Styles in Facilitation of Simulation

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Styles in Facilitation of Simulation

• Presented by
• Laurie D. Karmel MSN, RN
• The State University of New Jersey
• Rutgers College of Nursing

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Disclosure Statement

• The State University of New Jersey, Rutgers, the
  College of Nursing in worked in conjunction with
  METI to create simulations published in the PNCI
  curriculum

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Introduction

• Know your curriculum
• Identify learning needs
• Flexibility

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Advantages

• Learning in a risk free environment
• Interactive learning
• Repeated practice of psychomotor skills
• Immediate faculty feedback (prompting)
• Increased exposure to a variety of clinical
  events
• Teaching moments

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Disadvantages

• Students may not take it seriously
• Students may aggressively tune into the
  possibility that something may suddenly happen
  and be overzealous
• Faculty buy-in
• Equipment cost and overhead
• Equipment availability

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Overcoming Disadvantages

• Take me seriously, please
• Create realism
• Scenery (KB Port Backdrops)
• Voice
• Male vs. female
• Outfitting
• Instructor approach
• Equipment availability
• Student preparation
• Self evaluation Students dont know what they
  dont know

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Styles for Facilitation of Simulation and
Decisions Made

• Choosing an appropriate simulation
• Present simulation to meet needs identified

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The Beginning of Decisions

• Stable vs. altered health status

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Decisions continued

• States vs. jobs

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Decisions continued

• Assigning jobs/states vs. student
  choice

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Decisions continued

• Instructor led vs. simulation facilitator led

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Decisions continued

• When to correct behaviors
• Debriefing
• Evaluation-if a component of course

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Orientation

• Safe to make mistakes
• Group discussions
• Group decisions
• Not evaluated (if this is the case)
• Used as a learning tool
• Lab interpretations
• Clinical experiences in the RN role that are
  difficult to achieve in the clinical hospital
  setting
• Phone orders
• IVP medications
• Following patient the entire shift
• Communication with other health team members

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• Encouraged to take job to strengthen their
  weaknesses
• Receive report
• Find missing information
• Creation of a short term plan
• Begin head to toe assessments
• Some simulations have immediate needs presented
• Some simulations develop problems throughout the
  simulated shift
• Students identify those problems and prioritize
  treatment
• Group Learning
• Individual decision making
• Discussion among group
• Use of group as lifeline
• Inclusion of prevention

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Example 1

• Orientation
• Assign jobs/pick jobs
• State 1
• Out of room for prompts
• State 2
• Out of room for prompts, etc.
• debriefing

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Benefits/Pitfalls

• Allows for thinking time
• Allows students to self correct behaviors
• Allows for preparation of next state without
  students at bedside
• mistakes identified without the opportunity to
  correct at bedside
• Time consuming

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Example 2

• Orientation
• Assign jobs/pick jobs
• State 1-end, minimal cues
• At end, prompt questions
• debriefing

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Benefits/Pitfalls

• Flow of simulation is smooth
• Allows students the opportunity of identifying
  need for redirection
• Corrections made from students, not instructors
• May find that the simulation takes a turn in the
  wrong direction
• Unsure if student or students in the group will
  ever identify assessments missed
• May lead to poor morale at debriefing

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Example 3

• Orientation
• Assign jobs/pick jobs
• State 1 moderate cueing/prompts during states
• debriefing

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Benefits/Pitfalls

• Assures students going in the direction intended
  by immediate redirection
• Addresses the learning opportunity at the time
  the situation arises
• Positive moral at end of simulation
• Lengthens simulation time
• Can lead to spoon-feeding

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Time management

• Stable vs. altered health status
• Based on needs identified
• State vs. job assignments
• Inclusion of patient teaching and prevention
• Debriefing

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Junior Objectives

• By the end of this simulated experience, the
  student will be able to demonstrate a focused
  assessment.
• By the end of this simulated experience, the
  student will function as a part of a cohesive
  team in effort to deliver nursing care to clients
  at various levels of wellness.
• Deatrah Dubose, RN, CCRN, MSN, APRN-BC and
  Laurie Karmel, RN, MSN

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Senior Objectives

• By the end of this simulated experience, the
  student will be independent in his/her effort to
  develop and implement a comprehensive plan of
  care for clients at various levels of wellness.
• By the end of this simulated experience, the
  student will be able to appropriately prioritize
  care of clients at various levels of wellness.
• Deatrah Dubose, RN, CCRN, MSN, APRN-BC and
  Laurie Karmel, RN, MSN

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Terminal Objectives

• By the completion of the simulation program, in
  the senior year of the nursing program, the
  student will exhibit confidence in his/her
  assessment, plan of care, and interventions
  provided at various levels of wellness.
• By the completion of the simulation program, in
  the senior year of the nursing program, the
  student will be able to reflect upon their
  actions in the delivery of care as a tool for
  critical thinking as each student transitions
  from a graduate nurse to an experience nurse.
• Deatrah Dubose, RN, CCRN, MSN, APRN-BC and
  Laurie Karmel, RN, MSN

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Simulated Experience
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Debriefing

• Answers students questions
• Sort out and clarify student thinking
• Reinforces specific teaching points
• Refocuses direction of priorities

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Discussion/ Summary

• Lets chat!

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• References
• Gaba, D.M.(2006). The future vision of simulation
  in health care. Quality and Safety in Health
  Care, 13 (Suppl l), i2-i10.
• Mort, T.C.,Donahue, S.P. (2004). Debriefing The
  basics. In W.F. Dunn (Ed.), Simulators in
  critical care and beyond (pp. 76-83).
• Van Sell, S., Johnson-Russell, J.,k Kindred, C.
  (2006). The teaching power of high-tech dummies.
  RN, 69 (4), 30-34.