Undergraduate Nursing & Clinical SimulationKaren Edgecombe, CPIT

Undergraduate Simulation in NZ

Nursing Council of NZ

All students have access to simulation learning resources in order to prepare them appropriately for clinical experiences to ensure the safety of health consumers, students and staff

BN Programme– Feb/July intakes

• 135 students (approx)

Year OneFocus on Building Knowledge and Skills

– Bioscience– Communication– Nursing Knowledge

Clinical Experience– Aged Care Sector

Simulation– Skill focused

• Nursing skills – starts simple• 2013 change to curricula and focusing on small group simulation

activities, with lecturer rotating through with one group

Year Two

2A: Mental Health• Debriefing, de-escalation• Skills focus: injection techniques• Area for expansion in simulation

2B: Acute Care – Med/Surg• 5 weeks theory• Simulations each week

– Sim Man utilisation

Simulation gets students ready for practice

Objectives – what we try to teach

• Professionalism• Assessment skills• Communication skills

– with the patient– with the whanua/family– with health professionals

• Appropriate, safe nursing management• Documentation

Professionalism

• Attitude

• Appearance

• Clear identity

Systematic, organised approach to assessment

• Incorporating frameworks• ABCDE rapid assessment• PQRSTU• Focused assessment of specific system

– e.g. respiratory, musculoskeletal• Initial Assessment• Comprehensive Assessment

Students need to know what to do in an…

Teamwork

Meet the Patient

Communication

Tool

Recognising changes in a patient• Close attention to vital signs &

observations-Watching trends

• Report to a senior RN or doctor

Nursing Management

• On-going monitoring vital signs &

observations

• Positioning

• Medication administration

But…. not the real world

In the real world…documentation

Paper work Computer updates– Patient notes– Neuro obs– Neurovascular obs– Fluid balance– QM0004– Falls risk– Bristol stool chart– Lab results

But wait, always more!

A matter of time

Debriefing

Peer

Observation

Tool

Debriefing

What students say‘I don’t know anything’ ….

‘It makes more sense’

‘I didn’t know he was going to breathe.’ ‘He talks!’

‘I think we should call the doctor!’

‘You want me to do all that again?!’

‘I didn’t have time for the paper work’

‘Everything changed so suddenly.’

‘I didn’t know what to do’

‘now I see why how frameworks work.’

What is going well

We do have some humour and fun.

We are meeting different learning styles.

We see beginning critical thinking skills.

We build confidence and competence.

http://www.kon.org/urc/v9/hunter.html

What else could we be doing ?

Expand scenario library.

Video taping.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ ?

Year Three

3A: Family & Community Health• Paediatric CPR

3B: Transition to RN Practice• Simulation: Deteriorating patient

• Small group rotations, lecturer follows through with debriefing

What we know…Simulation and the Nursing Student

• Literature supports the use of simulation as an accepted teaching and learning strategy– Anecdotal & research based– Recognise that students ‘report’ feelings of

increased confidence & knowledge post simulation (Blum & Borglund, 2010; Cant & Cooper, 2010; Hovancsek & Jeffries, 2009)

– What are the BEST teaching &

learning strategies that lead to this point?

Simulation & the Nursing Lecturer• Recognise that the nursing student is electronically

‘savvy’ – Maybe more so than the nursing lecturer!– E-books, Web-based games, cell-phone technology– Have a greater understanding and reliance on technology

• Although they may love the technology, they can still be pretty naive about it!

• Use of simulation as a teaching & learning strategy to assist in scaffolding knowledge (Levett-Jones & Gersbach, 2011)

– Improving clinical decision making

• Recognise that clinical areas are

increasingly technology driven