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Curriculum Development: Where Does Simulation Fit (Models and Approaches). JCCC Simulation Conference September 17-18, 2010 Pamela R. Jeffries PhD, RN, FAAN, ANEF. Objectives: The participant will be able to:.

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curriculum development where does simulation fit models and approaches

Curriculum Development: Where Does Simulation Fit (Models and Approaches)

JCCC Simulation Conference

September 17-18, 2010

Pamela R. Jeffries PhD, RN, FAAN, ANEF

objectives the participant will be able to
Objectives: The participant will be able to:
  • Describe different simulation models that can be incorporated into your teaching
  • Discuss the deliberative practice curriculum model to use in simulations
  • Identify various other types of simulations to incorporate in the nursing curriculum
models of simulations
Models of Simulations
  • SCAPES
  • Deliberative Practice Model
  • Unfolding Case Model
uses for different types of simulations for different teaching areas scapes
Uses for Different Types of Simulations For Different Teaching Areas (SCAPES)
  • S = Skills Training
  • C = Communication Skills
  • A = Assessment of skills and critical behaviors
  • P = Problem-solving, decision-making
  • E = Exemplary Teaching the Teacher
  • S = Simulated Teamwork and collaborative learning
s skills training
S= Skills Training
  • Part-task training devices, such as IV arms and haptic (forced feedback) IV trainers are used in simulations for psychomotor skills with the learner able to practice a skill repeatedly before performing it on a real patient.
  • The part-task trainers typically ensure a satisfactory rate of achievement of objectives and benefit to the participant.
  • Studies have shown that these task trainers do instruct the participants on the psychomotor skill and that the skill set is transferred to the real-patient environment (Engum& Jeffries, 2002; Hovancsek& Horn, 2004).
part task training skills
Part-task training - Skills
  • Part-task training devices, such as IV arms and haptic (forced feedback) IV trainers are used in simulations for psychomotor skills with the learner able to practice a skill repeatedly before performing it on a real patient.
  • The part-task trainers typically ensure a satisfactory rate of achievement of objectives and benefit to the participant.
  • Studies have shown that these task trainers do instruct the participants on the psychomotor skill and that the skill set is transferred to the real-patient environment (Engum& Jeffries, 2002; Hovancsek& Horn, 2004).
slide7

Traditional Learning Method

Computer Virtual Reality Learning Method

c communication skills
C = Communication Skills
  • Students can learn to communicate and gain confidence in talking with family members and parents before going to the pediatric clinical setting
  • Students learn how to communicate with a grieving family member in an end-of-life scenario
a assessment skills
A – assessment Skills
  • Students can use various types of patient simulators to learn and practice their assessment skills.
  • Full head-to-toe assessment can be done in addition to specific auscultation skills, e.g cardiac and respiratory sounds
p problem solving and decision making using scenario based simulation
P = Problem Solving and Decision-Making using Scenario-based Simulation
  • Students are immersed in a 20 minute simulation followed by a 20 minute debriefing with a focus and objectives directed toward caring for a post-thoracotomy patient and what to do when the patient has tachypnea and chest pain
e exemplary teaching the teacher
E = Exemplary Teaching the Teacher
  • A new clinical model at JHU SO is the PEP unit, where staff nurses become the instructors for the students; faculty now precept and work with faculty
  • Simulations are set-up to teach faculty how to ‘deal with a difficult student’ and other types of activities an educator may confront
s simulated team work and interdisciplinary intraprofessional activities
S= Simulated Team work and Interdisciplinary/Intraprofessional activities
  • Simulations are ideal to promote interdisciplinary collaboration among different groups of healthcare professionals
  • An example of an interdisciplinary scenario with a physician and nursing student working with a deteriorating patient
teamwork collaboration
Teamwork Collaboration
  • Team skills such as a mega code, ACLS training, and other types of scenarios that are team-based can be done in a simulated environment using high-fidelity simulations.
  • Example AHA grant – training teams for ACLS
deliberative practice curriculum
Deliberative Practice Curriculum
  • Cardiovascular assessment skills including auscultation are deficient among nurses today
  • Effective instructional methods are needed
  • Prior studies have shown that simulation technology and deliberate, repetitive practice resulted in a large and significant improvement in the recognition of simulated heart sounds and findings of actual human sounds (Issenberg, 2002).
a multi site study to test deliberative practice of cardiovascular skills
A multi-site study to test deliberative practice of cardiovascular skills
  • A multi-site study was created to develop, implement, and evaluate outcomes from a cardiovascular assessment curriculum for Advanced Practice Nurses at 4 different institutions
  • 2 Project Directors –
    • Dr. Pam Jeffries – Johns Hopkins University SON
    • Dr. Barry Issenberg – Gordon Medical Research Center in Miami
deliberate practice curriculum features
Deliberate Practice Curriculum Features
  • Highly motivated learners
  • Engaged with well-defined objectives
  • Approved level of difficulty
  • Focused, repetitive practice
  • Rigorous, precise educational measures
  • Trainer monitors learning experiences
  • Advance to another task, once completed

(Ericsson & Lehmann, 1996, pp. 278-279)

goal in deliberate practice
Goal in Deliberate Practice

Constant skill, knowledge, or professional improvement, not just status quo.

A. Ericsson 2007

slide20

Mastery Learning

Goal: All learners accomplish all educational objectives without variation

Features

  • Baseline (e.g., diagnostic testing)
  • Clear learning objectives, units ordered by difficulty
  • Educational activities (e.g., deliberate skills practice) focused on objectives
  • Minimum passing mastery standard (MPS) for each unit
  • Formative testing → mastery of each unit
  • Advancement if performance ≥ MPS
  • Continued practice or study until MPS is reached
best evidence training using simulation
Best Evidence Training Using Simulation
  • Mastery Learning – benchmarks set
  • Deliberate Practice – repetitive practice/feedback
  • Curricular Integration – part of existing courses
  • Adaptive Learning – small group/self learning/remediation
  • Clinical Variation – 10 clinical cases

Key Features of BEME Review of Simulation

Issenberg, et al 2005

methodology
Methodology
  • Phase I – Curriculum Development Composition and Description
  • Phase II – Curriculum Evaluation – pilot tests
  • Phase III – Multi-site Study at 4 sites
phase i curriculum development multi center collaboration
Phase I - Curriculum Development Multi-center Collaboration
  • Univ of Miami Gordon Center
    • Michael Gordon
    • Joan Baker
  • Johns Hopkins Univ
    • Pam Jeffries
  • Florida International Univ
    • Jeff Groom
    • Lucie Dlugasch
  • Indiana Univ
    • Julie Settles
  • Texas Tech Health Sciences
    • Sharon Decker
  • Univ of Pittsburgh
    • Michael Beach
    • John O’Donnell
instructional tools harvey the cardiopulomonary patient simualtor
Instructional Tools - Harvey,The Cardiopulomonary Patient Simualtor

Pulses

Venous & Arterial

Chest Wall

Auscultatory Findings

Cardiac

Pulmonary

instructional tools introductory program
Instructional Tools - Introductory Program
  • Case-based
  • PowerPoint Format
  • Reviews Basics of Cardiopulmonary Assessment
  • Correlates bedside findings with cardiac anatomy and physiology
instructional tools nurses learner manual
Instructional Tools - Nurses Learner Manual
  • Case-based
  • Basic Material
    • Vital signs
    • Heart/lung sounds
    • Recognize normal
    • Detect abnormal
  • Advanced material
    • Identify extra heart sounds
    • Identify murmurs
    • Diagnose cardiac, lung conditions
slide27

Instructional Tools – Instructor Guide

  • Operational Guide
  • Identify Learner Needs
  • Use in Different Contexts
  • Integrating into Curriculum
  • Assessment Methods
  • Research Opportunities
slide28

Instructional ToolsSelf-learning Multimedia Program

  • One hour learning module
  • Covers 12 most essential heart sounds & murmurs
  • Video-based instruction
  • Case-based with practice and testing sections

Animations correlate with pathophysiology

outcome measures
Outcome Measures
  • Cognitive Knowledge
    • 31 item multiple choice exam
  • Skills Demonstration
    • 13 item skills check-list validated by 5 content experts
  • Self-efficacy
    • 3 item scale
  • Student satisfaction
    • 3 item scale
  • Instructor satisfaction and confidence
    • 8-item scale
  • Student training log
research questions
Research Questions
  • Can APNs perform accurate, cardiovascular assessment after completing the Harvey curriculum?

2. Is there a significant difference in nursing skill performance and clinical diagnostic reasoning pre-post testing?

3. Do students perceive improved self-confidence in their cardiovascular and clinical reasoning skills?

research questions cont
Research Questions (cont.)

4. Are students satisfied with instruction?

5. Are nurse educators satisfied and confident with the instruction?

6. What percent of students require remediation to obtain benchmarks set?

phase ii curriculum evaluation pilot study
Phase II Curriculum EvaluationPilot Study
  • 2 sites conducted small pilot studies
  • Required students to assess selected findings
  • Significant data results obtained in pilot
  • Teaching assessed and findings applied to Phase III – multi-site study

Pretest

Posttest

phase iii current study cohort
Phase III - Current Study (Cohort)
  • Time Frame: January – June, 2009
  • Institutions:
    • Florida International University
    • Indiana University
    • Texas Tech Health Sciences
    • University of Pittsburgh
  • Course:
  • Advanced pathophysiology or assessment of NP program
study design
Study Design
  • Pretest
  • Knowledge - MCQ
  • Skills – Checklist
  • Confidence - Survey
  • Training Intervention
  • Pre-Self Study Program
  • Instructor Guided Sessions
  • Learner Practice w/Feedback
  • Self Study Program
  • Learner Training Logbook

Advancement

Remediation

  • Posttest
  • Knowledge - MCQ
  • Skills – Checklist
  • Confidence – Survey
  • Instructor Satisfaction

MPS

Achieved

MPS Not

Achieved

results research questions 1 2
Results – Research Questions #1 & 2

Knowledge

Can APNs perform accurate cardiovascular assessments after completing the Harvey curriculum?

Is there a significant difference in nursing skill performance and clinical diagnostic reasoning pre-post testing?

Pretest

Posttest

Skills

Findings

Technique

Pretest

Posttest

research questions 3 4
Research Questions #3 & 4

Do students perceive improved self-confidence in their cardiovascular and clinical reasoning skills?

1 – strongly disagree 5 – strongly agree

* (p<.05)

Are students satisfied with the instructional method using the Harvey simulator and curriculum?

1 – strongly disagree 5 – strongly agree

research question 5
Research Question #5

Are nurse educators satisfied and confident with the instruction?

1 – strongly disagree 5 – strongly agree

1 – strongly disagree 5 – strongly agree

research question 6
Research Question #6

What percent of students needed remediation to obtain benchmarks set?

11% of the learners required remediation (4 of 36 students)

conclusion
Conclusion

Educational intervention using simulation technology that engages learners in deliberative practice of clinical skills produces significant improvement and are highly rated by learners and instructors

nursing implications
Nursing Implications
  • Institute more deliberate practice into the nursing curriculum
  • Utilize the patient simulators for hands-on experiences
  • Students can learn from a variety of methods, e.g. deliberative practice, CD ROM, instructors face-to-face, therefore educators need to be encouraged to utilize different approaches to your teaching
another simulation model approach
Another Simulation Model/Approach

Unfolding Cases

  • Using geriatric content as an exemplar
  • ACES – NLN work

www.nln.org/ACES

stages
STAGES

Pamela Jeffries, PhD, RN, FAAN, ANEF, Project Director

Teri Boese, MSN, RN

Mary L. Cato, MSN, RN

Jeanne Cleary, MA, RN

Cynthia Reese, PhD, RN, CNE

unfolding simulation cases stages
Unfolding Simulation Cases STAGES

Template for Unfolding Cases

Monologue 1

Monologue 2

Simulation Scenarios

Finish the Story

Instructor Toolkit

cases include
Cases include:

Complexity

Missing information

Varied settings

Family dynamics/role strain

Common syndromes of aging

Differences in responses of older adults to illness

Assessing risk/benefit in context of respect for individual’s preferences/values

Evidence-based practice/use of validated tools

Multidisciplinary team approach

monologue
Monologue

Hello, my name is Millie. I live in Minnesota in the same house for the last 50 years. Harold and I raised Dina here and we had many good years together as a family. Harold passed last year. He was 91 you know, and I miss him terribly. I think about him every day. Snuggles, my cat, keeps me company.

Location: Physician’s Office

slide46
Dina dropped me off and left me here. I’m not sure where I am or why I’m here. Why can’t I remember? They tell me I have an infection, but I don’t have a fever and I feel ok. Where is Dina? I haven’t seen her in maybe 6 years….

Location: Hospital

simulation cases
Simulation Cases

Scenario 1

Assessment, appropriate use of assessment tools, communication

Scenario 2

Falls risk assessment, conflict between patient and daughter

Scenario 3

Functional assessment, discharge teaching, referrals

slide48

Free download

http://sirc.nln.org

instructor tool kit
Instructor Tool Kit

Ideas for how to use monologues

Suggested for questions/guidelines for

Class discussion

Small group discussions

Web-based discussion/assignments

Reflective journaling

Links to appropriate “How to Try This” tools

instructor tool kit51
Instructor Tool Kit

Ideas for how to use simulation scenarios

Bring simulation into classroom

Videotaped simulation accessed on the web

Planning a simulation day with all 3 scenarios

Planning a simulation day with varied “stations” (skills practice, web assignments, etc.)

Suggestions for modifying scenarios and placement in semester

final assignment
Final Assignment

Finish the Story

Two-page paper

Journal entry

Incorporate community resources

Group assignment

next steps
Next Steps

Pilot first unfolding case

Public comment on Precepts & Nursing Considerations

Workshop in Philadelphia - June 11

Workshop in Florida (near Orlando) – June 25

Build 3 additional unfolding cases

Develop course for SIRC

Continued development of website

www.nln.org/ACES

slide55

Photo: The John A. Hartford Foundation Institute for Geriatric Nursing, James Schuck

www.nln.org/ACES

summary
Summary
  • Simulations can be integrated in your courses not only in the learning laboratory setting, but in various other settings
  • Educators need to continue to be creative and innovative, providing learners with experiential types of learning activities using different simulation models and approaches
  • Evaluation data is needed in these different areas where simulations are being conducted
  • Be creative and innovative to provide ultimate learning experiences for our students!