Simulation Centers and Faculty/Staff Development

 
 
 
My colleagues and I would like to "sound out" the simulation community and ask: During the simulation experience, do you find it beneficial to be in the room with your students or outside the room, observing? Some instructors feel that they are a distraction if they are in the room with their students; others feel it helps to catch those teachable moments "then and there." I was wondering what the prevailing wisdom is on this topic. We are having a difficult time finding any research on this. THANKS!
 
 

HI Allison,

I can speak to our process, that is we have faculty outside of the immediate area, either observing in the control room, or faculty acting in support roles to assist the scenario should it be that complex.  We find the faculty become a crutch to the student and are relying on them for information and how to proceed, rather than just utilizing their knowledge and skills to care for the patient.  So a "cutting of the umbilical cord" to the instructor as it may seem. In areas where the student has a question re location of a supply item or other need, myself or one of my colleagues steps in as the support role, (Unit coordinator, nursing assistant) to help guide the student to those items...we also do not prompt or cue the students during the scenario, just so we can gauge the level of understanding, preparation and such. Students make the decision when to ask or call for ancillary assistance based on the care and patient presentation provided.

Hope this helps!  Good luck!

Wendy

Wendeline J. Grbach, MSN,RN,CCRN,CLNC

Curriculum Developer for Simulation Education

UPMC Shadyside School of Nursing

Pittsburgh, PA

 

Wendy, I love your analogy of "cutting the umbilical cord". I agree. Also, the pressure of "going it alone" should not be new to them when they are released as new nurses. Thinking under pressure now will help them think through situations when the real pressure is on.

Theresa Dember-Neal BS,RN

 
Thanks very much Theresa!  And as others have spoken before, those teachable moments??  We also video and playback in debriefing and use that as the opportunity to fine tune process  discuss alterations needed, and safe practice goals.
 

I have been teaching with simulation for 7-8 years and I have experienced a range of methods. When I started, I was at the bedside and caught those teachable moments. I found that as I left the bedside, I saw the students asking the questions of each other and using their resources to find the answers. In general, being in the room with the students is a distractor, I feel. Students will find their own resources when left to do so and that is what we want. They can also make their own mistakes and witness the results. I take notes while watching so we can review everything in debriefing. Recently the addition of audio/video recording was made to our center so I can tag certain events and play them back in debriefing to make a point.

I also have a colleague that successfully stays in the room as a mother at the bedside and a charge nurse. In the mother role, she wears a hat. While in that role, she does not answer questions until the students have exhausted their resources. Generally, they do not need her to answer their questions and if she feels they haven't exhausted their resources, she tells then in her character role, "I wouldn't know the answer to that, maybe you should ask another nurse." When she does see they need assistance, she removes her hat and asks some questions of them to point them in the right direction or resource to find the answser.

Generally, I advocate for staying out of the room unless you can develop the ability to stay firmly in the role of the family member.

Jodi Nelson, MSN, RN, CNE

BryanLGH Center for Excellence in Clinical Simulation

BryanLGH College of Health Sciences; Lincoln, NE

jodi.nelson@bryanlghcollege.edu

 
We usually stay out of the room and watch the video and mark the times we want to discuss during debriefing and then discuss any learning at that time. That way we are not in the room with them at all unless we are playing a confederate role, but we don't go out of character. We were trained to do simulation this way; the learning should be happening in debriefing and let the students perform uninterrupted, then discuss any issues during debriefing. Hope this helps.
 

We try to stay out of the room. We will occasionally have a faculty member act as a charge nurse if there is a need, but they are in and out of the room quickly. Any teachable moments are discussed in the debriefing period. 

Dustin Hicks RN, MSN

Meridian Technology Center

Stillwater, OK

dustinh@meridiantech.edu

 

I stay out of the room. I find that if the students are able to see me, that they look to me for guidance and answers.  We have the video/ recording equipment and I am able to bookmark any parts of the simulation that I particularly want to discuss ( good or bad) and can do so during debriefing. I feel that this makes for a more  enhanced learning experience for the students.

Cynthia B. Cole

Nursing Simulation lab Specialist

Southern Virginia Higher Education Center

cynthiacole@svhed.org

 

I agree with Wendy re: faculty presence interfering. Students will automatically look at the faculty when they are unsure, rather than trying to think it through. We  also utilize a similar process. We have faculty watching & listening  via computer streaming, then they debrief the students immediately after. We also sometimes show the video to the students and debrief - that allows you to capture (replay) those teachable moments, while not interfering with the actual sim experience.

Deb Bambini, PhD, WHNP-BC, RNC

Grand Valley State University

Grand Rapids Mi

 
I really appreciate this discussion. I would like to branch into another related area. I am the coordinator of the Sim Lab at a Career and Tech Center (Practical Nursing Program). We usually have an enrollment of 280 - 300 students. Some of the faculty members seem to have the attitude that since I am the "Sim" instructor, I should do all the work related to the simulation (I am the only fulltime instructor in the lab. I have a very parttime who covers for me when I am off).  I am not the content expert. It is overwhelming to set the scene,  operate the computer, talk for the patient (manikin), watch the actions of the students, and do the debriefing. Can you share with me how you all coordinate simulation? Who writes the scenarios? Who implements the scenario? Who is the patient's voice? Who does the debriefing? How do you get the other faculty on board??? Thanks so much!
 

I am a PN Faculty member and resident "Sim" champion for our school. We do not have any full or part time faculty dedicated to our lab. Our enrollment is far less than what you have. Our simulations are integrated into the curriculum with dates set on the student calendar. Students sign up on specific days/times for when they would like to complete the scheduled simulation.

When working with other faculty in developing scenarios I start off by discussing which objectives they wish to cover in the scenario, what the overall feel of the scenario should be, and which specific tasks the students should complete.  This forms as a basis of how I develop the scenario. (I try to allow 1-2 weeks of development time prior to using the scenario since I also teach in the classroom and in clinical).If there are areas with specific diagnostic test reports, supplies, equipment, etc. that need to be included that I am not completely familiar with (OB information for example) I will have the faculty assist in providing that information/equipment for me. Once the scenario is developed and ready to run a faculty member is present when the students work through the simulation. I will set up and run the mannequin and speak through him as the patient. The faculty member watches the students and is the primary debriefing facilitator. I will often assist with debriefing once the audio/video system starts saving the recordings.

I think it is important for the faculty to be present during the scenarios to make sure it covers everything they want it to. If any major changes or additions need to be made they can recommend them as they see the need within the scenario. Also if there are specific questions asked during debriefing related to information that I am unfamiliar with, the course faculty can provide the information the students need.

This is our first year of having simulation incorporated into our program and this seems to be working for us so far.

Dustin Hicks RN, MSN

Meridian Technology Center

Stillwater, OK

dustinh@meridiantech.edu

 

Cheyryl, I feel your pain. Initially we rounded up a few people who were willing to be the champions of simulation, initially dubbed The SimMan Committee (2004). This group consisted of a few faculty and one staff member. We created 1 scenario modeling it after a case study on septic shock we found in the RN edition of Content Mastery . One of the faculty champions decided to run the scenario with her group. The student did the rest. All of the students who did not get to work with the simulator asked "why arent we working with SimMan?" The fire started with them. Little by little scenarios were added. The staff RN member who worked in the lab took great interest in simulation and started to take courses and attending seminars on the subject, bringing back liturature about simulation and distributing research articles to support its use in nursing. The Nursing Administration saw the value and gave much needed support. We now have a full time simulation person, who coordinates simulation activities, writes and co-writes scenarios, trains faculty and staff in the use of the simulators, programs scenarios, runs the simulator, is occasionally the voice of simman when the students ask a question there is no programmed response to. The faculty facilitate and debrief most of the time. Each faculty member is trained by the simulation coordinator in the use of the simulator, including how to run it, format of the activity and debriefing. We have 5 room which can be used simultainiously. each room is set up with a skill or lab activity. Every 45 minutes the student rotate to another station. one of the stations is the where the scenario takes place. Many faculty volunteer to do extra sessions with the students called SimTuesdays events.

Format (approximation)

Report: 5-10 minutes

Scenario: 15min

debrief: up to 25 min

Just to encourage you, nothing we did was original. We played a good game of follow the leader. Pam Jeffries book Simulation in Nursing Education, NLN Summit Sessions on simulation, the SIRC site with all of the wonderful classes, the journal on Simulation in HealthCare and all the free templates we could get our hands on!

I gave it to you as short as I could. I left out many details. But, I hope it helped

Theresa Dember-Neal BS,RN ISS

 
Thanks to everyone who has shared! I think that the faculty need more training. A year ago, I asked for a faculty inservice on the subject. Finally we will be having that in April...only 2 hrs...but at least it's a start! I think that perhaps I did the faculty a disservice by not getting them more involved. I continue to grow and learn. I have learned so much through books/journal articles/ and conferences on the subject. Mostly I have learned via List Serv such as this one. I need to back off and get faculty more involved. I also need to have a meeting w/ my director so that I have administrative support! Thanks again!
 

Cheryl,

It is learning by trial and error. It's hard to let students function so independently. I'm glad you're utilizing the resources and working hard to get those around you educated also. I'd like to recommend a simulation certificate program. You can find information about it on the Bryanlghcollege.edu website. It's a 9 credit hour program and many doctoral programs are accepting the credit hours.

Jodi Nelson, MSN, RN, CNE

 

Great Job Cheryl! approveWhen you have your meeting, dont forget your documentation on the benefits of high fidelity simulation. You will find that the faculty really want the best for students. So, it will take some time but you will get them on board if you show them the evidence.big grin

 

    I am THE Sim person in our Lab, also.  We have 50-60 students per class in our ASN program.  When we first received our SimMan, I had a desk in the room to use and students were told I was "not really there."  My husband later built a small "cubicle" to put around my desk with a small smoke glass window.  Not a control room, but what a difference!  The students stopped looking at me for guidance, and talked among themselves.  I only interject when the students are totally stumped, and then only to give a little push in the right direction.  They are only to ask for things they can't find, not to ask any care questions.  Almost all my teaching moments are done during debriefing as we review the video.  I don't have faculty help because students come to me a few from each clinical group during regular clinical time, and most faculty are on clinical or in class with their own students.

   I have inserviced our faculty on how to write a scenario, but realistically they give me a general idea, and I do it.  Faculty are good at giving suggestions when I have specific questions.  I also look to the Medical Center we are affiliated with for their protocols and such.  We did purchase the NLN Scenario sets which has helped a lot.  They are a good starting point.  My voices I pre-record so the students don't just hear my voice (I'm not an actress after all).  I've used my husband, my son and my daughter-in-law for voices.  I also have a wireless phone that is connected to my desk by the intercom button and that way students can call the doctor, call the labs, etc, and call report to the various units to give report.  I am the person at the other end.  That has really helped them practice something they never get a chance to practice at the Medical Center.  Hope this helps! 

Denise Maxwell, MS, RN

Nursing Lab Coordinator, Trinity College of Nursing & Health Sciences, Rock Island, IL 

maxwelld@trinityqc.com

 

Denise, I was in a similar situation as the single SIM faculty until about a year ago. Work in a Diploma program of anywhere from 350-500 students. Scenario writing/ development was me, in collaboration with course faculty who requested situations based on the curricular content for that session, or specific objective skills.  Our Sim time is designated as clinical time and we have just begun formally evaluating the students performance in the lab, and incorporating that into the clinical evaluation for the week.  Vocalizations by the patient, ancillary staff, whomever also was me, as we also allow the student to self decide when and if assistance is needed, and they can make the phone call....I am located in the control room as that individual, as well as running the programming. Agree that they have little opportunity to do this in reality but are much more capable of communications at entry to practice due to our inclusion of the experience.  Recently have adapted to add clinical faculty or course coordinator assistance where we can for consistency in evaluation opportunities, and to enable transfer of areas for development to be incorporated into the next weeks clinical experience...(So if a student is week in assessment, that becomes the focus of the clinical instructor for follow-up development.)

I have a colleague who joined me in FT Sim about 1 1/2 years ago as just too much activity for one person.

We did not purchase the NLN scenarios, and have adapted some of the Sim Man 3G sessions to meet our needs, from a content standpoint. 

Wendy

 

I find it is difficult for the student to suspend disbelief, and to keep the critical thinking part of the process engaged if the instructor is in the room. They always turn to the instructor to ask a question, even if they are told the instructor is not available for questions during the scenario. Their automatic response is to try ask the instructors questions. I feel the instructor should be out of the room. 

Theresa L. Dember-Neal BS,RN

 
Hey everyone -- thanks for all of your input! This is great information -- I will share with colleagues.