Critical thinking and clinical judgement of the nursing student is essential to the preparation of a competent novice nurse. Opportunities for students to practice making high-stakes decisions independently can be limited in the live clinical setting, for obvious safety reasons. Variations among local clinical placements may further limit the ability for entire cohorts to experience equitable patient cases. In addition, multiple nursing schools are competing for a limited number of clinical sites, straining programs’ abilities to meet clinical contact hour requirements. High-quality simulation of keystone standardized experiences can bridge this gap within the standards set by both the boards of nursing and the industry. The program-level challenge lies in the ability to create a catalogue of progressive simulations and a staff of competent situationists.

Simulation Proficiency Need

The journey to meet this challenge for Columbia State Community College’s nursing program began with attendance at a simulation convention. Faculty members identified the potential for significant growth, specifically in staff development and standardization of simulation cataloging to ensure quality across experiences. The existing curriculum included simulation in most courses with an emphasis on meeting the National Council of State Boards of Nursing (NCSBN) (2023) minimal requirements for debriefing. Faculty members conducted a strength and weakness analysis in response to the updated guidelines from the International Nursing Association for Clinical Simulation and Learning (INACSL)—the Healthcare Simulation Standards of Best Practice (HSSOBP) (Watts et al., 2021). The faculty team identified implementation gaps in the areas of prebriefing, the process of holistically preparing students for full immersion in the simulation experience, and in the standardization of simulation evaluation. Faculty members also identified a need to firmly root any quality improvement efforts in both nursing and pedagogical theories.

Simulation Proficiency Problem

The faculty team identified the following areas for program growth in accordance with the INACLS HSSOBP: The wide variance in simulationist proficiency, inconsistent use of prebriefing, and lack of standardization in debriefing and evaluation of simulation performance. Faculty members also noted an opportunity to streamline how simulation development is documented and catalogued within the program. Student evaluation and debriefing existed with significant course-to-course variation in evaluation methods and the presence or absence of formative or summative grading. Prebriefing was used minimally by most faculty and limited to a brief explanation of the simulated patient case and a quick review of the chart and order set prior to beginning the simulation. Psychological safety was a new concept in the updated INACLS HSSOBP not previously directly addressed by faculty. Another confounding issue for the department was a recent influx of new faculty transitioning from practice expert to novice educator.

The INACLS HSSOBP includes multiple standards. The team chose to focus on staff proficiency with the standard of professional development. A simulation education program (SEP) was designed to bridge the knowledge gaps and provide an opportunity to build on the prebriefing and evaluation elements of the simulation experience. Institutional review board approval was obtained for a pre- and post-design quality improvement project to evaluate baseline knowledge in simulation using the Faculty Competency Rubric (Leighton, et al., 2018). The initial training provided a platform upon which the team could build.

Process for Faculty Proficiency

The project team utilized best practices incorporating INACLS health care standards, Accreditation Commission for Education in Nursing (ACEN) criterion 2.6 standard (Ard et al., 2023), and NCSBN simulation guidelines (McDermott et al., 2021; NLN, 2023) for implementation of the quality improvement project to support simulation proficiency for the nursing faculty at Columbia State Community College. The project's focus areas mirrored additions noted in the recent update for INACLS: professional development and simulation design. The project team initially supported the nursing faculty through simulation-based education via the development of the online SEP over one semester. The theoretical framework of Kolb’s experiential learning theory was used, particularly elements in the teaching education of simulation (Davitadze et al., 2022). The training allowed for development of faculty proficiency utilizing the validated tool—Facilitator Competency Rubric—for self-assessment and evaluation of faculty competence in nursing simulation.

A non-measurable component of the SEP was the development of a template for simulation design and implementation. The template uses evidence-based constructs of measurable learning objectives which align with the simulation modalities (high-fidelity vs. escape room), prebriefing, debriefing, and evaluation of performance (McDermott et al., 2021). Faculty teaching teams were mentored by SEP team members to convert a current course simulation to the template. Templates were then reviewed by the nursing program’s curriculum committee for progression of complexity.

Impact of Faculty Training

A quantitative approach looked at the projectors of the null and the means in the statistical data. The data were skewed, showing all areas based on small project size (10 participants pre-test and 6 participants post-test). The null hypothesis was not rejected in any instance. As a result, the means were considered the most useful comparison. The means increased in all areas: preparation 14.2 to 23.6, prebriefing 9.8 to 12.8, facilitation 13.8 to 20, debriefing 21.4 to 26.2, and evaluation 21.4 to 26.2. The project helped the nursing faculty improve simulation proficiency, increase confidence, streamline workflow, document course and student learning outcomes with the template, improve psychological safety of faculty and students during simulation, and adhere to best practice standards.

Next Steps

Columbia State Community College is excited to provide high-quality experiences which meet the education needs of student nurses through the innovative teaching strategy of simulation. Next steps include inviting and training other academic disciplines for simulation participation with an initial emphasis on the health sciences. Engagement with the Paramedic department is already taking place. Other next steps include continued training for new faculty and simulation staff, further training regarding specific types of simulation, development of an expert panel to review templates using Benner’s model, and exploration of potential partnerships with other higher education institutions. The team recently provided template design assistance to educators and clinical partners from a regional hospital association to create a teaching module which helps bridge the gap between nursing education and clinical practice. Dissemination efforts include sharing at an ACEN Nursing Education Conference and a local nursing organization meeting. The ultimate long-term goal for the nursing department includes the achievement of INACLS’s endorsement in recognition of excellence in applying simulation standards in education programs for the Nursing department.

Conclusion

The nursing faculty team at Columbia State Community College is committed to continuous quality improvement in the preparation of entry-level nurses who demonstrate the knowledge and skills required to provide safe, competent, patient-centered care as registered nurses in the constantly evolving healthcare environment. Simulation, when compared to the live clinical setting, can be manipulated to create specific experiences on a schedule with a student-centered approach. High-quality simulation enhances and supplements learners’ experiences in a safe environment with zero patient risk. An institution’s investment in faculty preparation for simulation development, integration, delivery, and assessment results in exceptional experiences for the instructor, the student, and, ultimately, patients.

References

Ard, N., Nunn-Ellison, K., Farmer, S., & Beasley, S. (2023). The new 2023 ACEN standards and criteria. Teaching and Learning in Nursing, 18(2), 253-256. doi.org/10.1016/j.teln.2022.12.004

Davitadze, M., Ooi, E., Ng, C., Zhou, D., Thomas, L., Hanania, T., Blaggan, P., Evans, N., Chen,         W., Melson, E., Arlt, W., & Kempegowda, P. (2022). SIMBA: Using Kolb's learning theory in simulation-based learning to improve participants' confidence. BMC Medical Education, 22(1), 116. doi.org/10.1186/s12909-022-03176-2

McDermott D., Ludlow, J., Horsley, E., & Meakim, C. (2021). Healthcare simulation standards of best practice prebriefing: Preparation and briefing. Clinical Simulation Nursing, 58, 9-13. doi.org/10.1016/j.ecns.2021.08.008

Leighton, K., Mudra, V., & Gilbert, G. (2018) Development and psychometric evaluation of the facilitator competency rubric. Nursing Education Perspectives, 39(6), E3-E9.

National Council of State Boards of Nursing. (2023). National simulation guidelines for prelicensure nursing programs. https://www.ncsbn.org/null/null/national-simulation-guidelines

Watts, P., Rossler, K., Bowler, F., Miller, C., Charnetski, M., Decker, S., Molloy, M., Persico, L., McMahon, E., McDermott, D., Hallmark, B. (2021). Preamble. Clinical Simulation in Nursing, 58, 1-4. doi.org/10.1016/j.ecns.2021.08.006

This article is about Columbia State Community College’s 2022-2023 Innovation of the Year Award winner.

Lead image: Nursing faculty engage EMS and nursing students in simulation learning

Kae Fleming is Dean, Health Sciences; Virginia Massey-Holt is an Associate Professor, Michele Marbet is an Assistant Professor, and Jo Ann Hanson is the Clinical Laboratory Coordinator-WCC in the Nursing department at Columbia State Community College in Columbia, Tennessee.

Opinions expressed in Innovation Showcase are those of the author(s) and do not necessarily reflect those of the League for Innovation in the Community College.