Lab Innovations with Technology

Integrating Virtual Simulation into a Nursing Interventions Lab Course

Kathleen L. Shea EdD, MSN, RN, CHSE

Assistant Professor; Director of Nursing Simulation


Course Name & Description: N450 Nursing Interventions II  The focus of this course is the practical application of nursing interventions, assessment, patient-centered care, EBP, standard precautions, informatics and safety principles in a laboratory. This course provides students with the opportunity to learn new nursing interventions before applying them in an actual patient care setting.


Project Abstract:

          The N450 Nursing Interventions II is a nursing skills laboratory course which includes a combination of didactic, skills demonstration, skills practice with peers and 2 high fidelity simulation activities.  Evaluations are done using the traditional skills checkoff method and online quizzes. Lab time is utilized for teaching, practicing and demonstrating nursing skills.Each semester, students are assigned to a small group of 7-8 people who participate in high-fidelity simulation activities using Human Patient Simulators (HPS). The simulation activity takes place during one class period (3.5 hrs). During the simulation activity days (3 per semester) the “bottleneck” occurs because only one group attends class to participate.  The other 2 groups receive a take home alternative assignment and do not report to class on that day.  I would like to redesign this course by integrating and piloting two virtual lab experiences within the N450 Lab course.

          Using Laerdal Medical and Wolters Kluwer Health's virtual simulation software (vSim) and electronic health record software (Docucare) students will have the opportunity to complete a patient care virtual simulation.  Each patient scenario will support the content and skills already covered in the Nursing Skills Lab and Medical Surgical Theory course. Each patient scenario takes approximately 3-4 hours to complete. 

          Using our simulation space, I would like to provide students with alternate skills stations where they can practice skills such as IV insertion on task trainers, Medication Administration using Infusion pumps. The practice sessions will be facilitated by a clinical faculty member. The practice sessions will be video recorded so that the Nursing Skills Lab faculty of record will be able to watch the video and provide feedback on student performance


Keywords/Tags: Simulation, Nursing Lab, virtual simulation, nursing skills
Instructional Delivery: Hybrid
Pedagogical Approaches: Experiential learning, Deliberate Practice

About the LIT Redesign: Stage 1

Background on the Redesign 

Why Redesign your Course?

Course Characteristics:

This Nursing Skills Lab course includes a combination of didactic, skills demonstration, skills practice with peers and three simulation activities.Student assessments are based on the traditional skills checkoff method and online quizzes. Although this traditional method is effective in evaluating students, it is time consuming and students have to wait for their turn to be evaluated. 

Using an academic virtual simulation program by Lippincott/Wolters-Kluwer Health (vSim for Nursing) and an academic electronic health record program (DocuCare) in the N450 course will provide students with pediatric virtual simulation cases which can be completed online at home or during the down time in lab during check off sessions. Additionally, the vSim for Nursing program will be used to replace two alternative assignments that students complete independently during the course.

Each semester, N450 students participate in two simulation activities which take place over two 3.5-hour class sessions. One simulation activity involves the entire class working with five standardized patients to practice communication and physical assessment skills. The second simulation is a high-fidelity mannequin-based medical surgical scenario. First, the class of 20 students is divided into three groups of 6 or 7 students. During the simulation activity days (3 per semester) only one group of students attends class on campus to participate in the simulation activities. The remaining 2 groups receive a take home alternative assignment and do not report to class on that day


The Learning Problem:

The alternative assignments that students enrolled in the N450 course  complete are not closely aligned with the objectives and practical, clinical focus of the course. By replacing existing alternative assignments with virtual simulation scenarios, students will receive a more appropriate alternative to the high-fidelity simulation experience. During the virtual simulation activities, students will draw on concepts and skills learned in class to provide patient centered care.


High Demand/Low Success/Facilities Bottleneck Issues

As noted above, the students in this course have a good amount of "down time" on check off days and on simulation days when theyare required to complete alternate assignments.To make the course more robust, I propose the redesign to provide a virtual patient care simulation in which the students can apply the medical surgical pediatric concepts and skills learned in the course.


Course History / Student Resources

The course is one of the three nursing lab classes in the BSN program. Senior nursing students in their 3rd semester of the BSN program are enrolled in this course which is focused on medical surgical interventions.


Course Syllabus Syllabus from the pre-designed course, N450 Nursing Interventions II

Simulation MS2_CAPS_Student Packet.pdf Medical Surgical Simulation Student Information (Students review and prepare for simulation prior to reporting to campus)

Alternate   Assignments Information.docx

About the Students and Instructor: Stage 2

Accessibility, Affordability, and Diversity Accessibility 

  • Training on assistive technology is available through the DPRC to students with disabilities. Students should first meet with a DPRC staff member in order to be referred for the training. The type and amount of training provided is determined on a case-by-case basis.
  • Many students do not have computer access on a regular basis. To address this issue, the syllabus will include wording (below) to inform students of their options.
    •  Large computer study area on the Ground Floor for SF State Students. Sign in to use computers with University ID number. SF State OneCard required to print. Twelve Group Study Rooms that can be reserved are located here
  • Additionally, laptops may be checked out of the SFSU library for several hours or for a longer period of time. The students will be encouraged to contact the SFSU library for reservation requests.

Affordability

  • The addition of the v-Sim program will increase the cost per student by $125.00. If the pilot program is adopted permanently into the curriculum, I will work with the representative from Wolters-Kluwer to provide an institutional rate to our school.

Diversity

  • To be successful in performing the v-Sim activities, the students need to be competent in navigating the computer program.  There will be an in class orientation for all students in the N450 course.  The sales representative who is expertly trained in using the program will attend the orientation.  She will provide immediate feedback to students.
  • The v-Sim program includes several online training videos demonstrating how to use the program. Students will be encouraged to review concepts individually by watching video or by calling Wolters-Kluwer tech support directly.

Student Characteristics

  • The students who will participate in the LIT Pilot course in Spring 2020 are enrolled in the Nursing Bachelor of Science (BSN) prelicensure program at SF State. The BSN program is a two-year program which prepares students for entry level positions in professional nursing practice in a variety of settings including hospitals, community clinics, long term care, home care, and community health agencies. 

Reports on Demographics from Fall 2019 

Fall 2019 Prelicensure Demographics

Enrollment by Gender                    Female 79% (n=138)  Male 21% (n=37)


Enrollment by Unit Load 

49% Full time-12-14 units (n=34)

51% Full load-15+ units (n=47)

Unit Load Trends (Fall 2011 - Fall 2019)

Enrollment by Student Level

        Student Level Trends (Fall 2011 - Fall 2019)


Instructor Characteristics

Dr. Kathleen Shea has over 30 years of experience as a Pediatric RN and practiced at Lucile Packard Children’s Hospital, Stanford. Dr. Shea transitioned into nursing education and joined the faculty at San Francisco State University (SFSU) in 2008. She completed her doctorate in Education at the University of San Francisco in 2015 and is currently an Assistant Professor of Pediatrics and the Director of Simulation at SFSU. She has been certified by the Society for Simulation in Healthcare as a Healthcare Simulation Educator (CHSE) since 2017 and has presented on a variety of topics at INACSL, IMSH and SimGHOSTS USA. Her research interests include debriefing, participant preparation, faculty development and program evaluation. Her current focus is on integrating INACSL Standards of Best Practice into the simulation program curriculum and program accreditation at San Francisco State University.

Research Interests: Clinical Simulation in Nursing Education, Post-simulation debriefing, Learning and Instruction

Advice I Give my Students to be Successful 

As a pediatric theory instructor I advise my students to prepare for class by completing all readings and assigned activities. This way, they are ready to participate in the learning activities that I provide during class time. I encourage them to ask questions and communicate with me if they need any extra support in order to understand the content presented. I monitor their progress on a weekly basis (weekly quizzes and 4 Exams per semester) and reach out by email to anyone who seems to be falling in Quiz or Exam grades. I also encourage students to work together in study groups on a regular schedule.

Nursing Simulation at SFSU


Curriculum Vitae: CV Shea F2019.docx

LIT Redesign Planning: Stage 3

Implementing the Redesigned Course 

What aspects of your course have you redesigned? 

  1. I previously required 2 alternate assignments which were assigned to students on the two days when they were not participating in a small group simulation on campus (6-7 students/group). Additionally, student assessments included a drug calculation exam, four skills check-offs, and four online quizzes 
  2. The redesigned course incorporates 3 virtual simulation assignments, a drug calculation exam, three skills check-offs, and four online quizzes.

Describe the class size(s)  What technology is being used? 

  1. The redesigned course will be piloted in the Spring 2020 semester with one section of students enrolled in N450 Nursing Interventions Lab.  There are 19 students in the section.
  2. An academic virtual simulation program by Lippincott/Wolters-Kluwer Health's vSim for Nursing has been integrated into the Spring 2020 curriculum.
  3. Student orientation to the vSim for Nursing and DocuCare programs was conducted in the classroom with a learning consultant from Lippincott/Wolters-Kluwer Health.
  4. The students were presented with the program's purpose and one patient example was demonstrated. All students were given access codes to vSim and DocuCare.

The students were given a live demonstration which is shared here:

During the face to face orientation, students were given individual help accessing the program and enrolling in the "class" that was created by the instructor. Technical support information was introduced to the students and Student User Guides were provided:

DocuCare_STUDENT_UG_fall2019.pdfvSim_Pediatrics-Student_UGuide_html5r1.pdf

What professional development activities have you participated during your course redesign? 

I attended webinars and utilized training modules for instructors to learn how to create a class and assignments in vSim for Nursing and DocuCare. 

This is a sample of the training module:

Which Additional Resources Were Needed for the Redesign? 

There were no other resources purchased other than the vSim and DocuCare access codes.

Revised Syllabus S2020 N450-01 (Wed) Spring 2020 1 1(1).pdf

LIT Results and Findings: Stage 4

  LIT Redesign Impact on Teaching and Learning 

  • How has the course redesign strategies affected your instruction and your students’ learning? Did your redesign strategy solve the issues that motivated you to redesign the course? 
  • Describe how your students mastered the student learning outcomes. Were the students more successful in the redesigned course than in previous courses? Explain. 
  • Did you experience unexpected results after teaching the redesigned course? If so, what were they? 
  • Consider attaching a more in-depth report describing the impact of your activities and experiences during the course redesign as a document/link/image. If possible consider including samples of students' work that reflect the impact of the redesign. 

Assessment Findings 

  • Use table and chart template to report course data (required). 
  • Upload table and chart from your template (required) and reflect on your findings with a short description. You must include a course grades comparison of pre/post student achievements. 
  • Share how your students achieved the learning outcomes? Describe how they mastered the learning outcomes compared to previous courses?  

Student Feedback

  • What did your students say or how did they respond to the redesigned activities? Consider including your students' comments about their learning. Include survey results if you are able to capture them. Include student video feedback (optional).

Challenges my Students Encountered

  • What challenges did the students encounter in the redesigned activities? E.g., technical challenges, organization of course, and redesigned activities.

Lessons Learned & Redesign Tips

Teaching Tips

  • What advice do you have for others who might want to use this redesigned course?

Course Redesign Obstacles

  • What challenges did you confront and how did you overcome them?

Strategies I Used to Increase Engagement

  • What pedagogical strategies did you use in your new redesigned course to engage students?

Sustainability

  • How do plan to sustain the LIT redesign beyond the funding period?

Instructor Reflection

  • Reflect on your participation in redesigning a course, development of an ePortfolio, participation in CSU Course Redesign “Professional Learning Community Share any plans to disseminate/publish the findings of your course redesign activity.

Impact of Student Learning Outcomes/Objectives (SLOs) on Course Redesign 


Student learning outcomes for the N450 Nursing Interventions course are listed below. The redesign integrating virtual simulation will address several of the SLOs.

1. Demonstrate ability to perform advanced nursing interventions safely

2. Explain rationale for evidence based nursing interventions

3. Identify appropriate nursing interventions for specific patient conditions

4. Demonstrate ability to work collaboratively in provision of nursing interventions 

5. Use information technology to document nursing interventions utilized

Alignment of SLOs With LIT Redesign 

Virtual simulation activities will provide students with the opportunity to perform patient care in a psychologically safe environment. Simulation allows students to make clinical decisions and evaluate their effectiveness without risk to patients in actual clinical settings. (SLO 1, 3). By completing a reading assignment and attending face to face lab course meetings prior to beginning the simulation, the students will learn the theory and nursing care of a client with a specific condition (SLO 2,3).  Using the v-Sim program allows students to assess the patient, provide nursing care, educate the patient and family, communicate therapeutically and evaluate the effectiveness of their behaviors. Additionally, the program allows the student to chart nursing interventions in a simulated electronic health record (SLO #5).

Assessments Used to Measure Students' Achievement of SLOs 

Several assessment tools will be utilized to  to measure the students' achievement.  

  1. vSim Pre-test and vSim Post test
  2. vSim Score of 70% will be required
  3. Student Evaluation: vSim for Nursing
  4. Student Evaluation.docx
  5. Written journal reflection paper

The journal  assessment rubric is located below.

  1.  Reflective Journal Rubric.docx