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The Mandate Essay

The mandate to change the prevailing culture from opinion-based practice to evidence-based practice has influenced models designed as decision –making approaches to advance the integration of simulation education methods in higher education health professional programs, specifically among undergraduate and graduate education nursing programs. Simulation is one of the most rapidly growing strategies in clinical education and defining the best practices for dissemination is essential to the integration process.

The intent of this workshop is to facilitate the opportunity to explore an approach to seek evidence-based outcomes in the process of simulation integration in clinical nursing professional education. Doing things many times without proof or data indicating efficacy is probably a waste of time, talent and money. The efforts in education and technology for simulation integration require each of us to give serious attention to capability-building and center development strategies.

A critical appraisal of the efforts to integrate simulation education requires knowledge of research design and personal development. The development process for beginning a Simulation Center begin with a focus on identifying steps that will help one to accomplish the mission, executing a carefully laid out strategy and measuring process every step of the way. It is believed that the only way to achieve the overarching mission is to establish a direct link between strategy and execution.

Most institutions have a strategic plan, however very few execute upon their strategies. Research indicates that organizations do not execute the described strategy for four main reasons: Vision — lack of a shared vision People – unmotivated or limited understanding of clearly defined performance objectives and measurement guidelines—how the day-to-day activities contribute to the bigger picture in process for the fidelity of the intervention based on evidence.

Management- urgent trumps strategic—staffing decisions are driven by what is easiest or least painful rather than what is most strategic to achieve the objectives and proactively monitored for progress towards strategy execution. Resource – resources are the financial, human, and physical assets that are used for the rendering of the education services that have value to the institution. Most educational institutions are challenged by resource barriers, especially during these turbulent economic times in the U. S.

However, recognizing potential barriers to the simulation integration strategy provides the opportunity needed to critically appraise, why are we here? Our Charge/Rationale/Call to Action The evidence-based rationales to support an administration’s decisions to increase simulation methodologies in health professions education, whether it is medical, nursing, or allied health are many. Above those that have been cited during this conference, the literature has provided evidence of benefits and challenges. To review a few, the following studies were conducted recently to present the significant findings as evidence.

But in general terms a Simulation Center is created: To meet the ever-changing demands of nursing education, as well as those of the new graduates at the bedside or in the community, the administration and faculty for competence building and validation. Directing financial, human and physical capital toward the integration of simulation and technology methods within existing nursing education curriculum programs is a shift occurring in many institutional settings. Key specialty area faculty must be recruited or identified to generate interest and involvement in specific ways.

All core clinical courses within a Program Curriculum are expected to be included in this appraisal for integration to assess current methods and activities in general and related program requirements specifically for formative process measurement. The charge is to create a Simulation Center strategic plan that will have a significant impact on the clinical practice outcomes of future students and will have the capacity to complement the continuing education efforts for clinical practice improvement or certification of experienced and advanced practice nursing professionals.

The call to action is clear for EBP and evaluation strategies. To that end, the ten (10) steps applied for framing a simulation informatics infrastructure in the academic environment are presented in this graphic as an approach to outcomes for process evaluation in setting the stage for simulation integration. The Approach to Outcomes The initial step in the approach call for needs/resource appraisals: It is within this frame that the realities of environment relevance and requirements must be considered.

This may involve but not limited to (not exhaustive listings) gathering relevant data to describe outfitting required in the physical environment, supply inventory /requirements, technology capacities (system networking, audio-video, data to describe resources available for blending new/existing), staffing, scheduling , orientations, trainings. This is sometimes referred to as an academic environment transformation event which will vary in scope and scale based on the appraisal of resources available.

The human capital aspect is essential to the simulation integration process for the purpose of aligning people with the strategy. The key objective is to close skill gaps in strategic Simulation Center positions that allow each faculty to be equipped with the simulation assessment tools they need to carry out their work at peak performance levels. It is impossible to establish a high-performing simulation center unless the faculty knows what is expected of them, how their performance will be measured and rewarded, and what supports are in place to enhance their confidence and ability to serve.

The second step in the approach seeks clarity and commitment through clearly stating the vision/purpose, mission and goals, with measurable objectives defined by responsibility and functions. Again, the shared vision that can be communicated at each level in the accepted voice of the mission allows the alignment of information capital to the evidenced-based strategic plan for execution in the completion of formative tasks and activities required for simulation integration.

The third step in the approach gives priority to best practices that are recognized within a context for meta-analysis critical appraisal. This evidence is assessed not only for level of evidence but also for the study’s validity, the extent of bias present, and the overall usefulness or applicability to one’s clinical education situation. Appraising soundness of the methods, the extent of the search, and the methodological quality of the retrieved study becomes the challenge for administration and faculty.

It is indeed a search for integration of best scientific evidence, appraised evidence and evaluation of organizational outcomes after implementation of strategies based on evidence. Pooling and blending interdisciplinary expertise for sharing and dissemination, such as within the structure of this conference, is intended to achieve an environment to question and explore a particular area of simulation education for effect and influence. Administration and faculty must be able to access and use meaningful information to make critical decisions, set priorities, and allocate resources.

The efforts to determine implementation regimes may be used to address questions during the integration process that address, “How are we doing” and the usefulness of evidence in helping students through and with the use simulation clinical experiences for learning. Step 4 refers to fit and sometimes this notion may be referred to as goodness of fit to the simulation integration process. It is believed that fit of the strategy must align to the specifics defined by institutional objectives, the program requirements and course specific expected outcomes.

The intent is to ensure that there are rules and general policy guidelines for the Simulation Center operations will support a climate for growth, change and the maintenance of the simulation center strategy for formative process evaluation. What gets measured gets done!! Step 5 involves a highly interactive process to build capacities. This emphasis on capacity includes the critical appraisal of administration, faculty and students. Working as a collaborative and a team, simulation and technology trainings, simulation curriculum planning and timeline development emerge as priorities for strategy implementation.

Identification of key specialty faculty roles and responsibilities, course specific critical behaviors, and indicators for monitoring are essential to preparatory and piloting stages for simulation integration. Clear and frequent communication and reward systems are integral to fostering a climate that is motivating and innovative. Clinical faculty orientations, promotion and tenure policies, and annual performance reviews must be considered in communications to achieve high levels of accountability to what is expected for simulation integration value and continuous investment Step 6 refers to the plan.

Defining and confirming the plan for implementation. This may also be referred to as the roadmap for simulation center development and nursing curriculum integration as developed by administration and faculty that may be designed as a step-wise phasing methodology. It is not uncommon for the objectives of the plan to be scaffold to facilitate the development process and a decision grid that will promote team exploration, discussion, role-play that promotes modeling and testing of each critical path that is expected to advance the overarching mission.

A customize simulation integration plan is intended to make strategies relatable and relevant to aims of the academic program. Step 7 is the implementation stage. In addition and concurrently, the process evaluation is conducted to ensure fidelity of demonstration methods/applications as employed. For example, an administration and team decision to use a model to observe students in simulation will provide the context, background, and relationship for applications.

There are scheduled regular supervision for benchmarks of simulation clinical experiences and technology system equipment effectiveness. The pre-appraised and proactive plan for implementation, policies and rules guide the Simulation Center activities in the formative process evaluation. Step 8 refers to process outcome evaluation as the result of the Simulation integration monitoring and evaluation plan. The cumulative benchmark indicators are expected to provide data for program analysis in the context of progress and evaluation within the formative process.

The information gathered can define significant findings for preparatory stage, piloting stage and the implementation stage for setting the stage for integration. Step 9 is directly related to the need to improve, modify and re-examine decisions that can promote the continuous quality and corrective action interventions. Core areas for CQI in simulation integration must include ethics, professionalism, and confidentiality related to all materials and activities applied in the learning process outcome for administration, faculty and students. Step 10, the final step is focused on sustainment.

The research provides validation for studies and the content will facilitate replication of procedures. The replication allows the face of simulation to resemble the “real world” and to refine performance standards for practice competencies that are set based on evaluation of the quality of simulation-based education and assessment and evaluation methods for institutionalization within the programs of nursing and other health professions. The need for competency-based nursing education and standard methods to measure effectiveness of simulation technology performance remains.


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