim Team 1 hour

b. Confidentiality/ Fiction Contract signed

c. Relay for supplies

d. Expectations for professionalism

e. Manikin do’s and don’ts

f. Patient Monitor, Omnicell, DocuCare, etc

2. Simulation Experience is developed around

a. Needs Assessment

b. Learning Objectives

c. Fidelity

d. Designed to elicit clinical judgement and reasoning

3. STRUCTURE

a. Our goal is to take students to the edge of what they can do

b. Feeling safe does not equate to comfort

c. Be achievable within an appropriate timeframe

i. Students take 2X longer than a practicing nurse

ii. Students are notified of the time frame prior to beginning the scenario—”you have 15 minutes to

complete this portion of the scenario”

iii. Sim team will notify you as the time to end is approaching

d. Follow the scenario template

4. Simulation Map (required for each scenario‐provide justification and rationale for why we do what we do)

5. QSEN—Distractors and safety items are always planned and written into the scenario. No impromptu

6. Pre‐sim assignments—always give prior to them coming to sim (You decide when). Approx 30‐60 min. “Ticket to

Class”

a. Medications with distractions

b. Learning objectives‐broad

c. Skills needed to be successful

d. What will you do if a student comes unprepared?

7. Electronic Documentation Record‐if you decide to implement

8. Post‐Sim Assignments

a. What are the expectations for after sim?

b. How will you be documenting their progress in sim? Clinical antedoctal?

9. Debriefing

a. A skill that must be developed and continuously implemented to become proficient.

b. Organized, structured:

i. Not standing; sit in the circle with participants

c. Novice approach: Plus Delta technique; GAS model

d. Not a lecture—you are ONLY facilitating a discussion

e. Debriefing provides students with opportunities to:

i. Reflect on performances

SimulationinaNutshell(AreallyBIGnutshell!)MollyBryan,MSN,[email protected]�

ii. Ask questions

iii. Close performance gaps

iv. Synthesize curriculum content

f. Create a safe container

i. Tell them what you have done to make it safe; to prepare them; etc.

ii. Who will be watching?

iii. What will you be doing with your findings?

g. Role is to Elicit Frames of thinking: Do not tell them their frames—must encourage them to narrate their

thinking

h. Phases

i. Gather or Reaction—“How do/did you feel?”

ii. Analyze—Explore those frames; analyze performance gaps

1. “I noticed…Can you share with me what you were thinking as…”

2. Silence is okay—let them gather and learn to think reflectively

iii. Summarize—How do we do things differently for future; take a ways; close performance gaps

10. Orient to Room—SimTeam will do this prior to each session. They will greet you and provide you with a control

room access badge. You will need to let them know when to orient your students. (5‐10 min). Optimal to orient

prior to giving report. Part of your pre‐brief.

11. Realism

a. You are the voice of the patient—must maintain that realism. Don’t use nursing vocabulary‐use lay terms

b. Overhead is only for findings that manikin CANNOT give or to start/end scenario

c. Allow the simulation scenario to progress without interruption, allowing the participants to problem solve

independently.

d. Do not lead students

e. Use of appropriate cues

f. “You may begin; That’s a wrap”—find a phrase that works for you and be consistent

12. Role as a Facilitator

a. Schedules/plans Sim Experiences

b. Guides and supports students during QSE to achieve objectives

c. Creates safe learning environment

d. THE Content expert

e. Acts as Voice of patient

f. Facilitates Pre‐Brief and Debrief participants

g. Prepares Student Prep assignments

h. Plans Synthesis assignments

i. Seeks continued Faculty Development

13. Pre‐Briefing:

a. Fiction Contract

b. Confidentiality

c. Expectations for the day

d. Learning Objectives

e. What resources are available to them Ex: A physician is not readily available but in house and can be

paged; you do or do NOT need to draw labs, etc.

f. Establish baseline knowledge:


i. “Tell me what you know about…”

ii. “Top three priorities”

14. Ratio—Facilitating a Quality Sim Experience allows for a 2:1 ratio at Cox College

REACTION/GATHER STAGE “How did that feel?”

“Can someone summarize what the case was about from a medical point of view?”

“What were the main issues you had to deal with?”

Follow up: “What happened next?” “What things did you do for the patient?

ANALYSIS STAGE

“Now that we are clear about what happened, Let’s talk about case. There were aspects I think you managed effectively and other areas that you might want to have done differently. I would like to explore each area with you…”

“What aspects of the case do you think you managed well?” “What aspects of the case would you want to change?” “What aspects of the case would you want to do differently?”

“I noticed you [insert performance gap here]. “I noticed that…” “I heard you say…” “I saw that…” “I liked that…” “I thought that was interesting/fascinating…” “It seemed to me…” “I was thinking…” “That makes me think that…” “I was concerned…”

“How do you see it?” “I wonder what your thoughts were at the time” “What was going through your mind?” “How did you assess the situation?” “What were your priorities at the time?” “How did the team get organized?” “How did you decide that?”

“Are there any outstanding issues we haven’t discussed yet before we start to

close?”

“I like to close the debriefing by having each of you state one‐two take a ways that

will help you in the future”


Simulation Resources National Simulation Study

https://www.ncsbn.org/JNR_Simulation_Supplement.pdf Debriefing Articles

“Reflective Debriefing to Promote Novice Nurses’ Clinical Judgment after high‐fidelity clinical simulation: a Pilot Test” by Patrick Lavoie, J. Pepin, and L. Boyer

“There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment” by Jenny Rudolph, R. Simon, R. Dufresne, and D. Raemer

INACSL’s Standards for Best Practice Standards: Simulation http://www.inacsl.org/files/journal/Complete%202013%20Standards.pdf QSEN (Quality and Safety Education for Nurses)

http://qsen.org/competencies/pre‐licensure‐ksas/ http://qsen.org/wp‐content/uploads/formidable/Summary‐of‐Simulation‐Activities‐and‐QSEN‐Competencies.doc More Literature

Simulation in Nursing Education by Pamela Jeffries

“Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically by Patricia Benner, R.

Hughes, and M. Sutphen

DASH: Debriefing Assessment for Simulation in Healthcare https://harvardmedsim.org/debriefing‐assesment‐simulation‐healthcare.php Rudolph, J., Raemer, D., & Simon, R. (2014). Establishing a safe container for learning in simulation: the role of the

presimulation briefing. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 9(6), 339‐349.

Current as of

Patient Name: DOB: MR#: Allergies: Learning Topic: Intended Audience: Patient Background/Hx: You are starting your _____________ shift. Report given by ___________. Situation: Background: Assessment: Recommendations: Additional information that can be given if participants ask during report or use to guide script during scenario: Social History Home Medications Height: Weight:

Unit Timing Monitor Settings

Patient/Manikin Actions Student Interventions Cue/Prompt

Segm

ent 1

_____ minutes

Initial State: RR: HR: BP: SpO2: Temp:

Sim Team Notes:

Current as of

Segm

ent 2

_____ minutes

RR: HR: BP: SpO2: Temp:

Segm

ent 3

_____ minutes

RR: HR: BP: SpO2: Temp:

Equipment/Supplies/Medications:

List equipment here

List supplies here

Current as of

Patient Chart:

ID band (Barcode)

Allergy band

Physician Orders (Faculty to bring)

o Sim Team copy

MAR if needed (Faculty to bring)

o Sim Team copy

Orders/Chart developed in DocuCare

Simulation Objectives:

1. List Objectives here




⃝ I have a current simulation map on file

⃝ I do not have a simulation map on file

Student Name: Instructor/Evaluator:

Cox College Simulation Center Self‐Evaluation Sheet

Gather, Analyze, & Summarize

1. Gather: How do you feel about the simulation experience? Provide a couple of descriptive WORDS from each participant (i.e. exciting, confusing)

2. Analyze: Tell me some positives and some things you would change about what happened in this scenario (how you performed). Were you able to meet the objectives for the scenario? If not, why?

______________ ______________

(i.e. I introduced myself when I walked I the room.)

Note: If difficulty coming up with items‐ think through the entire scenario from the beginning. As you walked in the room what did you do? And then what? Did you notice what was going on with the patient?

3. Summarize: If you were able to repeat the scenario again, would you do anything differently? If so, what? What is your take a way? As a result of your simulation experience, I have a greater ability to:

Yes No Objectives

Demonstrates appropriate post-operative assessment

Demonstrates effective provision of care for surgical patient

Administers medications safely and appropriately

Prioritizes and implements physician orders appropriately

you otter know about sim - deanne blach · what you otter know about sim 17th nurse educator...

Documents