Simulation Resources To Follow

Simulation is a key component of nursing and healthcare training, and the knowledge base is continually increasing with research publications, conferences, online and social media resources. To aid knowledge translation, the nurse educator needs to embrace a global network of resources not just confined to local knowledge. To keep current on simulation focused research, here are some resources that may help (no conflict of interest to report). As ever please add any suggestions of other resources you know about in the comments section at the bottom of this post and I will update the below resource list.

This post supplements the recent Journals For The Nurse Educator To Follow  and these journals will also include simulation research.

Simulation Focused Journals

Online & Social Media Resources

Clinical Reasoning Cycle

Book Club: Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

Clinical Reasoning Cycle

Define reasoning as “the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process”.

“Clinical reasoning is often confused with the terms ‘clinical judgement’, ‘problem solving’, decision making’ and ‘critical thinking’. While in some ways these terms are similar to critical reasoning, clinical reasoning is a cyclical process that often leads to a series or spiral of linked clinical encounters” (pg.4 Levett-Jones, 2013).

Stages of the Clinical Reasoning Cycle

  1. Consider the patient
  2. Collect cues/information
  3. Process information
  4. Identify problems/issues
  5. Establish goals
  6. Take action
  7. Evaluate outcomes
  8. Reflect on process and new learning

Why is this book important?

For nurse training and education delivery, the stages of clinical reasoning can be incorporated into training sessions to discuss the clinical judgments and decision making during a care intervention and applying the ‘nursing process’.  Simulated nursing environments are an ideal educational approach to challenge clinical decision making and clinical reasoning skills. Nurses are the constant presence on the ward level, providing the monitoring and making judgments form the clinical reasoning encounters every shift over a patients hospital journey. Responding to complex and time critical events requires sophisticated abilities which expand further than pure theoretical knowledge, such as assessing and responding to clinical deterioration.

In the current economic drive for cost cutting measures across healthcare (nurses make up the majority of the healthcare workforce, so are often seen as a costly element), the drive to replace with lower skilled, trainees and eventually robots are factors for the nursing profession to consider. Nurses need to be able to understand and explain the role they play and have a voice to raise the profile of what it entails to be a nurse and the efficacy of such skills to maintain levels of care and safety.

Summary

Thinking on the go and decision making are skills to develop over time and with experience but need to be incorporated into nurse training. Nurses with effective clinical reasoning skills have a positive impact on patient outcomes (School of Nursing and Midwifery Faculty of Health, 2009). It’s important to remember, during all this consideration of the patient and reflective process that you (the nurse) are human and as such wont get everything correct all the time.

References

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Pearson Australia.

Alfaro-LeFevre, R. (2015). Critical Thinking, Clinical Reasoning, and Clinical Judgment E-Book: A Practical Approach. Elsevier Health Sciences.

Interprofessional Ambulatory Care Unit. Clinical Reasoning User Manual. Edith Cowan University.

School of Nursing and Midwifery Faculty of Health (2009) Clinical Reasoning Instructor Resources. University of Newcastle.

Peyton’s 4 Step Approach for Skills Teaching

We have all either delivered or been on the end of a “see one, do one” or “do one, teach one” approach to learning, often delivered in simulation with the aim for skill development. But maybe we should add another two-steps into the approach and follow Peyton’s four-step method. To aid the processing of information (learning) and then apply this new knowledge in context (situational awareness) the four-stage technique can be utilised.

Peyton’s Four-Step Approach: 

1. “The teacher demonstrates the skill at his normal pace without any comments (Demonstration)

2. The teacher repeats the procedure, this time describing all necessary sub-steps (Deconstruction)

3. The student has to explain each sub-step while the teacher follows the student’s instructions (Comprehension)

4. The student performs the complete skill himself on his own (Performance)” (Nikendei et al, 2014).

There are clearly defined instructional steps to guide educator and student. Provides small group or a 1:1 teacher:student ratio for successful instructional training in skills learning sims.

Keywords: Simulation; skills labs; 4-step; experiential learning; technical skills.

References

Bullock, I., Davis, M., Lockey, A., & Mackway-Jones, K. (Eds.). (2015). Pocket Guide to Teaching for Clinical Instructors. John Wiley & Sons.

International Clinician Educators (ICE) Blog. (2017). Effective teaching of technical skills requires more than see one do one. KeyLime podcast No. 142. ICE blog.

Münster, T., Stosch, C., Hindrichs, N., Franklin, J., & Matthes, J. (2016). Peyton’s 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression–a pilot studyGMS journal for medical education33(4).

Nikendei, C., Huber, J., Stiepak, J., Huhn, D., Lauter, J., Herzog, W., … & Krautter, M. (2014). Modification of Peyton’s four-step approach for small group teaching–a descriptive study. BMC medical education14(1), 68.

Walker, M., & Peyton, J. W. R. (1998). Teaching in theatre. Teaching and learning in medical practice. Rickmansworth, UK: Manticore Europe Limited, 171-180.

Wang, T. S., Schwartz, J. L., Karimipour, D. J., Orringer, J. S., Hamilton, T., & Johnson, T. M. (2004). An Education Theory–Based Method to Teach a Procedural Skill. Archives of dermatology140(11), 1357-1361.

 

 

Team Emergency Assessment Measure (TEAM)

Purpose

Development of a tool to measure teamwork performance in medical emergencies (TEAM measurement tool).

Background

The focus in healthcare on the importance of patient safety and developing safer healthcare systems. Reducing preventable errors in healthcare requires a culture of change. Errors are multi-factorial, but can be attributed to technical and non-technical skills as well as organisational issues. “The determinants of effective team performance include technical and nontechnical skills such as leadership and teamwork” (Cooper et al., 2010).

Key Performance Factors

  • Leadership skills
  • Team performance
  • Technical Skills
  • Task management
  • Non technical skills
  • Communication
  • Situational awareness
  • Environmental awareness

Findings

Study findings from the primary study found “TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties”.

Keywords: teamwork; situational awareness; training; debriefing; human factors.

References

Cooper, S. J., & Cant, R. P. (2014). Measuring non-technical skills of medical emergency teams: an update on the validity and reliability of the Team Emergency Assessment Measure. Resuscitation, 85(1), 31-33.

Cooper, S., Cant, R., Porter, J., Sellick, K., Somers, G., Kinsman, L., & Nestel, D. (2010). Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation, 81(4), 446-452.

Monash University (2017) TEAM.

Monash University (2017) TEAM measurement tool.

Debriefing in Simulation Based Learning

Simulation in healthcare is a vital part of the educational approach to learning. For the adult learner this provides problem-centred, relevant and hands-on training (active participation) where past experiences are valued. Simulation training is part of an experiential learning educational approach (Rudolph et al, 2007; Fanning & Gaba, 2007).

So you have your training planned, with level of fidelity, equipment, instructor/s, learning objectives all organised? The next part is to review the breakdown of the session and ask yourself, ‘have I left enough time for the debrief at the end? Instead of leaving a hurried 10 mins at the end of the session, the structure should be more a 50:50 simulation to debrief time frame. The debrief is just as, maybe actually more important for learning and development to take place. Evidence for simulation skill training states that the learning effect maybe lasts 6-12 months (possibly even only 3 months) and should then be repeated, which does question the value of yearly competency training.

The human factors aspect of simulation training provide the task training but the debrief then allows meaning and sense from the training itself, with the adult learner moving towards the key learning objectives and adjusts their performance and actions (Rudolph et al, 2007). Across healthcare and emergency services (including armed forces) the use of critical incident stress debriefing has been formulated to provide a review of facts and perceptions to allow recovery from stress after a traumatic event. In essence the debrief is the reflective practice, and where the learning and development actually occurs.

Debriefing with Good Judgement by Rudolph et al (2007) 

  • Theory of using reflective practice for self-scrutiny.
  • Create a safe, yet challenging environment.
  • The sweet point on the stress curve to challenge the participant but not to breaking point.
  • Environment of trust.
  • Safe environment to make mistakes- this is where the educator can really try to understand the ‘framing’ of the situation from the learners perspective and then provide clarifying education to then eradicate the previous error. Its not a shame and blame situation.
  • Allow the difficult discussions to be discussed, critical judgements are valued as long as the discussion is respectful (advocacy and inquiry approach). This is important in healthcare training to be direct about critical errors observed to then eradicate.
  • Both instructors and participants views are valued in the discussion phases.

advocacy-inquiry

Summary

Rudolph et al (2007) describe the debrief as the ‘heart and soul’ of the simulation experience, so we really need to ensure we follow the debrief with good judgement principles.

References: 

Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiology Clinics, 25(2), 361-376.

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in healthcare, 2(2), 115-125.

Thanks to Chris ‘LITFL‘ Nickson for guiding to these simulation resources.