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What Can We Learn from a Listserv?
Clinical Simulation in Nursing (2009) 5, e57-e58
www.elsevier.com/locate/ecsn
Editorial
What Can We Learn from a Listserv?
A very active Listserv is one of the valuable benefits of belonging to the International Nursing Association for Clinical Simulation and Learning. The Listserv connects members with each other, providing an easy way to network and receive helpful advice on many different types of issues. Listservs deliver e-mail right to your inbox, literally bringing the information to you! The diverse nature of our membership is evident when following the Listserv discussions. Members come with a variety of different experiences, responsibilities, and concerns. Everyone exists at different points on the novice-to-expert continuum, allowing all of us to learn from each other. Questions and concerns are posted, with responses coming quickly and from many different viewpoints. Discussions have been rich with insight, sometimes even resulting in more questions being raised than were answered! Two main types of questions have emerged on the Listserv, which follows the historical components of the Association: skills-related questions and simulation-related questions. Questions range from the specific, such as ‘‘Are wet-to-dry dressing changes still considered sterile?’’ to more general questions, such as ‘‘Are organisms from clinical areas transferred to the sim lab?’’ A recent discussion about cleaning up mercury spills from glass thermometers even resulted in some personal stories being shared that might help explain some of our individual quirks! Two topics garnered the most attention the last 2 months: simulated death experiences and evaluation of simulation experiences. Both are complicated issues that should be approached with a great deal of thought and care. No one person has all the right answers, but numerous approaches and considerations were offered by Association members. Some members are in the early stages of deciding what is best for their students, while others have shared both successful and unsuccessful attempts to incorporate these two areas into their simulations.
Should the Simulated Patient Be Allowed to Die? Questions tend to beget more questions, and these are helpful as faculty determine their own philosophy related to simulated death: Is simulated death compatible with the learning objectives for the experience? Is the death because students didn’t properly care for the patient? Or is it planned, perhaps a do-not-resuscitate (DNR) patient? Will students believe it is their fault that the patient died, and what are the implications of that? How will faculty support students in this often emotional experience? Members encouraged others to prepare students ahead of time for the possibility of death and what appropriate actions could be taken and to consider intervening with a crisis team rather than letting the patient die. Always be prepared to provide psychological support to students when they have experienced a death, regardless of whether it is in the simulation lab or in the traditional clinical environment. There are many learning opportunities that faculty have witnessed when facilitating student learning about how to care for the patient who is dying, such as providing support for family members, providing comfort measures to the patient, understanding DNR orders better, appropriately communicating with the health care provider, and providing postmortem care. Perhaps most valuable is the opportunity for students to identify and evaluate their own feelings about death.
Should We Evaluate or Test Students in the Simulation Lab? This discussion also raised more questions than it answered, providing numerous examples of what should be
1876-1399/09/$ - see front matter Ó 2009 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2008.12.002
What Can We Learn from a Listserv?
e58
considered when deciding whether to do formal evaluation or testing in the lab environment: Is the simulation lab better suited for facilitating learning or for evaluating students? Is it possible to do both? Is it fair to test students if they have not had significant exposure to simulated clinical experiences? Are the faculty all competent in their roles? How is this variable controlled for evaluation purposes? How do we account for the variety of student responses and interventions that are inherent in simulations? Are we sending mixed messages when we tell students that simulation is a safe environment to learn in and then use that same environment for evaluation? Do we test students in the traditional clinical environment? Is it then fair to test in the simulation lab? If the focus is on testing, will the experience become an experience about performing rather than about learning? What can you learn about your students in the simulation environment without formal evaluation or testing? If we say that most of the learning occurs in debriefing, can we fairly evaluate students before that debriefing occurs? Further discussion was raised about using simulation for high-stakes testing, such as the National Council Licensure ExaminationdRegistered Nurse. Many undergraduate nursing students have never been exposed to patient simulation. Not only is it still considered a new teaching methodology; it is an expensive one that not all schools can yet afford. Within existing programs that use patient simulation, a great disparity exists in how often students are exposed to simulation and the quality of that exposure. Our medical colleagues have begun using patient simulation for high-stakes testing; however, differences exist between the two professions in the use of simulation: Simulation has been used longer in medicine. It is used differently; that is, physicians diagnose and independently treat, whereas nurses are process oriented.
Simulation operators tend to be hired into that position exclusively and are specialized; nursing operators tend to be pulled from course groups, and simulation is a responsibility added to their existing learning resource center duties. There are more nurses to involve in simulated learning! Other questions that must be considered when building a philosophy around this topic are, What are the differences between evaluation and testing? Can students be tested or evaluated in small groups, or does this need to be done individually? Do schools have the resources to do this? How do faculty ensure that evaluations are objective? Is the scenario captured on video for review? Could the planned evaluation or testing occur with lower fidelity simulated experiences while maintaining the high-fidelity environment for a safe learning environment?
Final Thoughts So many questions, so few answers. I hope that this review of the recent Listserv discussions has stimulated you to consider how your program uses simulation. In the beginning, simulation faculty relied almost solely on trial and error to determine best practice. Now, more of us are in place and questioning the status quo. You are challenged to be intentional in your decision-making processes and to share what you do, both the successes and the disappointments, with others. Most important, contribute to the Listserv discussions and submit articles to this journal. We all know there are huge gaps in the literature for what we do: Help fill in those spaces. Kim Leighton, PhD, RN, CNE President-Elect, INACSL BryanLGH College of Health Sciences, Lincoln, NE, 68506, USA
pp e57-e58 Clinical Simulation in Nursing Volume 5 Issue 2
www.elsevier.com/locate/ecsn
Editorial
What Can We Learn from a Listserv?
A very active Listserv is one of the valuable benefits of belonging to the International Nursing Association for Clinical Simulation and Learning. The Listserv connects members with each other, providing an easy way to network and receive helpful advice on many different types of issues. Listservs deliver e-mail right to your inbox, literally bringing the information to you! The diverse nature of our membership is evident when following the Listserv discussions. Members come with a variety of different experiences, responsibilities, and concerns. Everyone exists at different points on the novice-to-expert continuum, allowing all of us to learn from each other. Questions and concerns are posted, with responses coming quickly and from many different viewpoints. Discussions have been rich with insight, sometimes even resulting in more questions being raised than were answered! Two main types of questions have emerged on the Listserv, which follows the historical components of the Association: skills-related questions and simulation-related questions. Questions range from the specific, such as ‘‘Are wet-to-dry dressing changes still considered sterile?’’ to more general questions, such as ‘‘Are organisms from clinical areas transferred to the sim lab?’’ A recent discussion about cleaning up mercury spills from glass thermometers even resulted in some personal stories being shared that might help explain some of our individual quirks! Two topics garnered the most attention the last 2 months: simulated death experiences and evaluation of simulation experiences. Both are complicated issues that should be approached with a great deal of thought and care. No one person has all the right answers, but numerous approaches and considerations were offered by Association members. Some members are in the early stages of deciding what is best for their students, while others have shared both successful and unsuccessful attempts to incorporate these two areas into their simulations.
Should the Simulated Patient Be Allowed to Die? Questions tend to beget more questions, and these are helpful as faculty determine their own philosophy related to simulated death: Is simulated death compatible with the learning objectives for the experience? Is the death because students didn’t properly care for the patient? Or is it planned, perhaps a do-not-resuscitate (DNR) patient? Will students believe it is their fault that the patient died, and what are the implications of that? How will faculty support students in this often emotional experience? Members encouraged others to prepare students ahead of time for the possibility of death and what appropriate actions could be taken and to consider intervening with a crisis team rather than letting the patient die. Always be prepared to provide psychological support to students when they have experienced a death, regardless of whether it is in the simulation lab or in the traditional clinical environment. There are many learning opportunities that faculty have witnessed when facilitating student learning about how to care for the patient who is dying, such as providing support for family members, providing comfort measures to the patient, understanding DNR orders better, appropriately communicating with the health care provider, and providing postmortem care. Perhaps most valuable is the opportunity for students to identify and evaluate their own feelings about death.
Should We Evaluate or Test Students in the Simulation Lab? This discussion also raised more questions than it answered, providing numerous examples of what should be
1876-1399/09/$ - see front matter Ó 2009 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2008.12.002
What Can We Learn from a Listserv?
e58
considered when deciding whether to do formal evaluation or testing in the lab environment: Is the simulation lab better suited for facilitating learning or for evaluating students? Is it possible to do both? Is it fair to test students if they have not had significant exposure to simulated clinical experiences? Are the faculty all competent in their roles? How is this variable controlled for evaluation purposes? How do we account for the variety of student responses and interventions that are inherent in simulations? Are we sending mixed messages when we tell students that simulation is a safe environment to learn in and then use that same environment for evaluation? Do we test students in the traditional clinical environment? Is it then fair to test in the simulation lab? If the focus is on testing, will the experience become an experience about performing rather than about learning? What can you learn about your students in the simulation environment without formal evaluation or testing? If we say that most of the learning occurs in debriefing, can we fairly evaluate students before that debriefing occurs? Further discussion was raised about using simulation for high-stakes testing, such as the National Council Licensure ExaminationdRegistered Nurse. Many undergraduate nursing students have never been exposed to patient simulation. Not only is it still considered a new teaching methodology; it is an expensive one that not all schools can yet afford. Within existing programs that use patient simulation, a great disparity exists in how often students are exposed to simulation and the quality of that exposure. Our medical colleagues have begun using patient simulation for high-stakes testing; however, differences exist between the two professions in the use of simulation: Simulation has been used longer in medicine. It is used differently; that is, physicians diagnose and independently treat, whereas nurses are process oriented.
Simulation operators tend to be hired into that position exclusively and are specialized; nursing operators tend to be pulled from course groups, and simulation is a responsibility added to their existing learning resource center duties. There are more nurses to involve in simulated learning! Other questions that must be considered when building a philosophy around this topic are, What are the differences between evaluation and testing? Can students be tested or evaluated in small groups, or does this need to be done individually? Do schools have the resources to do this? How do faculty ensure that evaluations are objective? Is the scenario captured on video for review? Could the planned evaluation or testing occur with lower fidelity simulated experiences while maintaining the high-fidelity environment for a safe learning environment?
Final Thoughts So many questions, so few answers. I hope that this review of the recent Listserv discussions has stimulated you to consider how your program uses simulation. In the beginning, simulation faculty relied almost solely on trial and error to determine best practice. Now, more of us are in place and questioning the status quo. You are challenged to be intentional in your decision-making processes and to share what you do, both the successes and the disappointments, with others. Most important, contribute to the Listserv discussions and submit articles to this journal. We all know there are huge gaps in the literature for what we do: Help fill in those spaces. Kim Leighton, PhD, RN, CNE President-Elect, INACSL BryanLGH College of Health Sciences, Lincoln, NE, 68506, USA
pp e57-e58 Clinical Simulation in Nursing Volume 5 Issue 2