the university of portland the university of portland school of nursing
TRANSCRIPT
The University of Portland
The
University of Portland
School
Of
Nursing
The University of Portland
The
University of Portland
School
Of
Nursing
Getting the Most Out of Simulation
Lorretta Krautscheid, MS, RN
Director, LRCUniversity of Portland
The University of Portland
The
University of Portland
School
Of
Nursing
• Identify strengths and gaps within curriculum (didactic/lab/clinical)
• Evaluate clinical competency
• Clinical faculty development
• Nursing education research
Simulation
Beyond Student Learning
The University of Portland
The
University of Portland
School
Of
Nursing
Strengths and Gaps
• Junior level Med-Surg simulation– ORIF 4 hours post-op
– Data Collection: what do you want to know?
• Determine what to assess (NPSG?)
• Define assessment items (what will it look like when ….?)
• Develop data collection form (objective)
– What is your benchmark?
– Data Review : what do you do with assessment information?
The University of Portland
The
University of Portland
School
Of
Nursing
97
100
91
100
78
92
55
78
75
100
55
74
50
73
42
81
47
65
77
81
28
68
62
78
0
10
20
30
40
50
60
70
80
90
100
Assessed painadequately
Assessed drsg overp/o site
Assessed ABC's p/otimely manner
Assessed JP drainoutput & drsg
Applied nasal cannulacorrectly
Performedreassessment of O2
sat
Nursing Assessments and Interventions Junior Med-Surg 2005 to 2006
Spring 2005 Summer 2005 Spring 2006 Summer 2006
The University of Portland
The
University of Portland
School
Of
Nursing
53
35
11
18
72
32
26
21
9
0
25
30
1614
26
119
0
21
03
0 0 0
0
10
20
30
40
50
60
70
80
Applied nasalcannula- choking
hazard
Did Not reassessO2 sat after O2
applied
Unsafe med delivery Did Not ID client Did Not performhand hygiene at all
Tripped over IVtubing- pulled out of
Pt
Unsafe Nursing Actions JR Med-Surg 2005-2006
Spring 2005 Summer 2005 Spring 2006 Summer 2006
The University of Portland
The
University of Portland
School
Of
Nursing
Data Review – safe actions• JR level Med-Surg 2005-2006• Assessment and Interventions
summary (benchmark set at >73% by Summer 2006)– Pain assessment: met– Surgical Dressing: met – ABC Assessment: met – JP drain assessment: met– Nasal cannula placement: met– SpO2 reassessment: met
The University of Portland
The
University of Portland
School
Of
Nursing
Data Review – unsafe actions
• JR level Med-Surg 2005-2006• Unsafe Nursing Actions
(benchmark set at <30% by Summer 2006)– Nasal cannula hazard: met– No reassessment of SpO2: met– Unsafe med delivery: met – No client ID: met– No hand hygiene: met– Tripping hazards avoided: met
The University of Portland
The
University of Portland
School
Of
Nursing
Achieving and sustaining the benchmark• SpO2 reassessment following
application of O2 via nasal cannula– When do students learn SpO2 and
respiratory assessment?
– What opportunities do students have for deliberate repeat practice of assessment item? (cognitive, psychomotor, affective)
– What gaps are identified in curriculum/ course content / clinical?
– What is within our power to change & what do others need to “own”. (CI’s, students)
The University of Portland
The
University of Portland
School
Of
Nursing
Clinical Assessment Simulation
The University of Portland
The
University of Portland
School
Of
Nursing
Simulation in Competency Assessment• Measure learning outcomes• Objective measurement of clinical
ability• Reliable (consistent) and valid
(representative)• Evaluate teaching/program
effectiveness• Senior level Med-Surg course
– Hypovolemic Shock client– Theoretical framework
The University of Portland
The
University of Portland
School
Of
Nursing
CAS Development
• Identify learning objectives
• Design scenario and grading rubric
• Run through – multiple learner levels
• Re-design scenario and grading rubric
• Run through
• Pilot – information gathering
The University of Portland
The
University of Portland
School
Of
Nursing
CAS Development
• Data analysis– Define test items? What will it look
like if…?– Test item validity?– Level for cohort– Interrater reliability
• Refine grading rubric• Test with “grading”• Data collection
The University of Portland
The
University of Portland
School
Of
Nursing
MD Notification SR Med-Surg 2005-2007
2118
53 53
6974
68
7471
55
8084
90
69
78
89
626165
56
26
82
56
78
697675 75
67
76
86
65
0
10
20
30
40
50
60
70
80
90
100
Client ID Baseline BP Current BP Baseline HR Current HR O2 Sat O2 LPM NG amount
Spring 2005 Fall 2005 Spring 2006 Fall 2007
The University of Portland
The
University of Portland
School
Of
Nursing
Data Review MD Notification• SR level Med-Surg 2005-2007
(benchmark set at >80%)– Client ID: met– Baseline vital signs: not met (75%)– Current vital signs: not met (75%)– O2 Sat: met– O2 LPM: not met (65%)– NG output: not met (62%)
The University of Portland
The
University of Portland
School
Of
Nursing
Achieving and sustaining the benchmark
• NG output description– When do students learn what suction is and
how to evaluate output?
– What opportunities do students have for deliberate repeat practice of assessment item? (cognitive, psychomotor, affective)
– What gaps are identified in curriculum/ course content / clinical?
– What is within our power to change & what do others need to “own”. (students & CI’s)
The University of Portland
The
University of Portland
School
Of
Nursing
Nursing Education Research
• Evaluating student application of theory– Example:
“How Should I Touch You? Instructing Male Nursing Students on
Touch.”
The University of Portland
The
University of Portland
School
Of
Nursing
Why an intimate touch lab?• The centrality of touch in the discipline of
nursing is documented• Nursing literature is completely lacking
information on how to instruct male students on the use of touch
• Nurse educators’ lack of attention to men and touch issues has led to feelings of resentment and confusion (Paterson et al., 1996).
• Male students fear that their touch might result in false accusations of sexual inappropriateness from female clients (O’Lynn, 2004, 2007).
• Simulations provide an active learning strategy for practicing and evaluating nursing assessment and skills.
The University of Portland
The
University of Portland
School
Of
Nursing
Simulation in research
• Quasi-experimental, using a comparison/ control group
• Survey and simulation performance data collected and analyzed
• Data examined for possible differences between the two groups.
• Nursing is an applied discipline, skill performance must be evaluated
The University of Portland
The
University of Portland
School
Of
Nursing
Research Methods
Intervention Group Control Group
Male Junior nursing students
Male senior nursing students
Questionnaire/ IT lab No intervention
Clinical experiences for 3 mos.
Prior clinical
experiences
Questionnaire Questionnaire
Demonstration of intimate touch in simulation
Demonstration of intimate touch in simulation
The University of Portland
The
University of Portland
School
Of
Nursing
Implications• Implications For Nursing Practice
– Optimally prepared students for practice
– Deliberate practice “ideal”
• For Nursing Research– Does an intimate touch simulation
lab improve male student comfort with providing intimate touch?
– Does a pre-clinical intimate touch simulation improve transferability?
The University of Portland
The
University of Portland
School
Of
Nursing
Clinical Faculty Development Simulations
The University of Portland
The
University of Portland
School
Of
Nursing
What about clinical faculty?
Clinical Faculty Experience– Expert clinical = Expert faculty?– New faculty orientation – what’s
covered?– Experienced faculty continuing
education– Barriers to immediate and consistent
feedback on teaching
The University of Portland
The
University of Portland
School
Of
Nursing
Clinical Faculty Development
• Didactic
– Recorded simulations of poor and best practices
– Facilitated discussion on teaching practices
• Active participation
– Clinical faculty simulation with student
– Reflection/debriefing
The University of Portland
The
University of Portland
School
Of
Nursing
Faculty evaluation of simulation
• Learner-focused clinical vs. teacher focused
• Teaching strategies developed and enhanced
• Verbal and nonverbal messages highlighted
The University of Portland
The
University of Portland
School
Of
Nursing
Recommendations• For Nursing Practice
– Optimally prepare clinical faculty for practice
– Deliberate practice – “ I don’t think anything is as valuable as walking through it – then reflecting on events and language.”
• For Nursing Research– Transferability from simulation lab to
clinical setting– Application for preceptors with new grads
or new hires
The University of Portland
The
University of Portland
School
Of
Nursing
Clinical Faculty Development Simulation Preview
The University of Portland
The
University of Portland
School
Of
Nursing
Selected References• Bucher, L (1993). The effects of imagery abilities and mental
rechearsal on learning a nursing skill. Journal of Nursing Education, 32 (7), 318-324.
• Feingold, C., Calaluce, M, & Kallen, M (2004). Computerized patient model and simulated clinical experiences: Evaluation with baccalaureate nursing students. Journal of Nursing Education, 43 (4), 156-163.
• Inoue, M., Chapman, R., & Wynaden, D (2006). Male nurses’ experiences of providing intimate care for women clients. Journal of Advanced Nursing, 55 (5), 559-567.
• Keogh, B. & Gleeson, M.(2006). Caring for female patients: the experiences of male nurses. British Journal of Nursing, 15 (11), 604-607.
• O’Lynn, C (2004). Gender-based barriers for male students in nursing education programs; prevalence and perceived importance. Journal of Nursing Education, 43 ( ), 229-236.
• Patterson, B. & Morin, K (2002). Perceptions of the maternal-child clinical rotation: The male student nurse experience. Journal of Nursing Education, 41 (6), 266-272.
• Routasalo, P (1999). Physical touch in nursing studies: a literature review. Journal of Advanced Nursing, 30 (4).
The University of Portland
The
University of Portland
School
Of
Nursing
Selected References• Billings, D.M., & Halstead, J.A. (2005). Teaching in nursing: A
guide for faculty. Philadelphia: W.B. Saunders.
• Bradshaw, M. (2001). Philosophical approaches to clinical instruction. In Lowenstein, A. & Bradshaw, J. Fuszard’s innovative teaching strategies in nursing (3rd ed.). Gaithersburg, Maryland: Aspen Publishers, Inc.
• Childs, J. (2002). Clinical resource centers in nursing programs. Nurse Educator, 27 (5), 232-235.
• Cook, L. (2005). Inviting teaching behaviors of clinical faculty and nursing students’ anxiety. Journal of Nursing Education, 44(4), 156-161.
• Dearman, C., Lazenby, R., Faulk, D., & Coker, R. (2001). Simulated clinical scenarios Nurse Educator, 26 (4), 167-169.
• De Young, S. (2003). Teaching strategies for nurse educators. Upper Saddle River, NJ: Prentice Hall.
• Feingold, C., Calaluce, M., & Kallen, M. (2004). Computerized patient model and simulated clinical experiences: Evaluation with baccalaureate nursing students. Journal of Nursing Education, 43 (4), 156-163.
• Gaberson, K., & Oermann, M. (1999). Clinical teaching strategies in nursing. New York: Springer.
The University of Portland
The
University of Portland
School
Of
Nursing
Selected References• Infante, M. (1975). The clinical laboratory in nursing
education. New York: John Wiley & Sons, Inc. • Johnson, J., Johnson, J., &Theis, S. (1999). Clinical
simulation laboratory, an adjunct to clinical teaching. Nurse Educator, 24 (5), 37-41.
• Letizia, M. & Jennnrich, J. (1998). Development and testing of the clinical post-conference learning environment survey. Journal of Professional Nursing, 14 (4), 206-213
• McCausland, L., Curran, C., & Cataldi, P. (2004). Use of a human simulator for undergraduate nurse education. International Journal of Nursing Education Scholarship, 1 (1), 1-17.
• O’Conner, A. (2001). Clinical instruction and evaluation: A teaching resource. Sudbury, MA: Jones and Bartlett.
• Tanner, C. (2002). Clinical education, Circa 2010. Journal of Nursing Education, 41, 51-52.
• Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45 (6), 204-211.
The University of Portland
The
University of Portland
School
Of
Nursing