presentation title - cancellation · charlene romer, phd, rn, cne nursing education consultant...
TRANSCRIPT
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Bringing Clinical into the Classroom Using
Screen-Based Simulation
Monday, April 1, 2019 10:15 AM – 11:15 AM
Tuesday, April 2, 2019 10:15 AM - 11:15 AM
Christine L. Heid, PhD, RN, CNE, CHSE
Nursing Education Consultant
Charlene Romer, PhD, RN, CNE
Nursing Education Consultant
Session Objectives
2
Following this presentation, the learner will be able to…
▪ Define clinical competence and screen-based simulation
▪ Identify how screen-based simulation can facilitate development of clinical competence
▪ Discuss strategies for incorporating screen-based simulation into the nursing curriculum
Laying the Foundation for Clinical
Competence
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Confidence versus Competence
▪ Confidence
― one’s own belief about one’s abilities
▪ Competence
― one’s actual ability to successfully perform what
is required to achieve a favorable outcome in a
clinical context
(Andreataa & Lori, 2014, p. 33)
Preparation of Graduates Survey
“Overall new graduate nurses are fully prepared to provide safe and
effective care in a hospital setting.”
89.90%
5.80% 4.40%
Nursing School Leaders
Agree
Ambivalent
Disagree
10.40%
48.10%
41.50%
Hospital Nurse Executives
(The Advisory Board, 2008)
Preparation for Practice
▪ Educating Nurses
― Expertise develops as the learner transfers
skills (clinical judgment, ethical comportment,
and formation) to actual patient care situations
(Benner et al., 2010)
▪ To Err is Human (IOM)
― Move away from task-based proficiencies to
higher-level competencies as foundational to
knowledge and skills to formulate decisions and
manage care across clinical situations and
settings (IOM, 2009)
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Developing Clinical Competence
▪Developing clinical competence
requires the assimilation of clinical
skills and problem-solving combined
with performance-based assessment
in clinical contexts, which can be
replicated for predictable outcomes
mastered at the novice level through
simulation.
▪(Plessas, 2017; Andreataa & Lori, 2014)
Benner’s (1984)
Clinical Competence
Model
Novice
• Lack experience, depend on context-free rules to make decisions
Advanced
• Operates on general guidelines; needs assistance prioritizing what is most important
Competent
• Lacks speed/flexibility, feels sense of mastery. Develops new guidelines with existing rules. 2-3 years
Proficient
• Looks at whole picture; consider less options; zoom in on the specific task. 3-5 years
Expert
• No longer relies on guidelines/assorted solutions. Considers fewer options; focuses on task. 5+ years
Simulation and Clinical Competence
▪ Educators can bridge the gap with realistic,
interactive, and meaningful learning experiences
through clinical simulation.
(Decker, Caballero, & McClanahan, 2014)
▪ Simulation allows students to engage in critical
thinking and decision-making in a safe learning
environment that takes into account student
experiences, interest, and learning styles.(Jeffries, 2015)
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Competence Assessment: Miller’s Pyramid (1990)
▪ Assess learning needs and
environment
• Who are the learners?
• What do they need to know?
▪ Consider expected performance /
competence
• What will the learner need to apply or
demonstrate?
• Real world performance assessment• clinical assessment
Does
• Applied clinical competence• simulation
Shows How
• Context-based assignments• quizzes, essays,
case studies
Knows How
• Knowledge• multiple
choice, short answer
Knows
Screen-Based Simulation and
Healthcare Education
What is Screen-Based Simulation?
▪ Screen-Based Simulations (SBSs)
― Use of digital technology to represent
patients, populations, or other
healthcare encounters on a computer
screen or a mobile tablet, smartphone,
or other screen-based device to impart
knowledge and achieve specific
learning outcomes
― (Chang, Gerard, & Pusic, 2016;
Quail, et al., 2016)
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Screen-Based Simulation in the Nursing Curriculum
Advantages
Replicable
Portable
Asynchronous
Individual Pace
Shared Across Devices
Trackable
Cost Effective
Standardization
Experiential Learning
Disadvantages
Functional Fidelity
Programming
Training
Technical Problems
Quick Tip: Make sure to fit learning
objectives/outcomes with the best
simulation resource.
Review of the Literature:
Screen-Based Simulation and Education
• Evaluate competency and development of situation cognition
• Support knowledge, clinical reasoning, and cognitive elements of
patient care
• Provide feedback related to clinical knowledge and critical-thinking
skills
• Facilitate iterative performance-feedback loop, mastery learning and
retention
• Develop abilities to achieve proficiency through deliberate practice
• Support teamwork and collaboration(Andreatta &
Lori, 2014; Butt, Kardong-Edgren, & Ellertson, 2018; Chang & Weiner, 2016)
Review of the Literature:
Screen-Based Simulation Integration
• Early introduction of virtual patient-based assessment with self-
evaluations led to student identification of clinical reasoning, clinical
practice focus, and clinical competence expectations (Forsberg, Ziegert,
Hult, & Fors, 2016)
• Engagement in authentic nursing activities web-based virtual
simulation can enhance nurses’ competencies in acute care (Liaw,
Wong, Chan, Ho, Mordiffi, Ang, … Ang, 2015)
• Nursing students’ use of virtual patients (VPs) provides learning
activities to support development of nursing knowledge and theory-
practice integration (Georg & Zary, 2014)
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Using Best Practices in Simulation to Create Clinical
Competence
Phase I: Planning and Pre-Briefing
• Criterion 1: Needs Assessment
• Criterion 2: Measurable Objectives
• Criterion 10: Participant Preparation
• Criterion 7: Prebriefing
Phase II: Scenario Implementation
• Criterion 3: Format of Simulation
• Criterion 4: Clinical Scenario or Case
• Criterion 5: Fidelity
• Criterion 6: Facilitative Approach
Phase III: Debriefing and Evaluation
• Criterion 8: Debriefing
• Criterion 9: Evaluation
• Criterion 11: Pilot
(INACSL Standards Committee, 2016; Oriot & Alinier, 2018)
Group Activity: Clinical Competence and the Nursing Curriculum Think – Pair – Share – Square
▪ What challenges do you face in helping students develop clinical competence?
“High quality clinical experiences are
a challenge…short patient stays, high
patient acuity, disparities in learning
experiences, and amount of time
instructors spend supervising skills” (Hayden, Smiley, Alexander, Kardong-
Edgren, & Jeffries, 2014, p. S3)
Screen-Based Simulation Strategies for Clinical Competence
▪ Unfolding Case Studies: Exploring Course Content
• Using a variety of instructional activities, such as animated video, multimedia, virtual
patient simulation and online quizzes, the student applies knowledge in context.
• Designed to deliver intentional content focusing on analysis, strategy and evaluation.
(Liaw, S. Y., Wong, L. F., Chan, S. W.-C., Ho, J. T. Y., Mordiffi, S. Z., Ang, S. B. L., … Ang, E. N. K., 2015)
Stimulate Motivation:
Patient Scenario
Knowledge Acquisition:
Assess Patient
Practice & Feedback: Plan
Collaborative Care
Formative Assessment:
Online Quiz
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Screen-Based Simulation Strategies for Clinical Competence
▪ Virtual Patients / Virtual Environments: Building Clinical Competence
• Using game-based technology, students enter the patient-care environment,
provide collaborative care, and engage in mental rehearsal for the real world.
• Participants reported improved confidence and ability to perform psychomotor
tasks. (Taekman, et al., 2017)
Practice & Coaching
Virtual Patient Care
Debriefing & Reflection
Evaluation & Remediation
Screen-Based Simulation Scenario
Before We Begin: Pre-Briefing
▪ Objectives
1. Participate in a screen-based simulation scenario incorporating clinical concepts in a
classroom environment
2. Reflect upon the screen-based simulation experience using a structured reflective
debriefing framework
▪ What to expect:
• Screen-based scenario using real actors followed by polling questions.
• A facilitated guided debriefing and reflection will follow the simulation case.
• Group discussion will be encouraged at specific points throughout the scenario and
debriefing phases.
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Scenario-Specific Objectives
▪ Upon completion of this module, the student will:
1. Use clinical reasoning to promote a positive outcome for a client who has diabetes mellitus.
2. Determine the correct dosage for prescribed medication.
3. Prioritize client care based on concepts of evidence-based practice.
4. Identify appropriate nursing interventions in the delivery of client care.
5. Apply the knowledge, skills, and clinical reasoning required to positively affect outcomes for
a client who has diabetes mellitus.
Simulation Briefing
Stimulating Motivation: Sharing the Patient’s Story
01:36:41
Situation
Background
Assessment
Recommendation
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Stimulating Motivation: Meeting The Patient
00:36:93
Formative Assessment
Text
Text
Practice & Feedback: Interpreting Client Results
00:18:04
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Formative Assessment
Practice & Feedback: Collaborating with Team Members
00:43:85
Formative Assessment
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Practice & Feedback:
Collaborating with Team Members
Part 1
0:26:19
Part 2
0:41:61
Formative Assessment
Knowledge Acquisition: Managing the Deteriorating Patient
0:00:32
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Formative Assessment
Practice & Feedback: Collaborating with a Team Member
0:17:42
Formative Assessment
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Practice & Feedback: Collaborating with a Team Member
0:39
Guided Reflection and Debriefing Our Experience
▪ Debriefing techniques promote critical
reflection and are essential to shape
student thinking in classroom, clinical
post-conference and patient care settings
― (INACSL, 2015; NLN, 2015)
Debriefing: Reactions (Emotions)
▪ How did this scenario go?
▪ How do you feel about this scenario?
― (INACSL Standards Committee, 2016;
Oriot & Alinier, 2018)
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Debriefing: Analysis
▪ What was this scenario about?
▪ What happened to this patient?
▪ Why did it happen this way?
▪ How could this have been prevented?
― (INACSL Standards Committee, 2016;
Oriot & Alinier, 2018)
Debriefing: Summary
▪ What worked well in this scenario?
▪ What can we learn from this case?
▪ What could have been performed in a
better way?
▪ If you happen to deal with the same case
at the hospital tonight, what learning point
will you particularly consider?
― (INACSL Standards Committee, 2016;
Oriot & Alinier, 2018)
Bridging the Gap from Classroom to Clinical with Screen-Based
Simulation
Employ learning tools as instructional strategies that
engage students in a more realistic manner
Provide a safe environment for
learning and foster mental preparation
Support educators in creating opportunities
to apply clinical judgment to practice
situations
Develop clinical competence to make
clinical judgments, closing the gap
between theory and practice
CLASS SIMULATION CLINICAL REAL WORLD
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What is your PEARL (key takeaways) from this session?
How will you apply what you learned to your SBLEs?
Christine Heid PhD, RN, CNE, CHSE
(913) 402-3162
www.atinursingconsulting.com
Contact Information
Charlene Romer PhD, RN, CNE
(913) 972-4871
www.atinursingconsulting.com
References
Andreatta, P., & Lori, J.R. (2014). Developing clinical competence and
confidence. Foundations in Simulation. In Ulrich, B. T., & Mancini, M. E.,
Mastering simulation: A handbook for success, 27-48. Sigma Theta Tau
International: Indianapolis, IN.
Benner, P., Sutphen, M., Leonard, V. & Day, L. (2010). Educating nurses: a call
for radical transformation. Jossey-Bass: San Francisco, CA.
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing
practice. Addison-Wesley Publishing Company: Menlo Park, CA.
Bloom, B. S. (1956). Taxonomy of Educational Objectives, Handbook I: The
Cognitive Domain. New York: David McKay Co Inc.
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References
Butt, A.L., Kardong-Edgren, S. & Ellertson, A. (2018). Using Game-Based Virtual
reality with haptics for skill acquisition. Clinical Simulation In Nursing, 16,
25 - 32
Chang, T. P., & Weiner, D. (2016). Screen-based simulation and virtual reality for
pediatric emergency medicine. Clinical Pediatric Emergency Medicine,
17(3), 224-230.
Chang T., Gerard J., Pusic M. (2016) Screen-based simulation, virtual reality, and
haptic simulators. In: Grant V., Cheng A. (eds) Comprehensive Healthcare
Simulation: Pediatrics. Springer, Cham
Decker, S., Caballero, S. & McClanahan, C. (2014). Foundations in simulation. In
Ulrich, B. T., & Mancini, M. E., Mastering simulation: A handbook for
success, 1-25. Sigma Theta Tau International: Indianapolis, IN
References
Ericsson, K.A., Krampe, R.T., & Tesch-Romer, C. (1993). Psychological
Review, 100(3), 363-406.
Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing progression
of clinical reasoning through virtual patients: An exploratory study. Nurse
Education in Practice, 16(1), 97-103.
Georg, C. & Zary, N. (2014). Web-based virtual patients in nursing education:
Development and validation of theory-anchored design and activity
models. J Med Internet Res 2014;16(4):e105. doi:10.2196/jmir.2556
Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., Jeffries, P. R.
(2014). The NCSBN national simulation study: A longitudinal, randomized,
controlled study replacing clinical hours with simulation in prelicensure
nursing education. Journal of Nursing Regulation, 5(2,Suppl.), S3-S40.
doi: 10.1016/j.ecns.2010.02.00.
References
Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing
Health. Washington, DC: The National Academies Press.
https://doi.org/10.17226/12956.
INACSL Standards Committee (2016, December). INACSL standards of best
practice: Simulation Simulation design. Clinical Simulation in Nursing,
12(S), S5-S12. http://dx.doi.org/10.1016/j.ecns.2016.09.005
Jeffries, P. R. (2015). The NLN Jeffries simulation theory. New York, NY:
National League for Nursing.
Kolb, D. A. (1984). Experiential learning. Englewood Cliffs, NJ: Prentice Hall.
Liaw, S.Y., Wong, L.F., Chan, S.W.-C., Ho, J.T.Y., Mordiffi, S.Z., Ang, S.B.L.,…Ang,
E.N.K. (2015). Designing and evaluating an interactive multimedia web-
based simulation for developing nurses’ competencies in acute nursing
care: Randomized controlled trial. Journal of Medical Internet
Research, 17(1), e5. http://doi.org/10.2196/jmir.3853
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References
Miller, G.E. (1990). The assessment of clinical skills/ competence/ performance.
Acad Med;65:S63–7.
National League for Nursing (2015). A vision for the changing faculty role:
Preparing students for the technological world of health care. NLN Vision
Series. Retrieved from http://www.nln.org
Oriot, D. & Alinier, G. (2018). Pocket Book for Simulation Debriefing in Healthcare.
Springer: Cham, Switzerland
Plessas, A. (2017). Computerized virtual reality simulation in preclinical dentistry:
Can a computerized simulator replace the conventional phantom heads
and human instruction? Simulation in Healthcare,12(5), 332-338.
Quail, M., Brundage, S. B., Spitalnick, J., Allen, P., & Beilby, J. (2016). Student
self-reported communication skills, knowledge and confidence across
standardised patient, virtual and traditional clinical learning environments.
BMC Medical Education, 16, [73]. https://doi.org/10.1186/s12909-016-0577-5
References
Schon, D. A. (1983). The reflective practitioner: How professionals think in action.
New York, NY: Basic Books.
Taekman, J. M., Foureman, M. F., Bulamba, F., Steele, M., Comstock, E., Kintu,
A., . . . Olufolabi, A. (2017). A novel multiplayer screen-based simulation
experience for African learners improved confidence in management of
postpartum hemorrhage. Frontiers in Public Health.
510.3389/fpubh.2017.00248
The Advisory Board Company. (2008). Bridging the preparation-practice gap.
Retrieved from https://www.advisory.com/research/nursing-executive-
center/onsite-presentations/bridging-the-preparation- practice-gap