Download - A new twist lk 03-26-12
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?