Nursing Students and Simulation

Curriculum Design
Introduction
As Terzioglu, Tuna and Duygulu (2013) state, “learning from experience is an important part of nursing education [and] using simulation as an innovative teaching strategy in nursing education” is an effective way to reinforce technique, principles, knowledge, skills and practice (p. 34). Simulation gives nursing students the opportunity to engage with real world dynamics in a controlled environment where they can receive immediate feedback following their active learning experience. This curriculum is designed to engage students in the art of simulation, and to highlight the importance of realistic experiences in the learning process.
Need for This Program
Nguyen et al. (2009) note that clinical knowledge and the skills and experience needed to treat patients with sepsis is lacking in the nursing field. This program has been developed to address this gap. Ortiz-Ruiz et al. (2018) have stated that “simulation is an efficient method for teaching in sepsis” (p. 151). For that reason, this program aims to use simulation to give nursing students the opportunity to receive sepsis training that can prepare them for the real world of nursing.
Who Benefits
Nursing students benefit first and foremost from this curriculum. Knowles (1984) suggested four principles that are applied to adult learning and that apply to the reason nursing students benefit from this curriculum. The principles are:
1. Adults need to be involved in the planning and evaluation of their instruction.
2. Experience (including mistakes) provides the basis for the learning activities.
3. Adults are most interested in learning subjects that have immediate relevance and impact to their job or personal life.
4. Adult learning is problem-centered rather than content-oriented (Knowles, 1984).
This curriculum allows educators to become facilitators of adult education, helping the adult learner to set and achieve goals and guide them in choosing the subjects and courses needed to fulfill these goals. This is important because the adult learner brings into the continuing educational arena a rich array of experiences that will affect the learning styles and assimilation of knowledge. Adult learners need to be able to apply the knowledge into their life situations.
The Effects
The advantage of an interdisciplinary nursing curriculum is that it encourages and empowers students to think critically and creatively and to be able to use the knowledge from other programs of study and incorporate that into their practice. If they were just to study and understand what is in their field then they would not be able to understand and appreciate what others are contributing to the care of these patients. Everyone in the healthcare field has a role, and everyone working together as a team makes it that much better not only for themselves, but for the patient as well. The World Health Organization recommends that students begin using the principles of teamwork in their education immediately because learning how to communicate effectively and work together can be time consuming, learning teamwork within the context of medical curricula will make students better prepared (Why is Teamwork in Health Care Important, n.d.).
General Description
This course is designed to educate the students on sepsis and to better understand that it is a complex and potentially fatal condition and occurs as a result of the systemic manifestation of infection. The course emphasizes the importance of early detection and that implementation of evidence-based guidelines are followed to ensure patient survival. Using sepsis as an impetus, this course will serve to educate future health care educators on the art of simulation as an educational modality. The foundations, design, articulation and evaluation of simulation will be accomplished using the pathophysiological processes of sepsis as a primary topic.
Mission and Philosophy
The mission and philosophy statements can be found in the Appendix.
The Foundational Theoretical Nursing Model
Dorthea Orem’s Self Care Model is the theoretical nursing model that serves as the foundational nursing model for this curriculum. Orem’s theory holds that self-care comprises those activities performed independently by an individual to promote and maintain person well-being (Nursing Theorists, 2011). Nurses should be able to operate independently, use critical thinking to make good decisions both for their patients and for themselves, and this curriculum was designed to promote and utilize the self care theory by guiding and supporting the students, which, ultimately, will help the students grow in confidence and become self-empowered nurses. If the student is dependent on someone or something else, then they will not be successful in what they do and will not be driven to continue their education. This model, therefore, helps to nourish the idea in the student that he or she is the main driver of success and that to succeed in nursing, he or she must become an active learner who takes ownership of the educative process.
Program Components
Course Objectives
At the end of this course the student will:
1. Identify and explore various modalities of simulation utilized in the educational setting
2. Understand and discuss the value of simulation in the educational setting and its impact on developing critical thinking processes and clinical skills
3. Design, construct, and perform various simulations involving the treatment of patients with sepsis/septic shock
Evaluation Methods
Students will be evaluated in this class by a combination of the following:
· Written or computerized quiz/exam
· Essay/Research Paper
· Group Q&A
· Return demo on simulation lab safety and operations
· Sim-lab evaluation
· Evaluation/test using different patient scenarios. 
· Each team will work through a mock code together.
Teaching Methods and Learning Strategies
Differentiation strategies, scaffolding, visual aids, and both low-fidelity and high-fidelity simulations will be used to instruct students. Low-fidelity simulations will include interactive multimedia patient simulation exercises and role playing; high-fidelity simulations will include clinical scenarios. Role playing has been found to be an effective method for simulation exercises as it gives students the opportunity to try out scenarios in an active manner; high fidelity simulations are best for advanced students (Munshi et al., 2015).
Learning strategies will include active learning (reading, role playing and other simulations), passive learning (listening to lectures and PPT presentations), group discussions, and self-directed learning (research and writing). These four learning strategies will help to provide students with multiple opportunities to engage in some form of learning style that is appropriate for them.
Course Content
(1) Define Sepsis Assigned readings 2 0
(a) Abnormal response to infection
Lecture, PowerPoint Presentation 1 0 Written or computerized exam
(b) Cytokines are unchecked, vasodilation, increased capillary permeability 
Group Discussion 1 0 Group Q & A
(c) Review pathophysiology progression
Simulation lab: orientation and introduction 1 3 Return demo on simulation lab safety and operations
(2) Recognize 5 signs & symptoms of Sepsis Assigned readings 2 0
(a) Fever, tachycardia, tachypnea
Lecture, PowerPoint 2 0 Written or computerized exam
(b) Clotting issues
Group discussion 1 0 Group Q & A
(c) Decreased output, hypotension 
Sim lab: identify a patient presenting the ER with S/S of sepsis 1 3 Sim lab evaluation: student will be able to identify a patient with sepsis versus one with a simple infection
(3) Care of the Septic patient Assigned readings 3 0
(a) Initial resuscitation 
Lecture, PP 2 0 Written or computerized exam
(b) Increase preload, normalize lactate, re-verse hypoperfusion
Group discussion 1 0 Group Q & A
(c) Increase oxygen-carrying capacity, pro-mote adequate cardiac contractility 
Sim lab: Sepsis rapid re-sponse team “code” 2 6 Evaluation/test using differ-ent patient scenarios. Each team will work through the code together.
(4) Summary and Key Takeaways 
(a) After patient is resuscitated, review next steps, monitoring, and recovery.
Sim lab: students will learn appropriate monitoring and stabilizing measures 2 3 Sim lab evaluation: student will demonstrate skills and patient education.
(b) Early identification is key
Assigned readings 2 0 Written or computerized exam
(c) Timely antibiotic administration improves outcomes
(5) Simulation and its uses in the educa-tional setting Lecture, group discussion 1 0 Group Q & A
(a) theoretical foundations, design and articu-lation of simulation
Online lecture 1 0 Written or computerized exam
(b) methods to effective simulation in the educational setting
Online lecture 1 0 Group discussion, Q&A
(c) evaluation of simulation performance and effectiveness
Sim lab, post-conferencing following simulation activi-ties 0 3 Group discussion, evaluation forms
Credits
Students will receive three credit hours as per standard class credit recognition.
Admission Requirements
Prerequisite(s): MSN 6603, MSN 7703
Syllabus
Week 1. Identify and explore various modalities of simulation utilized in the educational setting, Sepsis: Pathophysiology, diagnosis, treatment and nursing care
· Readings: Chapter 1 and 2
· Quiz
Week 2. Understand and discuss the value of simulation in the educational setting and its impact on developing critical thinking processes and clinical skills
· Readings: Chapter 3 and 4
· Introduction to Simulation/Lab
· Exam 1
Week 3. Design, construct, and perform various simulations involving the treatment of patients with sepsis/septic shock
· Reading: Chapter 5 and 6
· Simulation/Lab – Mock Code
· Simulation Test Out
Week 4. Review
· Simulation Presentations
· Exam 2 (online)
· Simulation Test Out
Topics to be Covered
1. Define Sepsis
a) Recognize 5 signs/symptoms (fever, tachycardia, hypotension, oliguria, tachypnea)
b) review pathophysiology progression
2. Care of the septic patient
a) initial resuscitation, monitoring and recovery
b) increased preload, normalize lactate, reverse hypoperfusion, increase oxygen-carrying capacity, promote adequate cardiac contractility
c) emphasize timely antibiotic administration
3. Simulation and its uses in the educational setting
a) theoretical foundations, design and articulation of simulation
b) methods to effective simulation in the educational setting
c) evaluation of simulation performance and effectiveness
Program Competencies
Understanding simulation in nursing education—Students will be able to define simulation, define how it is used in nursing education, and how simulation helps with critical thinking.
Understanding sepsis—Students will be able to define sepsis, understand the significance of a sepsis treatment protocol, and articulate nursing care of the patient with sepsis.
Development and performance of simulation—Students will be able to identify the components of an effective educational simulation, construct simulation involving the care of a patient with sepsis, and evaluate effectiveness/performance of constructed simulations.
Additionally, students will be able to do the following:
1. Students will be able to discuss five distinct variations of simulation scenarios
2. Students will be familiar with the literature supporting simulation use
3. Students will discuss the relevance of simulation use in education
4. Students will apply sepsis as a topic to create and conduct a simulation process
5. Students will apply concepts learned to develop comprehensive simulations
Delivery Format
The course will be delivered in the Medical Center Conference Room A, Tuesdays 6-8pm. Online Assignments/Activities will be provided.
Pre-Approval Process
The program must be reviewed by an accrediting agency recognized by the U.S. Department of Education and the Council for Higher Education Accreditation. The Accreditation Commission for Education in Nursing will provide accreditation. At this time it is not perceived that there are any barriers to accreditation.
Implementation Timeline
The course is designed to last four weeks.
Online Assignments/Activities
All assignments are provided online.
Curriculum Evaluation Methods
Individual and Systematic Evaluation Process
Individual evaluation will be conducted via formal assessments and informal assessments, using direct and indirect methods, as recommended by Beasley, Farmer, Ard and Nunn-Elison (2018): students are credited for attending all classes, participating in group discussions, performing in simulations, taking quizzes and exams. The systematic evaluation process is based on the Accreditation Standards and Criteria for the evaluation of nursing programs, including the evaluation of outcomes, of the Accreditation Commission for Education in Nursing. A schematic can be found in the Appendix.
Summary
There is a need for nursing students to better understand and be prepared and trained in how to identify and treat sepsis. Simulation exercises can be an effective means of preparing nursing students to achieve that goal. This curriculum has been designed to help prepare nursing students to understand the significance of sepsis and how to treat it in the real world of nursing. The curriculum covers a range of subjects over the course of four weeks, including how to identify and treat sepsis and how simulation can assist students in achieving learning objectives.
References
Beasley, S. F., Farmer, S., Ard, N., & Nunn-Ellison, K. (2018). Systematic Plan of
Evaluation Part I: Assessment of End-of-Program Student Learning Outcomes. Teaching and Learning in Nursing, 13(1), 3-8.
Knowles, M. (1984). Andragogy in action. San Francisco: Jossey-Bass.
Munshi, F., Lababidi, H., & Alyousef, S. (2015). Low-versus high-fidelity simulations in
teaching and assessing clinical skills. Journal of Taibah University Medical Sciences, 10(1), 12-15.
Nguyen, H. B., Daniel-Underwood, L., Van Ginkel, C., Wong, M., Lee, D., San Lucas,
A., ... & Clem, K. (2009). An educational course including medical simulation for early goal-directed therapy and the severe sepsis resuscitation bundle: an evaluation for medical student training. Resuscitation, 80(6), 674-679.
Nursing Theorists. (2011). Retrieved from
http://currentnursing.com/nursing_theory/nursing_theorists.html
Ortiz-Ruiz, G., Maestre, J. M., Szyld, D., Del Moral, I., Rudolph, J. W., & Díaz, G.
(2018). Simulation and Sepsis: What Is the Best Evidence?. In Sepsis (pp. 151-166). Springer, New York, NY.
Terzioglu, F., Tuna, Z., Duygulu, S. et al. (2013). Use of simulation in nursing
education. Journal of Curriculum and Teaching, 2(1): 34-41.
Why is Teamwork in Health Care Important? (n.d.). Retrieved from
https://www.hrhresourcecenter.org/HRH_Info_Teamwork.html
Appendix
Mission Statement
The mission of this curriculum is to understand, conceptualize and explore the incorporation of simulation in nursing education, specifically in regards to developing clinical decision making skills and fostering critical thinking abilities in patients with sepsis. The curriculum is designed to engage students in the art of simulation, and to highlight the importance of realistic experiences in the learning process. Students will be better equipped to interpret and develop creative and interactive simulation in the pursuit of modern, innovative educational modalities, specifically in regards to patients with a diagnosis of sepsis.
Philosophy Statement
The philosophy behind this curriculum is that students should be empowered to take ownership of their education. This course provides students with the opportunity to actively engage with the learning material and acquire a deep-down understanding that can prepare them for the real world of nursing.
Evaluation Schematic
1. Exam 1: Sepsis/Septic Shock: Pathophysiology, Diagnosis and Treatment – Week 2
a. Must achieve an 80% or higher
2. Exam 2: Simulation in Education: Theory, techniques and production – Week 4 (online)
a. Must achieve an 85% or higher
3. Research Paper: Simulation in Education – due Week 4
a. Must achieve an 80% or higher
4. Group Q&A’s – Weekly following group discussions
a. Must achieve an 80% or higher each week
5. Return demo on simulation lab safety/operations – Week 2
a. Must be able to verbally identify 5 lab safety principles
6. Sim lab evaluations – Weeks 3 and 4 following each simulation/patient scenario