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 Onanian 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 Onanian SON 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 Onanian 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.
The Simulation program is part of the Zvart Onanian 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.
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 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 Onanian SON specific program called the Simulation Educator Designation (SED) was developed and implemented in 2017. Currently over 30 Rhode Island College Zvart Onanian 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 Onanian 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 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 Onanian 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.