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Using Simulation as a Capstone Experience in a Nursing Residency Program A Collaborative effort between Academia and Practice. Arlene Coughlin MSN, CNE, RN J. Cedar Wang MSN, RN Lori Podlinski MSN, MBA, RN Barbara Blackwell EdD , RN-BC.

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Using Simulation as a Capstone Experience in a Nursing Residency Program A Collaborative effort between Academia and Practice

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Using simulation as a capstone experience in a nursing residency program a collaborative effort between academia and pr
Using Simulation as a Capstone Experience in a Nursing Residency Program A Collaborative effort between Academia and Practice

Arlene Coughlin MSN, CNE, RN

J. Cedar Wang MSN, RN

Lori Podlinski MSN, MBA, RN

Barbara Blackwell EdD, RN-BC

  • There is no financial relationship or conflict of interest with any product or class of products discussed in this educational activity.


Nurse residency program
Nurse Residency Program

  • Form collaborative relationships

  • Transition student into the professional role

  • Ease reality shock


Nurse residency
Nurse Residency

  • Institute of Medicine (IOM)

  • Increase skill attainment through the use of simulation

  • Enhance patient safety through

    reinforcing critical thinking skills


Clinical simulation reinforces adult learning theories
Clinical Simulation Reinforces Adult Learning Theories

Experiential Learning Reflective Learning

Transformational Learning

Clinical simulation finds support in educational literature

as a critical component of experiential learning (Dreifuerst, 2009).


Experiential learning
Experiential Learning

Kolb (1984) states:

“Knowledge is derived from and tested out in experiences of the learner. The knowledge and skill that is acquired in one experience becomes the foundation by which the learner adapts to new experiences” (p.27).


Reflective learning
REFLECTIVE LEARNING

Kolb (1984) proposes “learning occurs when an event is followed

by reflection and then critical discourse after which the learner

modifies their actions” (p.21).


Transformational learning
Transformational Learning

Daloz(1999) states that “mentors are a key part on our transformation reminding us that we can indeed survive the terror of our journey and undergo transformation by moving through not around our fears” (p.18).


Nurse residency simulation objective
Nurse Residency Simulation Objective

The nursing resident will integrate theory into practice by using the metacognitive skills of critical thinking and problem solving to determine priority-nursing actions in two clinical simulations.




Scenario objectives
Scenario Objectives

  • Accurate assessment and identification of client problems

  • Safety measures including standard of care

  • Therapeutic communication

  • Effective communication with interdisciplinary team

  • Prioritize and implement appropriate interventions

  • Evaluate client’s response to treatment


Resident simulation day vitalsim scenario 1
Resident Simulation DayVitalSim Scenario 1


Resident simulation day vitalsim scenario 2
Resident Simulation DayVitalSim Scenario 2


Equipment facility
Equipment & Facility

  • Laerdal® Vitals™ with medium fidelity Nursing Anne

  • 2 simulated acute care bedsides (oxygen, suction equipment, cardiac monitoring, IV pump, telephone, patient chart, simulated medications)


Resident simulation day schedule
Resident Simulation Day Schedule

  • 2 Scenarios

  • 2 Roles for each resident

    • RN

    • Observer (silent)

  • Faculty and staff development roles

    • Mannequin controller

    • Family member at the bedside

    • Physician

    • Respiratory therapist


Facilitation strategies
Facilitation Strategies

  • Partial facilitator prompting

  • Reflective learning

  • Formative

    assessment


Debriefing guided reflection
Debriefing/Guided Reflection

  • How did you feel during the simulation experience?

  • What did you learn about interacting with family members?

  • What did you learn about collaborating with interdisciplinary healthcare team members?

  • What do you think you did correctly?

  • What do you think you could have done differently?

  • What would you change about this experience?


Additional resources in scenario development
Additional Resources in Scenario Development

  • NLN, (2009). Chronic Obstructive Pulmonary Disease – Oxygen Therapy VitalSim Scenario. Laerdal Medical Corporation.

  • Debriefing/Guided Reflection Questions

    Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing education: Learner volume. (p. 431). Philadelphia, PA: F.A. Davis Company


Lessons learned
Lessons Learned

Run simulation earlier in the Residency Program

Use simulation as a formative assessment that factors into summative evaluation process


Lessons learned1
Lessons Learned

Include simulation throughout the student’s academic career to assess achievement of higher level skills and better prepare the graduate nurse for practice (Bensfield, Horsley, & Leann, 2012).


Lessons learned2
Lessons Learned

Simulation provides an effective means to evaluate practitioner safety and competency (Beyea, van Reyn, & Slattery, 2008)


Lessons learned3
Lessons Learned

Preparation is a key ingredient to enhancing

the fidelity of a simulation

  • Participant

  • Scenario

  • Environment


Lessons learned4
Lessons Learned

Effective debriefing is essential to the learning process (Dreifuerst, 2009).


Future implications education
Future Implications-Education

  • Integration of simulation into all areas of school curriculum to enhance attainment of metacognitive, communication, and psychomotor skills

  • Introduce simulation as means of formative assessment

  • Use simulation as a summative assessment of clinical skills


Future implications practice
Future Implications-Practice

Use simulation as a means to validate skill attainment and competency in the new graduate and experienced RN


New graduate orientation
New Graduate Orientation

Classic New Nurse Orientation

  • Paid Orientation

    • $15,460 or $32.21/hour

  • Time investment

    • 12 weeks orientation

      • Time added as necessary

  • Educational Benefit

    • Variability in content

    • Reality Shock


Return on investment new graduate orientation

Nurse Residency

Return on Investment New Graduate Orientation

  • No orientation after

    residency completed

  • Lower Salary

    • $9,600 or $20/hour

    • No paid benefits

  • Time investment

    • 12 weeks

  • Educational Benefit

    • Close theory-practice gap

    • Consistency in orientation practice


References
References

Beyea, S. C., van Reyn, S., & Slattery, M. J. (2008). A nurse residency program for competency development using human patient simulation. Journal for Nurses in Staff Development, 23(2), 77-82.

Bensfield, L. A., Olech, M. J., & Horsley, T. L. (2012). Simulation for high-stakes evaluation in nursing. Nurse Educator March/April, 37(2), 71-74.

Daloz, L.A. (1999). Mentor: Guiding the Journey of Adult Learners. San Francisco, CA: Jossey-Bass.

Dreifuerst, K. (2009). The essentials of debriefing in simulation learning: A concept analysis. Nursing Education Perspective 30, (2).


References1
References

Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing education: Learner Volume. Philadelphia, PA: F.A. Davis Company.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.

NLN, (2009). Chronic Obstructive Pulmonary Disease – Oxygen Therapy VitalSim Scenario. Laerdal Medical Corporation.

Tanner, C. (2009). The Case for Cases: A Pedagogy for Developing Habits of Thought. Journal of Nursing Education, 48(6), 299.

Taylor, E.W. (1998). The theory and practice of transformational learning: A critical review. Columbus, Ohio.


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