Nursing Simulation Evaluation
Maria Overstreet, PhD (c), RN, CCNS
First Question to Ask
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To do or not to do…that is the question?
Why evaluate?
Evaluate what?
What is the purpose of your simulation?
Is purpose to practice, to learn, to
experiment…
• Is purpose for competency?
After determination of purpose…
• Question becomes:
– What am I to evaluate?
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Performance
Knowledge
Skill
Attitude
Confidence
Teamwork
Communication
Then…How will I evaluate?
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Tools to measure outcome
We must develop the tools
Scant few in nursing (see Jefferies, 2006)
Have developed one…not tested for
validity or reliability measures
• Have tested face and content validity
• Medical field has worked on some specific
to discipline using simulation, anesthesia
(ANTS Tool)…
Competency
• School of Nursing Student Competency
– Evaluation of skill mastery
– Evaluation of synthesis of knowledge
– Evaluation of decision making under stressful condition
• Hospital Nurse Competency
• Licensing Competency
• License Renewal Competency
• Think about CPR renewals…
• Think about patient care standards…
• Think about legal issues…
Evaluation of Curriculum
• Where to add simulation in curriculum
• SON are going about this differently.
• Some use clinical hours (25% simulation)
– Non-clinical days vs. clinical days
• Some are adding to lecture time
– Pharmacology
– Physiology
• Some are adding simulation to laboratory
Faculty
• It is the faculty who must decide where
and when to use simulation to assist the
student.
• We are currently looking at the simulation
content to be concepts our students have
the most difficulty grasping. Such as
insulin administration, medication
management, and concepts from specialty
rotations (OB, Peds, Psych, M/S).
Example
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Review Insulin Administration Simulation
Purpose
Goal
Objectives
Plan
Action
Evaluation
Checklist of behaviors for student during diabetic medication error simulation
Technical Skills:
I/O measure urine
I/O measure IV bag for beginning of shift
Prepares insulin
Administers insulin
Prepares and administers other medications
Maintains safe environment: bedrails
Assessment:
Brief neurological assessment for orientation, pupils, skin
Assess heart
Assess lungs
Assess IV site
Assess injection sites
Communication:
Requests nurse or instructor to verify insulin calculation
Requests nurse or instructor to verify insulin preparation
Talks with charge nurse, instructor, or physician about concerns with medications
Talks with charge nurse, instructor, or physician as to when cystoscope is scheduled / NPO
Rewords technical language for patient educational level
Body language inviting for patient
Uses professional body mechanics
Critical Thinking:
Reviews V/S from tech
Reviews BG from tech and rechecks BG if value out of norm for client
Questions to hold metformin order due to possible IV dye
Questions order for HCTZ on dehydrated patient
Does not try to teach patient who is slightly confused
Organizes am duties within priority
Question need for O2 @2LNC (confusion, sat 93%) versus infection cause of confusion
Questions regular diet order for diabetic
Questions order for activity with confusion, is the patient steady?, can he follow directions?
*Rater will evaluate the overall performance
based on the decisions and interventions
chosen by the student to implement.
A rating scale of 0 – 5 will be used.
Rating Scale :
0 = did not perform
1= poor performance
2= performed, needs improvement
3= acceptable performance
4= good performance
5= exceeds level of peers
Essentials for Student Performance during Simulation Experience
© Overstreet/Miller February 3, 2008
(developed from “The Essentials of Baccalaureate Education for Professional
Nursing Practice, American Association of Colleges of Nursing)
Category I: Technical Skills
Category I: Technical Skill
Performance of interventions:
vital signs, bed making, bath,
recording I/O, basic and
advanced skills including
learner’s hand-eye
coordination.
0 1
2
3
Completeness
4
5
0 1
2
Accuracy
4
5
Comments:
*Rater will evaluate the completeness of
the skill and the accuracy of the
performance
3
Category II: Assessment
Category II: Assessment
Focuses assessment depending
on the diagnosis and responses
from patient
Completes all components of
the assessment required by
diagnosis and patient response
0
1
2
3
4
5
Chosen assessment items
Comments:
*Rater will evaluate evidence
of assessment performed and
the accuracy and preciseness
of the assessment
0
1
2
Accuracy
3
4
5
Category III: Communication
Category III: Communication
Performs therapeutic communication
techniques when applicable
Communicates effectively and clearly
with patient/family/colleague
Is or becomes aware of body language
of patient. Uses own body language
to communicate effectively
0 1
2
3
4
5
Communication techniques
Comments
*Rater will evaluate the appropriate
use of communication techniques
and/or body language in
compassionate care of patient/family.
Evaluate professional communication
with colleagues
0 1
2
3
Professionalism
4
5
Category IV: Critical Thinking
Category IV: Critical Thinking
Reviews data on hand and asks
questions for clarification when
appropriate. Is able to make decisions
at the patient’s bedside which will
effect the quality of the patient/family
care/life
0
Comments:
*Rater will evaluate the overall
performance based on the decisions &
interventions chosen to implement
1
2
3
4
5
Decisions and Interventions Chosen
Using 0-5 Rating Scale
• Run clip of student
performing during
medication simulation
and have audience
rate performance.
Audience Rating of Student
Behaviors
• Technical Skill
– Completeness 0-5
– Accuracy 0-5
• Assessment
– Chosen Items to assess 0-5
– Accuracy 0-5
• Communication
– Communication techniques 0-5
– Professionalism 0-5
• Critical Thinking
– Decisions and Interventions Chosen 0-5