Simulation: An effective pedagogical approach for nursing?

Simulation features strongly within the undergraduate nursing curriculum for many Universities. It provides avariety of opportunities for students as they develop their clinical nursing skills. The nursing literaturehighlights the potential of this approach and the positive opportunities afforded to students in terms ofdeveloping competence and confidence. However, much of this literature focuses upon the more operationalconcerns of simulation. This paper reflects upon the evolution of simulation in nurse education. It considersthe theoretical positioning and understanding of simulation as a teaching and learning approach forundergraduate nursing skills development. The work of Vygotsky (1978) and Lave and Wenger (1991) arehighlighted in order to begin to explore the theoretical basis of simulation as an effective pedagogicalapproach for nurse education today, enabling students to learn to be nurse

Learning nursing through simulation: Towards an expansive model of learning

This thesis explores the impact of simulation upon learning for undergraduate nursing students. A brief history of the evolution of pre-registration nurse education and the development of simulation for nursing provide background and context to the study.The conceptual frameworks used for this study draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen’s work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. These pedagogies present a framework, which enhances the understanding of the impact of simulation upon student learning. Engeström’s work on activity theory, recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. His notion of expansive learning offers nurse education a way of reconceptualising the learning that occurs during simulation. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities.Conducted as a small-scale narrative case study, this study tells the unique stories of a small number of undergraduate nursing students, nurse mentors and nurse educators and explores their experiences of learning through simulation. The nurse educators viewed simulation as a means of helping students to learn to be nurses, whilst, the nurse mentors suggested that simulation helped them to determine nursing potential. The students’ narratives revealed that they approached simulation learning in different ways resulting in a range of outcomes: those who were successfully becoming nurses, those who were struggling or working hard to become nurses and those who were not becoming nurses.A theoretical analysis of learning through simulation offers a means of conceptualizing and establishing different perspectives for understanding the learning described by the participants and offers new possibilities towards an expansive approach to learning nursing. The study concludes by examining what this interpretation of learning might mean for nurse education, nursing research and nursing practice

Learning nursing through simulation: Towards an expansive model of learning

My study explores the impact of simulation upon learning for undergraduate nursing students. Conducted as a small-scale narrative case study, this study tells the unique stories of a small number of undergraduate nursing students, nurse mentors and nurse educators and explores their experiences of learning through simulation. Data analysis through progressive focusing (Parlett and Hamilton, 1972) revealed that the nurse educators viewed simulation as a means of helping students to learn to be nurses, whilst, the nurse mentors suggested that simulation helped them to determine nursing potential. The students’ narratives showed that they approached simulation learning in different ways resulting in a range of outcomes: those who were successfully becoming nurses, those who were struggling or working hard to become nurses and those who were not becoming nurses. The conceptual frameworks used for this study draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen’s work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. Engeström’s work on activity theory and expansive learning recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities. A theoretical analysis of learning through simulation offers a means of conceptualizing and establishing different perspectives for understanding the learning described by the participants and offers new possibilities towards an expansive approach to learning nursing. The study examines what this interpretation of learning might mean for nurse education, nursing research and nursing practice

Developments in simulation and learning for patient safety. Churchill Fellowship Report

Executive Summary I travelled to Australia where I spent 4 weeks exploring educational initiatives to support undergraduate healthcare students to learn to deliver safe and effective care to their patients. In particular I was interested in inter-professional education and simulation as pedagogical approaches to highlight the importance of patient safety, quality improvement and preparing students for the real world of healthcare practice. The objectives of my project were to: •Explore how patient safety issues can be transformed into learning opportunities through the use of innovative simulation approaches. •Share and identify practical simulation methodologies to address different aspects of clinical practice and patient safety. •Work with colleagues at Bristol and Bath universities to design, deliver, debrief and evaluate interdisciplinary simulation scenarios to address patient safety. •Work towards embedding interdisciplinary simulations for patient safety within nursing, pharmacy and medical curricula. The project was and will continue to be carried out in a number of phases: 1. Development and pilot of inter-professional ward simulations for final year medical, pharmacy and nursing students. This was in progress prior to my Fellowship application. 2. Dissemination of results of the pilot studies to encourage debate, critical analysis, evaluation and awareness of this work. The project has been presented and published at a number of healthcare, medical and nursing conferences and in International Nursing Journals. 3. To meet Professor Levett-Jones and colleagues from the University of Newcastle, New South Wales (NSW), Professor Kelly at Curtin University in Perth, and international colleagues attending the NETNEP 2016 conference in Australia to explore, experience, work with and discuss their work and views on simulation and patient safety. 4. Develop collaborative working opportunities with colleagues in Australia to share good practice and further disseminate this work to colleagues locally, nationally and internationally. 5. To use this exceptional opportunity and learning experience to share with colleagues at UWE, Bristol University and the University of Bath. Learning from my visits across Australia, I hope to develop and embed brief and intense simulation-based scenarios which will increase perceived confidence in communicating and working in impromptu teams for pre-qualifying students from multiple health science disciplines. My findings highlighted that in order to develop and embed authentic and realistic simulation experiences for learning, there needs to be not only enthusiasm to drive development but also the support, knowledge and infrastructure to underpin and sustain development. During conversations with colleagues in Australia a number of themes emerged as essential to simulation learning for healthcare practitioners. These themes reflect both the educational experience and the focus of safety and quality improvement: quality indicators for simulation, clinical reasoning, inter-professional education for teamwork and communication skills, cultural empathy and professional identity. My recommendations have evolved from analysis of the information that was shared with me and the need to ensure that any learning experience must be sustainable and sufficiently flexible for the needs of the healthcare workforce and for the benefit of patients and service users. These recommendations are: • To develop and embed National and local simulation principles and quality indicators for simulation-based education (SBE). • To provide support, identify frameworks and adopt pedagogical approaches for the development of clinical reasoning skills. • To ensure IPE focuses upon communication and teamwork skills • To develop and foster cultural empathy for compassionate healthcare • To understand and support the development of professional identity

Using simulation pedagogy in nursing to enhance learning through assessment

Engagement with professional practice learning introduced through simulation, which includes peer and formative assessment and builds towards summative assessment in clinical practice, is central to the undergraduate nursing curriculum at UWE and at many higher education institutions across the world. This approach enriches the student experience and, as health care and the patient population continue to change and evolve, enables students to develop an adaptive and critical understanding of nursing (Berragan, 2014). These features are not just additional ways of learning nursing and developing fundamental nursing skills; they are ways of knowing nursing (Berragan, 1998). There is real potential for assessment through simulation to help students to understand the key features of nursing and learn to deliver skilled, integrated and compassionate care to their patients. This presentation focuses upon the opportunities provided through simulation to enhance learning through assessment. Simulation supports opportunities for authentic assessment of the fundamental skills of nursing (Wiggins, 1989; Walters, 2014). The notion that assessment tasks should acknowledge and engage with the ways in which knowledge and skills are used in authentic settings is important (Boud, 2007). Assessment has a major influence upon learning, directing attention to areas of significance, acting as an incentive for learning and having a powerful effect upon students’ approaches to their learning (Boud and Falchikov, 2007). Assessment also guides students, emphasizing what they can and cannot succeed in doing (Boud, 2007). It is this aspect of simulation that we wish to highlight. Our current research explores undergraduate nursing students’ simulation experiences, and their descriptions of simulation during feedback, debriefing and formative assessment. It also highlights the benefits of peer assessment within the simulation learning environment as nursing students work together to demonstrate, describe and reflect upon their learning

Simulation: a learning pedagogy for nursing

Simulation features strongly within the undergraduate nursing curriculum for many Universities. It provides a variety of opportunities for students as they learn and develop their clinical nursing skills (Berragan, 2011). The nurse education literature supports the use of simulation for helping students to feel more confident in performing clinical work (Leigh, 2008). However, self-confidence and self-efficacy are only part of the learning picture. Other important aspects of learning nursing include conceptual knowledge and skill development. This poster presentation considers the theoretical positioning and understanding of simulation as a learning approach for undergraduate nursing skills development. It offers an analysis of nursing simulation literature in relation to learning. My focus is to determine how learning is described and explored within the literature on simulation. My interest is also in the use of learning theory in the design and implementation of simulation for nursing students. This presentation is based on the work from part of the literature review for my current doctoral study with the University of the West of England. It has been inspired by my involvement with the facilitation and assessment of simulation within the faculty. My doctoral research explores the impact of simulation on learning for undergraduate adult nursing students. Literature reviews by Kaakinen and Arwood (2009) and Cant and Cooper (2010) and my own literature searches demonstrate that, although nascent, there is a developing body of literature, which has as its focus learning and simulation. This literature was examined in order to determine how learning was defined and understood within the field of simulation for nurse education. The learning theories and approaches explored include behaviourism, social learning theory, constructivism, adult learning theory, experiential learning, situated learning, activity theory and reflective practice. My analysis of the literature has shown that simulation offers very different ways of conceptualizing learning. A more explicit examination of theories of learning may therefore be useful in informing future practice and future research on simulation. This work highlights possibilities and raises questions in relation to learning through simulation, encouraging engagement with the conceptualization of learning through simulation. It is hoped that this will act as a catalyst to stimulate further debate in consideration of simulation as a learning pedagogy

1625 Independent People Trauma Recovery Model Pilot Evaluation Report

This report presents the findings of the Trauma Recovery Model (TRM) Pilot with young care leavers which formed an integral component of the wider Future 4 Me project (2016-2019) and the (F4M) toolkit evaluation undertaken by the University of Gloucestershire. The aim was to investigate the efficacy of the TRM model in helping practitioners to support care leavers and improve practice, knowledge, confidence and understanding of a trauma-informed approach. The pilot framework was developed in consultation with Jonny Matthew. The pilot provided for a multi-agency, psychologist led formulation of the cases of 7 care leavers, which informed the subsequent period of support and regular reviews. In each case, a F4M keyworker acted as the case lead, co-ordinating meetings and facilitating communication between professionals. The pilot delivery period was nine months. As well as the F4M team, the pilot involved 20 external professionals representing 11 different organisations across three local authority areas. Methods A mixed methods approach was deployed involving the use of quantitative and qualitative methods in order to elicit data concerning the efficacy of the TRM model in helping practitioners to support care leavers and improve practice, knowledge, confidence and understanding of a trauma- informed approach. This involved an online practitioner survey and individual interviews. The evaluation began in October 2019 and concluded in December 2019. Main findings The tools used were described as useful and accessible that helped practitioners from across a range of Statutory and Charitable organisations to develop empathetic attitudes towards young people and a greater understanding of their lives. Sequencing was identified as a principal benefit in helping professionals to stand back and assess all the relevant information and options available. This confirmed the model’s ability to initiate a developmental approach with young people and indicated the presence of a structured and considered approach. The opportunity to identify, explore and interpret life events through a trauma lens offered an important insight that helped develop client- centred interventions. Engaging and maintaining young people in TRM-informed approaches could be challenging and some staff may take longer to feel comfortable and confident in using the model. This draws attention to the importance of ongoing training and support for practitioners to ensure that they feel sufficiently secure in their knowledge and confidence to apply the model. Participants described the opportunity to engage with theory helped them to focus upon the practitioner-young person relationship and adopt a more mindful approach to practice and to their understanding of their work with the young person. Challenges to the implementation of the TRM included finding time to bring psychologist and professionals together for meetings and managing the complexities of multi-agency working. However, a key outcome was a greater awareness and appreciation of other organisations which fostered greater inter-professional and inter-organisational collaboration

Virtual drug round: Development and next steps

Internationally, nurses are responsible for the accurate administration of drugs to patients in their care, something that is vital to maintaining the safety and well-being of patients. Whilst educational input to drug administration is provided, there remain a high number of errors in medicine calculations and delivery. To address these areas of concern different approaches to the development of knowledge and skills in medicine administration are being explored. This paper discusses the development and proposed implementation of a virtual drug round (VDR) in a University in the United Kingdom that aims to support the safe administration of medicines. It reflects on the processes of developing the VDR in some detail and considers the implementation plan. Proposals for evaluation are also considered that will inform ongoing development and transferabilit

Learning to deliver compassionate care: The role of peer support for practice learning

Following publication of the Willis Report (2012) and the Francis Report (2010, 2013), there is an increasing focus upon how compassionate care is addressed in undergraduate nursing programmes (Cornwell et al., 2013). This poster presentation illustrates an educational initiative involving peer support and nurse educator facilitation as one way of enabling students on undergraduate nursing programmes to consider their understanding and experiences of delivering compassionate care to service users. Peer support in nursing has been taking place informally for a long time with the “tea break/tear break‟ described by Butterworth (1998) as an example, helping student nurses not only with emotional release but also serving as a feedback mechanism. Whilst it cannot be claimed that this is a new approach to support, many staff peer support mechanisms have died out in the past due to lack of structure, ideas, facilitation, group skills, leadership or motivation (Bond & Holland 1998). The need to learn from mistakes of the past building up stronger structures for such support mechanisms is perhaps more important than ever given the findings of the Francis report (2010, 2013). The introduction of peer support at the beginning of a nurse’s career embeds this approach as an instinctive and accepted learning activity. As students begin to recognise the contradictions between learning in university and healthcare settings, peer learning and support offers a means of establishing personal and professional approaches for the delivery of person centred compassionate care. Exploring the context and background of compassionate care, the presentation offers a theoretical perspective of practice learning and, in doing so, attempts to articulate the learning that takes place as students consider their understanding of compassionate care