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Featured Story

"We Ignited the Simulation Fuse"

Southern Illinois University Edwardsville (SIUE)

Edwardsville, Illinois

This featured story reflects one institution’s experience implementing the Simulation Education Solutions for Nursing (SESN) program. The following are discussed herein: the challenges prior to the change, the process of implementing change, and the results thus far. The featured story was developed in collaboration with, and approved by, SIUE.

Contributors from SIUE

Dr. Laura Bernaix, PhD, RN, Dean, Professor

Dr. Rhonda Comrie, PhD, RN, Associate Dean for Academic Programs, Associate Professor

Dr. Amelia Perez, PhD, RN, Associate Professor, Coordinator of the Simulated Learning Center for Health Sciences

Note: All information and quotes were provided as a group.

Education at SIUE School of Nursing

The SIUE School of Nursing incorporates simulation learning throughout its undergraduate and graduate curricula.

The undergraduate program comprises six semesters of intense didactic and clinical study (about 15-18 credits per semester). Courses are delivered via face-to-face and web-based instruction. Clinical course work is held at selected health care agencies throughout southern Illinois, St. Louis, and the Illinois Metro East area.1 An accelerated BSN option is also available for those who have already completed a baccalaureate degree in another field. These students are able to complete the accelerated BSN program in 15 months.

The graduate programs that engage in simulation include the Nurse Anesthesia Doctor of Nursing Practice and the Family Nurse Practitioner Doctor of Nursing Practice. 

Simulation Before SESN

Before the initial assessment with Laerdal, simulation experiences throughout the curriculum were limited. The only high-fidelity simulation was offered in the Women and Childbearing Families clinical course. Low and mid-fidelity simulations occurred in the Foundations of Nursing course.

The SIUE School of Nursing began to explore options for expanding their simulation program and challenges that needed to be addressed were identified. Recognizing growing demand for clinical site placement, the administration felt it was important to prepare for alternative teaching strategies for selected clinical experiences.

A study by the National Council of State Boards of Nursing (NCSBN) found that up to 50% of clinical time in undergraduate nursing programs could be replaced with high-quality simulation.4 Following this study, the Illinois State Board of Nursing approved that up to 25% of the undergraduate nursing clinical hours can be achieved through high-quality simulation. This presented new opportunities to expand the simulation program and devote part of the clinical hours to nursing simulation. The SIUE School of Nursing’s undergraduate program now devotes approximately 5-15% of the total clinical time in each clinical course to simulation instruction.

Allowing the lab to be underutilized, with all of its state-of-the-art equipment, would be a waste of investments to date.

Perceived Barriers

Some of the anticipated concerns prior to expanding the simulation program included cost, and faculty buy-in and apprehension regarding learning new technology.

We wanted a solution that would be effective and worth the investment.

How SESN Helped

The essential components of the SESN program are the initial assessment, the implementation, and regularly scheduled pulse checks. The assessment provided an opportunity to collect and analyze data to establish a baseline, as well as explore and understand the needs and existing resources in the nursing program. At this stage, simulation methods and operations were evaluated using a combination of electronic and on-site measurements based on industry standards and best practices.

 

SESN Essential Components

This analysis was then used to shape the implementation phase of the program, with the intent of helping improve simulation utilization and student learning. The training environment (SLCHS) was deemed well-designed and the equipment met the needs for low, mid, and high-fidelity simulations. Through the assessment, it was also found that faculty varied in their knowledge and experience with simulation education, and were concerned about the level of technical support available to them. 

We anticipated that there would be faculty who were unfamiliar with simulation education, which was revealed in the assessment, but we also learned that almost all of our faculty were eager to learn and become proficient in simulation.

The resulting first-year goals focused on simulation education best practices to achieve an integrated curriculum and enhanced student learning experience.

Curriculum Integration Goals:

  • Include a minimum of one high quality simulated clinical experience into each course.
  • Adopt a unified debriefing model, and ensure faculty is competent using the model.
  • Develop and facilitate a formal staff orientation and training program.
  • Plan for future developments of the simulation center using the allocated budget.

Student Learning Goals:

  • Improve critical thinking and application of knowledge.
  • Improve skill performance.
  • Increase opportunities for clinical learning.
  • Provide experiences that are unavailable or that are not permitted in a clinical setting.

Using these goals as the foundation for success, the implementation followed an extremely specific list of short-term and long-term recommendations. Once the planning was completed, the SIUE School of Nursing began the three year SESN program on February 4, 2016. The implementation included:  Foundation of Simulation workshop in May 2016; Debriefing workshop in August 2016; a Mental Health Integration Consultation in October 2016; a Curriculum Integration workshop in January 2017; a Community Health workshop on March 2017; and a Maternal Health workshop on October 2017. These workshops were carefully crafted to meet the specific needs of the school’s faculty. The success of these workshops was measured during the pulse checks provided by the SESN program.

We have been conducting simulation, but we didn’t really have a strong foundation of the theory behind it. Now it makes more sense, and I feel more confident.

Results

Now, in the second year of the SESN program, the SIUE School of Nursing has incorporated high-fidelity simulation into every undergraduate clinical course (Adult Health, Care of Children and Adolescents, Care of Women and Childbearing Families, Mental Health, Care of Populations, Complex Health Needs, and Transition to Professional Practice). 

Students have demonstrated and expressed how much simulation is helping their learning, critical thinking, and application of knowledge. Student evaluations have demonstrated very positive opinions regarding the quality of the new simulation program, and expressed increases in their perceived confidence in clinical skills, critical thinking, and clinical preparedness. Evaluation data also reveal that the simulations depict accurate clinical practice realism, and the debriefing process heightens the overall quality of the simulation experiences. 

As a result of the workshops, faculty have expressed an increased level of confidence in using the simulation center. They now feel more comfortable and knowledgeable about the process of simulation, and their ability to debrief the students has significantly improved. Additionally, as recommended by the SESN program, the school has hired a Simulation Technology Support Specialist to provide technological support during simulations, and assist in the maintenance of equipment and the design for future expansion.

Having a Simulation Technology Support Specialist has been very helpful. The Technology Support Specialist focuses on the technology aspect of the simulation lab so that the Coordinator, simulation staff, and faculty can focus on simulation development, evaluation, teaching and learning, and evaluation research.

As a result of the guidance and consistency provided by the SESN program, the students and faculty have been prepared to engage in simulations in an effective manner. The program has helped SIUE School of Nursing improve the process by which they deliver simulations, resulting in a high-quality program that is consistent across the curriculum.

It was a tremendous amount of work the first year, but now the faculty and simulation staff are well-trained in simulation. In addition, the SESN program has empowered us with the ability to efficiently evaluate our simulations and modify them, as appropriate, based on faculty and student feedback.

About SIUE School of Nursing

 

Southern Illinois University Edwardsville School of Nursing

The SIUE School of Nursing Simulated Learning Center for Health Sciences (SLCHS) supports critical thinking, application of nursing knowledge, and skill development in an interactive healthcare learning environment.3

The SIUE School of Nursing operates at three sites in southern Illinois, and is the only full-service public institution offering baccalaureate and graduate nursing education for the lower half of the state, south of Springfield, Illinois.  All undergraduate and graduate programs are offered and administered at the Edwardsville, Illinois campus.  In 2010, a second site for offering the traditional baccalaureate program was established at the SIU Carbondale campus.  The third site is in East St. Louis, Illinois where the School of Nursing operates the WE CARE Clinic, a nurse managed primary care clinic.

The SIUE School of Nursing has a team of dedicated faculty who are committed to excellence in didactic and clinical education. The faculty are engaged in simulation training in order to effectively conduct simulation teaching and learning.

References

  1. SIUE. (n.d.). School of nursing. Retrieved from http://www.siue.edu/nursing
  2. SIUE. (n.d.). Message from the dean. Retrieved from http://www.siue.edu/nursing/about/message-dean.shtml
  3. SIUE. (n.d). Simulated learning center. Retrieved from http://www.siue.edu/nursing/about/simulated-learning-center.shtml
  4. National Council of State Boards of Nursing (2015). Simulation study. Retrieved from https://www.ncsbn.org/685.htm