I'm here to give me the first MOOC, with the presentation entitled Essential Elements in Getting Started With Clinical Simulations. The objectives for this session, will be to define the simulation model and the new NLN/Jeffries simulation theory. Second, we'll discuss the components of the new NLN/Jeffries simulation theory. Three: describe the essential steps needed when getting started with creating and implementing simulations. So how do we build a good simulation? Incorporating simulations into a nursing curriculum is just one approach to hopefully prepare better nurses to provide safe, quality, patient care. But when we incorporate simulations into a curriculum, what teaching learning practices contribute to positive outcomes when using simulations? Let's define a simulation. It is an event or a situation made to resemble clinical practice. We use simulations to teach theory, to assess progress, we can use simulations to integrate technology, and also to develop clinical reasoning skills among many approaches. I'm timing on simulations under construction, because let's talk about how to actually build a simulation and the components thereof. So first of all, I want to talk about using a simulation educational theory. Then once we have the theoretical foundation and how to build it, then you have to procure the bill of materials. What do you need to gather? What do you have to have to incorporate a simulation? Third, we'll assemble the structure. Lastly, using a building analogy, we'll finish the project. So let's study now to build a simulation. I like to build on either simulation model or a theory. In 2015, working with the in NLN and our knackso, the NLN/Jeffries simulation theory was created. That's a theoretical theory that can set the foundation for your simulation work. Let's talk about the components of that theory. I'll explain a little bit what contexts, background, design, simulation experience with the facilitator experiences are, participant, and outcomes. Simulation characteristics, it sets the context. They're contextual factors that need to be considered. This comprises of the circumstances and the setting of why we're doing the simulation. What are those important starting points when you design and evaluate simulations? For instance, what's the purpose of the simulation? What are we using the simulation for? What's the context? A little bit about background. Within that context, the background includes the goals of the simulation or specific expectations or benchmarks that influence that design. So in other words, in this simulation, are we teaching pain management? Is just the outcome that we're designing, because then the simulation design, when we're setting up the scenario, we'll need to include components or pathways, or decision points on how to set up that simulation on how to manage pain. The simulation design. This is outside of and proceeding the actual simulation experience. What specific elements need to be within the simulation design? Some elements may change during the implementation. There are aspects of the design that need to be considered. For example, if it's care of a cardiovascular patient with an arrhythmia, you may start out with normal sinus rhythm, but as the simulation unfolds, the patient may have ventricular ectopic actopy, and go into the ventricular fibrillation. So it can unfold or change as a simulation scenario goes. But what are those aspects, those specific elements that we're going to include? Design features also for the simulation, includes objectives. For every simulation, this is a best practices, the learner needs objectives within the simulation. What are we trying to assess? For the student, usually these objectives are pretty broad. You don't want to say to the student, they're taking care of a diabetic patient and by way as a hypoglycemic patient, it might just be care the diabetic patient, very broad. So the student or the learner, the participant will not know till they go in and start assessing that diabetic patient. So here's some examples on the screen, demonstrated how to assess the complications when caring for our post-thoracotomy patient. Implement priority interventions when carrying for a post-thoracotomy patient. Locate these objectives that are not specific but pretty broad, but it does set parameters for that participant to understand what type of simulation he or she's going to go into. Fidelity, is another simulation design feature. We want simulations to suspend disbelief. So we want simulations to mimic reality, to fill authentic. So what are those components both physical and conceptual do we need to include? For instance, conceptual components include, if it's a hypertensive patient, the blood pressure should be going up or it should be high, because we're taking care of a hypertensive patient. If it's a patient that's hypovolemic shock, the blood pressure should be coming down. So conceptually and physiologically, the numbers in the simulation scenario, they should replicate real physiological responses. Other elements could be physical. In other words, if patients are diaphoretic, they need to appear diaphoretic. The simulation experience it's characterized by the environment, that's experiential, interactive, collaborative, and learner-centered. We're trying to buy or suspending the disbelief, and we try and to promote the engagement of the student. Another type of reality is psychological fidelity. So many times in your simulation rooms, you have the monitors, the beeps, the alarms are sounding. That's all real, that's the psychological fidelity. you wanted to feel. If you have an emergency situation, you've got the crash cart coming in, there's a sense of urgency. That psychological fidelity. So let's talk about the facilitator and educational strategies a little bit. With the inner stimulation, there's interaction with the participants. The facilitator or the person running the simulation, has the skill, they have the educational techniques and the preparation to not only design the simulation scenario, but to implement it. The facilitator responds to the participants needs by adjusting strategies. They can provide cues or they can facilitate debriefing. For instance, a cue within a simulation. If the scenario is not moving forward and as per the hypokalemic patient, we just have the participants looking at the EHR electronic health record, and doesn't see the hypokalemic case, we may have lab come in or somebody to bring lab results or to phone them. So there's some cue to say, ''Hey, this potassium low, it's hypoglycemic.'' Also the facilitator is a huge asset in debriefing. The facilitator and debriefing will connect theory to practice, connecting the dots. That's where the participants are high, the light bulb comes on and they understand what's going on. What are the outcomes of the simulation? This goes along with the objectives to match the outcomes. So for instance, if, let's look there's three outcomes. One is about participant. Second was about patient or the care recipient. Third could be system. An example of a participant outcome could be, its care of the patient on how to manage pain. I've got the simulation, the objectives, the goals, is about pain management. Why would we want to make sure the learner, an outcome of that, is can they manage pain? Are they delivering strategies to help manage the post-op pain, say in a post or economy patient. Another outcome measure could be at the patient level, and this is a very hard one to do. On the Kirkpatrick's evaluation model, that's level four, so very high, and you will get more on evaluation in another module in the MOOC. But the patient is, are we transferring knowledge and skills from a simulation center and endeavor to the patient? The third outcome could be a system level. So now, we've talked about simulation, we're building our simulation design and all that on- I gave you an example using NLN Jeffries Theory and we talked about the components. Now, before we implement the simulation, we got to procure the bill of materials. In other words, before we construct, we have to have equipment. We got to get the props, we got to get the materials. We have to schedule time across. How are we going to get our participants moving through the simulation encounters? Staffing needs. We have to consider personnel. We also have to set up the computers, the electronic health record, and we have to have places to debrief, or have the participants to reflect. So all those are consideration in getting materials ready for that simulation you're going to implement. Assembling the structure. So we're getting materials together. Now, we're going to actually assemble the simulation to immerse the participant. To assemble the simulation, we need to think about the educator role, the participant's role, the process that we're going to embed these educational practices, and also the timing of the simulation and the reflection. Let's talk about that. Educator's role. These are the teachers. They're essential to the success of alternative learning experiences. Teachers or educators, they facilitate the students. As I said earlier through providing cues, through learner support during the simulation, and most importantly in the debriefing or guided reflection. Educators must be prepared with the knowledge of the simulation. For instance, if I'm delivering a pediatric simulation, I have to have some pediatric knowledge and expertise. If not, I don't know if the learners or participants are going down the right pathway and doing what's appropriate. Also, facilitators must feel comfortable. Participants. These are the learners or participants. They could be new graduates, they could be new orientees, they could be students. But they need to know the specific role they're playing. So we assign the roles. You may be the role of the nurse, you may be the role of a new employee on orientation. So you assign the roles going into the simulation to be more effective and to understand their roles. With inter-professional simulations, there's different ones, you have a physician role, you have a nurse role. But usually their scope of practice is considered in those roles. Type of roles. We have process-based and response based. Process based is an active participant in the teaching- learning process. So if I'm the primary RN in the role, the registered nurse, then I'm going to make the decisions, I'm going to assess, I'm going to call for the interventions. Response-based is an inactive role. I could be playing the member of a sister, or a family member, a mother. That's an inactive role, so I don't have any control over the material, but I'm still within the scenario and still will be part of the debriefing. So assembling the educational strategies when building the simulation. We need to remember to look at our teaching educational strategies. One prominently that comes from the simulation theory. If you look in the literature, it's active learning. You're immersing the participants and they are actively assessing, engaging, and implementing those interventions. Collaborative learning. That happens with the team. Inter-professional simulations are great example of that. Also, collaborate with one nurse and an orientee, that's collaboration. Another educational strategy is diverse ways of learning. Students are immersed, experiential, there's audio, there's visual, all of that. Lastly, with simulation, there's high expectations. To me, we're raising the bar of learning. This is a higher-order of learning. I'm not telling the students what to do or the participants. They go into simulation and they have to think, they have to assess, they make the decisions, they're problem-solving within that environment. So these educational strategies are all important. Other ones to consider, let's talk about that. Timing of the simulation. Usually, I run about a 20-minute simulation 15, 30 minutes. It depends on the complexity. But usually, they're pretty short, and then we have guided reflection or debriefing following the simulation. The reflection follows the simulation. A best practice, we don't wait for a day to reflect or debrief, it's immediately after that simulation. You'll hear more on a module about debriefing coming up in our MOOC. But this reflection provides a mechanism for peer review. It allows those participants to reflect and verbalize what went well, what didn't go well, and this is an important role for facilitator to facilitate that reflection. Lastly, finish the project. We want to complete the details. Now, we got to evaluate the quality of work. Did our simulation meet the purpose, the objectives, the goals that we set out to do? If not, we need to redo. We need to modify. But finishing the project will include evaluations on this simulation design, on the process, how we implemented as a simulation, was the debriefing done well, did the facilitator navigate the simulation well with the participants? Then you can measure learning outcomes, whether the outcomes were about the participant, the patient care, or system level. Again, another module done more elaborate and comprehensively in this MOOC. Evaluation helps us to understand the participants' knowledge. It provides us more of a research database in the field of simulation, because we want to collect data, and it helps me to understand the learners. Did we meet the outcomes that we meant to achieve? So in summary, simulations, they offer experiential learning experiences. They must be evaluated to ensure that we're meeting the outcomes that we set out to go for. They also provide nurse educators an innovative way to teach students about real-world nursing in an experiential, immersive, and non-threatening environment. At this time, if you have questions, let's think about it and there's going to be discussion forums as well. Thank you, very, very much.
