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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

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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

Christine.Heid@atitesting.com

www.atinursingconsulting.com

Contact Information

Charlene Romer PhD, RN, CNE

(913) 972-4871

Charlene.Romer@atitesting.com

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

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Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing progression

of clinical reasoning through virtual patients: An exploratory study. Nurse

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Georg, C. & Zary, N. (2014). Web-based virtual patients in nursing education:

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Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., Jeffries, P. R.

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Liaw, S.Y., Wong, L.F., Chan, S.W.-C., Ho, J.T.Y., Mordiffi, S.Z., Ang, S.B.L.,…Ang,

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References

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Springer: Cham, Switzerland

Plessas, A. (2017). Computerized virtual reality simulation in preclinical dentistry:

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Quail, M., Brundage, S. B., Spitalnick, J., Allen, P., & Beilby, J. (2016). Student

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standardised patient, virtual and traditional clinical learning environments.

BMC Medical Education, 16, [73]. https://doi.org/10.1186/s12909-016-0577-5

References

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Taekman, J. M., Foureman, M. F., Bulamba, F., Steele, M., Comstock, E., Kintu,

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