Does Your Nursing Simulation Meet Current Regulations?

Hillary Gamblin:

Hello. Thank you for joining today’s workshop, about making the grade when it comes to simulation regulations. My name is Hillary Gamblin, I’m a GoReact employee. And today I’ll be interviewing two members of INACSL’s Regulatory Initiatives Committee, Dr. Kim Curry-Lourenco, and Dr. Ann Loomis. Dr. Patty White was going to join us today, but she had a last minute schedule change, and couldn’t make it. But we still have two other fabulous members of the committee. Starting with Kim, and then moving to Ann, do you two want to introduce yourselves?

Dr. Kim Curry-Lourenco:

Hi. I’m Kim Curry-Lourenco. I’m the Director for the Clinical Learning Center, and the Assistant Dean for Academic Affairs at Virginia Commonwealth University School of Nursing. And a member of the INACSL Regulatory Initiatives Committee.

Dr. Ann Loomis:

And I am Ann Loomis. I’m a Clinical Assistant Professor at Purdue University, Midwest Indiana, and I have been a member of INACSL for many years, and several years on our regulatory committee. Thank you for having us today.

Hillary Gamblin:

Thank you for joining us. Now, for those of you who are new to GoReact, our virtual events, let me just describe how this is going to work out, so you know what to expect. For the first 30 minutes or so, we’re going to discuss simulation regulations with our two wonderful guests. And then after the interview, we’re going to do a live Q&A for about 15 minutes. So if you’d like to submit a question for the Q&A, there is a tab just below the video feed, and if you like a question someone else asked, there is a wonderful up-vote feature, so you can vote for other questions. And then, don’t forget about the chat feature, which is on the right side of the video feed. A lot happens here, this is where people share their contact information, links.

Hillary Gamblin:

A lot happens there, so just make sure that you don’t miss out. And then right next to that, is the ‘ask a question’, which is a polling feature. And today we’re actually going to start our workshop with a quick poll. And the question is, “Do you know your State Board of Nursing’s regulation for simulation?” Yes, or no? I think this is one of our more straightforward polling questions that we’ve asked. Okay. It looks like most of them do, which I think is a good sign here. The question actually plays right into the goal of today’s workshop, which is to help nursing educators find, understand, and meet simulation regulations. So to start us off, let’s take care of that polling question. For those of the people that said no, who don’t know their State Board regulations for simulation, is there a good resource where they can find this information?

Dr. Ann Loomis:

The answer is yes. On the INACSL site is a State map. That is our regulatory map, and there is a link provided where you can go in, scroll right over top of your map, click. And you’re going to see the information contained on what is located there for your specific State.

Hillary Gamblin:

Okay. Now, this research was developed from research that you did on simulation regulations in the United States, and you actually published those findings in an article in 2019. We’re actually going to put a link to the article in the chat, so look for that. But can you share some of the highlights of what you discovered during that project?

Dr. Ann Loomis:

Sure, absolutely. It was interesting, this seemed like it was going to be a very straightforward project, and it became long, and complicated. So again, what we found, we were looking for which States had established simulation regulations, did they account for a percent of clinical hours that could be replaced by simulation? We wanted to know what are programs ratio of simulation to their clinical hours, and then could they define simulation for us? And then the last, did they have any simulation educator requirements? And so the information we got back was minimal. We spent many hours going on a search, State-by-State reaching out to Boards of Nursing, and trying to figure out the answers to these questions. And again, that data collection is still ongoing. We will get to that in a minute, but we still have quite a few States that we are lacking information on. So hopefully today with our audience, we will hit some of these States that they might have information on that could help us out.

Hillary Gamblin:

Yeah. It actually brings me to something really important. We actually want to use the chat feature today for that very purpose. If you went to the map that we just brought up, and you know some information, and there is nothing there, please use the chat to help us fill in the gaps. Whether it’s a name, an email, a website, anything, any information that you have. And then we’re actually going to take all of that, and put it into a PDF, and send it to our two guests today. And so, that they can have some leads to complete this brilliant resource that they’re trying to put to give to everybody.

Hillary Gamblin:

So anytime between now, and the end of the workshop, if you can use the chat to give your lead so we can sleuth out the rest, that would be great. Now, before we start giving tips on meeting simulation regulations, I wanted to start by doing a definition. I know it’s basic, but as we were planning the workshop, I made the mistake of thinking recording a skills lab was a simulation. So there’s a lot of value in starting with the definition. How would you define simulation for nursing programs?

Dr. Kim Curry-Lourenco:

What we have here, is the definition of simulation that is provided in the Dictionary of Simulation, from the Society of Simulation in Healthcare. And so this states, that simulation is an array of structured activities, and that’s really important, that these structured activities that represent actual, or potential situations in education and practice. And these activities allow the participants to develop, or enhance their knowledge, skills, attitudes, or to analyze and respond to realistic situations in a simulated environment. And so Hillary, to your comment about skills labs, this is a misunderstanding, or a question that we hear quite often.

Dr. Kim Curry-Lourenco:

Do skills labs qualify as simulation? And the simple answer is no, not really. Simulations may include performance of skills, and skills practice certainly can be nested within simulations. But the idea of a simulation based learning experience, or learning activity, is that it is structured, and it gets higher order thinking, in addition to allowing practice of psychomotor skills. So it’s really about the context.

Hillary Gamblin:

And you were saying specifically, that a lot of simulation structure, structure was a big word in that definition that you gave for us. So what should nursing programs, how should they structure the simulation? For example, should debriefing always be included? How can they structure that, to make sure that they’re meeting the simulation definition?

Dr. Kim Curry-Lourenco:

Sure. INACSL’s standards of best practice, provide guidance on elements to be included in simulation based activities. That includes, beginning the experience with a pre-briefing, so that the learners know what to expect. And then of course, implementing the actual simulation experience itself, or the active part of simulation, if you will. Followed with a debriefing, or feedback session, also guided by a facilitator. And then importantly, including an evaluation of the participants, the facilitators, the simulation itself, what that experience was like. The facility, and then a number of other elements, including the support team. Also importantly, I’ll mention that prior to the simulation, there’s

New Speaker:

a number of steps that need to be considered. Doing a needs dassessment, and this is really at the curricular level, to identify what content, or concepts are best addressed through simulation as a teaching methodology, or an evaluation methodology, including measurable objectives.

Dr. Kim Curry-Lourenco:

What is the goal of the simulation? The simulation should be designed, and implemented with purpose grounded in theory, so that the simulation is theoretically sound, using educational and simulation theories. And then, considering the modality of simulation. Will this be a mannequin based simulation, or a standardized patient simulation? The context, and this refers to the clinical context. What is that situation that we’re trying to replicate, fidelity, or realism? What is the level of realism that’s needed, in order for the learners to meet the learning objectives. Preparing materials and resources, and this can be time intensive, but it’s work well done at the beginning as part of this planning, and designing phase. So it’s twofold. It’s preparing any resources or materials that are needed to actually run the simulation, and it’s planning for the learners’ preparation. What do the learners need to complete in order to be prepared, and ready to come in, and demonstrate the appropriate knowledge, skills, and attitudes. And then, the all-important pilot test, or run-through of the simulation.

Hillary Gamblin:

I can actually see how maybe preparing students, might be one of those that gets forgotten. I like how you brought that up. You pay so much attention to the simulation itself, you have to prepare your students to get the most out of it. That’s great, thank you for sharing that. Now, also in your research, it shows you did a lot looking at the variation about the appropriate ratio, between simulation, and traditional clinical hours. Now, in addition to what is recommended by their State Board of Nursing, what else should nursing programs consider as they’re looking at this ratio for themselves?

Dr. Kim Curry-Lourenco:

Yeah. There are still questions, regarding the ratio of simulation to clinical hours. And remember when we’re talking about this ratio, what we mean, is how many hours of simulation are equivalent to hours in the traditional clinical setting? And so, there are questions about, how is that best determined? What we found, is that three Boards of Nursing did specify a 1:1 ratio. So one hour in simulation was equivalent to one hour of traditional clinical time. And one Board of Nursing did define, that simulation hours could be counted as 1:1, or 1:2, but this is really still an area that’s being flushed out, and it’s really not well defined nationally.

Hillary Gamblin:

Interesting. Let’s see, one of the things that was missing a lot in your research, as you were looking at from State-to-State, the thing that was missing the most, was the requirements for simulation educators. Knowing that there are a lot of missing information here specifically, from your experience, what are some of the basic requirement nursing programs should consider requiring for their simulation educators?

Dr. Ann Loomis:

This is so important, so thank you, Hillary. Again, how the educator runs the simulation experience, is vital to the student’s takeaways from that experience. Again, looking at facilitation of any simulation-based experience. You have to have that facilitator who has the education, the skill, and the ability to guide, and support, and seek out ways to help each participant achieve those expected outcomes. And so, to maintain the skill as an effective facilitator, you have to keep up with the continuing education, and assessment of your own skills. That includes being peer reviewed, to make sure you’re staying on track with the updated standards, and you are efficient and effective at what you do. Again, you want to look at selection of facilitation method, that’s guided by theory, and research. And again, this is following the INACSL standard of simulation facilitation. The facilitation methods vary greatly, based on the level of the participants.

Dr. Ann Loomis:

So how I’m going to facilitate a sophomore level student, is going to vary greatly from how I would be required to facilitate a group of senior level nursing students, or those that are about to graduate. Again, taking into consideration cultural, individual differences that can affect participants’ knowledge, their skill level, attitudes, and behaviors, all of that comes into play when you’re facilitating any group. And then again, looking at faculty to faculty, how do they interact with one another? If they’re doing a group facilitation, how do you facilitate, say three groups within the same day at your same facility? Oftentimes we have variation in that, which creates issues, and concerns. One group of student had a particular experience, and maybe the other two, not such a good one. And we all know students talk. They exchange this information, and, “Here’s what I learned.”

Dr. Ann Loomis:

And it’s even gone as far as to say, “I missed that exam question, because that’s not what I received in simulation. We went over this, I did not get the equivalent training. I didn’t get that.” In other words, equivalent information. So again, the ramifications of not doing a solid facilitation of any sim experience, there can be definite fallout. On the flip side, it’s amazing what students walk away with from a good facilitated simulation experience, and yes, that ties in the whole debriefing. But what we’re looking for, is that overarching takeaway from that patient care experience. Were they able to use those critical thinking skills? Were they thinking like a nurse? It’s not so much the hands-on skills, like what Kim was referencing. Sometimes I think our focus goes to, “Can we get that Foley catheter in? Can we get that IV started?” But what I’m concerned about, is did they notice that the oxygen saturation stats were dropping?

Dr. Ann Loomis:

Did they notice a change in the patient’s color? Did they lose a pulse somewhere along the line? Did we change in cardiac, or what happened? Did they notice those things? That is what we are going after for a true simulation experience. Not that the other things don’t matter, but. So again, noticing the potential consequences of not following the standards that are listed here, these different objectives, can definitely have an impact on reducing positive opportunities for our students, therefore impacting those student outcomes. Again, we want to follow what’s listed here on the slide, take into consideration all the different bullet points, and then recognizing the consequences that come from not following these standards.

Hillary Gamblin:

Thank you for emphasizing the critical thinking to that. That is the emphasis for a simulation, especially with the next generation NCLEX coming out, and that is what they’re focusing on. It’s are they thinking like a nurse? What is their critical thinking skills? And so, that’s so important. So it’s great that you really focused on that. Now, fingers crossed that we’re nearing the end of the pandemic. I have to ask, what have been some interesting solutions that you’ve seen, or used during the pandemic to keep simulations going in nursing programs?

Dr. Ann Loomis:

I’ll be excited when we get to that part, to hear from our audience, because people have gotten pretty darn creative during this process. And so, I know there have been the robotic computers, I call it. It looks like a laptop wheels, and those computers can go into the actual sim center, into the patient rooms, and can be broadcasted to other students, that due to COVID guidelines, you cannot have your entire clinical group in there. You may have two students functioning at the patient bedside, and you can use the computer in multiple ways. One, you can be a spokesperson per se, talk through the computer, and have them be another fill-in person to help guide them at the bedside. You can also use it as an observation role. So they’re watching the two students that are at the bedside, while their peers are watching through the screen.

Dr. Ann Loomis:

Again, with restrictions, you can actually have the faculty member go in, and the students can talk to them through the computer. And say, “Here’s what I would do next.” So the faculty member, becomes the hands, and eyes of the student. And so, it has been wonderful utilizing that, as far as distanced based. Again, there are so many wonderful virtual simulations out there now, and every university is different, as far as what they have purchased, or what they already had, and can utilize. But we did see a giant leap in the virtual simulation material coming out, and accessing to that. Any of our virtual platforms, the avatars, the list goes on as far as trying to be creative through the lens of Zoom, and the other platforms.

Dr. Ann Loomis:

Being able to do debriefing sessions virtually, because that is the whole impetus behind simulation. You’ve got to end with that debriefing to pull it all together, and really get down to those critical thinking aspects. And so, we’ve gotten creative with whiteboards via Zoom, there’re lots that you can do with that. Sharing the Google Docs as a debriefing tool. So, yes. Again, I will be interested to see what our audience have ventured out and doing during this process.

Dr. Kim Curry-Lourenco:

Yeah. And I’ll add, that we’ve been able to provide distance based simulations, just using PowerPoint as a platform, and Zoom with our undergraduate students. For our psychiatric mental health courses, we do use a standardized patient, which automatically lends them some fidelity, so that students are interacting with a standardized patient via Zoom. But for our maternal health, pediatrics, and adult health simulations, we just use a nonlinear PowerPoint platform, so that we’re able to advance the slides, if you will, or the presentation, based on the student’s decisions in the sim. That directs the flow of the simulation, along with think aloud technique. So [inaudible 00:20:44] thinking through their decisions, and their assessments.

Dr. Kim Curry-Lourenco:

We’ve used QR codes, so that students could scan medications, and scan patient arm bands. A lot of graphics, videos embedded in those simulations, to keep the multimedia reality as interactive as possible. And medication calculations are handled through poll questions. So the scenario does not advance until everybody’s answered the poll question, and there’s a consensus about what’s the correct dosage. And a lot of breakout rooms, and collaboration. There’s some structure that’s needed, so that designing phase is quite time intensive. And then, there is a bit of support that’s needed during the actual simulation, just to ensure that all of those different elements come together. But overall, that’s been successful for us.

Hillary Gamblin:

Thank you for sharing those. I’m just amazed by the ingenuity of all the different programs, and how they’ve come to approach this with the pandemic. It’s fantastic. And all the technology too. I was wondering, if you could provide our participants with a list of your favorite simulation resources. I know INACSL will probably be in there. But they can be books, organizations like INACSL websites, articles. Could you provide some of your go-to favorite resources for sim?

Dr. Kim Curry-Lourenco:

Sure. I’ll say, of course I keep copies of the standards of best practice always nearby. Just to help it, because of course, as we learn more about the science of simulation, we need to be sure that we’re always referencing best practice, and best known knowledge. For me, I keep those handy. And there’s just so many resources that are available on the INACSL website, specifically underneath the educators tab. I keep that saved on my desktop.

Dr. Ann Loomis:

To pick up where Kim left off, there are numerous conferences, fellowships, fellowships are outstanding to be involved in. And again, we have our regular journals that are out there. Clinical Simulation in Learning, and the SSH journals, we have repositories. The Simulation Dictionary, all these things you want to familiarize yourself with, to help vamp up your program to make sure you are meeting the newest, and latest standards, and as Kim pointed out, those are ever changing. As we garner more, and more information through the science, we update these standards. Again, lots of free resources, there’s paid resources you can access too, but lots of very good free resources that anybody can access.

Hillary Gamblin:

Speaking of resources, I know a lot of nursing programs have limited resources, as far as budget and funding. What three pieces of advice would you give to nursing programs that want to improve their simulations, but they don’t have maybe the capital to buy the newest, and greatest simulation technology?

Dr. Ann Loomis:

I think, again, realism is vital in simulation, getting what we call the buy-in from the students. The more realistic you can make your simulation room, or wherever you’re working from believable, you want to do. In using Moulage, where you make a wound look like a real wound. You can make a black eye look like a black eye, or a hemorrhage, a scar, again, it’s a knack, a talent. They also do the home remedy Moulage, and will instead of paying for these expensive wounds, et cetera, you can learn to make your own. And that became very important, so many supplies were lacking during COVID, again, getting involved on how to do-it-yourself type of thing. Yes, it’s time consuming, but a lot of these things that you create and do, you can save to reuse. And then recycling supplies.

Dr. Ann Loomis:

Again, it doesn’t have to be use-once, and throw it away. And I would say most nursing schools are very good about doing that anyway, but doing our due diligence during COVID was vital, because again, the necessary supplies were all being utilized. So we actually had friends, grandparents, different people that were sewing PPE for us, because we couldn’t access the PPE. Little things like that make a huge difference. And again, reusing an O2 oxygen tubing, reusing IV tubing, the saline locks, anything like that, that is not going to cost you in the longterm, that can be revamped or multipurposed.

Dr. Ann Loomis:

And then, again, donations from community members. I.e, especially the hospitals’ long-term care, different places, as products they were using expired. It’s perfectly good for simulations. So recruiting your partners out there to keep their eyes, and ears open for those types of supplies, make a world of difference. And then, obviously, our volunteers, and we mentioned volunteers coming in to serve as standardized patients in some situations. Student on off hours in different courses who want to volunteer, again instead of a paid standardized patient, which can be costly. They’re wonderful, but push comes to shove, and once again, during this COVID crises, trying to come up with people that you could still use to be your patients was challenging, and so you become pretty creative.

Hillary Gamblin:

Yeah. I’m curious. Do you guys ever go to the theater department to ask people to be patients?

Dr. Ann Loomis:

Absolutely. We ran into a crediting issue, because our push was if we could start them as freshmen, and you train them, and so you’d have them for four years, would be wonderful. And then it came to a scheduling issue. And then how many credits was it worth it for the training? Yeah, it’s been challenging. I can’t say we have implemented it in full yet.

Dr. Kim Curry-Lourenco:

Yep. And something that I’ll add, because Ann made a great point of fidelity and realism, and just remember that it doesn’t have to be expensive to be effective. And there’re many ways to create realism in a simulation scenario. Although of course the environment is important, and we like things to appear to be realistic, but also consider how important the reality of the concepts are, so that conceptual fidelity. Does it seem real, in terms of patient responses, facilitator cues, things that a provider would actually say in a clinical setting? So a lot of the reality can be achieved, just through the design of the simulation itself. Is it a realistic situation, and is the facilitation realistic? Is this likely to happen in actual clinical practice?

Hillary Gamblin:

I like that. Not focusing as much on the toys, but everything else?

Dr. Ann Loomis:

Sure, right. It all comes together.

Dr. Kim Curry-Lourenco:

Yeah.

Hillary Gamblin:

Now, you guys have been sharing with us some brilliant stuff that you’ve been working on over the past few years. Can you share with us what you’re currently working on for INACSL?

Dr. Ann Loomis:

Absolutely. We sent out a survey, and we’re trying to garner information moving forward, where we simply asked them to follow up. Again, trying to figure out what are our current simulation regulations for each State, so we can keep our regulation maps current, and the survey information we used to update our map accordingly. And so again, we were now doing phone surveys asking, is this information accurate? Has anything changed? And trying to, again, get current information out there for anybody wanting to access that through the INACSL site. And then, that was the map link that we shared at the very beginning. And again, trying to share difficulties that were encountered, hopefully opening up some portals here for people to try to really look into, what can they do to make a difference within their own States? How do we make this information more visible? Again, I think this is going to be a definitely rolling out, ongoing process, and yes, we have faced our challenges. Kim, did you want to add to that?

Dr. Kim Curry-Lourenco:

Yep. I just think to emphasize, that it’s important to check back also with your Boards of Nursing, because this is an evolving area. And so there’s likely to be changes, from time to time. So I think it’s important to just remain aware, if you do know your Board of Nursing regulations, just stay in touch, and check for any changes or updates. And if you’re not aware, then maybe stay connected to INACSL, and then also maybe join in helping to identify how those regulations can be made more accessible.

Hillary Gamblin:

And I’m sure that there have been quite a few changes with the pandemic especially. So I would think that now is a good time to maybe touch back, and see if anything has changed. If any of our participants are interested, what are some ways that they can help with this project?

Dr. Ann Loomis:

As Kim was saying, any information you can provide, we would love that. And with COVID guidelines still being in place, the manpower at the State Boards of Nursing are not there. People are working remotely, and even though they’re routing calls, forwarding calls, again right before we got on today, I finally heard from a particular State that I had emailed. I had left multiple calls, and I emailed them, did another follow-up February 1st, and I literally heard from them today after all this time saying, “Oh, here’s that information you wanted.” And it’s like, “Okay. Another update coming.” And then turnover, people being let go.

Dr. Ann Loomis:

They can’t afford to keep all these extra people on, so whoever you’d reached out to previously is no longer there, so then who’s going to pick that ball up, and run with it. Again, everybody has been stressed, overworked, overloaded. And so, it’s challenging when there’s one more thing on the list. “Gee, can I ask you another question?” And it’s like, “No. I’m done. I maxed out.” And so again, it’s been challenging trying to get this information in from all States. So if you know of any of that information from your own State, or any contacts even, anything like that, that is very valuable information that we would appreciate having.

Hillary Gamblin:

For those of you that are with us live, please use that chat feature. If you watch a recording of this, I believe that they have your email information on the slides that we’re going to be sending out, so that’s a way to reach out to. But yes, please do reach out with any leads that you have. That would be amazing. Well, thank you guys for answering all of my questions. I’m sure that this sparks some of our participants’ ideas, and questions for them, so we’re actually going to take the next 10, to 15 minutes to do a live Q&A. If you still haven’t submitted a question, it’s not too late, you can do it. My colleagues have been monitoring your questions, and have selected a few that we can ask. I already have two, let’s see if I can pull up the one before. How can I be sure that I maintain simulation standards with the Zoom simulation lab, or screen-based simulation, vSim Shadow Health, et cetera.

Dr. Kim Curry-Lourenco:

I’ll be glad to answer that from the Zoom aspect. Using Zoom, again, it’s just the technology, so it’s not, of course the actual learning experience itself, it’s just the tool. So the approach that we took, is we started with scenarios that we already had, our mannequin based sims, and we’re in the practice of regularly aligning those simulations with the INACSL standards. So we’ve developed a tool in our simulation center, and that’s part of our continuous quality improvement process. And so we already knew that the mannequin based sims were already aligned to the design, and facilitations, and outcome, and evaluation standards in particular. And so we were then able to take those parts, and pieces from the mannequin sims, and just transition those into the PowerPoint model, if you will.

Dr. Kim Curry-Lourenco:

And then we went back, and we remapped to all of those standards again, to be sure that we were retaining all of the essential elements that we would have in any simulation. And we placed a high focus on interactivity, and engagement. One of the challenges that we had upfront before we even ran one of the distance based sims using Sim, was how are we going to address the large number of students participants that we were going to have on each sim? So we have tried to, from a scheduling perspective, run as many small groups as possible, in order to allow the most participants to participate as possible. But for those students who will not have an active, or speaking role in that scenario, they observe as is common in simulation, but they have a guided observation tool that requires them to remain in the mindset of the nurse. So they too are in the position to make decisions throughout the simulation, and then to collaborate with the active participants to help direct the sim. So they’re participating in the thinking, and the decision making as well.

Hillary Gamblin:

Ann, do you have anything that you want to add to that.

Dr. Ann Loomis:

To follow up on what Kim shared, it’s a juggling act. It’s challenging. It’s more work, period. And I think that’s been the challenge in general, because everybody has felt that the workload has doubled, period. And then when it comes to simulation, and trying to create virtually, an equivalent experience, it’s challenging. And again, there’s a lot of wonderful resources out there, they can also be very costly. And so, again, whatever route you choose to go, it’s are you sticking to those standards? Because I think a lot of times that’s where we’ve seen the quality drop, because it’s virtual, so therefore, no. Whether it is virtual, or live-in-person, you still want to meet those standards. And again, as Kim shared, make sure you are still mapping what you’re doing to those standards, to make sure you’re following them, because some things you can unintentionally omit.

Hillary Gamblin:

The next question, is do you recommend a tool to evaluate the participants, or the simulation experience, and should the simulation be evaluated every time it is run?

Dr. Kim Curry-Lourenco:

I’ll jump in. Again, there are a number of tools that are available, and there is a repository also on the INACSL website, so there’s a number to choose from. That would be part of your assessment at the curriculum level. What is the best fit with the needs, the purpose of your simulation, as well as the learning objectives that you have established for your simulations? And the second part of that question, Hillary, was?

Hillary Gamblin:

Should the simulation be evaluated every time it is run?

Dr. Kim Curry-Lourenco:

Yes. Because, we know that over time the data become more robust, and so just looking at a reiteration over time can be more helpful, and give you a more comprehensive view, than just an episodic evaluation. That really should become part of every simulation that’s run.

Dr. Ann Loomis:

And to play off of Kim, quality matters, and quality assurance by evaluating each time, because it goes back to those facilitator requirements, and you have somebody that comes in, and struggle. They’re in there lecturing, versus doing an actual simulation experience, and debriefing. And so that is, I think, very strongly reflected in those evaluations as well. And then that’s a learning curve on our end, as far as what do we need to tweak to make sure everybody gets that same positive experience.

Hillary Gamblin:

Perfect. The next question is, is student observation of simulation any part of the regulations? That’s the question.

Dr. Kim Curry-Lourenco:

It is. I have not seen student observation identified in any of the regulations that we have scanned for. I think the question remains, will it become a component in regulations across State Boards of Nursing? I think that remains to be seen.

Dr. Ann Loomis:

And Kyle Johnson, out of Texas Tech has been doing extensive work on the observer role, and the importance of it, because it used to be all about the RN at the bedside. And now as I have often referred to it, is it’s so easy to be quarterback in the stands. You’ve got that Eagle eye view, no pressure, and you can see everything that’s going on. And to me, that’s the observer role. You get to sit back without the stress of being on the hot seat, and it’s so easy to go, “Oh. They didn’t check the IV. Oh, I would’ve turned them. Oh, Fall hazard.” It’s so much easier, and there’s such value in that coming out. So it will be interesting as we move along, what they do with that observer role. What’s going to come, and if that’s going to end up in our standards, because it’s definitely changing.

Hillary Gamblin:

Interesting. I think that’s a fascinating question. I’m curious to see how that changes over the next few years. The next question are, are there any updates, or formats for training novice facilitators, and debriefing skill developments?

Dr. Ann Loomis:

I will jump on this one. There are some wonderful debriefing methods out there. Again, you want to make sure it is theory based, and well supported, and the key is being consistent in your program of how you debrief, and always debriefing. And again, it’s learning that theory based debriefing that’s evidence-based, well-supported, that is going to truly allow you to get to the heart of the situation in that simulation experience. Because when you debrief well, is it’s about asking that next right question, not providing the answers. And so that debriefing is 2:1 minimum.

Dr. Ann Loomis:

So if you did a 20 minute SIM, you should do a minimum of a 40 minute debriefing. If you can pull off an hour, which is hard for a lot of programs, it’s too tight, it is so valuable. And again, I don’t want to plug one debriefing method over another. It’s just understand it, learn it, attend the workshops that support it, whatever you need to do, but yes, you have to have a well-grounded debriefing method, to get the most out of the simulation experience.

Hillary Gamblin:

Kim, do you have anything that you’d like to add to that?

Dr. Kim Curry-Lourenco:

No, except to emphasize what Anne said about that, that any debriefing method should be theoretically sound, and be systematic, and support discovery, so that the learners discover their own learning. They’re able to connect new knowledge to knowledge that already exists, and quite often they don’t even realize that they’re coming to these experiences with some existing knowledge. There really is a skill, and an art to it. There’re many resources out there that are available to train in principles of debriefing, and not necessarily a specific debriefing method, but many of the principles are very similar across debriefing methods.

Hillary Gamblin:

Okay. And I think this is our final question. Are there any guidelines for the education that simulation coordinators should have, to deliver simulation development to faculty?

Dr. Ann Loomis:

Read that again, Hillary.

Hillary Gamblin:

Are there any guidelines for the education of the simulation coordinator should have, to deliver simulation development of faculty?

Dr. Ann Loomis:

All of the standards. It takes you right back to how every simulation should be laid out. How do you set it up? What do you do before, and after? And again, regardless of what position you are in, we have to follow those standards.

Dr. Kim Curry-Lourenco:

Yep. I would agree. And there are some States that are beginning to look at competencies for simulation facilitators. There are requirements for educators, but this is really even looking at getting a step further, and demonstrate a competency for faculty who are facilitating running simulations. That may be on the forefront in the not too distant future. In terms of faculty development, just really being in the literature, as Ann said, looking at the standards, but keeping an eye on the literature, because there is a lot of work that’s being done around characteristics of simulation facilitators. And more than having the skill, and the knowledge of simulation, but there are also qualitative aspects, because so much of what happens in simulation is unanticipated on the learner’s end. We can’t always predict what decisions, or actions they’re going to take. There’re many nuances, as well as much overt knowledge, and skill that’s needed. So just really, keep an eye on the literature, look up facilitator, competencies, facilitator characteristics, keep the standards close-by.

Hillary Gamblin:

Fantastic. Now, I don’t know if we were able to answer everyone’s question, but I appreciate everybody that did ask a question. This real-time Q&A is so important. I think it makes these workshops the most valuable resource that we can possibly do, especially during a pandemic. Thank you for taking the time to ask those questions. And if we didn’t get to your question this time, don’t lose heart, you can ask for during the next workshop, and we will try to answer it then. Now before we end, I like to ask our guests to share with us three takeaways. If you could give our audience three things that they would remember 10 to 15 days, a couple months after this workshop, what would they be?

Dr. Ann Loomis:

One, simulation does not have to be expensive. That’s it, because that’s always beaten into our heads. So be creative, get in there, use your outside resources, and if somebody offers you money, great, take it.

Dr. Kim Curry-Lourenco:

Yes. I would add, to use the INACSL resources, and to better understand what simulation is, and how to develop effective simulations, as well as how to advance simulation practice in your institution.

Dr. Ann Loomis:

And then, follow up on your state regulations. Look into it, give a little push towards the higher ups there. “Why aren’t standards in place? What are we going after?” Because COVID has really shed light on simulation, and the necessity. Especially as our students weren’t able to get out into their clinical sites in so many areas, and so again, really relying heavily on sim. Again, what are your Board of Nursing Regulations regarding your simulations? And again, if you guys have any information for us, please throw that in the chat box, and let us know.

Hillary Gamblin:

Kim, and Ann, thank you so much for sharing your expertise with us today. You did this workshop voluntarily, and we really appreciate you taking your personal time to do that. So if you do have any information, help them, so that they feel like have a yes. And thank you for everybody that’s joined in live. To show our appreciation, we actually have randomly selected one participant who joined us live, to win a pair of AirPod Pros, which, I love my AirPod Pros. So congratulations to [Moira O’Shea 00:47:28]. We will reach out to you, and ensure that you get your AirPods Pro, and if you would like to win them, we’re actually going to be doing this for every live nursing workshop that we’re doing in the future.

Hillary Gamblin:

Join us next time, so you get a chance to win. We know that this workshop will be particularly valuable to those who participated. So we’re going to send an email with a link of the recording of today’s workshop, as well as the slide deck. Watch for that in your inbox. But that is it for today. Thank you for those that have been watching, those that are working behind the scenes, and of course our guests. Kim, and Ann, thank you so much, and we will see you time.

Dr. Ann Loomis:

Thank you.

Dr. Kim Curry-Lourenco:

Thank you for having us.