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

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

A New Twist on Simulation:

DevelopingIndividual

Clinical Reasoning

A New Twist on Simulation:

DevelopingIndividual

Clinical Reasoning

Simulation in Education

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

Group vs. Individual Sim

Group vs. Individual Sim

Group Simulation

• Large groups• Group dynamics• Difficulty evaluating

individual performances• Faculty involvement

Individual Simulation

• Must rely upon individual knowledge and abilities

• Each student must participate

• Faculty can easily evaluate each student’s individual performance

• Faculty involvement is minimal and controlled

"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

OverviewOverview• 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

Foci of Simulations

Foci of SimulationsFirst Simulation Focus

• Report • Assessment

– Recognition of abnormal findings

• SBAR• Prioritization of multiple

patients

Second Simulation Focus• Report• Assessment

– Analysis of data– Planning care

• SBAR• Prioritization of multiple

patients

+ Identifying priority problems and interventions

+ Family interaction; therapeutic communication

Third Simulation

Third Simulation

• Evolving scenario where the situation changes– Assessment– Intervention– Evaluate– Alter intervention to changing status

• Debriefing– Faculty & Peer Feedback

Student viewing computer information

• Low-fidelity simulator

Students assessing patients

• Medium-fidelity simulator

Students assessing patients

• High-fidelity simulator

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

Assessment/Evaluation

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

Lasater Clinical Judgment RubricLasater Clinical Judgment Rubric

•Effective noticing•Effective interpreting•Effective responding•Effective reflecting

Simulation Across

Disciplines

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

Application to Other

Disciplines

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

ResourcesResources• 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

Questions?Questions?