Facilitating Learning in the 21st Century

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Table of Contents

Identify Educational Innovations
Identification of Course Title
Peer Feedback Solicitation
References

Healthcare system complexities call for innovations in nursing education to cater to the learning needs of aspiring nurses. Innovative changes in the teaching environment will ensure clinical knowledge acquisition and student engagement. Consistent with the national focus on quality and safety, providing a safe environment that supports experiential learning without compromising a patient’s health is essential. Simulations represent an innovation that allows learners to apply acquired clinical knowledge through real-life situations (Zulkosky, Husson, Kamerer, & Fetter, 2014). This course – Nursing Fundamentals – will employ simulated environments as a pedagogical approach to practical learning in clinical settings.

Identify Educational Innovations

A core element in nursing education is the application of knowledge and skills in practice, primarily through live clinical placements. However, with technological development, simulation/gaming strategies are identified as educational innovations that can be used to impact student outcomes positively. They offer a rich environment of patient care scenarios that replicate reality and interactive learning for nursing students (Zulkosky et al., 2014). As a result, they improve the clinical skills, critical thinking, and self-confidence of students, making them competent in safe patient care.

Current Usage of Innovation

The usage of high-fidelity simulation in nursing education is growing. It has already been infused into accredited nursing programs offered by reputable institutions. Among the organizations currently using this innovation are the John Hopkins School of Medicine (JHSM) and Duke University. It has been integrated into core courses such as anatomy and casualty.

JHSM’s Simulation Center is a product of collaboration between John Hopkins medical school and the hospital. It is a part of the International Network for Simulation-Based Pediatric Innovation, Research, and Education (INSPIRE) program. The center offers training that includes simulated standardized client/teaching associates, human patient simulation, virtual reality, and task trainers (John Hopkins Medicine, 2019). Through role-playing involving clinicians acting as patients, the students can learn physical assessment and communication strategies. High-fidelity simulators and mannequins allow them to learn procedures such as intubation. Learners also practice catheterization and IV placement through virtual reality simulations. Further, computer programs are available for practicing decision-making skills in critical care domains like trauma management (John Hopkins Medicine, 2019). The goal is to enhance patient care safety through exposure to clinical simulation exercises. Nursing students are taught critical clinical skills, including diagnosis, via video assessments.

Duke University’s Human Simulation and Patient Safety Center (HSPSC) seeks to enhance patient safety and care through inter-professional collaboration. Nurse educators, clinicians, and students work together throughout a continuum of simulated environments, including OR and ICU suites (Duke University, 2019). Simulation-based education is also offered through three multimedia classrooms at the facility. The institution utilizes virtual simulations for distance learning for its critical care nursing program (Duke University, 2019). The center is equipped to serve students from the schools of nursing and medicine via state-of-the-art simulations and quality improvement projects.

Benefit of Innovation

JHSM and Duke University have benefited from implementing simulation centers. Through the INSPIRE program, the JHSM simulation center has developed effective educational methods and simulation-based diagnostic kits for medication error root-cause analysis in clinical teams. The simulation-based program has resulted in patient safety improvement at the hospital. Through the simulations, nursing staff and students first develop familiarity with specialized clinical procedures before using them on patients (John Hopkins Medicine, 2019). Competent clinicians inspire confidence from the patient/family in the quality and safety of care offered at the facility. The educational mission of the center is to train learners on effective diagnostic methods through video assessments (John Hopkins Medicine, 2019). Requiring students to practice first on mannequins and simulated environments before moving to the patient enhances their clinical experiences. As a result, JHSM has been appointed by regulators to offer nursing certification and credentialing.

Duke University’s HSPSC is cited as an international model for simulation in academia and research. It has contributed to better patient safety and quality in the healthcare system. The simulation center has generated resources for the institution. According to the Duke University (2019) website, since its establishment in 2001, HSPSC has attracted $8.1m in extramural funding to universities from federal bodies like the Department of Defense. As a result, HSPSC has developed in-house innovations with commercialization potential. The center also funds several quality improvement projects within its health network. Implementing simulation-based education has contributed to the development of talent at Duke University, making it a leader in simulation research.

Innovation Changing Faculty Roles

Simulated clinical experiences in nursing education are associated with enhanced learning outcomes. The roles of the teaching staff are bound to change when students learn in a simulation-based environment versus an actual clinical setting. The faculty must develop a competency evaluation tool for the assessment of learners’ clinical decision-making skills, patient safety practice, and communication (Zulkosky et al., 2014). Standardized criteria such as the Creighton Competency Evaluation Instrument (CCEI) can be adopted to evaluate individual performance in simulated scenarios. The faculty is responsible for weekly student assessments based on the CCEI.

Apart from evaluation, the educators must become content experts to help design high-fidelity simulations. Thus, they will have the opportunity to review clinical scenarios to ensure their consistency with the learning goals and course guidelines in collaboration with designers. Their role also entails setting performance requirements in authentic situations. In particular, the clinical faculty must guide students and respond to content questions, program simulated clinical activities, arrange for supplies and medications required in a scenario, prepare the simulation area, orient learners on their roles, and manage the session from the control room (Zulkosky et al., 2014). The teaching staff may also encourage learners to design simulated experiences. These obligations differ from the traditional responsibilities of educators; thus, simulations are bound to change faculty roles.

Nurse Educator Preparation Strategy

Simulation is a useful innovation for developing competent practitioners. Nurse educator preparation is critical to the effective implementation of this mechanism in courses and programs. One way the instructor can prepare is by attending in-person training to acquire the specific skills required to create and use simulated activities. Train-the-trainer programs are a useful way that nurse educators would receive this education to become simulation champions in academic settings. Among the training outcomes are the ability to identify simulated educational tasks, develop scenarios, implement learning activities, and operate equipment (Haukedal, Reierson, Hedeman, & Bjørk, 2018). The program will allow one to understand how class materials are related to the simulation.

An educator can also prepare for the program by scheduling the activity to begin ahead of the course. The goal is to orient students to learning in simulated environments and relate it to the student outcomes. The approach will also allow the educator to identify resources needed for the program in advance. He or she can create a catalog of all simulations that can be offered online or through a hardcopy format (Zulkosky et al., 2014). Developing toolkits that contain instructions on how each simulated activity should be conducted and related materials is another educator preparation strategy. Instructors can visit this resource repository and use it to implement simulations.

Identification of Course Title

A nursing framework for a module will determine its content and the delivery of learning experiences. In the present case, the course is identified as Nursing Fundamentals. The aim is to incorporate simulation into the syllabus.

Identification of Course Competencies

Students must demonstrate the core knowledge and skills required to achieve each learning outcome. Based on QSEN goals, the course competencies identified for the Nursing Fundamentals course include:

The student should be able to recognize abnormal values during simulated physical assessment
The learner should perform the correct evaluation for the body organ and make an accurate diagnosis
The student should conduct procedures safely based on standard guidelines and precautions
The learner should determine and administer medications correctly and uphold patient rights
The student should demonstrate effective inter-professional and therapeutic communication when working with patients/family in simulated environments

Implementation of Chosen Innovation

The procedure for implementing simulations in the Nursing Fundamentals course will first involve the development of a high-fidelity, evidence-based scenario. For example, a simulated case involving a pediatric patient with septic shock can allow students to demonstrate the above competencies. They will first receive a learner guide on the scenario three weeks before the simulation is conducted. The document will contain preliminary questions, client medical history, and comorbidities. They will be required to work as a team during a simulated activity. Students will not be given instructions about their specific tasks; rather, they will self-select each individual’s responsibility when planning for patient care.

For ease of assessment, a cohort will be split into smaller groups of about five learners. Each unit will have 90 minutes to complete a simulated exercise. Thereafter, the group will meet with the nurse educator at the simulation bay to review student performance. Three nursing faculty members will observe all simulations from the control room to ensure a consistent evaluation process. Furthermore, each simulated activity will be taped and the video recordings reviewed to support the inter-rater reliability of the evaluators’ feedback and fairness. The evaluators will independently rate student performance and behaviors during a simulation. A standardized tool will be used for the evaluation. The evaluators will meet to discuss a student’s performance and whether he or she attains the learning outcomes or requires remediation.

Learners will receive individual feedback detailing their performance during the entire simulation. Those who fail to meet the learning objectives will be required to repeat the simulated activity. The demonstration of competencies is expected to vary between students. Some may verbalize their actions, anticipate tasks, or collaborate with colleagues to develop a successful plan of care for the patient. Other students could use data management tools, such as SBAR, to conduct physical assessments. All these behaviors will contribute to an individual’s performance in a simulation.

Peer Feedback Solicitation

The opinions and views of stakeholders on each simulated activity will help strengthen the course. One method that will be used to solicit feedback from nurse educators and peers is open forums. The action will allow peers to post and respond to comments and give proposals on how simulations can be improved. A question would be posted on the course’s page, and the faculty can contribute to the conversation. The forum will take a single simple discussion format to allow users to focus on one topic – simulations. Posts with meaningful information will be identified and used to improve innovation.

The second solicitation method will involve anonymous written evaluations. Dedicated professional feedback forms will be used to collect views on the simulation’s effect on students and faculty satisfaction. The goal is to determine the overall success of the innovation. Faculty can give anonymous comments, preferences, and experiences of the simulations and their effect on the research agenda. Further, views on unintended impacts, such as the number of courses offered in simulated environments and widespread adoption of the innovation in the school, will be collected from nurse educators. The data will help improve simulation-based teaching and learning.

Peer Feedback Evaluation

Peer educator feedback will be useful in supporting the simulation-based course – Nursing Fundamentals. However, a variation in quality is an instructional problem that may impact the implementation of educational innovation. Therefore, assessing peer feedback is necessary to determine how accurate and insightful it is to learning. One evaluation method that will be used for this course is comparing the scores/comments of three nurse educators according to a negotiated assessment repertoire. The goal is to ensure inter-rater validity of the feedback given on specific aspects of the innovation. The appropriateness, specificity, and depth of the responses will be another critical evaluation criterion. Well-articulated strengths and weaknesses of the simulations, including patient simulators, will be considered as high-quality feedback compared to superficial comments.

Predetermined evaluation criteria for the feedback will be used. The comments collected from peer educators will be categorized into views to disregard and those to use based on their usefulness and relevance. A discussion on the quality of peer feedback in open forums will also help in the evaluation. Members will provide star ratings on each comment and the top-rated responses used to improve the innovation. Through the interaction, peers will have an opportunity to defend their post and negotiate with others on its quality.

Advantages of the Chosen Innovation

High-fidelity simulations replicate real clinical cases and settings that enrich learning in a safe environment. Their use in nursing education has certain advantages. First, simulators offer a life-like substitute to patients. Nursing students can hone their clinical skills on mannequins designed to display certain symptoms, need care, and simulate vital signs as humans do. Thus, simulations prepare aspiring nurses for clinical competency in a safe environment.

Second, simulators can mimic high-risk cases, preparing students on how to handle serious clinical emergencies. They can be adjusted to simulate all manner of high-risk scenarios, expanding the scope of learning activities. The hands-on experiences may not be acquired in actual critical care settings where inexperienced nurses are not expected to practice with patients. Using simulations in nursing education gives room for students to learn from their mistakes, as they increase their knowledge and experience. Medical errors may temporarily ‘kill’ the patient simulator, but it can bounce back ready for use in another simulation activity. Although harming a mannequin can disturb a student, the experience is less distressing than when bad judgment causes complications or the death of a real patient.

Disadvantages of the Chosen Innovation

No matter how lifelike simulations used in the Nursing Fundamentals course may be, they are bound to have some limitations. First, a patient simulator is not real; thus, students may not mistake it for reality. Due to this constraint, there is a potential for learners to put in less effort than when caring for the actual patient (Garner et al., 2018). Additionally, students may underperform when the situation becomes too real due to the pressure to provide safe and quality nursing care. The same anxiety may not be experienced when practicing on mannequins. Second, clinical simulators are quite costly to acquire and maintain for the course. Setting up simulation centers requires substantial investment in software and hardware. Maintenance costs for equipment, faculty training, and repairs in case of breakdowns are also high.

Student Outcomes

Determining the impact of learning on student outcomes is a core component of assessment. According to Garner et al. (2018), learner performance at the course level depends on the instructional approaches used, including the adoption of educational innovations. One impact of simulation on student outcomes is an improvement in professional communication, a vital skill in nursing. Simulated activities will help learners to communicate better and confidently in team setup, contributing to patient safety.

The use of simulations will also affect nursing skills. Students will have an opportunity to develop proficiency in practical, cognitive, affective, and psychomotor domains in a safe environment. Practicing these skills using simulations leads to increased performance and confidence when caring for patients (Garner et al., 2018). Taking part in simulated clinical scenarios will enhance student understanding of course concepts. They will be able to synthesize knowledge and acquire a deeper understanding of the class materials using simulations.

Simulated environments will also contribute to the development of critical thinking skills, an important learning outcome associated with this innovation. Compared to a classroom setup where learning is passive, simulations promote engagement and spontaneity (Kim, Park, & Shin, 2016). Thus, using patient simulators will allow learners to make independent decisions and apply theoretical knowledge in patient care scenarios. As a result, they will develop a logical approach to clinical decision-making. The simulations will also encourage problem-solving in teams. Students in a group will learn to assign roles and assume leadership in a clinical context. The type of simulation will also impact their experience level. Patient simulators can be adjusted to reflect students’ skill levels and learning pace.

Integration of Innovation into Future Courses

Simulation-based learning (SBL) can improve student knowledge and performance in clinical practice. Integrating simulations into future courses will ensure safe, structured educational experiences for all learners. One approach to integration will involve a blended learning model where simulation-based activities are offered alongside clinical practice on actual patients. The innovation will also be integrated into future courses through content/syllabus redesign. Each module will be designed to contain a simulated project activity for students. Working with faculty members to create content for simulations and evaluate learning outcomes under a new paradigm will ensure that SBL is incorporated in all courses under the program. In this way, the innovation will be embraced by the department, resulting in changes to the traditional methods of pedagogy.

References

Duke University. (2019). About the Duke human simulation and patient safety center. Web.

Garner, S. L., Killingsworth, E., Bradshaw, M., Raj, L., Johnson, S. R., Abijah, S. P., … Victor, S. (2018). The impact of simulation education on self‐efficacy towards teaching for nurse educators. International Nursing Review, 65(4), 586-595. Web.

Haukedal, T. A., Reierson, I. A., Hedeman, H., & Bjørk, I. T. (2018). The impact of a new pedagogical intervention on nursing students’ knowledge acquisition in simulation-based learning: A quasi-experimental study. Nursing Research and Practice, 2018, 1-10. Web.

John Hopkins Medicine. (2019). John Hopkins medicine simulation center. Web.

Kim, J., Park, J., & Shin, S. (2016). Effectiveness of simulation-based nursing education depending on fidelity: A meta-analysis. BMC Medical Education, 16(152), 1-8. Web.

Zulkosky, K. D., Husson, N., Kamerer, J., & Fetter, M. E. (2014). Role of clinical faculty during simulation in national simulation study. Clinical Simulation in Nursing, 10(10), 529-531. Web.

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