● Sharon W. Hutchinson, PhD, MN, RN, CNE, Dean and Professor of Nursing, Dillard University
● Charlotte S. Hurst, PhD, RNC-MNN, CNM, RN-BSN & Senior Level Coordinator Curriculum Committee Chair, Dillard University
● Sheila C. Haynes, PhD, RN, Psych-Mental Health Course/Sophomore-level Coordinator, Dillard University
● Falicia McKarry, MSN, RN, Skills Lab Coordinator, Dillard University
Published August 2022
Dillard University is a historically black college and university (HBCU). The College of Nursing (DUCON) was the first accredited baccalaureate program in the State of Louisiana. The DUCON was established in 1942 and accredited in 1953 by the ACEN. The DUCON currently offers three nursing program options that lead to a bachelor of science in nursing (BSN) degree, including the generic/traditional prelicensure, the LPN-to-BSN, and RN-to-BSN program options. The DUCON also offers an interdisciplinary minor in healthcare advocacy. Our belief is that simulation provides students at all levels of the program with non-threatening patient care experiences that promote clinical judgment and develop essential skills for effective practice as a graduate nurse. Faculty therefore collaborated to develop a simulation integration plan.
This article was a collaboration between the Dean of Nursing, the Curriculum Committee Chair/Certified Nurse Midwife, the Psych-Mental Health Course/Sophomore-level Coordinator, and the Skills Lab Coordinator working within the DUCON.
Like our guiding framework, our simulation plan is eclectic; it includes faculty-made virtual simulations and virtual simulation software, the use of low-, medium-, and high-fidelity simulation mannequins and task trainers (usually coupled with unfolding case studies), and preexisting vendor simulations. All simulations contain a documentation component, a care plan generation, and an evaluation component. Products used that align with course texts include vSim by Wulters Kulwer, Real Case Scenarios by ATI, Sentinel-U’s Sentinel City and Leadership and Management, Laerdal’s Nursing Anne and Kid mannequins, and Nasco’s birthing and adult-geri mannequins.
At the sophomore level, simulation consists of primarily low-fidelity simulations with task trainers coupled with skill checkoffs. Medium- and high-fidelity simulation at the junior and senior levels begin in the lecture environment as unfolding case studies or role play, culminating with a high-fidelity simulation. The greatest difficulty associated with the integration of the DUCON’s simulation plan was faculty buy-in. Some faculty were hesitant and did not favor an increased use of simulation as a part of the clinical component. However, with the advent of the COVID-19 pandemic and the need to continue engaging in clinical learning experiences without the benefit of patients, a new mindset evolved. Everyone was on board. Clinical is now 50% direct patient care and 50% simulation. Specific examples of faculty use of simulation and the impact it had on the students is to follow.
The Skills Lab Coordinator believed the completion of skills checkoffs were important, but she also believed that students should have the ability to apply the skill during a simulated scenario with a patient. “The students believe in it so much that their class president asked for time during the summer break to have the simulation lab open for practice as well as virtual simulations, so non-local students who could not attend in person could attend online.”
The Skills Lab Coordinator complied to their request. Students who chose to participate received four sessions of hybrid simulation activities, and the feedback has been great. Students used the clinical judgment measurement model (CJMM) to identify cues that indicated a sudden change in the patient’s condition quickly. By bringing classroom content into the simulation labs, students can place all the puzzle pieces together to see the greater picture. Because of students’ different learning styles, it helps them to better retain the content received in class.
It is also important that we as faculty protect the psychological safety of our students during simulation. “Students are reminded that if a mistake is made during the simulation, it is better in the lab than with a patient.” This places the students at ease, invokes them to pause, ask questions, and allows for time to verify they are deciding on the best plan of care for the patient without the weighted stress of being with an actual patient. So, when they do have the opportunity to care for a patient that has similar symptomatology and diagnosis to that of a simulated patient, they in turn feel more confident and comfortable while assessing and performing the tasks.
The Psych-Mental Health Course Coordinator favored the vSim packet that accompanied the course textbook. vSim interactive activities enhanced students’ acquisition of knowledge and confidence when caring and instructing patients diagnosed with a mental disorder and experiencing harmful behavior. Coupled with roleplaying during in-class activities, students stated the realization of increased knowledge and skills gained from the interactive simulation experiences. Additionally, low-fidelity activities involving the use of MP3 players provided students with attitude and sensitivity activities, exposing students to the daily challenges that individuals face while hearing distressful sounds or voices that are part of their disorder. During debrief, students shared previous faulty beliefs and embarrassing reactions to individuals they had noted either self-conversing or reacting to the voices. At the end of the simulation session, students stated they had better insight, new senses of empathy, and greater respect for individuals hearing voices or engaging in self-conversing; this aided them in assisting them to satisfy their essential life needs.
A prime example of the use of the unfolding case scenarios coupled with a delivery in the simulation lab is the most popular learner simulation activity. Classroom time served as prebriefing from conception to management of the pregnant client to managing the client during the stages and phases of labor. Students received a perinatal script prior to the simulation. Assignment of student roles occurred by student self-selection from a hat. The simulation experience included two scenes. The final activity was the simulated birth, which is demonstrated in the video.
The DUCON’s nursing students appreciate and are satisfied with the simulation program. The request for operation of the lab during the summer break is an indicator of their satisfaction and the desire to engage in simulated learning. As we continue to refine our plan, data collection and trending will help determine which methods work best for our students.
Funded by the U. S. Department of Education Strengthening HBCUs Title III funds.
Sharon W. Hutchinson, PhD, MN, RN, CNE
Dean and Professor of Nursing
Charlotte S. Hurst, PhD, RNC-MNN, CNM
RN-BSN & Senior Level Coordinator/Curriculum Committee Chair
Sheila C. Haynes, PhD, RN
Psych-Mental Health Course/Sophomore-level Coordinator
Falicia McKarry, MSN, RN
Skills Lab Coordinator