Gotta get this boat to sail!
A few caveats! This is a first draft, I am focused on content rather than formatting, so there may be citation errors or awkward sentences, etc (I expect the same in my final draft too because… I’m only human!), so please don’t feel compelled to correct those! Also I am still trying to figure out what this chapter one business is all about. But I feel like publishing here makes me accountable to keep working on it! Also, if I had the time or the inclination, (and the html patience) I would link citations and such. But NAH.
I am taking a risk here, sharing my ideas and thoughts regarding my research- so if you, for whatever reason, happen to care about this topic passionately… have plans to research it yourself – first I’d say, wow. Sorry. Second I’d say, PLEASE reach out and contact me. I’d rather find a way to collaborate instead of find myself at a loss for my topic (or see it presented at a conference). This is a big enough field, with enough “space” that we could share ideas and still get our work done! Again PLEASE email me and let’s talk about it. I would be happy to send you citations, suggestions and ideas!
Finally, an update – I am currently stuck at home with a casted leg from the knee down. I managed to snap my achilles tendon taking a step (nothing exciting) and am recovering from surgical repair of the tendon. A couple of weeks of non-weight bearing on my RIGHT leg, then a couple months of cast and boot. It’s been 20 day since surgery and I’m finally feeling productive! So bear that in mind as you read:
Description of Simulation
Simulation is the use of a “true to life setting” for the practice and performance of skills in healthcare (Society for Simulation in Healthcare, 2016). It is modeled on the training of pilots and other individuals who perform in high risk environments where there is a very narrow margin for error (Al-Elq, 2010). While there are many different ways to describe, define and use simulation in healthcare, the Society for Simulation in Healthcare identifies four major applications of simulation in healthcare: education, assessment, research, and health system integration in facilitating patient safety (Society for Simulation in Healthcare, 2016). In all of these, simulation is defined by what it does: provide a safe, realistically developed environment where the participants may engage in patient care, practice a skill, evaluate competency, test a process, demonstrate team dynamics and communication skills and research situations that occur in healthcare.
Simulation in nursing education has become a standardized part of many nursing schools and hospital training programs. In 2013, the International Association of Clinical Simulation and Learning published the first seven Standards of Best Practice: Simulation, adding two more standards in 2015 (Ackermann et al., 2013; Decker et al., 2015; Lioce et al., 2015). These standards came at crucial time with an increase in the use of simulation in nursing and the need for evidence based guidance. The goal of the standards is to “advance the science of simulation, share best practices, and provide evidence based guidelines for implementation and training” (The International Nursing Association for Clinical Simulation and Learning, 2015).
Prebriefing/Briefing in Simulation
It is in these Standards that the essential elements of simulation are found. The original seven Standards outlined the basic elements of simulation throughout. Overall the basic structure of a simulation scenario must include, among other elements, prebriefing or briefing
(Ackermann et al., 2013).The newest Standard, Simulation Standard IX: Simulation Design includes a more specific list of elements of simulation design, which also includes prebriefing/briefing (Lioce et al., 2015).
In the Standards and other simulation literature, prebriefing and briefing are interchangeable terms. This paper will refer to it as prebriefing. Simulation Standard I: Terminology defines prebriefing as:
An information or orientation session held prior to the start of a simulation-based learning experience in which instructions or preparatory information is given to the participants. The purpose of the prebriefing or briefing is to set the stage for a scenario and assist participants in achieving scenario objectives. Suggested activities in a prebriefing or briefing include an orientation to the equipment, environment, mannequin, roles, time allotment, objectives, and patient situation. (Ackermann et al., 2013, p. pp S3–S11).
According to the Standards, simulation prebrief is an essential element of simulation best practice. Simulation Standard IX: Simulation Design provides three guidelines for prebriefing:
Guideline 1: Briefing activities include the establishment of an environment of integrity, trust, and respect. Briefing includes identification of expectations for the participant(s) and the facilitator(s). This includes establishment of ground rules and a fiction contract.
Guideline 2: Briefing should include orientation of the participant(s) to the space, equipment, simulator, method of evaluation, roles (participants/facilitator/standardized patient), time allotment, broad and/or specific objectives, patient situation, and limitations.
Guideline 3: A written or recorded briefing plan standardizes the process and content for each scenario/case
(Lioce et al., 2015, p. pp 309–315)
Prebriefing is an essential element of simulation, however the practice and content of prebrief varies widely. There is a paucity of research supported models for nursing faculty to use to guide the development of pedagogically sound prebriefing for simulation in pre-licensure programs.
Background and Significance
It has been almost 15 years since the Institutes of Medicine recommended the use of simulation in health care education to promote safe and competent nurses (Kohn, Corrigan, & Donaldson, 2000). Simulation now is considered a viable option to supplement and replace clinical experiences in nursing education. It can be designed to provide consistent learning opportunities for groups of students in a way that the less predictable clinical setting cannot (Gates, Parr, & Hughen, 2011).
This is important because clinical sites are becoming increasingly difficult for nursing programs to secure (Ellis, 2013). In 2010, a national survey conducted by the National League for Nursing questioned over 2,300 nursing programs across the United States and found that a major barrier to clinical learning for nursing students is “lack of quality clinical sites” (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014; Ironside & McNelis, 2010). A 2010 National Council of State Boards of Nursing (NCSBN) survey found that many schools are turning to simulation as a way to provide students additional learning opportunities with 69% of schools surveyed reporting they used simulation to substitute for clinical learning experiences (Kardong-Edgren, Willhaus, Bennett, & Hayden, 2012).
The use of simulation as an adjunct or replacement for clinical hours is evidenced based. The results of a national, multi-site, longitudinal study of simulation, the NCSBN found that substituting simulation for up to 50% of students’ traditional clinical experience in pre-licensure nursing programs was as effective as traditional clinical learning and did not affect National Council Licensure Examination (NCLEX) pass rates (Hayden et al., 2014). Six months into clinical practice, the study found that there was no significant differences in nursing practice between those groups of students (Hayden et al., 2014).
As programs are moving to include simulation as a crucial component of their curriculum, faculty require guidelines based on solid pedagogy and evidence based practice that can be used to develop consistent simulation experiences for their students. Exploring the current practices of prebriefing among pre-licensure programs will help identify the gaps in practice and the development of such guidelines to assist simulation developers and programs to support student learning.
Aim and Research Questions
The aim of this research is to collect data regarding current simulation prebriefing practices in US pre-licensure nursing programs as a basis for developing a prebriefing framework for faculty to use when developing simulations.
This research seeks to answer the following questions:
- What is the current state of the science of pre-briefing in US pre-licensure nursing programs?
- What are the current pre-briefing/briefing practices in US pre-licensure nursing programs?
- How do they compare to the expert recommendations (DELPHI study?)
- What are the next steps necessary to establish pre-briefing standards?
NOTES: COMING SOON (maybe): preliminary design and theoretical framework
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Al-Elq, A. H. (2010). Simulation-based medical teaching and learning. Journal of Family and Community Medicine, 17(1), 35–40. http://doi.org/10.4103/1319-1683.68787
Decker, S. I., Anderson, M., Boese, T., Epps, C., Mccarthy, J., Motola, I., … Scolaro, K. (2015). Standards of Best Practice : Simulation Standard VIII : Simulation-Enhanced Interprofessional Education ( Sim-IPE ). Clinical Simulation in Nursing, 11(6), 293–297. http://doi.org/10.1016/j.ecns.2015.03.010
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Hayden, J., Smiley, R. a, Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. Journal of Nursing Regulation, 5(2 Suppl), S1–S64. Retrieved from https://www.ncsbn.org/JNR_Simulation_Supplement.pdf
Ironside, P. M., & McNelis, A. M. (2010). Clinical Education in Prelicensure Nursing Programs : Findings from a National Survey. Nursing Education Perspectives, 31(4), 5–7.
Kardong-Edgren, S., Willhaus, J., Bennett, D., & Hayden, J. (2012). Results of the National Council of State Boards of Nursing National Simulation Survey: Part II. Clinical Simulation in Nursing, 8(4), e117–e123. http://doi.org/10.1016/j.ecns.2012.01.003
Kohn, L., Corrigan, J., & Donaldson, M. (2000). To err is human: Building a safe health system. Washington DC: National Academies Press. http://doi.org/10.1093/bja/aeq146
Lioce, L., Meakim, C. H., Fey, M. K., Chmil, J. V., Mariani, B., & Alinier, G. (2015). Standards of Best Practice: Simulation Standard IX: Simulation Design. Clinical Simulation in Nursing, 11(6), 309–315. http://doi.org/10.1016/j.ecns.2015.03.005
Society for Simulation in Healthcare. (2016). About Simulation. Retrieved July 20, 2016, from http://www.ssih.org/About-Simulation
The International Nursing Association for Clinical Simulation and Learning. (2015). Standards of Best Practice: Simulation. Retrieved July 20, 2016, from http://www.inacsl.org/i4a/pages/index.cfm?pageid=3407