Author: Donna M. Thompson, MSN, RN, AGCNS-BC, CCRN
Institution: Frances Payne Bolton School of Nursing, Case Western Reserve University
Coauthors: Second Author: Amy D. Lower MSN, RN, CCRN, CHSE Title: Lecturer Institution: Frances Payne Bolton School of Nursing, Case Western Reserve University Email: firstname.lastname@example.org. Additional credit to our actors Angela Arumpanayil DNP, RN, AGACNP-BC, CCRN (Instructor) and Shalyn Adams BSN, RN, BBA(Clinical Instructor) from Frances Payne Bolton School of Nursing, Case Western Reserve University. Simulation expertise, technical and video assistance was provided by Thomas Baum Paramedic (Simulation Manager) and Jared Lee AAS, Paramedic, CHSOS (Simulation Operations Specialist) from the Center for Nursing Education, Simulation, and Innovation, Frances Payne Bolton School of Nursing, Case Western Reserve University. This strategy was adapted from a simulation co-created by Eric Simpson MSN, RN, AGACNP-BC, NREMT.
Skills or Simulation Laboratories
Online or Web-based Modules
The student will prioritize the integration of their plan of care. (Knowledge)
The student will formulate 2 effective ISBAR (Identify, Situation, Background, Assessment, and Recommendation) handoffs at transitions in care. (Skill)
The student will analyze the communication styles and team dynamics observed in the simulation. (Knowledge)
The student will assess their own potential to contribute to effective team functioning. (Attitude)
This simulation was originally written for student participants, but was converted to a virtual format to meet clinical or lab program requirements during the Covid-19 pandemic. The simulation actors are practicing intensive care unit registered nurses who are also faculty and clinical instructors, acting out specifically created transport roles. The Ohio Board of Nursing stated creative options for meeting course objectives could be utilized, such as remote or virtual simulation (OBN, 2020). This virtual simulation is FREE for use. Once you have made your own google forms copy, feel free to modify any portion to meet your course educational needs.
The simulation template was adjusted to include 4 video simulation segments. Each video is structured to have a specific stopping point in which the students were prompted to answer strategic questions. The questions provided the students with an opportunity to critically think about the management of the patient. Students also created 2 ISBAR communications at each transition in care. A Google Form was utilized to house the videos and questions with the ability to section the materials so the students couldn’t skip ahead without answering the prompts. Additionally, students had the ability to re-watch the video segments as needed. This made the virtual simulation completely self-directed and easily accessible with an internet connection.
Video simulation allows the students to complete the activity at their own pace and at a location of their choosing. This flexibility not only facilitates learning but also motivates the student (Da Silva et al., 2020 from Harris et al, 2008). Virtual simulations have the ability to bring real-world situations to students and engage their clinical reasoning skills, which allows the students to experience the role of the registered nurse and practice thinking like a nurse.
Students report feeling comfortable and engaged, appreciating the ability to make decisions independently through virtual simulation (Padilha, Machado, Ribeiro, & Ramos, 2018). Healthcare professionals do not work in a silo, and patient management can be quite complicated. Patricia Benner (2010) theories state that simulation is a strategy used to integrate higher-level thinking and problem-solving activities appropriate for practice readiness when facilitated by a clinical faculty experienced in the art of debriefing. Debriefing is where opportunities to tease out “how to think like a nurse” arise. Students need to know that errors are expected, and feel comfortable discussing mistakes and rationale with peers, as the literature demonstrates that the majority of learning occurs during skilled debriefing (Deifuerst, 2012; INACSL, 2016; Jeffries, 2014; Rudolph, et al 2007). Although limited, literature related to the debriefing in the realm of virtual simulation does exist, and the concepts are the same: appropriate pre-briefing, small groups, experienced faculty, and sufficient time allotment (Gordon, 2017).
With more nursing schools moving to online instruction during the Covid-19 pandemic, there were limited resources to meet program requirements. Facilitating learning is the first core competency mandated by the NLN (Halstead, 2019). Virtual reality is one strategy that will help master this competency, especially during times when clinical or lab experiences are limited or absent. This ICU Transport Virtual Simulation could fulfill 4 hours of clinical or lab hours.
– Establish the time of the lab and notify students. Allow approximately 2 hours for assigned pre-reading and completion of the virtual simulation.
– Arrange for video conferencing times for debriefing, provide students with meeting ID ahead of time. It is best to use groups of 6 students or less.
– Provide the link for Virtual Critical Care Transport Communication Simulation Activity.
– If debriefing is being recorded, students must be informed of this prior to the start of the debriefing. Provide students rationale for recording and who may be listening to the recording.
– Provide the participants with the debriefing agenda, including that discussion may focus on exploring student responses.
– May utilize Virtual Critical Care Transport Communication Simulation Debriefing Points as needed.
– Allow for at least 2 hours for debriefing.
– Upon completion of debriefing, encourage participants to complete Virtual Critical Care Transport Communication Simulation Evaluation.
– Faculty should have skill and experience with debriefing. We are planning to share the faculty development seminar on debriefing as a QSEN teaching strategy, feel free to utilize this succinct presentation if needed.
– If this virtual simulation is utilized, please complete the Virtual Critical Care Transport Communication Simulation Survey listed in the links below.
– Virtual Critical Care Transport Communication Simulation Activity: https://forms.gle/8fzqyJ64UkaZh69X8
– Virtual Critical Care Transport Communication Simulation Debriefing Points: https://docs.google.com/document/d/1mCjAh4oBg7882EklrmoZ4xJgZZ4DABp9Ta0ypKkDqEM/edit?usp=sharing
– Virtual Critical Care Transport Communication Simulation Evaluation: https://forms.gle/kM1vvHKeQg8bRA7V9
– Virtual Critical Care Transport Communication Simulation Survey: https://forms.gle/zfs4uifKoVdHfQSG7
Benner, P., Sutphen, M., Leonard, V., Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, Jossey-Bass.
Da Silva, C., Peisacovich, E., Gal, R., Aniyinam, C., Coffey, S., Graham, L. (2020). A programmatic approach to the design of a video simulation care study. Clinical Simulation in Nursing, 41, 1-8.
Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, (51)6, 326-333.
Foronda, C., Godsall, L., & Trybulski, J. (2013). Virtual clinical simulation: The state of the science. Clinical Simulation in Nursing, 9, 3279-e286.
Gordon, R. M. (2017). Debriefing virtual simulation using an online conferencing platform: Lessons learned. Clinical Simulation in Nursing, 13, 668-674.
Harris, A., Hegg, M., Harris, A., Mikkelsen, J. (2008). Nursing students learning of managing cross-infection- scenario-based simulation training versus study groups. Nursing Education Today, 28(6), 664-671.
INACSL Standards Committee (2016). INACSL Standards of best practice: Simulation debriefing. Clinical Simulation in Nursing, 12(S), S21-S25. http://dx.doi.org/10.1016/j.ecns.2016.09.008
Ohio Board of Nursing (2020/03/24). Additional Guidance to Prelicensure Nursing Education Programs. Obtained on 4/10/2020 from https://nursing.ohio.gov/wp-content/uploads/2020/03/Education-Program-Guidance.pdf
Padilha, J. M., Machado, P. P., Ribeiro, A. L., & Ramos, J. L. (2018). Clinical virtual simulation in nursing education. Clinical Simulation in Nursing, 15, 13-18.
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 Clin, 25, 361-376.
Students participated in a 2-hour debriefing session on the same day as the virtual simulation activity by skilled facilitators. Each facilitator was assigned to read specific student responses to the virtual simulation activity. Debriefing facilitators asked about what went well, what could have been improved upon, considered student responses, and integrated some of the debriefing points which provided students with a formative evaluation of their responses. This virtual simulation’s primary focus was on interprofessional collaboration, so specific questions were asked about what was observed regarding communication and teamwork during the virtual simulation and in their clinical setting. After each debriefing session, students were provided a link to an anonymous google forms evaluation to express their feedback regarding the experience including the debriefing. Two main themes emerged including focusing more on critical thinking skills as opposed to hands-on skills and being able to observe how experienced nurses would effectively manage a deteriorating patient. One student stated “I think it was nice to see how things are “supposed” to go and then try and make decisions about what should happen next.”
Faculty are rewarded with positive feedback from the students during the debriefing, in the virtual simulation and course evaluations. Students consistently enjoy simulation and ask for more throughout the program.
Students complete an end of semester course evaluation, which includes some questions specific to labs provided to them with Likert scale questions and open-ended responses. This simulation could be considered for use by advanced practice provider students in a deeper evaluation of the treatment plan.
We did not make our debriefing groups small enough for virtual simulation due to inexperience in this method of lab delivery, this was also mentioned in the students’ evaluation of this lab. Additionally, providing facilitators time to read their assigned student responses to formulate group-specific debriefing points.