The use of simulation continues to increase in prelicensure nursing curricula in the United States. Findings from the National Council of State Boards of Nursing (NCSBN) national, multisite, longitudinal, randomized controlled study on replacing clinical hours with high-quality simulation in prelicensure nursing education (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014) indicate that simulation can substitute up to 50 percent of traditional clinical hours without negatively impacting students. For that to happen, an educational framework must be used with planned debriefing and incorporation of International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM (INACSL, 2013). The NCSBN developed simulation guidelines (Alexander et al., 2015) to assist nursing simulation educators with the integration of simulation into their curricula, and many institutions and state boards of nursing are beginning to substitute simulation for traditional clinical time.
NCSBN guidelines (Alexander et al., 2015) state that the institution must support sustainability of the simulation program. This includes providing the appropriate facilities as well as dedicated and trained faculty to facilitate and guide the simulations to meet intended learning objectives. The guidelines state faculty must receive training on facilitation and debriefing and should be prepared to follow INACSL Standards of Best Practice: Simulation (INACSL, 2013). These standards were revised in 2016 and updated to include Simulation Design, Outcomes and Objectives, Facilitation, Debriefing, Participan Evaluation, Professional Integrity, Simulation-Enhanced Interprofessional Education, and Simulation Glossary (INACSL Standards Committee, 2016). They highlight that the facilitator must be trained in the pedagogy of simulation, facilitation, debriefing, role-modeling professional behavior, and creating an effective and safe learning environment.
The Jeffries/National League for Nursing (NLN) conceptual framework (Jeffries & Rogers, 2012) has advanced to the NLN/Jeffries simulation theory. Major changes occurred within the educational practices of the simulation experience, with the titles of teacher and student changed to facilitator and participant to more clearly reflect current practices. Within the simulation experience there must be an environment of trust; the experience must be experiential, interactive, collaborative, and learner-centered. Outcomes are measured on a system, patient, or participant level and address knowledge, skill performance, learner satisfaction, critical thinking abilities, and self-confidence of participants (Jeffries, 2016). The NLN/Jeffries simulation theory depicts the triadic relationship of participants, facilitators, and educational practices and their influence on simulation design and outcomes and supports the need for trained facilitators to conduct simulation.
IMPETUS FOR CHANGE
The University of South Florida College of Nursing (CON) leadership team made a strategic decision to increase undergraduate nursing prelicensure program simulation activities to 25 percent over a two-year period. Guided by NCSBN national study results (Hayden et al., 2014), the NCSBN guidelines (Alexander et al., 2015), and the INACSL Standards of Best Practice: Simulation (INACSL Standards Committee, 2016), a decision was made to develop a Foundations of Simulation Teaching faculty development course for all faculty conducting simulation activities. To facilitate accessibility, it was determined that an online, asynchronous course was the best delivery mode.
DESIGN AND DEVELOPMENT
The CON funded the project and tasked the in-house instructional design team (ID) and simulation faculty subject matter expert (SME) to develop the course based on educational and instructional design best practices. The SME and ID collaborated throughout the initial analysis, design, and final development phases of the course. Their collaboration followed a systematic, flexible, and iterative approach to course design (Reiser & Dempsey, 2006).
The ID followed the ADDIE process (Analysis, Design, Development, Implementation, Evaluation) to guide the development of the course (Dick, Carey, & Carey, 2015). In addition, to ensure the course was designed to meet learning outcomes, the team integrated evidence-based research practices as outlined by the Quality MattersTM (QM) rubric. QM (http://www.qualitymatters.org) is a national organization recognized as a worldwide leader in providing research-based quality assurance guidelines for online education. According to QM, a well-designed course will lead to increased student engagement and overall student satisfaction with the course.
To begin the development process, the ID and SME collaborated on a roadmap of the course. The first step was to identify objectives, learning outcomes, course content, learner activities, and an assessment plan. The content was designed to be presented in eight modules or learning units. The team worked together to ensure course objectives were aligned to learning outcomes, content, activities, and assessments.
The SME identified articles, chapters, videos, and examples of concepts that the ID reviewed to ensure they aligned with course objectives. According to QM, students will know what is expected of them if all course components (content, activities, and assessments) relate directly to the stated learning objectives. The ID developed the course for online delivery via the existing learning management system. The SME provided content and scripts for key concepts that the ID used to design and develop multimedia interactive presentations for asynchronous Consensus was obtained between the ID and SME for each module. The overall course development spanned 12 weeks with the ID and SME meeting once a week. The assessment plan was designed concurrently to ensure that learners achieved the desired learning outcomes.
The design of the course is sequential, from Module 1 through Module 8. Learners start with a short overview that outlines the purpose of the course, the objectives, and what learners should be able to achieve by the end of each module. This is automated via the learning management system. Learners complete a 40-question pretest; they have one chance with no time limit to complete the pretest. Each module contains an overview, assigned readings, a multimedia interactive presentation, one or two resources, an assignment, and a five-question postmodule quiz. The next module can be accessed once the quiz is submitted.
The course includes several formative assignments and a final assignment, designed to be completed in sections based on module topics. Learners are provided several simulation scenario templates and self-select a simulation template. As their knowledge grows, learners add key component areas to the simulation template until the assignment is completed by the seventh module. The final assignment guides learners to use a simulation design template to produce a peer-reviewed, evidence-based simulation with pre- and postlearning activities, prebriefing, a scenario, and debriefing guided by the INACSL Standards of Best Practice: Simulation (INACSL Standards Committee, 2016).
Learners work through the eight modules at their own pace, although the course is available for eight weeks. Some students complete one module per week, whereas others complete several in one week working at their own pace. After learners complete all eight modules, they are required to complete a posttest with the same 40 questions as the pretest. They have two chances to complete the posttest and achieve a score of 80 percent or higher. If 80 percent is not attained, the learner can contact the instructor to discuss any issues and request an opportunity to take the test again. Learners receive a certificate of completion upon attaining a score of 80 percent.
RESULTS
The collaboration between the faculty SME and ID produced a course that integrates the best practices in course design, online pedagogy education, and appropriate foundational simulation teaching content. The development of the course has had an impact on improving simulation content knowledge and teaching practice among faculty. Over the last two semesters with eight participants, the pretest mean was 27.17 out of 40; the posttest mean was 36.13 out of 40, indicating an increase in knowledge regarding simulation teaching.
Faculty exposed to the course have incorporated what they learned into practice, thus increasing consistency in their simulation teaching approach. Simulation faculty are now using a modified version of the NLN Simulation Design Template for designing and using appropriate simulation scenarios for high-fidelity simulation (download at http://sirc.nln.org/mod/forum/discuss.php?d=83).
SUMMARY
By following best practices in education and simulation, a faculty development course can be developed to provide faculty with a foundation in simulation knowledge. This online course is one example of training conducted in a CON to address the NCSBN guidelines for faculty development in simulation (Alexander et al., 2015). The desired outcome of the course was achieved as simulation faculty can now clearly identify and incorporate best simulation teaching practices and INACSL standards.
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