School of Nursing Simulation Program

Nursing students

Simply put, our goal is to prepare students for professional, safe, and equitable nursing practice through innovative, experiential learning in a simulation environment.

 

Simulation-based clinical education provides nursing students with opportunities to practice their clinical and decision-making skills through varied real-life situational experiences, without compromising the patient’s well-being.

The discipline of nursing is an applied science which involves didactic theory courses and clinical practice. Clinical education in nursing aims to integrate theoretical knowledge into practical knowledge in real-life situations and assists students to develop their problem-solving skills. Hands-on learning is paramount, however, due to rapid changes in clinical placements, especially with the impact of the current COVID-19 pandemic, students’ direct experience with patient care and opportunities to handle problem-based clinical situations have been diminished.

Simulation-based clinical education in nursing refers to a variety of activities using low to high-fidelity patient simulators (mannequins) that replicate real-world scenarios in a lifelike simulated environment. With realistic clinical scenarios, simulation-based educational interventions, nursing students can gain experience and confidence in providing safe, effective, culturally competent care. 

EDUCATE. INNOVATE. LEAD.

The Simulation Program will be built upon these three strategic pillars.

The SON faculty, from the Bachelor of Science in Nursing to the Doctor of Nursing Practice, will educate and prepare graduates for the challenges of today’s complex health care settings. The faculty, under the guidance of the Simulation Director, will undertake mapping of the curriculum to effectively integrate simulation into and throughout the nursing curriculum. 
Faculty will attend professional development activities and events to gain a greater understanding of sound pedagogical design that support simulation-based experiences that actively engaged the learners and meet learning outcomes. 

The SON will be known for promoting and engaging in Interprofessional Education. Interprofessional education encompasses individuals from various health care fields and emphasizes a collaborative approach to develop health care students as team members, resulting in improved communication and outcomes for patients.

The SON will also enhance the education of our community partners through the offerings of professional development workshops and courses focused on simulation in the health care setting. 

 

Innovation in healthcare and in nursing education is the practical application of new concepts, ideas, processes, or technologies into clinical practice. The SON is committed to integrating technology in the learning environment to accelerate the discovery of knowledge to better prepare our graduates for the challenges of today’s health care arena. 

The SON will be the only nursing program in the area to develop and implement an Innovation Center for Creative Ideas. The Center will foster innovative solutions by providing the environment, infrastructure and support for faculty and students to collaborate on exploring new technology and course design. Additionally, the Center will enable faculty to link with experts from across the nation to promote collaborations and to learn the newest and most effective means of integrating simulation and innovation into the curricula. 


The SON’s Simulation Program will be known regionally for educational excellence. The Simulation Program currently holds accreditation by the Society on Simulation in Healthcare, an international accrediting body of simulation programs. The Endowed Simulation Director/Professor will be a high caliber academician who is exceptional in the role and who can also engage faculty. The person will bring a dynamic approach to embracing simulation and technology strategies to educate future nurses. 

The Simulation Program will have an established Advisory group – this group will consist of faculty and external individuals who understand the nuances of nursing education and the impact that simulation has. Group members will include individuals who are experts in the field – from other colleges and universities and health care partners. 

The SON Simulation Program will facilitate the development of community partnerships to promote collaboration and Interprofessional Education. Faculty will be engaged in scholarly activities such as research and grant procurement. 
The SON will graduate nurse leaders who are critical thinkers and confident with technology so they are able to seamlessly access the technology they need to provide effective care without losing sight of what is most important—the patient.

Simulation Program Governance

The undergraduate and graduate programs both implement simulation throughout the curriculum. Simulation is defined as low, medium and high-fidelity simulation, virtual simulations, task trainers, sim pads and clinical scenarios. The SON Dean and Graduate and Undergraduate Department Chair oversee all activities associated with using simulation throughout the curriculum. The Simulation Program curricula development and faculty simulation education are directed by the Simulation Director. The Informatics/Simulation Sub-Committee provides advisory functions to the program.
The Informatics/Simulation Sub-Committee functions specific to simulation include:

  • Support accreditation of the RICSON Simulation Program. 
  • Review, revise and update policies and procedures related to the simulation program. 
  • Develop a strategic plan for resource acquisition, allocation, funding, grant writing and sustainability of the simulation program. 
  • Create activities that support on-going continued education and research opportunities for simulation educators and faculty.
  • Simulation Program Goals

Simulation Program Strategic Plan (2020 – 2023) 

Provide a safe environment for high-quality simulation experiences that support the mission and vision of the simulation program intersecting with the overall SON mission and vision, achieved by ongoing assessment and review of best practice in simulation. 

Improve simulation effectiveness by facilitating opportunities for faculty development in simulation pedagogy by responding to faculty needs and providing access to training via on-line webinar sessions and expanded Simulation Program workshops and simulation web page resources. 

Improve simulation program evaluation by using a variety of feedback tools that permit ongoing assessments of simulation educator performance, student performance, and overall user satisfaction with simulation resources incorporating the best evidence from the simulation evaluation literature.

Expand opportunities for interdisciplinary simulation education that focuses on delivery of safe patient care through collaboration with other healthcare partners. 

Support faculty scholarship using simulation, creating professional development opportunities in simulation education and research, achieved by developing scholarly partnerships internal and external to the program.

Center Utilization

The Simulation program 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.  During the academic year, the center hosts 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.  Student learner numbers average between 700 – 800+ annually. Clinical preceptors gain additional training on-site at the center through specialized instructor training and simulation workshops.  Special programs are 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. External partners interface with grant-funded projects that involve simulation scenarios. 

Simulation Spotlight

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 examples of 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).  Faculty develop, present and publish on simulation topics. 

The program video/audio software by CAE Learning Space "Intuity" © enhances the program's ability to capture student performance, assess simulation learning outcomes and critique program effectiveness.  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 about simulation use, student experiences, and learning outcome measurements are reported to back to the SON. 

Simulation Pedagogy

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. Faculty and students receive instruction about simulation methods, equipment, best practices, as well as the hands-on opportunities to learn in simulation from qualified simulation educators.  The Simulation Director holds Certification as a Simulation Healthcare Educator (CHSE). To meet faculty development in simulation needs, a RICSON specific program called the Simulation Educator Designation (SED) was developed and implemented in 2017. Currently over 30 Rhode Island College School of Nursing faculty have attained SED status, which is renewed every 3 years with targeted training and competency in simulation effectiveness assessments. Consistent use of best practices in simulation is the cornerstone of The Simulation Program.  The SON graduate awards several assistantships in simulation, where the graduate student receives initial simulation orientation to their role and ongoing training that covers material included in the SED program.  Student learners are introduced to simulation in a special orientation class in the sophomore year. Prebriefing, simulation, and debriefing resources are made available to faculty and students. 

Simulation Evaluation

Simulation Program evaluation occurs annually following standard criteria measurements set forth by the Program’s accrediting body, The Society for Simulation in Healthcare (SSH).  As of 2014, the program is fully accredited in the areas of Teaching and Education. The next accreditation cycle is planned for 2020.  

Facilitator Evaluation occurs at least annually through self and peer evaluation using instruments designed to measure requisite skills in conducting quality simulation experiences. In 2018, the SON faculty adopted the Debriefing Assessment in Healthcare Simulation (DASH ©) tool to evaluate simulation practices.  The DASH © tool allows faculty the opportunity for reflection on best practices in simulation-based education (SBE). The DASH © assesses the following elements:

  • I set the stage for an engaging learning experience
  • I maintained an engaging context for learning
  • I structured the debriefing in an organized way
  • I provoked in-depth discussions that led them to reflect on their performance
  • I identified what learners did well or poorly – and why
  • I helped learners see how to improve or how to sustain good performance

In 2020, the Facilitator Competency Rubric (FCR) was introduced as a self-assessment tool. 

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. The program has been measuring student confidence and satisfaction with simulation for several years. In 2020, the Simulation Effectiveness Tool-Modified (SET-M) was introduced to capture prebriefing, mastery of learning in simulation and debriefing components. 

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.

Simulation Use in Nursing Education

A Review of Best Practices

 

RICSON Simulation Center Anytime Training

*MODULE 1: Simulation Design – new *Access through Blackboard

Available 2019-2020

MODULE 2: Simulation Outcomes and Objectives 

MODULE 3: Simulation Facilitation

MODULE 4: Simulation Debriefing

MODULE 5: Simulation Participant Evaluation

MODULE 6: Simulation Professional Integrity

MODULE 7: Simulation-Enhanced Interprofessional Education (Sim-IPE)

MODULE 8: Simulation Operations

MODULE 9: Simulation Glossary

RICSON Simulation Center Workshop Slides

Focus on Facilitation and Debriefing 2019​ ​

Working with Actors 2018  

Low Resource Mobile Simulations for the Classroom 2016  

Post-Simulation Debriefing Practices 2016  

REPORT ON THE RICSON SIMULATION PROGRAM YEAR IN REVIEW: view document​

Additional Resources

INTERNATIONAL NURSING ASSOCIATION FOR CLINICAL SIMULATION AND LEARNING (INACSL)

https://www.inacsl.org/​

THE SOCIETY FOR SIMULATION IN HEALTHCARE

https://www.ssih.org/About-SSH/About-Simulation

QUALITY AND SAFETY EDUCATION FOR NURSES (QSEN)

http://qsen.org/teaching-strategies/simulation/simulation-evaluation/

NATIONAL LEAGUE FOR NURSES/SIMULATION INNOVATION RESOURCE CENTER (NLN-SIRC)

Institutional access codes may be available* https://sirc.nln.org/

CENTER FOR MEDICATION SIMULATION

For training sessions, blog posts, podcasts, etc. on Simulation

https://harvardmedsim.org/

DEBRIEF 2 LEARN

https://debrief2learn.org/

HEALTHY SIMULATION

Free Simulation Scenarios - https://www.healthysimulation.com/5689/free-medical-simulation-scenarios/

About Medical Simulation - https://www.healthysimulation.com/medical-simulation/

About Surgical Simulation - https://www.healthysimulation.com/surgical-simulation/

About Moulage - https://www.healthysimulation.com/moulage/

EVALUATING HEALTHCARE SIMULATION

Free Downloads

https://sites.google.com/view/evaluatinghealthcaresimulation/home​

*Note: Many other faculty resources in simulation are available on the SON private shared drive and the RIC Library. ​

Nursing Simulation Lab

Graduate Assistantships in Simulation

Graduate Assistantship in Simulation Graduate nursing students awarded simulation assistantships are notified by the Chair of the SON Graduate Department. Once assigned to simulation, GA’s will participate in a structured orientation led by the Simulation Director. 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: RICSON-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 the Graduate Department Chair at RICSON.

 

SIMULATION PROGRAM INFORMATION AND RESOURCES

Simulation Lab

RIC SON campus OPEN laboratory hours: TBD amid COVID

Please contact rmcvay@ric.edu for updated information or visit the COVID19 RIC page

 

RINEC location OPEN skills laboratory hours: TBD amid COVID

Please contact rinec.simulation@rinec.org for updated information. 

Student Version

What is Healthcare Simulation?

Healthcare simulation uses a variety of techniques to mimic the representation of  healthcare situations for the purpose of learning while practicing in a safe environment. The type of learning that occurs in healthcare simulation is termed, experiential learning and is used for performance improvement, patient safety, working in teams and mastery of procedures through deliberate practice. 

What Do I need to know?

Simulation is considered clinical time. Appropriate clinical attire is required. Pre-simulation activities are planned. See your professor for details.  Also, review the Power Point on How to Prepare for Simulation at www.ric.edu/simlab​. Ask questions. Come to Open Labs. We are all here to help you succeed. You will experience simulation through-out your program. Simulations are designed to increase in complexity as you move through the nursing specialty courses. 

What is a simulation scenario? 

In simulation, a case is called a scenario. Each scenario focuses on concrete objectives that you should be able to achieve given the theory and prior study and preparation prior to simulation day. An introduction to the environment is first. You will interact with simulators (technology-enhanced simulation manikins), actors, medical/diagnostic equipment and demonstration-drugs. Actors may play patients or family members. The overall idea is to create a realistic vignette that you may likely encounter in the clinical setting, school, home, or specialty unit (such as the Emergency Room). 

How should I behave in simulation? 

We ask all student learners to sign a professional confidentiality and integrity agreement. This document outlines professional behaviors and aligns with the American Nurses Association’s (ANA’s) Code of Ethics.  We ask that you treat a simulated patient case scenario as you would a real patient.  We know this isn’t real. However, we ask you to accept what is called a fiction contract that stipulates then when in simulation, you treat the situation as if it was a real situation.  

Do I have to engage in simulation if I feel anxious or distressed?

No. There is something called an opt-out clause that means if you experience emotional distress you may observe the simulation rather than be participant in it.  You should let your professor know if you feel this way. All facilitators/professors/simulation educators are trained to recognize students in distress and will support you if this ever happens.  There is evidence in the simulation literature that observing simulation can provide a passive opportunity to learn and reflect. This is called vicarious learning. However, unless student distress occurs, all nursing students are expected to participate in simulation as an active learner. 

What happens if I make a mistake in simulation?

Coming to simulation prepared will be your best opportunity to succeed in achieving the objectives.  Ask your professor questions about how best to review for the simulation. Typically similar case studies will be available for review. If you make a mistake in simulation, your professor or simulation educator will review performances immediately after the simulation.  This is called the debriefing.  Mistakes in simulation provide the opportunity to review thinking and actions in a safe environment. We all learn from our mistakes, and simulation provides the environment to make mistakes without harming real patients.  Your professor will tell you what type of performance review is attached to a particular simulation. For example, if simulations in your course are designed to provide foundation skills in simulation 1, then by simulation 3, those foundational skills should be present along with additional skills development.  Remember, feedback in simulation is similar to feedback in clinical. Performance gaps need to be addressed before taking care of real patients. 

How do can I learn from our mistakes?

Immediately after simulation, a debriefing session is held.  The professor conducting the debriefing will use a method of questioning that encourages self-reflection on thinking and performance. This process of reflection creates a conscious path for learning to improve. After reflection, you should think how you will change your approach next time.  Make a note of it and experiment later.  You can use Open Lab time to practice a variety of newly learned skills.  

What can I do if I feel the simulation could have been better? 

After simulation and the debriefing session, students are required to complete post-simulation surveys.  You will have the opportunity to reflect again on anything that wasn’t covered in debriefing and to add comments about what you liked or did not like about the simulation.  This information is extremely helpful, and professors use all student feedback in surveys to try and improve our simulation-based educational activities.  Post-simulation surveys are administered by the CAE Learning System. Your facilitator during NUR222 will show you how to log on to complete data entry.  https://learningspace.ric.edu  Students should log on and complete Professional Integrity and Confidentiality Agreement during this orientation. This agreement is an extension of the Academic Honesty Policy (see course syllabus). 

How can I get the most of my simulation experiences?

Be open and honest. Prepare. Relax. Get into it – suspend your disbelief. Value this opportunity to practice without causing harm to real patients.  Be proud of your accomplishments!! Take a tour of the center, meet a simulated patient.  Learn to get comfortable in a simulated environment!  TIME TO HAVE SOME FUN! ​

Rhode Island College entrance

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Penni Sadlon

Assistant Professor