AANP Member Spotlight: On the Leading Edge of Health Care Simulation
Hear from AANP members Kristen Brown, DNP, CRNP, CPNP-AC, CHSE-A, and Pamela Slaven-Lee, DNP, FNP-C, FAANP, CHSE, on their experiences with health care simulation.
As technology evolves, the health care landscape evolves with it — leading to the advent of electronic health records (EHRs), telehealth, health informatics, continuous glucose monitoring devices, robotic-assisted surgery and much more. One of these quickly growing fields is health care simulation, which can be defined as the imitation or representation of real-world situations by health care providers for the purpose of education, assessment, research and health system integration.
“Health care simulation provides an experiential learning opportunity to influence behavior change,” says Dr. Brown. “It’s a great multimodal technique to help the development of cognitive and psychomotor skills.”
While health care simulation is a technique, not a technology, it can take many forms, including everything from virtual reality-based programs to manikins and role play. The realistic patient scenarios and medical equipment allow clinicians to develop skills or be retrained while they make real-time decisions in an environment that poses no risk to real patients.
“When nurse practitioner [NP] students are sent out into the clinical environment with preceptors, those experiences can vary. When we are able to bring that experience into the simulation lab, we have an opportunity to standardize students’ learning to demonstrate competencies,” says Dr. Slaven-Lee.
A Passion for Simulation Education
Dr. Slaven-Lee first learned of health care simulation during her faculty appointment at the Uniformed Services University: “They were really ahead of the game by using simulation in advanced practice nursing, and as a brand-new faculty member, I had the opportunity to work with others to understand this powerful pedagogy.”
Now, at the George Washington University School of Nursing (GW Nursing), she has worked alongside Dean Pamela R. Jeffries, PhD, RN, FAAN, ANEF, FSSH, a leader in simulation theory. “Once I learned the methodology, it changed everything about the way I was doing simulation. My responsibility is to educate other NP educators about proper simulation design, best practices and standards,” she says, adding that, for students, it’s important to take every learning opportunity available. “Being in a clinical and an augmented clinical environment is always so valuable, and much of the learning happens in the debrief. Embrace the experience and seek out feedback. Simulation can be anxiety-provoking, but simulation done well should prepare students so that they aren’t anxious and able to fully engage in the learning activity.”
Dr. Brown adds that her passion for simulation education stems from, “years in clinical practice as a critical care nurse and NP. I have always been engaged in learning strategies that will ultimately provide better care for patients.”
As a new NP working in pediatric critical care, Dr. Brown initially entered into simulation activities designed for her medical colleagues. “I noticed that there was a lack of post-graduate simulation training for NPs. Thirteen years ago, I took my first position in the Pediatric Intensive Care Unit [PICU] as a newly minted pediatric nurse practitioner [PNP]. Early on, I sought out any opportunities to participate in simulation either as an embedded actor or a participant with the residents and fellows. I was fascinated by using simulation as an education tool to create real-world environments for participants,” she says.
She sought out the opportunity for a fellowship in health care simulation — and became the first nurse to be named a Zamierowski Simulation Fellow at the Johns Hopkins Medicine Simulation Center: “I had been a nurse and critical care NP for a long time, but this was the first time I was taken out of my element to become a true simulation educator. The fellowship was an invaluable resource. It focused on the operations of a large simulation center, design and conduct of simulation research, education and program evaluation, instructional design and curriculum development.”
Based on the lack of post-graduate simulation education specifically for NPs, for her doctoral work, Dr. Brown designed and implemented a pediatric critical care simulation boot camp for advanced practice nurses. The one-day training focused on a patient with congenital heart disease. “This is a high-risk patient population. If clinicians do not recognize early signs and symptoms of an acute deterioration, the patient’s life will be at risk,” she explains. “Afterwards, I decided to expand the boot camp into a two-day program, and it’s now become an annual event attracting NPs from around the U.S. and Canada. Educating NPs is my passion. I want to show the proficiency of NPs and highlight that we are health care leaders.”
Bringing Simulation to Health Care
GW Nursing recently founded the Simulation in NP Education Consortium, with the mission to create a collaborative network and professional community of educators dedicated to high-quality simulation NP education, research and practice. Dr. Slaven-Lee, who is the executive manager and chair of the Simulation in NP Education Steering Committee, works with NP faculty to provide curricular support, leadership and coordination of on-campus, simulation-based learning events.
“The consortium is an incredible group of scholars who are devoted to NP education and committed to research, tool development and developing recommendations for simulation in NP practice,” she says. “In my role as clinical associate professor and senior associate dean for academic affairs, I require that faculty are involved in simulation events and are mandated to do training because it impacts student learning outcomes,” she says. In fact, GW Nursing opened its own Simulation and Innovation Learning Center in October, which is equipped with primary care practice rooms and swing rooms for specialty simulations.
In her role as assistant professor and the advanced practice simulation coordinator at the Johns Hopkins University School of Nursing, Dr. Brown develops simulation curriculum, plans training events and studies the use of simulation as a teaching method. Recently, she earned her certification as a Certified Healthcare Simulation Educator-Advanced® (CHSE-A) from the Society for Simulation in Healthcare™, becoming one of just 50 CHSE-As in the world.
“This has been an evolution in NP education, and educators are learning more about it. People are recognizing the need for simulation — the need to do it right and the need for proper resources. I really think, and hope, that just like we’ve seen a rise in Certified Nurse Educators [CNEs®], we’ll see a rise in certified simulation educators. That skillset is really important so that students can get the full benefit of simulation,” says Dr. Slaven-Lee, who is also a Certified Healthcare Simulation Educator® (CHSE).
“Ultimately, the goal is to provide an educational opportunity that focuses on the development and maintenance of competency. Before bringing simulation into your organization, it’s really important to first complete a needs assessment — what would be most beneficial to your organization and ultimately your patients?” Dr. Brown says. “Building a simulation program can also be expensive, so getting appropriate stakeholder buy-in or finding existing resources in your community is crucial. We also want to incorporate technology in a very mindful way to meet learning objectives. I am constantly pursing new and innovative strategies to deliver the highest quality education to a diverse group of learners. My goal is to provide experiential learning opportunities that ultimately change behaviors.”
“It’s important to think about what you are trying to teach and if simulation is the best way to do it. There is often a mistake of thinking that simulation is how you want to teach a concept as opposed to using it to give students the opportunity to demonstrate competency,” agrees Dr. Slaven-Lee. “What are you really trying to do? The concepts in the didactic portion should be appropriately aligned with the curriculum. What type of design is appropriate? Each simulation requires different skillsets and a degree of sophistication to be done well.”
Beyond education, simulation can be used in integration assessment, such as to identify delays in care, or in research, like for medical device testing. Dr. Brown notes that it can also be a valuable tool for self-evaluation.
“Utilizing simulation pedagogy is an effective methodology to engage a diverse group of learners in the active learning process. Furthermore, simulation allows for exploration of learners’ thoughts and reactions, which invokes critical thinking. I love applied knowledge and pushing the learner to understand why they are doing something — not just memorizing a task. Simulation training allows the learners to practice with a ‘coach’ in a safe environment to improve performance and ultimately improve competency,” she says. “Simulation offers a very good check point to identify those areas that need improvement. When we meet within the actual clinical environment, we break down walls and can engage in dialog to ultimately improve patient outcomes.”