“Simulation allows students to develop their critical-thinking skills,” says Joan Fedor-Bassemier, MSN, RN, assistant professor of nursing and simulation coordinator in the Dunigan Family Department of Nursing and Health Sciences at the University of Evansville (UE) in Indiana. “Our students are really excited when they have a patient in the clinical setting with the same signs and symptoms they had during a simulation, and they know what they are expected to do.” Fedor-Bassemier, along with assistant professors of nursing Donna Cobb, MSN, RN, and Melissa Rea, MSN, RN, have integrated simulation into the school’s curriculum.
Achieving Benefits of Simulation
Fedor-Bassemier says UE was an early adopter of the Simulation Learning System (SLS) and the educational electronic health record (EHR) SimChart. “We started using them as soon as they became available,” she says, adding that the nursing school was already using Elsevier electronic textbooks and HESI testing. “We have had very successful implementation with our students for both on-campus and off-campus clinical experiences,” Fedor-Bassemier notes. Simulations start during students’ freshman year.
Better critical-thinking skills are important because, as Fedor-Bassemier says, “On NCLEX, you have to demonstrate how to problem solve and think critically. You can’t just memorize.” Simulation provides other benefits too. “It gives the students a lot of self-confidence, and it’s a safe learning environment,” Rea says. “If they make mistakes, they can see the skills they need to practice, and they can do that before they care for a human.”
Cobb adds that students can practice more than hands-on clinical skills. “We might require them to call the physician so they can practice their communication skills, or we might throw in a safety situation that you can’t control in the clinical setting,” she says. “We can make sure students get the practice they need.”
Simulation also allows students to gain experience in areas where they might not have a real-world opportunity to practice their skills. “We recognized, as a faculty, a few years ago that our pediatric scores on HESI weren’t as high as we would like them to be,” Rea says. “Fewer and fewer children are being admitted to the hospital, and they aren’t staying long, so our students’ exposure is limited in the number of pediatric patients in the hospital and the different pediatric issues and problems.” To combat the problem, the faculty added pediatric simulation to both semesters of students’ junior year and ensured the content also was covered well in the classroom. “They are getting so much more exposure to pediatrics, and our HESI scores have improved,” Rea says. The school’s NCLEX® pass rate averages are at or above state and national averages.
Creating the Simulation Experience
The UE nursing faculty strive to align simulations with content being covered in class. Students are asked to read the patient information part of scenarios at least 24 hours before the simulation experience, so they are prepared. “We want them to be familiar with the patient’s EHR,” Rea says. That way, students can review medications or procedures that are unfamiliar to them ahead of time.
Faculty, particularly Fedor-Bassemier, have to prepare as well. In addition they must make a moulage for the manikin, “You have to make sure everything is set up, get the paperwork sorted, and gather all your supplies,” Rea says.
One area that does not require prep time is creating the scenarios because faculty use the ones built into SLS. “They are so well developed from beginning to end that I have to make few modifications,” Fedor- Bassemier says. “Everything I need is there.” Rea adds that the scenarios also help faculty members meet their goal of incorporating cultural aspects of care throughout the program’s four years. “We love how the simulations already have a lot of cultural components and psychosocial issues,” she says.
About five to seven students participate in a simulation, and they rotate through roles, including nurses, visitors, and observers. “We give the overview of the situation, and the faculty give an RN-to-RN report at the bedside because that’s how our community hospital partners do it,” Fedor-Bassemier says.
The simulation, which lasts about twenty minutes, is videotaped, so faculty and students can watch it during the debriefing held in the adjoining classroom.
Providing a Powerful Debriefing
The debriefing session takes at least thirty minutes. UE faculty members feel this is a vital part of the simulation experience and welcome SLS tools, such as guided discussion questions, that help them make the debriefing highly effective. Faculty supplement the SLS questions with their own methods for encouraging self-reflection and insight, such as, “Tell me about the knowledge, skills, and experience that have helped you provide patient care during the simulation experience,” “Tell me what influenced your actions during the scenario,” and “Talk to me about your personal values and beliefs that influenced your actions.” Rea notes that during debriefing, students “can critique each other and themselves,” including identifying areas for improvement, to facilitate learning.
Students do not receive a grade for simulation, but “every simulation counts toward the clinical grade, so they are expected to come prepared, having read SimChart and thus being prepared in terms of delivering care,” Fedor-Bassemier says.
UE faculty have found that SLS helps in creating teamwork and interdisciplinary relationships. One simulation included students from two courses: one psychiatric mental health and the other a medical and surgical introduction to pediatrics. “We didn’t have to write the scenario; it was already there,” Rea says. The family in the scenario was from another culture and had a child who died. Now another child was in the hospital. “Students had to incorporate grief management and crisis management as well as provide hands-on medical care,” she notes.
“It was the first time we had ever done that, and we’re going to do it again in the future,” Rea adds. “We always talk about how, within nursing, you don’t separate mental health from med/surg because they oftentimes are together; the students got to see that firsthand.”
Faculty also held their first interdisciplinary simulation, which included physical therapy and physical therapy assistant students. “It was exiting to see two disciplines doing a simulation together as students,” Rea says. Faculty chose the SLS simulation of a patient with a hip fracture. “It’s very realistic,” Rea notes, adding, “it makes sense for them [nursing and physical therapy students] to interact because that’s how it is in the real world.” The faculty plan another interdisciplinary simulation.
Maximizing EHR Value
UE faculty have found SimChart valuable for student learning in the classroom, in simulation, and in clinical experiences. Rea recounts that when one hospital was changing computer systems, the administrators did not want students to document in the EHR. During that time, she says, “We solely used SimChart for all the students’ practice charting. It’s very realistic and helpful.” Students now document patient data in the hospital’s EHR but continue to use SimChart for care planning.
Cobb, who teaches a physical assessment course with a skills lab, but no clinical component, finds SimChart ideal for maximizing learning. She enters assignments into SimChart, so after students practice their skills, such as listening to heart and lung sounds, they can document their findings. “The proficiency is not only listening to sounds on the manikin and identifying the sounds, but they then have to document what they found,” she says. “Over the course of a semester, they build a head-to-toe assessment that they submit as their final assignment for the course,” Cobb says.
Cobb took a similar approach for a sophomore pharmacology course. The students were assigned a patient in SimChart who required an intramuscular injection, eye drops, PRN medications, and routine morning medications. “They did the medication administration and then documented it,” Cobb says. “It made it so much easier for us, and students got to do a variety of mediation administration.”
SimChart also yields benefits for faculty. Cobb notes that since it was implemented, the time it takes for her to grade a student’s in-depth case study for a complex patient went from as much as an hour and a half down to about thirty minutes. “Students don’t miss data, and the flow [in SimChart] helps students with the flow of their thoughts,” she says.
Enriching the Teaching Experience
Fedor-Bassemier, Cobb, and Rea are passionate about teaching. “It’s very gratifying to know that you’ve helped somebody to learn and understand a concept—and know that they are then going to go out, and patients are going to benefit from all these people you have educated,” Cobb says. “I really enjoy those light-bulb moments when you have a student who ‘gets’ something,” Rea says. “It’s so rewarding to see somebody understand a new concept, to apply it, and use it clinically; there’s nothing like it.”
Fedor-Bassemier, who has been in nursing for forty-one years, says that when she started teaching as an adjunct, “I found a new energy, a new excitement, a new passion for me to continue learning, so I then wanted to turn around and give back and share my experience with students to help pave the way for their transition to becoming professional nurses easier.” In addition to teaching students, Fedor- Bassemier takes manikins on the road to local schools to encourage others to explore nursing as a career.
The UE faculty value what simulation brings to their teaching experience. “Simulation is never boring; it’s always exciting,” Fedor-Bassemier says. “You can do the same simulation multiple times, and it can go in entirely different ways, depending on the group of students. I love it.”
Cobb, whose simulations often involved complex patients, appreciates “the ability to stop and step back and say, ‘Let’s think this through,’ which you obviously couldn’t do with a real patient,” she says. “That’s what I really like about simulation. You can take a step back and listen to the thought processes everyone’s having.”Download