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So I did it! I finally finished my PhD. I successfully defended my dissertation, entitled: “A survey of simulation prebriefing practices in prelicensure nursing programs in the United States” on May 21, 2021. It’s pretty amazing to be done and feels a bit unreal.

Among my many post-grad to-dos, updating this blogfolio is on my list, and my resume. And getting my other two manuscripts published. What? What manuscripts you say? Well, I may have mentioned this before, but my dissertation was the 3 paper approach. I wrote my chapters as stand alone journal articles. One has already been published:

Ludlow, J. (2020). Prebriefing: a principle-based concept analysis. Clinical Simulation in Nursing. In Press. https://doi.org/10.1016/j.ecns.2020.11.003

(that’s weird to see my OWN name in citation format!)

My other 2 articles are the findings of a national prebriefing survey with almost 300 responses from prelicensure nursing programs. Very interesting information came out of this survey- and a better understanding of the faculty perspective of prebriefing and preparation.

Now that I am done with school (a 7 year journey, BTW) I plan to rest my brain for a bit. Focus on my work (aka my day job), and get myself grounded again. But that doesn’t mean I am done. OH no, expect more from me!

But for now— GO COUGS! GO DAWGS!

It has been a while since I’ve posted- which is how I pretty much start every post here. I think I will someday really get to dedicate time to this site, once I finish school (maybe in a year?) and I can focus some good energy here. I am working on a post based off of a presentation I did recently, but I have other priorities.

Such as:

Which is happening this week. So I am supposed to be working on my slide deck, but I needed a break. Here’s my abstract:

And a really important update I should also make: I have a new job! I am now the Director of Simulation for the University of Washington School of Nursing! Which is an amazing opportunity! I am less than a month in, and working to figure things out as our university (and the nation) moves all education online for at least the rest of this academic year. So right into the fire! But I love a challenge and I cannot say enough positive things about the dedicated faculty and support staff, along with University and SoN administration. We are all in this to ensure students are supported and have the opportunity to learn.

But now I am thinking/developing a prebriefing approach to online and virtual simulations in response to the shift in our educational delivery methods.

OK for real: I am working on my Prelim Defense slide deck. And on that note, I will sign off. And hope to be updating this site again someday! I am officially a CATDOG. (WSU student- Cougars, UW Staff- Huskies) Also known as a #cougsky

It’s been a while since I’ve posted here, but that’s only because I have been busy! I am working at Virginia Mason as a Education Program Manager . It’s a job that is a little bit of everything, but mostly a chance for me to use my simulation knowledge to support the development and improvement of training and education here.

As for my academic pursuits, I am continuing on the course. I am going to be a pilot case for WSU’s School of  Nursing PhD by manuscript approach. Here’s my proposal in a nutshell:

Aim and Research Questions
The overall objective of this PhD by manuscript is to develop a survey to collect and evaluate data on the prebriefing practices of pre-licensure nursing programs in the United States which will to inform nursing education practice. The first manuscript will be a principle-based concept analysis that will explore prebriefing in the literature. Based on these findings, a survey will be developed that includes both quantitative and qualitative questions. It will be distributed to pre-licensure nursing programs in the United States that are using simulation in their curriculum. The second manuscript will address quantitative findings. The third manuscript will address the qualitative findings.

Purpose: To explore the simulation prebriefing practices (including preparation) of pre-licensure nursing programs in the United States.
Aims:
1. Assess current practices in simulation prebriefing within pre-licensure nursing programs in the United States.
2. Better understand the activities that occur in the pre-simulation period within pre-licensure nursing programs in the United States.
3. Determine how nurse educators in the United States are preparing their pre-licensure students for simulation-based learning.
4. Assess for alignment in prebriefing practices with the recommendations in the INACSL Standards.

At this point, I am finishing up my first manuscript and preparing to format it for submission. I will then work on a draft of my survey in preparation for my prelims in March. After that it will be fast and furious as I get through IRB and try to get the survey out before the academic school year ends. I am hoping to collect data this spring, summer and some of fall. My goal is to defend in Spring of 2021. Wish me LUCK!

I’ve not been here recently because so much has been happening!

The biggest update to share is that I have accepted a position as the education program manager at the Jones Learning, Innovation and Simulation Center at Virginia Mason Medical Center in Seattle, WA! It is a brand new role for the organization and for me.

As a result of this transition, I have some work to do to update this blogfolio and align it with my current work. I do feel keeping my academic experience and nurse educator work here is relevant, but I plan to acknowledge my new role and what it means for my teaching philosophy.

I’m making progress with my first 3 chapters, hoping to finish up chapter 2 this month and be in a position to take my prelim exam in Spring. I may share some sneak peeks of progress in the near future!

Looking forward to attending IMSH 2019 with my new team members, learning the ways of VMPS, and finding new ways to bring learning to life through simulation!

This year, I got the chance to return to the Boise NLN simulation conference, hosted by Boise State University. This is my third time here. Added bonus: I was a presenter! Such an exciting opportunity.   I presented the findings of my principle-based concept analysis of prebriefing, which I shared here.

I brought along some of my co-workers from the hospital, too. I was nervous they might not find anything interesting, but the program contained a variety of sessions and a few that applied to nursing residencies and other more general topics.

I was a bit nervous about my presentation, too. Mostly that no one would show  up because… well a concept analysis?? How boring! OK! So that didn’t happen. Most of the room was full! Then I worried the topic would not be as interesting to them as it was to me. But luckily again! Most people were engaged, and during the break out/discussion session as I wandered the room, people were excited to think and discuss research ideas for prebriefing. Finally I had about a dozen folks who were interested in getting a copy of my slides and references!   (click  if you want to see them!). I was worried I’d go over on time, and I did cut it a bit too close (and went over by a few minutes), but the group participation was worth it.

I will admit I have been looking forward to getting to speak and share at conferences for a long time. I had found I was reaching a saturation point at sim conferences, where I felt it was time for me to start contributing. So I am super excited that I had this opportunity to share. And while it’s not as comfortable for me as teaching in front of a class, speaking in front of 40 people who are a different level was not as scary as I expected.

I am also realizing how much I miss  being hands-on with simulation. While I am working with my team at Valley to add more sim activities and interactive learning in general to our educational materials, I do miss the challenge and reward of navigating learners through the realistic experiences of simulation and facilitating their learning through an effective debrief session.

Simulation takes deliberate practice, with mindful planning,  action  and evaluation. I am glad to see how far we’ve come in nursing with this learning tool. I am sad to see we are still finding under supported teams, often single faculty, trying to provide a high quality experience- at risk of burn out and potential eventual deterioration of quality… I do hope academic institutions will finally figure out how to appropriately compensate simulation educators and provide them the resources necessary to provide simulation that will give students those critical learning opportunities they are not getting in clinical.

We will see…

Another assignment that I figured would be nice to share here.

The book I am referencing is

Benner, P. E., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco: Jossey-Bass.

Educating Nurses was published 10 years after I graduated, yet my experience has similarities to the descriptions in the book.  In all honesty, it is tricky to reflect back on my undergrad without the bias of my own experience as a nurse educator. In fact, much of my motivation to study nursing education and become well versed in it was a result of my perception of my own educational experience- and my continued assessment of the state of nursing education while working as a full-time faculty in ADN and RN-BSN programs.

I went to nursing school at a private Baptist college in Texas., University of Mary-Hardin Baylor (UMHB). I was not Baptist, but it was the closest BSN program. I already had my AA in English and Music and when I decided to study nursing instead, I figured I should get my bachelors instead of another associate’s degree.

I took pre-req courses from a variety of community colleges- from Kentucky, Oklahoma, California and Texas. I was the ultimate transfer student. I took more than I needed because I did not what program I would apply to (or where I was going to live even- Army life) so I went in with a very solid foundation.  I think I only took one or two non-nursing classes at UMHB. Instead I had transcripts from 5 different schools. And I was a nontraditional student in that I was in my late 20s with two small children and my husband was active duty army.

So, with all that, my only goal in that program was to get done. I came in with a lot of pathophysiology knowledge (I used to read the Merck Manual as a teenager for fun) and a solid science- and liberal arts background. There was not as much of a crunch of content into our brains as things were more spread out over the curriculum. That’s in contrast to the ADN program I taught at- that concept that nursing education is additive is SO true, every year it seemed we added more material and never felt like we could let things go.  As a student in my BSN program, we did have mostly lecture (overheads not powerpoints!) and multiple choice exams. And usually one written assignment per semester. That was how the diadatic content was covered.

My favorite class was our senior leadership class, I think the instructor enjoyed teaching it also. She had an MBA and marched to her own drum. And it was not “life or death” content, so she could have fun with it- it was very much applied knowledge- teaching presentation (I made overhead slides!), a change project on our assigned units (mine was developing a policy about whose responsibility it was to change out full sharps containers). Overall there were other elements presented in the book that occurred in my program: team teaching, heavy emphasis on the NANDA diagnoses and all the crazy strict rules about how to write a nursing diagnosis, lots of sage on the stage style lecturing and the occasional game to make things interesting.

My clinical is even harder to recollect. I was not paying attention to how I was being taught and I was kind of on survival mode most of the time (my husband was deployed to Korea my entire senior year). How much my instructors took time to question me and help me find learning opportunities was completely lost on me. I showed up exhausted from staying up late, after my small children went to bed, making my drug cards and getting up way too early. I honestly cannot remember a single post conference. I have a blur of a few key moments- putting a foley in a small child, who they thought had Kawasaki disease and she had a terrible rash all over her peri area, yet no one guided me to consider NOT putting iodine on that raw tender skin. Now I know I could have used soap and water.  I got in big trouble taking a Dr. up on his invitation to observe a circumcision during my OB rotation- I still have no idea why it upset my instructor so much. That was one of those clinicals where our hands were tied and all we could do is observe anyhow! There was some bullying by faculty in that program for sure, but also some kind and compassionate instructors. I also struggled with feeling comfortable taking care of patients and asking them all the questions on our assessment paperwork. They were so tired, miserable and in pain. And I was supposed to ask them about their sex life? Finally, I have a distinct memory of working up a sweat while trying to put TED hose on a knee replacement patient. That was most likely because of the terrible, hot, impractical, polyester uniform, complete with purple apron, we had to wear.

I spent most of my clinicals feeling terrified and unsure of what I was doing. The instructors overall (with a few exceptions) were kind and supportive. I think some of my anxiety stemmed from the fact that while I had a great deal of knowledge, I had very little patient care skill or experience. And our lab experience was dismal to say the least. This was pre-simulators and we did not even have mannikins to practice on. The only hands on practicing we had was assessment on each other (in our sports bras, with the 2 boys in the class sent to another room) and injections – of saline into our thighs.  Everything else was talked about and we hoped to get a chance to see it in action and maybe try it out.  I went into nursing terrified of doing any skills… and eventually became a skills lab instructor. What a way to face my fears!

So reading Benner’s book, I mostly find myself going, “yup, seen that, did that, still do that” when they discuss some of the challenges in nursing education. I think my own experiences as a nursing student were what drove my obsession with giving my students a good solid lab experience, yet balanced by understanding I could teach them everything and allowing some things to fall away for other things to move in (for example no longer testing trach care in exchange for some informatics content).

I am working on a concept analysis of prebriefing. It’s a thing you do as part of your research anyhow, and it’s for a class (of course). But I am getting a lot out of it. Much like my  last post that talked about my why for this topic, I am now seeing my what– as in what do I want to do in this topic?

I have said before, I want to lay the ground work for a framework for prebriefing, much like there is for debriefing (there are many, in fact). As I review this literature, I am beginning to form an idea, and I need to write it down here. Bear in mind, I am brainstorming, so I am not citing all the great minds who have come before me in this field. But I will say there are a few names who pop up regularly in prebriefing- and as a baby novice researcher, I’d like to connect with at some  point:

Donna S. McDermott, PhD, RN, CHSE

Karin Page-Cutrara, PhD RN

Jill Chamberlain, PhD RN

Anyhow back to me.

I think that while I might only be aiming to gather survey data about prebriefing (and participant preparation) practices in prelicensure nursing programs, I have a larger goal if I continue in research and in this field. I see that prebriefing is finally getting research attention. And while the INACSL Standards of Best Practice: Simulation^SM continue to separate out the concepts of prebriefing and participant preparation, we need to move to a more integrated framework for the activities that take place before the simulation.

Once I collect data about what educators are actually doing in their simulations, I feel I can make the following proposal:

Best Practice is not just what everyone is doing,  but sometimes what everyone is doing (especially in a field that is young, yet well established like simulation) might be a good starting point. I think we need to develop a framework that is supported by the experts, learning theories and the reality of practice to structure the elements of prebriefing. It must be more than an orientation or a speech about “safe space” It should be in phases. Each phase addresses a learning domain.

The preparatory phase (cognitive domain) where learners prepare by learning about the the content they will encounter in the simulation. They may review pathophysiology or medications. Or develop concept maps or care plans for their simulated patients. They will be accountable for this prep work. This phase allows the learner to develop a foundation on which to build their learning in the scenario.

The orientation phase (psychomotor) which allows the learners to hands on experiment with equipment, or examine the space the simulation will occur and become familiar with it. In this phase, they may even review skills that may be required in the simulation whether it is auscultation of the mannikin or insertion of a foley catheter. This phase allows the learner to gain some comfort and eliminate distractions so they can focus on their higher level actions and decisions in the scenario.

The prebriefing phase (affective) where the facilitators reviews the expectations,  elements of psychological safety, fiction contract, the process of debriefing and other aspects that will provide a safe and respectful learning environment for the participants.  This phase is intended to help alleviate the learner’s anxiety going into the simulation and give them a sense of self-efficacy.

Yeah so, that’s my idea.

This blog has been neglected. It was created almost a year ago as part of an assignment for a course. The assignment was to create a teaching portfolio. I decided to create my own “blogfolio” that combined some permanent content – the portfolio, with updates that focused on my academic pursuits.

Well, fast forward a year. My resume has been updated and uploaded, but much of the  portfolio content does not apply to my current situation. I have transitioned from  academic nurse educator to clinical (hospital based) nurse educator. I have  moved back to the patient care setting, where I am the unit educator assigned to a surgical and an orthopedic unit.

I love being back in the hospital, I enjoy working with practicing nurses. I miss my students – although many former students are working as nurses at my facility, which is pretty great. I realized early on in this job that my talents and skills as an educator serve me in ways I took for granted in the academic setting. And in this new position, they are appreciated and supported.

I am still pursing my PhD although I have been thinking about options and other pathways that might serve me better (more in a future post, if I find time). I had a set back over the summer when I ruptured my achilles tendon and had surgery a month before I started my new position. I am back in classes- taking a class to explore my research method and a class on leadership (Organizational Foundation for Leading Change).

Which is what brings me back here today. To share something I am working on for my leadership class. My personal mission statement. While I have written nursing philosophies and a teaching philosophy, the personal mission statement was a bit of a new thing for me. I cheated a bit and used a website recommended by the instructors. It generated a series of statements which did not flow well or make sense to me. But they inspired me to put something together that did.

I now present to you my Personal Mission Statement:

My life’s journey is to learn and grow so that I can make the world a better place by using my talents as a natural teacher to share knowledge and inspire others. I thrive when I am working on something I am passionate about, and I want my life’s work to reflect my passions, while not letting myself get overwhelmed by my own personal goals and aspirations.  I strive to become a better listener who thinks about others first and facilitates growth and development in others. I want to learn to slow down, enjoy life and incorporate wisdom, charisma, a sense of the sacred and spiritual in to my purpose.