- Email: [email protected]
End-of Life Simulation
Poster Abstracts
e130
End-of Life Simulation Patricia N. Allen, MSN, APRN, BC. Indiana University School of Nursing, 1033 E. Third St., Sycamore Hall 444, Bloomington, IN 47405 This project outlines a clinical simulation experience to be included in an undergraduate senior or upper level course for students enrolled at four different nursing schools located in the Midwest. This study seeks to examine the undergraduate’s student knowledge and skills caring for a patient at the end-of-life in a hospice unit. The study will investigate the students’ knowledge and skills set pertaining to four learning outcomes: 1) knowledge related to end-of-life care; 2) self-confidence in caring for a dying patient; 3) communication skills in working with end-of-life patients; and 4) satisfaction with the simulation experience. Participants will be involved in a 20minute scenario followed by a 20-minute debriefing period immediately after the simulation. Schools of nursing and other health profession programs have been challenged to use expand-ing technologies and support innovations throughout the educational process (Institute of Medicine (IOM), 2004). These educational innovations include reforms in the methods, approaches, and settings used to provide clinical education, all in anticipation of the expectation that future ‘‘patient free’’ learning environments (such as simulation centers) will enhance the training of health professionals while minimizing harm to patients (Ziv, Small, & Wolpe, 2000). The demand on health care providers has become more complex (Koerner, 2003; Long, 2004), due to the increased complexity of patient care situations, the need for rapid decision making despite conflicting or incomplete information, advanced technology, and increased need for collaboration among members of the health care team (Hamman, 2004; Maddox, Wakefield, & Bull, 2001). Such realities challenge nurse educators and others in the health professions to design teaching, learning, and evaluation strategies that enhance students’ abilities to practice safely and effectively in this health care environment. Among the strategies suggested to assist educators to meet student learning needs and develop their practice competencies are e-learning, virtual reality, and scenario-based simulation (Koerner, 2003; Ziv, Wolpe, Small, & Glick, 2003). The use of scenariobased simulation holds exceptional promise for education, particularly the education of nurses. Another rising issue facing healthcare educators today is the concept of patient safety as public reports are being announced on the number of errors occurring in the healthcare settings. The use of simulation as a tool to assist in resolving the patient safety issue while promoting student learning is identified in the report Envisioning the Future of Academic Health Centers (Commonwealth Fund, 2003). This study will use simulations as a part of the clinical education component for nursing students to learn applications of critical assessments and clinical decision-making. The specific content area, caring for an endof-life patient, has been chosen to develop and test the simulation and learning outcomes. This content area was chosen since it is a critical learning objective for these upper level nursing students. The content will have been covered in the didactic component of all four nursing programs in the form of a DVD. The DVD was produced by a certified ELNAC instructor and will be used in all programs so that the end-of-life content is consistent across sites.
Students’ Perceptions of Simulation’s Effectiveness on Learning Elizabeth (Libby) Archer, Ed. D., RN. Baptist College of Health Sciences, Office phone 901-572-2845, Home phone 901-837-3719, [email protected] The purpose of this study is twofold: to determine if timing of simulation affects students’ ability to understand critical care concepts; and, to determine how the simulation experience affected their ability to meet course objectives. One-half of the students will have simulation prior to beginning their clinical in the critical care areas while the other half of the students will have simulation after their clinical experience.
From Summer 2008 through Spring 2009, a study will be conducted to determine how simulation affects student learning. This is a qualitative and quantitative design. The format for obtaining information consists of a survey with five questions that ask students how the simulation experience influenced their progress on attaining course objectives. The scale is from 1-5 with 1 being slight progress to 5, which is substantial progress. Additionally, there are two open-ended questions that ask for both their feedback on the experiences and for their suggestions on how the simulation process can be improved. The study will be completed during the first 6-weeks of Spring 2008 with approximately 150þ participants. The participants will be all senior nursing students in the Advanced Adult Health Concepts (AAHC) will participate in 30 hours of simulation. They will have three separate simulation cases that deal with patients who have heart, lung, and neurologic involvements.
Evaluation of the Lasater Clinical Judgment Rubric Alyce Ashcraft, PhD, RN, CS, CCRN, CNE, and Laura Opton, MSN, RN. Texas Tech University Health Sciences Center School of Nursing, 806-743-2730, [email protected] Clinical judgment is an elusive concept that educators struggle to present and assess. Benner’s seminal work in 1984 and continuing work in 1996 of novice to expert along with Tanner’s continuing work on clinical judgment provides a model of ‘‘thinking in action’’ that focuses on four phases: noticing, interpreting, responding, and reflecting. This model served as the basis for the Lasater Clinical Judgment Rubric (LCJR) that was developed to evaluate a single patient encounter requiring clinical judgment using simulation. Using Tanner’s Clinical Judgment Model (2006), the LCJR incorporates the concepts of effective noticing, interpreting, responding, and reflecting. Using rubric scoring, this tool simplistically allows for prospective analysis of a clinical encounter. Because simulation is a teaching method frequently used in nursing schools, effective feedback is essential for student performance improvement. As the literature reveals no consensus regarding best practices for evaluation/grading of simulated exercises (both formative and summative) in nursing education, the purpose of this descriptive study was to explore the usefulness of the LCJR as an evaluation tool for senior nursing students in the simulation laboratory. The sample consisted of 85 senior level baccalaureate nursing students enrolled in the final semester prior to graduation. Students were randomly divided into groups of four and remained in the same group throughout the semester. Students were also randomly assigned to one of four roles for each simulated exercise: family member, primary nurse, secondary nurse, or peer evaluator. Each student had the opportunity to participate as the nurse during the semester. Data was collected using four separate and commonly encountered patient care scenarios topics (sepsis, hypovolemia, DKA, and PCI). The objectives for each scenario included (a) evaluation of signs, symptoms, and precipitating factors of specific disease process, (b) prioritization of nursing interventions (c) utilization of evidence-based practice skills, (d) demonstration of effective inter-/intra-disciplinary and patient/ family communication, and (e) evaluation of rationales for implemented actions. Content validity of each scenario was established through expert panel review. The LCJR, as printed in the November 2007 edition of Journal of Nursing Education, was adapted to add a numerical grading scale for scoring of student performance. Frequencies were calculated to describe the scoring of each of the LCJR dimensions (effective noticing, effective interpreting, effective responding, and effective reflecting) for formative and summative evaluations. Analysis of variance was calculated to determine differences in student clinical judgment total scores between formative and summative evaluations. In addition, a post hoc factor analysis was conducted to correlate variables with each domain. As a result of the statistical analysis, the LCJR was expanded by two categories, variables rearranged in the domains, and a separate patient safety variable included to account for sentinel events.
pp e129-e155 Clinical Simulation in Nursing Volume 5 Issue 3S
e130
End-of Life Simulation Patricia N. Allen, MSN, APRN, BC. Indiana University School of Nursing, 1033 E. Third St., Sycamore Hall 444, Bloomington, IN 47405 This project outlines a clinical simulation experience to be included in an undergraduate senior or upper level course for students enrolled at four different nursing schools located in the Midwest. This study seeks to examine the undergraduate’s student knowledge and skills caring for a patient at the end-of-life in a hospice unit. The study will investigate the students’ knowledge and skills set pertaining to four learning outcomes: 1) knowledge related to end-of-life care; 2) self-confidence in caring for a dying patient; 3) communication skills in working with end-of-life patients; and 4) satisfaction with the simulation experience. Participants will be involved in a 20minute scenario followed by a 20-minute debriefing period immediately after the simulation. Schools of nursing and other health profession programs have been challenged to use expand-ing technologies and support innovations throughout the educational process (Institute of Medicine (IOM), 2004). These educational innovations include reforms in the methods, approaches, and settings used to provide clinical education, all in anticipation of the expectation that future ‘‘patient free’’ learning environments (such as simulation centers) will enhance the training of health professionals while minimizing harm to patients (Ziv, Small, & Wolpe, 2000). The demand on health care providers has become more complex (Koerner, 2003; Long, 2004), due to the increased complexity of patient care situations, the need for rapid decision making despite conflicting or incomplete information, advanced technology, and increased need for collaboration among members of the health care team (Hamman, 2004; Maddox, Wakefield, & Bull, 2001). Such realities challenge nurse educators and others in the health professions to design teaching, learning, and evaluation strategies that enhance students’ abilities to practice safely and effectively in this health care environment. Among the strategies suggested to assist educators to meet student learning needs and develop their practice competencies are e-learning, virtual reality, and scenario-based simulation (Koerner, 2003; Ziv, Wolpe, Small, & Glick, 2003). The use of scenariobased simulation holds exceptional promise for education, particularly the education of nurses. Another rising issue facing healthcare educators today is the concept of patient safety as public reports are being announced on the number of errors occurring in the healthcare settings. The use of simulation as a tool to assist in resolving the patient safety issue while promoting student learning is identified in the report Envisioning the Future of Academic Health Centers (Commonwealth Fund, 2003). This study will use simulations as a part of the clinical education component for nursing students to learn applications of critical assessments and clinical decision-making. The specific content area, caring for an endof-life patient, has been chosen to develop and test the simulation and learning outcomes. This content area was chosen since it is a critical learning objective for these upper level nursing students. The content will have been covered in the didactic component of all four nursing programs in the form of a DVD. The DVD was produced by a certified ELNAC instructor and will be used in all programs so that the end-of-life content is consistent across sites.
Students’ Perceptions of Simulation’s Effectiveness on Learning Elizabeth (Libby) Archer, Ed. D., RN. Baptist College of Health Sciences, Office phone 901-572-2845, Home phone 901-837-3719, [email protected] The purpose of this study is twofold: to determine if timing of simulation affects students’ ability to understand critical care concepts; and, to determine how the simulation experience affected their ability to meet course objectives. One-half of the students will have simulation prior to beginning their clinical in the critical care areas while the other half of the students will have simulation after their clinical experience.
From Summer 2008 through Spring 2009, a study will be conducted to determine how simulation affects student learning. This is a qualitative and quantitative design. The format for obtaining information consists of a survey with five questions that ask students how the simulation experience influenced their progress on attaining course objectives. The scale is from 1-5 with 1 being slight progress to 5, which is substantial progress. Additionally, there are two open-ended questions that ask for both their feedback on the experiences and for their suggestions on how the simulation process can be improved. The study will be completed during the first 6-weeks of Spring 2008 with approximately 150þ participants. The participants will be all senior nursing students in the Advanced Adult Health Concepts (AAHC) will participate in 30 hours of simulation. They will have three separate simulation cases that deal with patients who have heart, lung, and neurologic involvements.
Evaluation of the Lasater Clinical Judgment Rubric Alyce Ashcraft, PhD, RN, CS, CCRN, CNE, and Laura Opton, MSN, RN. Texas Tech University Health Sciences Center School of Nursing, 806-743-2730, [email protected] Clinical judgment is an elusive concept that educators struggle to present and assess. Benner’s seminal work in 1984 and continuing work in 1996 of novice to expert along with Tanner’s continuing work on clinical judgment provides a model of ‘‘thinking in action’’ that focuses on four phases: noticing, interpreting, responding, and reflecting. This model served as the basis for the Lasater Clinical Judgment Rubric (LCJR) that was developed to evaluate a single patient encounter requiring clinical judgment using simulation. Using Tanner’s Clinical Judgment Model (2006), the LCJR incorporates the concepts of effective noticing, interpreting, responding, and reflecting. Using rubric scoring, this tool simplistically allows for prospective analysis of a clinical encounter. Because simulation is a teaching method frequently used in nursing schools, effective feedback is essential for student performance improvement. As the literature reveals no consensus regarding best practices for evaluation/grading of simulated exercises (both formative and summative) in nursing education, the purpose of this descriptive study was to explore the usefulness of the LCJR as an evaluation tool for senior nursing students in the simulation laboratory. The sample consisted of 85 senior level baccalaureate nursing students enrolled in the final semester prior to graduation. Students were randomly divided into groups of four and remained in the same group throughout the semester. Students were also randomly assigned to one of four roles for each simulated exercise: family member, primary nurse, secondary nurse, or peer evaluator. Each student had the opportunity to participate as the nurse during the semester. Data was collected using four separate and commonly encountered patient care scenarios topics (sepsis, hypovolemia, DKA, and PCI). The objectives for each scenario included (a) evaluation of signs, symptoms, and precipitating factors of specific disease process, (b) prioritization of nursing interventions (c) utilization of evidence-based practice skills, (d) demonstration of effective inter-/intra-disciplinary and patient/ family communication, and (e) evaluation of rationales for implemented actions. Content validity of each scenario was established through expert panel review. The LCJR, as printed in the November 2007 edition of Journal of Nursing Education, was adapted to add a numerical grading scale for scoring of student performance. Frequencies were calculated to describe the scoring of each of the LCJR dimensions (effective noticing, effective interpreting, effective responding, and effective reflecting) for formative and summative evaluations. Analysis of variance was calculated to determine differences in student clinical judgment total scores between formative and summative evaluations. In addition, a post hoc factor analysis was conducted to correlate variables with each domain. As a result of the statistical analysis, the LCJR was expanded by two categories, variables rearranged in the domains, and a separate patient safety variable included to account for sentinel events.
pp e129-e155 Clinical Simulation in Nursing Volume 5 Issue 3S