- Email: [email protected]
Developing Nurse Educator Competency In The Pedagogy Of Simulation
e409
Presentation Abstracts from 2012 INACSL Conference
Development of an Audit Tool for Evaluating Team Competency for the Simulation Procedure ‘‘Emergency Resternotomy’’ in the ICU Post Cardiac Surgery Level of Presentation: Novice Margaret Kohn, RN MSN, Department of Veterans Affairs Greater Los Angles Healthcare System 11301 Wilshire Blvd/Los Angeles, CA 90073, 562-477-8910, [email protected] Sharon Valente, PhD APRN, FAAN, Associate Chief Nursing Service, Research/Education West LA Veterans Hospital
Objectives: Through participation in this presentation, the attendee will have to opportunity to:
Objectives 1) State brief definitions of reliability and validity. 2) Describe the steps in developing and testing an audit tool for reliability and validity. Background: Emergency Resternotomy, reopening of the sternum at the bedside in the postoperative cardiac surgery patient requires a high e level team response and a unique skill sets. Timing of the chest reopening is critical to survival of the patient Success of this low frequency (0.8-2.7% of post cardiac surgery patients) but high stakes procedure is dependant upon team performance in a crisis situation. A search of the literature did not provide a tool to measure team competency for this procedure. Purpose: Develop a reliable and valid audit tool that would measure team competency for the procedure, ‘‘Emergency Resternotomy’’ in a realistic simulation that provides the opportunity for the team to act out the steps of the procedure such as removing sternal wires and placing a retractor in the sternum to expose the heart. Methods: The audit tool was designed by using evidence based criteria taken from the 2007 proposed modification of the European Resuscitation Council advanced life support cardiac arrest (CALS) algorithm for postoperative cardiac surgery patients. The tool consisted of five parts: 1) Timing of delivery of emergency measures 2) Comparing performance to the evidence based CALS guidelines 3) Availability of organizational support, including availability of needed equipment as well as physical support at the scene 4) Evaluation of team communication 5) Lessons learned data gathered at debriefing Validity was provided by a panel of 5 experts (one surgeon, one physician assistant and three ICU nurses) who rated the form for how clear it was and if it was measuring what it was supposed to measure. Inter-rater reliability was tested in a mock code simulation where 2 volunteer participants filled out the tool. Answers were then compared for consistency. The film’s clock/ timer was then used to compare the reported written timing during two mock codes. Conclusions/Implications: The tool was found to be reliable and valid. There was 89-100% agreement on the items evaluated for validity by the judge panel. Testing for inter-rater reliability showed >85% r. Reliability (r ¼ above 85%) and validity (measured by judge panel) were confirmed. The tool is now being used in a formative evaluation to study to improve team competence in this procedure.
Developing Nurse Educator Competency In The Pedagogy Of Simulation Level of Presentation: Advanced Jeanette McNeill, RN, DrPH, Professor, University of the Incarnate Word, School of Nursing and Health Professions, 210-829-3161, [email protected]
Ramona Parker, PhD, RN, Associate Professor, University of the Incarnate Word, School of Nursing and Health Professions Julie Nadeau, PhD, RN, Assistant Professor, University of the Incarnate Word, School of Nursing and Health Professions Lu Pelayo, PhD, RN, Director, Alamo Colleges J. Robert Jr., Helen C. Kleberg, Center for Innovative Research and Clinical Learning, (CIRCLe), 4301 Broadway, San Antonio, TX, 78209
1. Describe a program for developing novice faculty in the educator role and the pedagogy of simulation. 2. Discuss the challenges of developing experienced faculty, who are new to simulation, in the use of simulation as a teaching strategy. 3. Examine the use of Rogers’ Diffusion of Innovations, within the context of the NLN Educator competencies, as frameworks for faculty development programs regarding use of simulation. The purpose of the project was to evaluate the preparation to use simulation for novice and experienced faculty, and secondarily, to explore the use of two frameworks, the NLN Nurse Educator competencies, and Rogers’ Diffusion of Innovation, for faculty preparation specific to simulation. A synthesis of research evidence regarding current practices in preparing educators to use simulation provided a foundation for faculty development. Educator competencies have been developed and are the basis for certification for nurse educators (NLN, 2005); these competencies serve as a framework for preparation of faculty to meet new challenges in education. Using the NLN competency framework to organize the faculty development approach, Rogers’ Diffusion of Innovations theory formed the conceptual framework for a systematic plan for faculty development. Two individualized approaches were implemented. For seasoned faculty who were new to simulation, a continuing education offering in two settings (n¼33; n¼20) was implemented with a follow-up ‘‘hands-on’’ workshop (n¼7) and continuing seminars. Program content determined to be most pertinent for faculty in the simulation environment included for novice faculty, an intensive six week course, Educator 101, was offered. NLN Competencies, 1, Facilitating learning; 2, Facilitating learner development and socialization; and 3, using assessment and measurement strategies. Strategies included group discussion, debate and reflective journaling. In both approaches, faculty developed scenarios using the NLN template (www.sirc.org) modified to integrate Quality and Safety Education for Nurses’ knowledge, skills and attitudes in the six competency areas (www. qsen.org). Results included high satisfaction reported by 15 novice faculty, BSN prepared and furthering their education, educated in three cohorts (10, 2, 3), which was measured using a 24-item standard satisfaction instrument (mean of 4. 5). Several scenarios were developed and subjected to trial and revision before implementing. Seasoned faculty reported high satisfaction with the Continuing Nursing Education offering, indicated intention to implement simulation activities within the two years, and developed and trialed three scenarios. Plans to offer the Educator 101 in an online format which could be completed on a self-paced basis are being developed. A program of ongoing faculty development to enhance effective application of this pedagogy is also in the development stage. Recommendations include designing faculty development for simulation within a framework for systems change, maintaining flexibility to meet diverse needs, and use of existing online resources. In conclusion, preparing novice and seasoned faculty is needed for effective use of this emerging teaching strategy. A Diffusion of Innovations approach, preparing a core of faculty members to more effectively use simulation in their courses, was shown to be effective in increasing faculty comfort and skill in the use of this pedagogy.
pp e385-e416 Clinical Simulation in Nursing Volume 8 Issue 8
Presentation Abstracts from 2012 INACSL Conference
e410
Jeffries, P (2005). Designing, implementing and evaluation simulation used as teaching strategies in nursing. Nursing Education Perspective. 26 (2), 96-103. NLN (2005) NLN Competencies for Nurse Educators. www.nln.org. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.
NLN-Jeffries Simulation Framework Project e Outcomes of Simulation Education Level of Presentation: Presentation is intended for novice, intermediate and advanced audiences John M. O’Donnell, DrPH, RN, CRNA, Director and Associate Professor- Nurse Anesthesia Program, University of Pittsburgh School of Nursing, VB 360 A, 3500 Victoria St., Pittsburgh, PA 15261, 412624-4860 (w)/412-980-5176 (c)/ 412-624-1508 (f) Tracy Levett-Jones, PhD, RN, University of Newcastle, Callaghan, NSW Sharon Decker, PhD, RN, ANEF, FAAN, Texas Tech University, Lubbock, Texas 79430 Valerie M. Howard, EdD, RN, Robert Morris University, Moon Township, PA 15108 Session Objectives: Following attendance at this session, participants will be able to: 1) Describe the goals and progression of the NLN-Jeffries Simulation Project. 2) Discuss the current state of the science for outcomes of simulation education in nursing. Session Summary: This session is one of six breakout sessions from the NLN-Jeffries Simulation Framework Project. The ‘Outcomes in Simulation Education’ team will present preliminary findings related to this construct and the underlying concepts (cognition/knowledge, skills performance, learner satisfaction, clinical judgment/reasoning and self-confidence). Participants will be engaged in a facilitated discussion in this area and future directions for research will be identified. Abstract: NLN-Jeffries Simulation Framework Project e Outcomes of Simulation-Based Education. Background: In 2005, Jeffries published ‘‘A Framework for Designing, Implementing, and Evaluating Simulations Used as Teaching Strategies in Nursing’’ which described the major components that were proposed to be core to the design, implementation and evaluation of the evolving methodology of simulation-based education. The framework identified five core constructs: teacher, student, educational practices, simulation design characteristics and outcomes. The proposed framework was the consensus of a national project team working on the NLN-Laerdal Nursing Simulation study (http://www.nln.org/research/LaerdalReport.pdf). In 2010, the NLN-Jeffries Simulation Framework Project was initiated to review the current state of the evidence in support of the framework. A Project Team of simulation experts was assembled to review the literature for each of the five constructs. This session will focus on the construct ‘outcomes’ of simulation-based education including the underlying concepts of cognition/knowledge, skills performance, learner satisfaction, clinical judgment/reasoning and self-confidence. The Simulation-Based Education Outcomes Team will present our preliminary findings related to this construct as well as engage participants in a facilitated discussion of the underlying concept areas with identification of future directions for research in this area. Methods and expected outcomes: Simulation experts participating in the Project were subdivided into five teams to review the empirical and theoretical literature to date addressing each of the five constructs and their respective subcomponents. Literature citations and findings were abstracted into a standardized database to assist with analysis
and summarization. Findings will be presented during breakout sessions at the 2012 INACSL Conference and in a follow-up report in the journal Clinical Simulation. Project teams will solicit participant feedback and perspective from session participants and will collectively identify areas for future research, framework revision or framework enhancement with respect to outcomes of simulation-based education. Findings: Preliminary findings from the Project Teams indicate a wide variance in the volume and strength of the evidence in support of each construct and their subcomponents as well as a general lack of an identified theoretical framework underpinning the majority of empirical simulation literature. Constructs and their subcomponents were found to be described in a varying array of terms. Within the Simulation-Based Education Outcomes construct, supporting evidence appears to be the greatest in the area of knowledge attainment/cognition and the least for areas of skills performance and clinical judgment. The volume and strength of the evidence for each of the underlying concept areas is not proportionate within the construct. Conclusion/ Implications: Many of the concepts comprising each construct, including Simulation-Based Education Outcomes, are widely discussed within the simulation community even in the absence of clear supporting evidence. Based on our team’s review of the current literature there would appear to be numerous opportunities for future research validating the role of this construct, the underlying concepts and the framework as a whole. This session will attempt to review the evidence for the outcomes construct, evaluate the strength of the evidence and develop agreement among participants as to terminology. Relevance to conference themes: The NLN-JSF Project is focused on reviewing the current evidence supporting the framework and identifying areas for enhancement, revision and future research. Conference participants will be more widely informed about the Project and about potential research ideas and topics for presentation at future conferences and publication.
State of the Nursing Science Summary: A Review of the NLN/Jeffries Simulation Framework Level of Presentation: Advanced Patricia Ravert, PhD, RN, CNE, ANEF, FAAN, Associate Professor, Brigham Young University, Provo, UT; 801-422-1167, [email protected] Julie McAfooes, MS, RN-BC, ANEF, Web Development Manager, Chamberlain College of Nursing, Downers Grove, IL; 740-385-3614, [email protected] Objective: Participants will grasp the overall findings and recommendations from the year-long concept analysis of the NLN/Jeffries Simulation Framework project. Background/purpose: Meleis (2007) suggests progress in a discipline is based upon a relationship between research, theory, clinical application, and education. The NLN/Jeffries Simulation Framework was originally constructed in 2003, through a National League for Nursing-sponsored study. This work provided a nascent nursing education framework to assist nurse researchers, educators, and nursing doctoral students to pursue research in simulation. The framework includes five major concepts: teacher, student, educational practices, simulation design characteristics, and outcomes. It has become one of the most used theoretical frameworks in nursing simulation education research and simulation development. Eight years after the NLN/Jeffries Simulation Framework was devised, simulation research is burgeoning. Researchers have noted that the original conceptual definitions in the framework were not clearly defined. As research has progressed and evidence has accumulated over the past few years, the original concepts may have changed. Few large scale reviews of the science
pp e385-e416 Clinical Simulation in Nursing Volume 8 Issue 8
Presentation Abstracts from 2012 INACSL Conference
Development of an Audit Tool for Evaluating Team Competency for the Simulation Procedure ‘‘Emergency Resternotomy’’ in the ICU Post Cardiac Surgery Level of Presentation: Novice Margaret Kohn, RN MSN, Department of Veterans Affairs Greater Los Angles Healthcare System 11301 Wilshire Blvd/Los Angeles, CA 90073, 562-477-8910, [email protected] Sharon Valente, PhD APRN, FAAN, Associate Chief Nursing Service, Research/Education West LA Veterans Hospital
Objectives: Through participation in this presentation, the attendee will have to opportunity to:
Objectives 1) State brief definitions of reliability and validity. 2) Describe the steps in developing and testing an audit tool for reliability and validity. Background: Emergency Resternotomy, reopening of the sternum at the bedside in the postoperative cardiac surgery patient requires a high e level team response and a unique skill sets. Timing of the chest reopening is critical to survival of the patient Success of this low frequency (0.8-2.7% of post cardiac surgery patients) but high stakes procedure is dependant upon team performance in a crisis situation. A search of the literature did not provide a tool to measure team competency for this procedure. Purpose: Develop a reliable and valid audit tool that would measure team competency for the procedure, ‘‘Emergency Resternotomy’’ in a realistic simulation that provides the opportunity for the team to act out the steps of the procedure such as removing sternal wires and placing a retractor in the sternum to expose the heart. Methods: The audit tool was designed by using evidence based criteria taken from the 2007 proposed modification of the European Resuscitation Council advanced life support cardiac arrest (CALS) algorithm for postoperative cardiac surgery patients. The tool consisted of five parts: 1) Timing of delivery of emergency measures 2) Comparing performance to the evidence based CALS guidelines 3) Availability of organizational support, including availability of needed equipment as well as physical support at the scene 4) Evaluation of team communication 5) Lessons learned data gathered at debriefing Validity was provided by a panel of 5 experts (one surgeon, one physician assistant and three ICU nurses) who rated the form for how clear it was and if it was measuring what it was supposed to measure. Inter-rater reliability was tested in a mock code simulation where 2 volunteer participants filled out the tool. Answers were then compared for consistency. The film’s clock/ timer was then used to compare the reported written timing during two mock codes. Conclusions/Implications: The tool was found to be reliable and valid. There was 89-100% agreement on the items evaluated for validity by the judge panel. Testing for inter-rater reliability showed >85% r. Reliability (r ¼ above 85%) and validity (measured by judge panel) were confirmed. The tool is now being used in a formative evaluation to study to improve team competence in this procedure.
Developing Nurse Educator Competency In The Pedagogy Of Simulation Level of Presentation: Advanced Jeanette McNeill, RN, DrPH, Professor, University of the Incarnate Word, School of Nursing and Health Professions, 210-829-3161, [email protected]
Ramona Parker, PhD, RN, Associate Professor, University of the Incarnate Word, School of Nursing and Health Professions Julie Nadeau, PhD, RN, Assistant Professor, University of the Incarnate Word, School of Nursing and Health Professions Lu Pelayo, PhD, RN, Director, Alamo Colleges J. Robert Jr., Helen C. Kleberg, Center for Innovative Research and Clinical Learning, (CIRCLe), 4301 Broadway, San Antonio, TX, 78209
1. Describe a program for developing novice faculty in the educator role and the pedagogy of simulation. 2. Discuss the challenges of developing experienced faculty, who are new to simulation, in the use of simulation as a teaching strategy. 3. Examine the use of Rogers’ Diffusion of Innovations, within the context of the NLN Educator competencies, as frameworks for faculty development programs regarding use of simulation. The purpose of the project was to evaluate the preparation to use simulation for novice and experienced faculty, and secondarily, to explore the use of two frameworks, the NLN Nurse Educator competencies, and Rogers’ Diffusion of Innovation, for faculty preparation specific to simulation. A synthesis of research evidence regarding current practices in preparing educators to use simulation provided a foundation for faculty development. Educator competencies have been developed and are the basis for certification for nurse educators (NLN, 2005); these competencies serve as a framework for preparation of faculty to meet new challenges in education. Using the NLN competency framework to organize the faculty development approach, Rogers’ Diffusion of Innovations theory formed the conceptual framework for a systematic plan for faculty development. Two individualized approaches were implemented. For seasoned faculty who were new to simulation, a continuing education offering in two settings (n¼33; n¼20) was implemented with a follow-up ‘‘hands-on’’ workshop (n¼7) and continuing seminars. Program content determined to be most pertinent for faculty in the simulation environment included for novice faculty, an intensive six week course, Educator 101, was offered. NLN Competencies, 1, Facilitating learning; 2, Facilitating learner development and socialization; and 3, using assessment and measurement strategies. Strategies included group discussion, debate and reflective journaling. In both approaches, faculty developed scenarios using the NLN template (www.sirc.org) modified to integrate Quality and Safety Education for Nurses’ knowledge, skills and attitudes in the six competency areas (www. qsen.org). Results included high satisfaction reported by 15 novice faculty, BSN prepared and furthering their education, educated in three cohorts (10, 2, 3), which was measured using a 24-item standard satisfaction instrument (mean of 4. 5). Several scenarios were developed and subjected to trial and revision before implementing. Seasoned faculty reported high satisfaction with the Continuing Nursing Education offering, indicated intention to implement simulation activities within the two years, and developed and trialed three scenarios. Plans to offer the Educator 101 in an online format which could be completed on a self-paced basis are being developed. A program of ongoing faculty development to enhance effective application of this pedagogy is also in the development stage. Recommendations include designing faculty development for simulation within a framework for systems change, maintaining flexibility to meet diverse needs, and use of existing online resources. In conclusion, preparing novice and seasoned faculty is needed for effective use of this emerging teaching strategy. A Diffusion of Innovations approach, preparing a core of faculty members to more effectively use simulation in their courses, was shown to be effective in increasing faculty comfort and skill in the use of this pedagogy.
pp e385-e416 Clinical Simulation in Nursing Volume 8 Issue 8
Presentation Abstracts from 2012 INACSL Conference
e410
Jeffries, P (2005). Designing, implementing and evaluation simulation used as teaching strategies in nursing. Nursing Education Perspective. 26 (2), 96-103. NLN (2005) NLN Competencies for Nurse Educators. www.nln.org. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.
NLN-Jeffries Simulation Framework Project e Outcomes of Simulation Education Level of Presentation: Presentation is intended for novice, intermediate and advanced audiences John M. O’Donnell, DrPH, RN, CRNA, Director and Associate Professor- Nurse Anesthesia Program, University of Pittsburgh School of Nursing, VB 360 A, 3500 Victoria St., Pittsburgh, PA 15261, 412624-4860 (w)/412-980-5176 (c)/ 412-624-1508 (f) Tracy Levett-Jones, PhD, RN, University of Newcastle, Callaghan, NSW Sharon Decker, PhD, RN, ANEF, FAAN, Texas Tech University, Lubbock, Texas 79430 Valerie M. Howard, EdD, RN, Robert Morris University, Moon Township, PA 15108 Session Objectives: Following attendance at this session, participants will be able to: 1) Describe the goals and progression of the NLN-Jeffries Simulation Project. 2) Discuss the current state of the science for outcomes of simulation education in nursing. Session Summary: This session is one of six breakout sessions from the NLN-Jeffries Simulation Framework Project. The ‘Outcomes in Simulation Education’ team will present preliminary findings related to this construct and the underlying concepts (cognition/knowledge, skills performance, learner satisfaction, clinical judgment/reasoning and self-confidence). Participants will be engaged in a facilitated discussion in this area and future directions for research will be identified. Abstract: NLN-Jeffries Simulation Framework Project e Outcomes of Simulation-Based Education. Background: In 2005, Jeffries published ‘‘A Framework for Designing, Implementing, and Evaluating Simulations Used as Teaching Strategies in Nursing’’ which described the major components that were proposed to be core to the design, implementation and evaluation of the evolving methodology of simulation-based education. The framework identified five core constructs: teacher, student, educational practices, simulation design characteristics and outcomes. The proposed framework was the consensus of a national project team working on the NLN-Laerdal Nursing Simulation study (http://www.nln.org/research/LaerdalReport.pdf). In 2010, the NLN-Jeffries Simulation Framework Project was initiated to review the current state of the evidence in support of the framework. A Project Team of simulation experts was assembled to review the literature for each of the five constructs. This session will focus on the construct ‘outcomes’ of simulation-based education including the underlying concepts of cognition/knowledge, skills performance, learner satisfaction, clinical judgment/reasoning and self-confidence. The Simulation-Based Education Outcomes Team will present our preliminary findings related to this construct as well as engage participants in a facilitated discussion of the underlying concept areas with identification of future directions for research in this area. Methods and expected outcomes: Simulation experts participating in the Project were subdivided into five teams to review the empirical and theoretical literature to date addressing each of the five constructs and their respective subcomponents. Literature citations and findings were abstracted into a standardized database to assist with analysis
and summarization. Findings will be presented during breakout sessions at the 2012 INACSL Conference and in a follow-up report in the journal Clinical Simulation. Project teams will solicit participant feedback and perspective from session participants and will collectively identify areas for future research, framework revision or framework enhancement with respect to outcomes of simulation-based education. Findings: Preliminary findings from the Project Teams indicate a wide variance in the volume and strength of the evidence in support of each construct and their subcomponents as well as a general lack of an identified theoretical framework underpinning the majority of empirical simulation literature. Constructs and their subcomponents were found to be described in a varying array of terms. Within the Simulation-Based Education Outcomes construct, supporting evidence appears to be the greatest in the area of knowledge attainment/cognition and the least for areas of skills performance and clinical judgment. The volume and strength of the evidence for each of the underlying concept areas is not proportionate within the construct. Conclusion/ Implications: Many of the concepts comprising each construct, including Simulation-Based Education Outcomes, are widely discussed within the simulation community even in the absence of clear supporting evidence. Based on our team’s review of the current literature there would appear to be numerous opportunities for future research validating the role of this construct, the underlying concepts and the framework as a whole. This session will attempt to review the evidence for the outcomes construct, evaluate the strength of the evidence and develop agreement among participants as to terminology. Relevance to conference themes: The NLN-JSF Project is focused on reviewing the current evidence supporting the framework and identifying areas for enhancement, revision and future research. Conference participants will be more widely informed about the Project and about potential research ideas and topics for presentation at future conferences and publication.
State of the Nursing Science Summary: A Review of the NLN/Jeffries Simulation Framework Level of Presentation: Advanced Patricia Ravert, PhD, RN, CNE, ANEF, FAAN, Associate Professor, Brigham Young University, Provo, UT; 801-422-1167, [email protected] Julie McAfooes, MS, RN-BC, ANEF, Web Development Manager, Chamberlain College of Nursing, Downers Grove, IL; 740-385-3614, [email protected] Objective: Participants will grasp the overall findings and recommendations from the year-long concept analysis of the NLN/Jeffries Simulation Framework project. Background/purpose: Meleis (2007) suggests progress in a discipline is based upon a relationship between research, theory, clinical application, and education. The NLN/Jeffries Simulation Framework was originally constructed in 2003, through a National League for Nursing-sponsored study. This work provided a nascent nursing education framework to assist nurse researchers, educators, and nursing doctoral students to pursue research in simulation. The framework includes five major concepts: teacher, student, educational practices, simulation design characteristics, and outcomes. It has become one of the most used theoretical frameworks in nursing simulation education research and simulation development. Eight years after the NLN/Jeffries Simulation Framework was devised, simulation research is burgeoning. Researchers have noted that the original conceptual definitions in the framework were not clearly defined. As research has progressed and evidence has accumulated over the past few years, the original concepts may have changed. Few large scale reviews of the science
pp e385-e416 Clinical Simulation in Nursing Volume 8 Issue 8