Designing a Mental Health Simulation Experience:

From Concept to Implementation

Dr. Jeffrey K. Carmack, MSN, RN, CHSESara Fruechting, RN, MNSc, CCRN

Debra Rurup, MNSc, RN, CNEUniversity of Arkansas at Little Rock

Department of Nursing

ANCC Required Disclosures

Conflict of interest • Dr. Jeffrey Carmack

• Reports he is a member of the Board of Directors for INACSL and a paid consultant for Wolters Kluwer Lippincott Williams & Wilkins

• Sara Fruechting reports no conflict of interest• Debra Rurup reports no conflict of interestSuccessful completion • Attend 90% of session • Complete online evaluation

Objectives

• The participants will – Understand the historical clinical methods– Explore the concierge model of simulation based

learning experiences– Examine the financial benefits of using a rotational

design for scheduling of students for simulation based learning experiences.

So how does simulation fit in with Mental Health?

A technique used “to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner”

Gaba, D. (2007). The future vision of simulation in healthcare. Journal of the Society for Simulation in Healthcare, 2(2), p. 126.

CLINICAL TEACHING BEFORE SIMULATION

Debra Rurup, MSN, RN, CNE

Learning Objective

The learners will understand the historical clinical methods

History – How this all began

• 2011• No structured orientation for students• Role-playing• Then, off to the facilities

History, con’t

• Lack of full curriculum integration (Simulation Across the Curriculum)

• Lack of resources • Manikins are not the only way.

History, con’t

• The first step was to search for resources.• Collaboration with theatre department• Tried house-made videos first

History, con’t.

• Improving orientation with videos• Two of nurse – patient interaction– Focus on communication– Mental status assessment

• One psychiatric emergency• Orientation videos still used• Positive student feedback

History, con’t.

• Communication – Feedback from students “don’t know what to say”– Faculty reported student struggles with

communication• No formal evaluation of

communication skills• Started planning simulation

Hooray! Funds! 2012

• Technology and grant funds• Clinical includes one day of simulation • Simulation planning– Teaching team– Simulation faculty

SCENARIO SELECTION

Sara Fruechting, RN, MNSc, CCRN

Scenario Selection

• Needs assessment based on program assessment– Evolve HESI sub-scores in Mental Health– End of course evaluations– End of program evaluations– Clinical faculty feedback on student experiences in

facilities

Student Learning Outcomes

• High risk, low occurrence situations• Focus on communication skills• Simulation replaces first one, then two clinical

days• Course team chooses scenarios that ‘every

student should have’

SIMULATION CURRICULUM

Debra Rurup, MSN, RN

Simulation Development

• Funds for standardized participants• Hearing Voices• Full clinical day in simulation– Interaction with SP and debrief with facilitator

Simulation, con’t.

• Depressed / suicidal patient• Bipolar in manic phase• Hearing Voices

Simulation, con’t.

• Learning objectives for simulation experience– Effective communication techniques for

psychiatric patients– Reinforces classroom content on communication

theory– First clinical includes interaction process recording

with a real patient

Simulation, con’t.• 2014: SBLEs expanded to two full clinical days• Student learning objectives relate back to the

specific experience• Three more scenarios were developed:– Admission assessment of an alcoholic patient– Communicating with a schizophrenic patient– A psychiatric emergency, the “hanging man.”

Simulation, con’t.

• Communicating with a schizophrenic patient• The “hanging man” psychiatric emergency• Structure– Experience– Debrief– Written reflection

STANDARDIZED PATIENTS

Dr. Jeffrey K. Carmack, MSN, RN, CHSE

We built it… Can we staff it?

Finding a Workforce. . . Cheap!

• Started with only a minimal budget– 1st year departmental grant• Covered one adjunct salary of $8,100• Covered a some of the SP hours• Encouraged to find funding within our normal budget

– After year one, SimCare had to cover all cost• Had cover over 330 SP hours• Did not have a formal training program in

place

Year 1

• SimCare faculty recruited SPs from other programs, when not in use at their home institution

• Faculty played the roles when needed• Student volunteers

Year 1 Evaluation

• Volunteers were a weak area– Priority Conflicts• Paid Work• Test Tomorrow• Bad Weather

– Unreliable• Faulty– Did not create same stress as unknown SPs

Creating a Long Term Solution

• Needs Assessed– Fund SPs– Fund Adjuncts– Reliable Workforce

Standardized Participants: Willing Participants are Waiting

• Nursing had a long established set of Special Topics courses

• Varied credit hours (1-3 credits per semester)• Pass/Fail only • Ratio was stated as 1:1• Allowed only AAS Nursing students to enroll• Meet special scholarship requirements

Special Topics Down Side

• “I need it to help my GPA.”

Year 3: A Plan Came Together

• Realized Special Topics courses created faculty workload

• Knew simulation faculty needed workload

NURS4305 Standardized Patients in Simulation

• Designed a course to be an upper level course that. . . – Was open to all majors– Could be taken twice– Moved from Pass/Fail to A,B,C Credit– Could be staffed at a 1:24 ratio

NURS4305 Course Description

Students will be assigned to specific SimCare courses. Under the guidance and direction of the simulation

faculty facilitators, students will participate in simulation-based learning experiences (SBLE) as

standardized patients (SP) and embedded actors (EA). Student will have opportunities to experience, practice and model the essential nursing competencies; quality

improvement, teamwork/collaboration, patient-centered care, evidence based practice, informatics, and safety within the SBLE. 3 credit hours. Open to students

from many disciplines. Instructor approval required.

The SLOs1. Verbalize and display individualized patients’ conditions, needs and preferences. (PCC)2. Provide patient perspective feedback to participants who are using the nursing process, good judgment, the multidisciplinary team, delegation and error prevention. (T&C )3. Participate in debriefings using SimCare PEARLS*. (I, EBP) 4. Use + / Delta to uncover common errors that SimCare participants make. (S)5. Demonstrate effective use of SimCare equipment, scenarios, and virtual and real personnel, including patients and family members. (I, T&C)6. Explain how the SBLE relates to quality improvement in actual practice areas. (QI)

(Key: S – Safety; EBP – Evidence-based practice; T/C – Teamwork and Collaboration; QI – Quality Improvement; PCC – Patient-centered Care; I – Informatics)

*Promoting Excellence and Reflective Learning in Simulation

The Good

• Understood the monetary benefits– Very low return– Projected 1 or 2 students a semester– Offered 3 times since approval• Spring 2015 – 4 enrolled = 148 hours• Summer 2015 – 6 enrolled = 222 hours• Fall 2016 – 14 enrolled = 518 hours

MANAGEMENT CONCERNS

Dr. Jeffrey K. Carmack, MSN, RN

UALR Simulation Curriculum Model

MH Simulation Facilitator

• Designed cases in conjunction with course coordinator (This model was limited to Mental Health Simulation only)

• Reviewed off the Shelf Curriculum.

Course Team

• Review in house development and approved• Recommended purchases to Simulation Technology & Resources (STR)

Chairperson

MH Facilitators

• Implemented scenarios• Staging• Character development training

• Recommend changes post 1st implementation to Course Team• Recommend new cases as requested by STR Chairperson

Pros of Current Model• Worked well for initial adoption of simulation– Single Champion – Converts clinical content into simulation-based learning

experience – Allows quick modification (trial and error)

• Clinical faculty primarily were simulation faculty in the early days

• Low cost – The champion takes on the added workload, often as a

trial, but may become the status quo

Cons of Current Model• Simulation has advanced– New recommendations (immersion training)– Trained specifically in simulation– Increase hours running simulation (50%)– Decreased clinical workload in the acute care setting

• No input from teaching team

Con’s of Current Model• No oversight• Single person– Not updating skills across curriculum – Not updating curriculum links between learning

outcomes & SBLEs • Low cost – The champion takes on the added workload and it

becomes the status quo

UALR Simulation Draft Curriculum Model All Content Areas

Course Team

Conduct needs assessment based onEnd of course EvaluationsEnd of Course Standardized Testing (HESI/ATI, Final Exams)Facility evaluations by clinical facultyObservational data relayed to team by Simulation Facilitators Updated EBP

Recommend new simulation-based learning experiencesRecommend revisions to existing simulation-based learning experiences

UALR Simulation Draft Curriculum Model All Content Areas

Simulation Technology

& Resources

Review simulation-based learning experiences

Validate INACSL Standards of Best Practice: SimulationSM are present Validate that SimCare Policy and Procedures are meet

UALR Simulation Draft Curriculum Model All Content Areas

Simulation Technology

& Resources

Validate simulation-based learning experience is feasible given facility, facilitator, and equipment limitations

Tech Sheets are completedMission, Vision, and Philosophies are respected by the design Extracts capital purchases needed to complete the experiences and prioritizes purchases

Recommended purchases to Simulation Technology & Resources (STR) ChairpersonForwards simulation-based learning experiences to Curriculum Committee

UALR Simulation Draft Curriculum Model All Content Areas

Curriculum Committee

Review recommendations of SRT committee Reviews

Fit with Drugs across curriculumFit with Commonly Recurring Health Conditions across curriculumFit with Skills across curriculumUpdated EBP

UALR Simulation Draft Curriculum Model All Content Areas

Curriculum Committee

RecommendsApproval without modificationsRevisions be completed and resubmitted to Curriculum Committee

Maintains a simulation-based learning experiences in a central locationValidates that simulation-based learning experiences are reviewed every three years