Simulation Center and Nursing Resource Laboratory
Simulation Center – Downtown RINEC
Rhode Island College School of Nursing Graduate Assistants AY 2017-2018
L to R: Jessica Collinson, Jon Cerami, Simulation Coordinator - Penni Sadlon, Jackie Hurteau, Lauren Slater, Brent Medeiros, and Erika Leonard
Graduate Assistantship in Simulation
Graduate nursing students awarded simulation assistantships are notified by the Chair of the SON Graduate Department, Debra Servello, DNP, APRN-ACNP-BC. Once assigned to the SCNRL, GA’s will participate in a structured orientation led by the Simulation Coordinator/Educator, Penni Sadlon, MSN/Ed, RN, CHSE. The graduate assistantship in simulation (GA) requires 5 (half-time) or 10 (full-time) hours worked per week. Orientation includes a ‘workshop style day’ with training in simulation methodology, simulation design and debriefing strategies. Manikin use and maintenance is also introduced. Simulation center tours are held at 2 campus locations: RIC-SON-North Providence and Rhode Island Nursing Education Center/RINEC-Downtown Providence. Students eligible for application are nursing students matriculated in the MSN or DNP programs at RIC, enrolled in a least six credits but no more than 9 credits of coursework….If you are interested in applying for a graduate assistantship in simulation, contact Debra Servello, Graduate Department Chair at
Simulation use in nursing education relies on low to high fidelity modalities that frame specific objectives for simulation activities. Specific learning objectives are clearly written for each activity and follow evidenced-based practice (EBP) standards. Formative (assessing) and summative (grading) evaluation tools are used throughout all levels. Courses that use the lab frequently are: Fundamentals, Health Assessment, Adult Health, Pediatrics, Maternal-Child Health and Psychiatric-Mental Health. Programs outcomes are aligned with 1) the mission and vision of the SCNRL and RICSON, 2) the recommended standards of best practice by The International Association for Clinical Simulation in Nursing (INACSL), and 3) the accreditation standards by the Society for Simulation in Healthcare (SSH).
RIC Nursing Simulation Lab Receives National Accreditation
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RI College School of Nursing Students learn to think critically by caring for complex simulated patients in a safe setting. Students are expected to complete preparation work prior to coming to the simulation. They are expected to act professionally, and adhere to safety principles at all times. Safety for patients and providers is the focus of our simulation center.
To prepare students for professional, safe, and equitable nursing practice through innovative, experiential learning in a simulation environment.
To be a regionally recognized leader of simulation-based learning, research, information and technology use for improving healthcare and outcomes.
The Simulation Center and Nursing Resource Laboratory (SCNRL) is part of the School of Nursing (SON) at Rhode Island College. The space is fully utilized throughout the academic year. Newly equipped spaces provide state-of-the art areas that mimic a variety of clinical settings. For the academic year (AY) 2016-2017 the center hosted undergraduate nursing classes, skills labs and simulations Monday – Friday 7am – 4 pm. Graduate nursing classes were held mostly in the evenings, except on interprofessional simulation days. A total of 887 students were learners and active participants in experiential education this year. Clinical preceptors gain additional training on-site at the center through specialized instructor training and simulation workshops. Special programs were developed on request. For example, a Science, Technology, Engineering, Art, and Math (STEAM) project geared toward grades 3-5 was created and offered as a 'field trip' to our nursing simulation center. The
Vascular Access Devices presented on-site by the Infusion Nurses Society was another well attended workshop offered to all Student Nurse Association (SNA) members and was such a success with students that it will be offered as a recurring presentation.
Several simulations recur each semester as part of the overall curriculum. Unique opportunities to expand simulation include new simulations designed by faculty and students. These projects may be part of larger grant projects, or created to meet newly identified program needs. For example, an unfolding case about caregiver burden and respite training; a verbal de-escalation in the emergency room; and a serotonin syndrome as a psychiatric emergency are a few newly funded projects. A healthy newborn discharge simulation was designed by faculty to fill a current need for students studying maternal and child health and a community/population health simulation is in the initial design stages.
Typically, 60-80 students
per course are scheduled to participate in simulation activities during each semester. Smaller groups of 6-8 students enter simulation as active learners or observers. Observer role direction is an important factor in designing good simulations and work is being done to standardize this experience, enhance student engagement and improve student outcomes. A poster about formalizing observer roles in simulation was presented at the 2017 International Nurses Association for Clinical Simulation and Learning (INACSL).
A newly purchased software audio/visual system by CAE Learning Space "Intuity" © continues to enhance the program's ability to capture student performance, assess simulation learning outcomes and critique program effectiveness. Here are a few photographs of recurring simulations using the system:
Each simulation is audio/video-taped and stored within the system for easy retrieval and post-simulation, student performance (individual or group) and case metrics. Our program recognizes the importance of capturing textual data, so conversation analysis is possible. The reporting structures are customizable depending on each instructor's described needs. For example, one metric consistently measured in all acute care simulations is the
National Patient Safety Goals (NPSGs). These goals are written as pre-set annotations attached to each acute care activity allowing student observers, faculty and/or simulation educators to capture when students meet or miss goal achievement. Annual metrics are reported to the Dean.
Simulation pedagogy is generally understood to mean the theoretical foundations used in experiential learning and teaching approaches used to achieve learning objectives. Jeffries (2015)
The NLN Jeffries Simulation Theory defines "simulation as an evidence-based teaching methodology that is grounded in theory from diverse fields, including education, cognitive psychology, and adult learning (p. 43)." The importance of using simulation as a teaching method ensures students the opportunity to engage in clinical reasoning and critical thinking in a safe environment. Students develop critical skills (psychomotor, cognitive, interprofessional, and interpersonal) prior to professional practice in real clinical situations.
Simulation Education Training
Feedback from faculty and students engaged in simulation offers tremendous opportunity for improve simulations and simulation training. Those faculty and students increasingly involved in the design and deployment of simulation activities or the participation in simulation require instruction about simulation methods, equipment, best practices, as well as the hands-on opportunity to learn in simulation from qualified simulation educators. Certification Simulation Healthcare Educator (CHSE); Advanced (CHSE-A) qualified instructors spear-head simulation curriculum oversight and professional development programs. The program is staffed by a full-time CHSE simulation educator and a part-time CHSE-A consultant. To meet the need for faculty training in simulation, a new program
Simulation Educator Designation (SED) was developed and implemented this year and offered twice so far with over 40 attendees. Currently over 30 Rhode Island College School of Nursing faculty have attained SED status. This leap of a cadre of simulation focused faculty enhances the uptake and best use of simulation resources in nursing education now and for the future. Consistent use of best practices in simulation is the cornerstone of beginning knowledge about simulation use. The program awards 4-5 graduate assistantships in simulation, and each graduate student receives the same initial training as the SED program. Undergraduate students who enter the nursing program are introduced to simulation in a special orientation class. Each simulation is preceded with anticipatory activities (often virtual on-line simulations prior to simulation day) and structured orientations prior to each simulation.
Simulation evaluation is a broad term. The program recognizes that each simulation is to be evaluated at each step in the design process. Evaluation of the simulation program overall is also important for quality measures. Individual, instructor, graduate assistant, and faculty simulation educators should be knowledgeable in how to fulfill the requirements for simulation best practices, yet there are currently no competency mandates (INACSL, 2016). There is more work to be done. Each simulation program is different and evaluation relies on individual program goals and grading procedures. Currently, all nursing simulations conducted at the center are not graded and are conceived as experiential opportunities. Faculty involved with the simulation steering committee are investigating this interesting topic presently. The literature shows that several ongoing studies about simulation evaluation are under way. Overall, the simulation program evaluation is currently responsive to the Society for Simulation in Healthcare (SSH) accreditation metrics. As of 2014, the program is fully accredited in the areas of Teaching and Education. SSH re-accreditation is scheduled for 2019.
Student Outcomes Evaluation
Each simulation is designed around a set of learning objectives. Faculty decide which objectives should be met by each student. Some faculty even design post-evaluation tools to elicit student's thinking about the simulation experiences and their textual answers provide some qualitative measures of learning. As mentioned earlier, the NPSG's are assessed for all acute care scenarios. Confidence and satisfaction surveys are standard. The program welcomes all survey designs ideas for structuring robust outcome measurements.
Student Support in Simulation
Students are supported and enriched through experiential learning methods and one-to-one remediation in safe environments. Reflection and constructive feedback are shared between students (peer feedback), students to faculty, and faculty to students. All feedback is viewed as instrumental in meeting students learning needs and achieving program goals.
Student Evaluations of Simulation
General satisfaction surveys are conducted for each simulation to assess simulation effectiveness. Confidence surveys are completed immediately after a simulation to determine level of student self-efficacy. Group metrics are reported each semester and annually.
Business and Operations
The SCNRL is part of the school of nursing and shares its mission and vision. The simulation program has one full-time simulation coordinator/educator, 4-5 part-time graduate assistants, and 4-5 part-time work study students. The simulation coordinator/educator reports directly to the Dean of the SON. A new simulation steering committee was created in 2017. This committee submits an annual report to the SON. The simulation coordinator/educator is a key member of the simulation steering committee and the informatics committee. The simulation coordinator/educator is responsible for program oversight, development, and maintaining SSH accreditation standards and all supplies and equipment used in the program. The simulation coordinator/educator directly hires work-study students, and supervises and evaluates work-study and graduate assistants. The simulation coordinator/educator is also responsible for the education, training, and safety aspects for all student employees, SON faculty using simulation methods and faculty, actors, and student learners.
The current annual budget for simulation and skills lab supplies is $7,000.00. This amount has increased by $2000.00 in 2017. Consumable supplies such as gloves, alcohol wipes, needles, syringes, practice medications, dressing supplies, and patient care equipment uses approximately $3000.00 to $4000.00 dollars each year. Some monies are allotted to new projects that require hiring independent actors who portray standardized patient or family roles in simulation. Other times, monies are used for acquisition of new products or services (see other expenses).
Capital equipment preventative maintenance contracts are purchased sparingly. The program attends to equipment upkeep according to an established plan. One maintenance contract was exercised this year on the Sim Man 3G® Manikin for a total cost of $ 4757.90. This is reported under other expenses and is a separate funding pool provided by the SON.
New Capital Equipment
New simulation equipment acquired in 2016 includes 6 Sim Pad full-size manikins (Laerdal Nursing Kelly ® and Nursing Anne's ®) with 5 all-in-one (AIO) computers, 4 Laerdal ® child/toddler manikins, 3 control room computers, 2 manikin instructor laptops, and 4 TV monitor presentation screens with mini-computers, a ceiling attached patient lift, 9 wall-mounted oto-ophthalmoscopes, BP cuffs and thermometers, 2 simulated stethoscopes (sim scopes by Cardionics ®) and two Laerdal Mama Natalie ® birthing partial task trainers. Refurbished hospital beds with patient cabinets, and over the bed tables, 9 examination tables, and 18 student work tables with 36 chairs, a conference table with 12 chairs, and a computer table. These costs are reported elsewhere in the SON annex construction costs.
Inventory and Existing Capital Equipment
Supplies and equipment inventories are conducted each summer in July and again in January. A spreadsheet is kept in the simulation coordinator/educator's office Rm. 164 and on a flash drive for use by the work-study students assigned to assist with inventory tallies. This excel document is adjusted each time a shipment of supplies is acquired. Donations as counted and reported separately. Estimated costs of all donations are noted. Thankyou letters are sent to all major donors. This year donations included mostly consumable intravenous catheters, syringes, two balloon catheters for use with post-partum hemorrhage, one chest tube, pediatric electrode pads, a newborn car seat, and simulated newborn soft doll. Existing capital equipment are listed by serial number and date acquired.
Existing manikins include:
- One Laerdal Sim Man® 3G
- One Laerdal Sim Junior ®
- One Laerdal Sim Baby ®
- One Laerdal Sim Toddler ®
- Three Nasco © static manikins
- One Gaumard© static manikin
- One ALS® Laerdal Simulator (on loan from VA Providence)
- One Laerdal Nursing Anne ®
- Two Laerdal pediatric child (Nursing Kid ®)
Large existing capital equipment includes items such as a Welch Allen automatic vital sign machine, one Sigma Spectrum pump; four plain IV stands; 5 privacy screens; two portable patient lifts; one adult and one pediatric wheel chair; one code cart, two stretchers, one arterial pump training arm, one adult and one pediatric venous training arm, two portable suction machines; one portable pulse oximeter, one CPAP machine; one home-nebulizer; several partial task training anatomical models, two Chester chest central line trainers; one breast examination model; one testicular examination model, two Surgi-Sally surgical wounds models; decubitus model, and several articulating arm and leg parts, and manikin replacement skins.
Small existing capital equipment includes items such as thermometers, blood pressure cuffs, glucometers, insulin pens, urinary catheter bags, chest tubes, incentive spirometers, personal protective equipment, phlebotomy supplies, vascular access device (VAD) supplies, reflex hammers, tuning forks, battery powered oto-ophthalmoscopes, dentures, wigs, community clothes, duffle bags, walkers, canes, crutches, orthopedic boots, gait belts, sliding boards, CPR back boards, training AED, EKG machine, and medical and nursing historical artifacts, including an antique "Martha Chase" simulation training doll.
Other or miscellaneous expenses over $500.00 requires a special approval process that aligns with the college's purchasing policies. Other expenses support special projects, faculty development, standardized patient program development, research activities and travel associated with simulation education, training, and scholarly presentations. For example, to support faculty development in simulation education, monies were used to purchase three critical NLN simulation courses that faculty could access for up to one year, complete on their own time schedule prior to attending an SED workshop. This approach to resource utilization was cost-effective, flexible, and user-friendly.
Policies and Procedures
The 2016 SON Fogarty annex addition provided much needed additional simulation, classroom and skills lab spaces. This increase in space also supports program expansion. The current policies and procedures need revision to reflect these changes. The simulation steering committee is tasked with guiding the direction of this revision project. The simulation coordinator/educator presented a prototype manual from the University of Pennsylvania's clinical simulation program 2015. The committee has agreed to review and edit any policy or procedure written, created, or revised by the simulation coordinator/educator for inclusion into our new manual for AY 2017-2018. This project is a priority in anticipation of re-accreditation in 2019.
Collaboration and Program Expansion
The Rhode Island Nursing Education Center, or RINEC is a new expansion project scheduled to open fall 2017. This 133,000-square foot space in downtown Providence, RI is housed in an historic waterfront building, has undergone renovation specifically to accommodate shared spaces for Rhode Island College and the University of Rhode Island nursing programs, and the administrative offices of Brown University. The downtown location is within the hub of the Brown medical school and area hospitals. Several skills labs with high-technology manikins, high-fidelity rooms, standardized patient rooms, a home-care suite, and scaled-up classrooms are some features. This expansion is another positive step for integrating simulation education and ensuring its impact in the education of health professionals. The facility will support research collaboration within the community of scholars, and external professional development and simulation activities for a variety of health professions. The SCNRL program will continue to develop simulation curriculum at both the main RIC and downtown RINEC campuses.
The SCNRL accredited simulation program has a positive impact on students and faculty. The SON expanded its enrollment in undergraduate and graduate levels, and the SCNRL developed faculty champions in simulation methodology, and collaborated with other scholars in nursing, social work, and medicine using interprofessional activities. The future of simulation at RICSON is promising. Our home-grown solutions, innovations, and strong simulation presence regionally and nationally predicts a bright future for experiential education of the region's healthcare professional students and ultimately for the betterment of the care we provide to all our patients, families, and communities.