International Nursing Association for Clinical Simulation and Learning 2019 Day 2 Recap
Yesterday in Phoenix Arizona, day 2 of INACSL 2019 opened with a keynote from United Nations Medical Director Dr. Jillann Farmer, MD on crossing boundaries of “Leadership in Healthcare”. The International Nursing Association for Clinical Simulation and Learning celebrated its annual event to over seven hundred Healthcare Simulation champions from around the world. Here we cover the keynote address and showcase some of the nursing simulation presentations provided throughout the three day event.
Leadership in Healthcare: Lessons from the UN
Dr. Farmer’s keynote discussed how leadership can be challenging, and requires awareness of both yourself and those around you. Her talk explored leadership challenges and shared how to apply them to our educational practices, describing key leadership competencies and challenges. Highlighting elements that are applicable in simulation educator roles, she shared how to appreciate the importance of intentional practice of leadership. Identifying technical challenges vs complex challenges, Dr. Farmer explained how the UN had to become adaptive in leadership because of the multitude of sovereign member states they support.
She reminded the audience that the more we connect with our team to understand their reality, the more credibility we gain. In other words, we must become what our team needs, not what they want, and to do that we must know them. “Leadership is not the same as command” she explained, remembering that “if you want to go fast, travel alone – but if you want to go far, travel with others”.
Jillann shared how her journey into leadership has helped the UN cease low value work, delegate low risk / high volume work, implement credentialing, incorporating medical records, identify system health risks, develop nursing posts, and established the first UN Simulation training programs in Entebbe Uganda, which is hiring its first Simulation Program Director.
Awards Given During Keynote Ceremonies
- Dr. Mary Ann Shinnick, PhD and Dr. Michelle Aebersold, PhD, RN won the first INACSL Excellence in Research Awards
- Dr. Carrie Eaton, PhD won the Excellence in Academia Award
- Dr. Susan Prion, PhD won the Service Award
- Dr. Penni Watts, PhD won the Spirit of Leadership Award
- Syretta Spears, MA won the Frontline Champion Award
Example of INACSL Presentations
Building a strong simulation center staff: Lessons in operations (Scott Crawford, MD, FACEP, CHSOS): Simulation centers support a variety of educational missions, including primary training to enter practice, hospital-based refresher training, or community and ancillary testing and training. All simulation activities require organizational, administrative and technical expertise to support each educational mission. This session provided an overview of simulation center organizational structures including the creation and implementation of an organizational chart to ensure each individual is fulfilling their full potential. Skill expectations of all faculty and staff that are responsible for supporting the larger mission will be presented. Individual functions for the specific roles and titles in simulation were described and showcased as they relate to a cross-section of job descriptions and job announcements posted for simulation centers around the world.
Improving patient outcomes by using simulation education to teach the Modified Early Warning Score (MEWS) as a strategy to quantify patient decline (Helen Stacks, DNP, RN-BC, NEA-BC, CHSE): This presentation described how the Inova Health System used multi-modal in-situ simulation as an efficient and effective way to teach hospital teams how to use the Modified Early Warning Score(MEWS). MEWS is an evidence–based scoring tool, based on vital signs and level of consciousness that can quantify and identify patient decline. Our health system wanted to improve patient outcomes , especially in the management and recognition of sepsis with co-morbidities. Sepsis is one of the most common reasons for patient decline. An interprofessional team of medical and nursing staff worked with simulation facilitators to create in-situ simulation experiences based on prior case studies. Healthcare teams were taught in simulation how to leverage MEWS calculations in our electronic health record, and use scores to trigger further evaluation. Learners simulated calls to Rapid Response RNs who would evaluate further, and if needed, adjust the plan of care, or call for further critical care evaluation. After MEWS implementation went live in our pilot units, the departments saw a 51% decrease in unplanned admissions to higher level of care and subsequent reduced mortality from sepsis. MEWS education and implementation has now spread throughout our 5-hospital system with continued improvements in patient outcomes. Participants in the education and roll out units have complemented the education, commenting it was one of the best education and roll outs they have ever had. In addition, they have also shared that they now feel ‘safer’ in the care of their patients.
Implementing a virtual telehealth simulation in an undergraduate nursing program (Elizabeth Burrows, MSN, RN): As the population ages, instances of care in the home are increasing, though nursing education continues to focus on inpatient clinical education. Smith and Barry (2013) outlined the need for nursing educators to include community-based clinical experiences to meet the needs of future nurses. While telehealth is a popular tool for providing care virtually to the home-based setting, it is rarely used in nursing education or in simulation. Telehealth is a virtual modality used in hospitals, rehabilitation centers, and outpatient clinics that allows providers to remotely communicate, assess, and determine a plan of care for patients. A pilot project was developed to provide an educational experience introducing telehealth to undergraduate nursing students. Students viewed the telehealth interaction independently, then had a multi-step assignment to complete. This assignment included the students capturing a video of themselves providing patient education as if they were the telehealth nurse, among other objectives. The completed student assignments demonstrated a continued need for instruction in the areas of prioritization and determining the appropriate level of care for a patient. Compared to pre-survey results, students felt more confident in completing an assessment, providing client education, and discussing family dynamics after completing the assignment. Students also reported an increase in their ability to communicate via video technology and reported a stronger understanding of the use of video technology in health care delivery. The student outcomes reported for this telehealth simulation learning experience support creating additional telehealth simulation assignments to meet the needs of nurses and communities.
Enhancing exposure for your simulation laboratory using the 7Ps of marketing (Debra Alexander, MSN, RNC-OB): In a competitive market, there are several different choices in pursuing a nursing degree. Nursing programs want to attract the brightest students. In order to do so, nursing programs need to use strategies commonly used by other professions to showcase their programs. When thinking of a nursing program as a consumer product, one can apply the marketing mix (7Ps) conceptual framework to gain exposure for simulation laboratories. The 7Ps of marketing include: product, price, place (or distribution), promotion, physical evidence, process, and people. The purpose of this project was to describe the benefits and implementation plan of the 7Ps in terms of target audiences (children, prospective students, alumni, donors). For example, we designed tours showcasing our nursing program (product) is cost effective (price), targeting groups of consumers differently (distribution), by provided by knowledgeable (promotion) and personable (people) in the simulation laboratory (physical evidence) that describe the use of the laboratory space (process). By creating individualized tours that fit consumer needs (length of time in the laboratory space, hands-on, or demonstration only) we are honing in on the “it” factor that helps make our program stand out on campus and in the community. As a result, there has been tremendous growth of our tours from few campus tours to 320 elementary school student, 220 high school students, and 80 prospective nursing students in one semester. The 7Ps of marketing have the potential to enhance exposure of simulation laboratories on campus and in the community.
Using intraprofessional collaboration to improve clinical competence and confidence: The hospital simulation experience (Jaimee Kastler, PhD, RN, CHSE): First-semester students entering a local baccalaureate program have limited to no experience in the clinical setting. Students report feeling ill-prepared for the clinical setting, not knowing how to enter rooms, what to expect when they see the patients, and how to interact with the patients and staff. This effects the students’ confidence, willingness to assist staff, and performance in clinical as well as the ability for them to meet their clinical objectives. Faculty spend valuable time walking students into patient rooms and instructing them on how to interact with patients and staff. Aim: The purpose of the hospital simulation was to improve student confidence and competence at clinicals. Method: Using Bandura’s social cognitive theory as a foundation, faculty matched graduating seniors with incoming juniors to provide care to eight volunteer “patients”. The volunteers were trained on the purpose of the simulation, roles, and learner expectations. Lab staff set up 2 rooms as hospital units. Task trainers were used for IV starts and indwelling foley insertion. Moulage allowed for wounds, incisions, soiling of dressings, and urine output. Sim pads and monitors allowed for manipulation of vital signs. 79 first semester students acted as student nurses and 55 second-semester leadership students acted as primary nurses or charge nurses, rotating through 2-hour shifts. First semester students followed the primary nurse, observing and assisting in patient care and communication. Results: Faculty reported students being more confident in clinical, more assertive and willing to answer call lights and provide basic nursing care without coaxing.
Exploring faculty perceptions about simulation training: Influence on career, confidence, knowledge, skill acquisition and competence (KT Waxman, DNP, MBA, RN, CNL, CENP, CHSE, FSSH, FAAN): Supporting evidence as to the best practices for faculty development, is well published. A gap exists on how simulation education training has influenced faculty career fulfillment, acquisition of knowledge, and overall self-confidence and competence. Purpose: The purpose of this qualitative study was to query faculty participant cohorts who completed the structured comprehensive California Simulation Alliance three-day training to understand the influence of education and training on faculty career fulfillment, acquisition of knowledge, overall self-confidence and competence. Methods: 113 participants who participated in the training over a period of two and a half years were invited to participate in focus group interviews. Semi-structured interviews were conducted using an interview guide. The questions were reviewed by a research methodological expert and revised based on the feedback. Results: Four focus group sessions of three hours at each session were completed. All interviews were recorded (audio) and transcribed. The data was coded and aggregated. Qualitative text analysis with MaxQDA was used to identify themes and key issues from the focus group notes. Conclusion: This study assisted to shed light on area of skill acquisition, competence, confidence and career footprint following training. Surprising new themes emerged regarding incompetence and “humility threshold”. As individuals increase skill level, one learns the better you get, the more incompetent you often feel. As the study results disclose, ongoing faculty development is critical to the success of simulation programs and assisting faculty to achieve an expert level toward successfully implementing simulation activities improving student, faculty, and program outcomes.
Building an interprofessional education experience using INACSL Standard: Simulation-Enhanced Interprofessional Education (Susan Eller, MSN, RN, CHSE): Simulation-based education allows for an immersive learning experience that can translate into improved patient care delivery and patient outcomes. It is used in both the academic and the in-service arenas to prepare healthcare providers and maintain skills and is often used for clinical replacement time. For the most part the training is done with single disciplines. The reality though is that interprofessional teams deliver most care. “Interprofessional learning is dependent on opportunities for learners to learn with, from, and about each other.” (World Health Organization, 2010). The simulation community has embraced Interprofessional Education (IPE) and there is now the INACSL Standards of Best Practice: SimulationSM – Simulation-Enhanced Interprofessional Education (Sim-IPE). INACSL guidelines include: conducting Sim-IPE based on theoretical or conceptual framework; utilizing best practices in the design and development of Sim-IPE; recognizing and addressing potential barriers to Sim-IPE; and having an appropriate evaluation plan for Sim-IPE. There are numerous challenges with IPE, which must be addressed and carefully considered to ensure successful outcomes. A primary barrier to IPE is scheduling all of the groups. Other challenges include creating a meaningful scenario for all of the participants and having instructors who are able to both facilitate and debrief interprofessional groups. This presentation provided an overview of what IPE is and offer practical advice for implementing it in your facility based on experiences using the Crisis Resource Management Framework (CRM) as a conceptual model at both an academic institution and from an in-hospital simulation program.