Patient simulators are an additional opportunity to develop students' nursing skills in a safe and controlled environment. Although patient simulators provide a structured experiential learning experience for students, they require a large time and resource commitment from faculty. Seeking customizable tools or resources to help faculty at my school prepare for implementing simulations, we developed a simulation toolkit for faculty. This toolkit's contents helped launch the school's simulation program, setting a spark for integration and perceived need in both faculty and students.
In health informatics, open-source tools and toolkits have been developed and used over time.1 Toolkits "offer intellectual property in a way that everyone can learn from, participate in and extend."2 A toolkit is set of materials-written documents, PowerPoint presentations, and other resources-that support a particular practice or program. These tools are continually improved through user trials and feedback. Although literature is lacking on the value of faculty toolkits as a source to prepare faculty and plan for patient simulations, our experience with toolkit development and use has been positive.
Faculty Considerations
Once the decision has been made to purchase and use a simulator in clinical education, faculty often feel unprepared for this type of teaching.3 This was no different for my diploma nursing program when a moderate-fidelity VitalSimTM manikin (Laerdal Medical Corp, New York) was bought in spring 2008. The lofty goal of developing 1 simulation scenario per course by the end of the year was set. Being neophytes in regards to simulation as an educational pedagogy, the faculty decided to start slowly-a trial-and-error experimental approach. Jeffries4,5 reports that this is often the case as many nursing school faculty face administrative, resource, and faculty development challenges. Innovative ways to teach students about the real-world of nursing are needed, as well as innovative ways to prepare faculty for that role, thus the development of a practical simulation toolkit.
The faculty had voiced unease with initiating and incorporating simulation into their curricula. To decrease some of the burdens associated with the start-up,3-6 our toolkit was designed to increase faculty's ease and confidence as they started their new work. Most of the faculty wanted to integrate simulations into their work, but they wanted a resource guide or "how to" manual to help them with the effort. Our school's approach to these issues was the development of our own simulation toolkit using faculty champions: I and 2 faculty mentors. Faculty champions, like me, serve as gung ho leaders willing to put in the extra time for toolbox compilation, testing, and dissemination. The toolkit was to be a faculty guide for exploring and developing scenarios, evaluations, simulation examples, and simulation templates.
The Toolkit
The goals for the toolkit project were the following:
* increase faculty ease and confidence with introducing and developing patient simulation scenarios into curriculum
* ensure that the faculty had a reference tool that provides current thoughts and findings on simulation in nursing curricula as well as provide strategies and templates for future development
* provide an enduring material for the school's learning resource center teacher to use in faculty continuing education and student orientation to simulation.
Items for inclusion were evaluated by my faculty mentors prior to final assembly. Contents were placed in a tabbed 10in x 11in binder that also included a pocket sleeve for the reproducible content CD. All materials placed in the toolkit are provided as Word documents meant to be copied and completed when needed. The accompanying CD contains the same Word documents (ie, checklists, scenario templates, and evaluation) that allow a fill-in option and the capability to individualize and edit based on ongoing faculty feedback.
The eye-catching PowerPoint-developed tab titles include journal articles, scenario templates, simulation references, reading list, and miscellaneous. Copyright permission was obtained to provide a sampling of relevant simulation articles discussing frameworks, teaching strategies, and performance. The template section is comprehensive, containing (a) a simulation framework/process modified and derived from Jeffries' model4,5 and Laerdal Medical (http://www.laerdal.com), (b) generic objectives that are then tailored by faculty to their own specific simulation content, (c) a simulation checklist, (d) scenario scripts, and (e) evaluation. The simulation checklist includes case-specific patient props such as Foley catheters, blood pressure cuffs, intravenous tubing, and syringes (Table 1). These items are essential in planning a realistic simulation scenario. Faculty can consider collaborating with staff at local hospitals, clinics, or medical equipment companies to rent or purchase outdated supplies and related equipment to assist in making the simulation more realistic. Purchasing used props and equipment can be a significant cost-saving effort. Our school's first simulation event required all the equipment seen in Table 1 along with case-specific props brought from faculty's homes, such as actors' wardrobes (ie, visitor and charge nurse).
The evaluation template allows for individually created, as well as suggested, simulation debriefing questions, including, "How did you feel during the simulation experience?" and "What were the key assessments and interventions?" The student evaluation allows faculty to document how the simulation was evaluated (debriefing, formative, standard school evaluation, video review, and/or grading rubric) and has space for overall summary. The templates are designed to be similar to our school's formatting and can be customized for adult or pediatric scenarios. The toolkit's templates provide standardization to scenario development, which, in turn, aides in further faculty education and quality.
A comprehensive bibliography is part of the "Reference" section, as well as Web links that provide references to adult learning, national simulation centers, and actual depicted simulations. Faculty can adjunct their student simulation orientation by adding one of the listed YouTube-type videos that provide learners with a "see it before doing it" approach. The "miscellaneous" tab was the natural location for the student honor code and the "introduction to simulation" PowerPoint for student viewing.
The faculty now share components of the toolkit with their students as they introduce concepts, expectations, and examples. Simulations provide an environment that requires a degree of self-directed learning. The toolkit contents give faculty tools for assisting students in such planning and preparation. Faculty report ease in using the toolkit when planning their first simulation activity. They commented that it contained everything they needed, and more. More important, faculty are starting to share their scenarios with each other and adding new items. Video files from the school's simulation laboratory events are now included; they are used for debriefing and continuing education among faculty. As a quality improvement measure, our school's learning resource center teacher is now responsible for monitoring further revisions to the toolkit.
Summary
Flexible content simulation toolkits are easy to further develop and/or replicate, which is often the case as faculty feel more comfortable and prepared when using simulation with their students. Whereas our school had a volunteer, interested in technology applications, who designed the toolkit, another option for toolkit development would be the use of a project team. The simulation toolkit proved to be the foundation on which faculty were able to design and implement their simulations to produce the best possible outcomes, for students and faculty alike.
References