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Inacsl standards presentation
1. The International Nursing
Association for Clinical
Simulation and Learning
(INACSL)
Standards of Best Practice:
Simulation
2011
Pearson Faculty Development March 23, 2012 Fort Lauderdale
2. Presenters and Disclosures
Laura Gonzalez PhD, ARNP, CNE
INACSL Chair of Education
Assistant Professor of Nursing, University of Central Florida
Disclosure: Pearson Faculty Consultant & Contributor
Pearson Faculty Development March 23, 2012 Fort Lauderdale
3. Mission and Vision Statements
The Mission of INACSL is to promote research and
disseminate evidence based practice standards for
clinical simulation methodologies and learning
environments
The Vision Statement: Nursing’s portal to the
world of clinical simulation pedagogy and learning
environments
Pearson Faculty Development March 23, 2012 Fort Lauderdale
4. Development of Standards
2 Years
Survey to INACSL Membership
Committee Draft
Peer Review
Final Draft
Publication – Summer 2011
Pearson Faculty Development March 23, 2012 Fort Lauderdale
5. Special Thanks to the 2009-2011
INACSL BOD
Teri Boese, MSN, RN
Jimmie Borum, MSN, RN
Janis Childs, PhD, RN
Sharon Decker, PhD, RN, ANEF
Jana Faragher, ND, CNS, RN
Cheryl Feken, MSN, RN
Teresa Gore, DNP, APRN
Nicole Harder, PhD, MPA, RN
Beverly Hewett, PhD, RN
Valerie Howard, EdD, RN
Pearson Faculty Development March 23, 2012 Fort Lauderdale
Kim Leighton, PhD, CNE, RN
Colleen Meakim, MSN, RN
Meg Meccariello, MS, RN
Patricia Ravert, PhD, RN, CNE,
ANEF
Leland (Rocky) Rockstraw, PhD,
RN
Carol Sando, PhD, CNE, RN
Renee Schnieder, MSN, RN
Marianne Schubert, MSN-Ed,
CEN, MICP, RN
6. Special Thanks
Standards Committee 2010-2011 for their
continued work on revisions and peer-review
process
Jana Faragher, ND, CNS, RN-Chair
Sharon Decker, PhD, RN, ANEF
Teri Boese, MSN, RN
Carol Sando, PhD, RN, CNE
Pearson Faculty Development March 23, 2012 Fort Lauderdale
7. Standards of Best Practice
1. Terminology
2. Professional Integrity of Participant
3. Participant Objectives
4. Facilitation Methods
5. Simulation Facilitator
6. The Debriefing Process
7. Evaluation of Expected Outcomes
INACSL Board of Directors, (August, 2011). Standards of best practice: Simulation.
Clinical Simulation in Nursing, 7(4 Supplement). S1-S20. Available at
http://www.nursingsimulation.org/issues?issue_key=S1876-1399(11)X0005-1
Pearson Faculty Development March 23, 2012 Fort Lauderdale
8. Standard One: Terminology
Statement:
Consistent terminology provides guidance, clear
communication, and reflects shared values in
simulation experiences, research, and
publications.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
9. Rationale
Standardized terminology:
Enhances understanding and communication among
planners, participants and others involved in simulation
experiences
Promotes consistency in the development,
implementation, evaluation and publication of or about
simulated clinical experiences or research studies for use
in education and practice
Pearson Faculty Development March 23, 2012 Fort Lauderdale
10. Nursing Skill Development &
Judgment Model
Pearson Faculty Development March 23, 2012 Fort Lauderdale
11. Standard Two: Professional Integrity of Participants
Statement:
The simulation learning and testing environment will
be one of clear expectations for the attitudes and
behavior of each participant and an area where mutual
respect is supported. Professional integrity related to
confidentiality of the performances, scenario content,
and participant experience is expected to be upheld
during a simulation experience. These performances in
simulation experience may be live, recorded, and/or
virtual.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
12. Rationale
Failure of the participants to maintain professional
integrity related to simulation and lack of respect
or professionalism could undermine the benefits of
this pedagogy
Sharing of confidential information of any kind
before, during or after the simulation experience
can alter the experience
Pearson Faculty Development March 23, 2012 Fort Lauderdale
13. Outcomes
This standard offers the opportunity for similar
learning experiences to all participants
Upholding professional integrity promotes a safe
learning environment
To achieve the desired outcomes, the facilitator
must address key areas during the simulation
Pearson Faculty Development March 23, 2012 Fort Lauderdale
14. Standard Three: Participant Objectives
Statement:
The simulation experience should focus on the
participant objectives and experience level.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
15. Rationale
Participant objectives are the guiding tools for
simulation and essential to achieve the outcomes
Identification of appropriate scenario, fidelity,
instructor prompting/facilitating, and
environment is crucial for best experiences and
meeting the participant objectives
Pearson Faculty Development March 23, 2012 Fort Lauderdale
16. Outcomes
The focus of simulation is on the outcome to be
achieved and on participant learning-Know your
participants
Should facilitate the development of clinical
judgment in order to deliver high quality and safe
nursing care that is holistic and includes cultural
awareness
Pearson Faculty Development March 23, 2012 Fort Lauderdale
17. Standard Four: Facilitation Methods
Statement:
Multiple methods of facilitation are available, and
use of a specific method is dependent upon the
learning needs of the participant(s) and the
expected outcomes.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
18. Rationale
Facilitation methodology should vary because
participants bring cultural and individual differences
that affect their knowledge, skills, attitudes (KSAs),
and behavior
Facilitation assists the learner to meet the objectives
by incorporating learner’s needs and experience into
the planning and implementation of a simulated
clinical experience
Pearson Faculty Development March 23, 2012 Fort Lauderdale
19. Outcomes
Facilitation revolves around engaging participants
within the scenario by assisting them to meet the
objectives of the clinical scenario
Effective facilitation requires using the facilitation
method and personnel/faculty indicated by
participant objectives and expected outcomes
Pearson Faculty Development March 23, 2012 Fort Lauderdale
20. Standard Five: Simulation Facilitator
Statement:
A proficient facilitator is required to manage the
complexity of all aspects of simulation.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
21. Rationale
The facilitator is the key to participant learning:
guides and supports participants to understand and
achieve the objectives
Engages the participants to search for evidence-based
practice solutions to develop participant’s skill
development and clinical judgment
Adjusts simulations to meet objectives based on
participant’s actions or lack of actions
Leads the participants in identifying the positive actions
and changes
Pearson Faculty Development March 23, 2012 Fort Lauderdale
22. Outcomes
Facilitator promotes and assists with achieving the
desired outcomes of a simulated experience by
utilizing various methods
Pearson Faculty Development March 23, 2012 Fort Lauderdale
23. Standard Six: The Debriefing Process
Statement:
All simulated experiences should include a planned
debriefing session aimed toward promoting
reflective thinking.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
24. Rationale
Learning is dependent upon the integration of
experience and reflection
Reflection is the conscious consideration of the
meaning and implication of an action
The skills of the debriefer are important to ensure the
best possible learning
Learners report the debriefing session is the most
important component of a simulated learning
experience
Pearson Faculty Development March 23, 2012 Fort Lauderdale
25. Outcomes
The integration of the process of debriefing into
simulation:
Enhances learning
Heightens self-confidence for the learner
Increases understanding
Promotes knowledge transfer
Identifies best practices
Promotes safe, quality patient care
Promotes life-long learning
Pearson Faculty Development March 23, 2012 Fort Lauderdale
26. Outcomes (Continued)
To achieve the desired outcomes, the effective
debriefing process should:
Be facilitated by individual competent in debriefing that
observed the simulation
Use evidence-based debriefing methodologies
Be based on a structured framework for debriefing
Be based on objectives, the learners, & the outcomes
Be conducted in an environment that supports confidentiality,
trust, open communication, self-analysis & reflection
Pearson Faculty Development March 23, 2012 Fort Lauderdale
27. Standard Seven:
Evaluation of Expected Outcomes
Statement:
This standard addresses summative evaluation as
opposed to formative assessment.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
28. Rationale
Simulation is an acceptable method of evaluating
the three domains of learning:
Cognitive (knowledge)
Affective (attitude)
Psychomotor (skills)
Pearson Faculty Development March 23, 2012 Fort Lauderdale
29. Outcomes
The participant’s achievement of expected
outcomes of a simulation experience should be
based on valid and reliable instrumentation, tools,
and methodologies in the evaluation process
To achieve valid and reliable evaluation results, the
simulation used for the purpose of assessment and
particularly high-stakes evaluation must follow
certain aspects.
Pearson Faculty Development March 23, 2012 Fort Lauderdale
30. Resources
International Nursing Association for Clinical
Simulation and Learning (INACSL):
http://www.inacsl.org/INACSL_2010/
Society for Simulation in Healthcare (SSH):
http://www.ssih.org/SSIH/ssih/Home/
Simulation Innovation Resource Center (SIRC)
http://sirc.nln.org/
METI: Human Patient Simulation Network (HPSN)
http://www.hspn.com/
Laerdal: Simulation User Network (SUN)
http://simulation.laerdal.com/
Pearson Faculty Development March 23, 2012 Fort Lauderdale
31. Evaluation Tools
Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C. (2010,
January). A review of currently published evaluation
instruments for human patient simulation. Clinical
Simulation in Nursing, VOL(6), e25-e35.
doi:10.1016/j.ecns.2009.08.004
METI Simulation Effectiveness Tool and Educational Material
http://www.meti.com/mymeti/education_main.html
NLN and Laerdal Simulation Study Evaluation Tools
http://www.nln.org/research/toolsandinstruments.htm
Other tools are available
Pearson Faculty Development March 23, 2012 Fort Lauderdale
32. What Can I Do With the Standards?
Curricular Integration
Evidence Based Practice in Education
Administrative Support
Faculty Buy-In
Research Opportunities
Funding Opportunities
Pearson Faculty Development March 23, 2012 Fort Lauderdale
33. INACSL Conference
11th Annual International Nursing
Simulation/Learning Resource Centers
Conference:
Saddle up for Simulation: Rope in the Best Ideas
Pre-conference: June 20, 2012
Conference: June 21 -23 2012
San Antonio Marriott Rivercenter
Pearson Faculty Development March 23, 2012 Fort Lauderdale
34. How to Obtain Standards of Best
Practice: Simulation
Initial publication of the Supplement to Clinical
Simulation in Nursing was made possible by an
educational grant from METI
Will be printed and mailed to current members of
INACSL
Available through the official journal of INACSL:
Clinical Simulation in Nursing
http://www.nursingsimulation.org/
Journal access is just one benefit of membership in
INACSL
Pearson Faculty Development March 23, 2012 Fort Lauderdale
35. Conclusion
Thank you for attending this presentation
Question and Answer Session
Pearson Faculty Development March 23, 2012 Fort Lauderdale
Notes de l'éditeur
Special thanks to the INACSL Board of Directors 2009-2011 for developing initial standards draft
Terminology has not been standardized until this point.
Clinical Scenario:
The plan of an expected and potential course of events for a simulated clinical experience.
-provides the context for the simulation and can vary in length and complexity, depending on the objectives.
This model shows the progression from psychomotor skills to clinical judgment
Sharing of Information can:
Interfere with learning outcomes
Bias an individual’s performance
Alter perception of a safe learning environment (psychological safety)
Modify group dynamics
Negatively alter the future participants’ learning experience
This standard offers the opportunity for similar learning experiences to all participants.
Upholding professional integrity promotes a safe learning environment where:
Formative assessment and/or summative evaluation can occur.
Simulation participants will consider their performance and the performance of others as confidential interactions.
Violation of professional integrity may be viewed as an honor code/ethical violation, eliciting similar consequences.
Upholding Professional Integrity Promotes a Safe Learning Environment where:
Formative assessment and/or summative evaluation can occur
Participants consider performances confidential interactions. Performances include self and others in the simulation
Violation of professional integrity may be viewed as an honor code or ethical violation and may elicit consequences invoked by honor code or ethical issues
Facilitator must address these:
Ensure a safe learning environment
Ensure steps are taken to protect the content of the scenario & simulation
Provide clear direction to the participants: expectations of the simulation environment, learning or testing
Demonstrate professional & ethical behavior
Role model constructive feedback during simulation and debriefing
Monitor for unprofessional participant behavior during simulation and take steps to abate it
Objectives should be:
Achievable within an appropriate time frame
Incorporate evidence-based practice
Address domains of learning
Appropriate to the participant ‘s level of learning and congruent with overall program outcomes
See Standard I: Terminology for Nursing Skill Development and Clinical Judgment Model
Multiple methods should be used to meet the participant objectives and expected outcomes
Level of Facilitation:
Facilitator Prompting
Partial Facilitator Prompting
No Facilitator Prompting
The facilitator assists the participants with identifying actions that could have been changed to promote better patient outcomes and how the actions could have been changed to meet the learning objectives, if these objectives are not met
Clearly communicate and ensure understanding of objectives, goals, and expected outcomes
Create a safe learning environment
Promote maintenance of fidelity in the simulated environment
Recognize and use appropriate facilitation method(s)
Identify & evaluate individual and group performance as it relates to the acquisition of knowledge, skills, appropriate attitudes & behaviors
Demonstrate professional and ethical behaviors
Foster enthusiasm & support for simulation as a learning modality
Establish methods for obtaining meaningful feedback from participants, observers, & other facilitators/instructors re: effectiveness of facilitator
Demonstrate role modeling when assuming a role in the simulation
Reflection: assimilation of knowledge, skills, and attitudes (KSAs) with pre-existing knowledge and can lead to new interpretations by the learner
Reflective thinking does not happen automatically, but it can be taught; it requires time, active involvement in realistic experience, and guidance by an effective trainer/facilitator (coach).
Learning without guidance could lead to the learner repeating mistakes, focusing only on the negative, or developing fixations
Debriefing and reflection are essential determinants of professional development at all levels and are linked to professional nurse competencies
Encourage reflective learning:
Provides an opportunity to discuss the process, outcome, and application of scenario to clinical practice
Enables the facilitator to review relevant teaching points
Promotes reflective thinking
The debriefing should be facilitated by an individual who has observed the simulated experience; based on a structured framework for debriefing; based on standard III, in a safe learning environment
Formative Assessment
Assessment wherein the facilitator’s focus is on the participant’s progress towards goal attainment.
Summative Evaluation
Evaluation occurring at the end of a learning period where participants are provided feedback about their achievement of outcome criteria.
The participant outcomes should include, but are not limited to:
Safe patient care and/or decision-making abilities
Skill performance
Critical thinking/reasoning
Knowledge level of the participant
In addition, self-confidence & satisfaction with the experience can be assessed
When these domains interact in the context of a novel simulation experience, problem-solving and analytical skills can be evaluated in terms of the achievement of identified outcomes.
Simulation used for assessment and high-stakes evaluation:
Be explained to the participant prior to the start
Conducted in a familiar environment on previously tested evidence-based content
Be standardized in format and in scoring method
Use appropriate fidelity level
Be accompanied by specific participant objectives
Use pre-established guidelines for responses/prompting if any
Have predetermined parameters for terminating the scenario
Include the participant’s self-assessment of performance as part of the evaluation.
