I've been reviewing the AACN's new document, The Essentials: Core Competencies for Professional Nursing Education, which is just out this month after 13 years, and I am struck by the number of times the document refers to the importance of integration in nursing education. Much of the discussion of The Essentials' domains, concepts, competencies, and sub-competencies refers to the need to promote integration of knowledge and skills by students. Integration is defined in The Essentials as: "An experience designed to provide the student with an opportunity to synthesize the knowledge and skills acquired during previous and current coursework and learning experiences" (AACN, 2021, p. 66).
We have focused on integration since we began this journey with our nursing integrated simulations a few years ago. We use the AAC&U definition which views integration as: "connecting theory and practice, across courses and disciplines, toward a deepened understanding. [It] involves synthesizing and transferring learning to new, complex situations within and beyond the curriculum" (AAC&U VALUE Rubric). This is what we seek to accomplish through SCHOLAR'S unique opportunity to have an impact on nursing education and nursing students.
So, how do we accomplish this? We modeled our integrated simulations after the integrated training provided in space shuttle simulations. Since multiple teams and centers needed to work together in space shuttle missions, simulations needed to mirror this process to accomplish actual mission objectives. This integrated training provided the big picture learning that was needed.
In nursing, I was seeing more and more observation by students in clinical experiences related to safety and legal factors, as well as the decline in student clinical experiences available to actually meet program objectives. What we needed was integrated learning experiences that facilitated critical thinking, clinical judgment, clinical decision-making, communication, interprofessional collaboration, technology integration, task management, and so on. The 72-hour nursing integrated simulation was the answer to this need.
The nursing integrated simulation provides a holistic, realistic, hospital environment. This provides the perfect environment for integration just as in the actual hospital environment. Patients have varying illnesses and co-morbidities; they come and go from surgery or procedures, or the ICU; they have families who are concerned and asking questions; they have religious and cultural beliefs that affect their treatment decisions. Patients get admitted and discharged. It's a busy place. Students have their multi-patient assignments, they document in an EHR, and since it's a 24 hour/day environment they hand off to the night shift or day shift as they finish their own shifts. Students are truly on their own, making clinical decisions. "The whole idea is to really push the team, everybody on it, and find out what do you really know and what do you not. And then deal with the real world consequences of all that, because that's what's going to happen in a hospital" (Andy Foster, as quoted in TMC Pulse, 2018, p. 37). Students' patients have multiple IVs running, often with blood transfusions, they have complex medication orders, they deal with providers who are writing new orders, they interpret lab data, and communicate with the interprofessional team.
We have actual providers in every sim. We also provide interprofessional participation with students from other disciplines, social workers, chaplains, outside agency professionals, and others, depending on the scenario and availability, just as in the actual hospital environment. The possibilities are endless. If graduate students are participating, nurse educator students and nurse practitioner students engage in learning and interact with undergraduate students too. Visitors to our sims are amazed at the reality of the atmosphere of our integrated simulations.
Our integrated simulations provide for integration of learning. Students learn to set priorities and organize their days and their care. They provide discharge teaching and they deal with emergent situations. Even with the wonderful experiences that students can get in actual clinical experiences, it is not possible to get the independent integrated learning that our experiences provide. As an example, this video shows a patient in the sim with PTSD who has an outburst at 3AM during the nightshift (nursing faculty at table are purposely not participating). It is not easily possible to get this kind of experience where events like this couple with other events in an already busy hospital environment, unlike in other typical simulated experiences. Even in clinical environments where anything can happen, these kinds of experiences, especially with the decision-making aspects, cannot be assured for all students.
References
AACN (2021). The Essentials: Core Competencies for Professional Nursing Education.
AAC&U. Integrative Learning Value Rubric.
Becker, A. (2018). Simulating Nursing. TMC Pulse, 4:11, 37.