Welcome to Nursing EDge Unscripted Saga, as we use stories to connect the past to the present and then our future as we reimagine our teaching and learning. As we celebrate the NLN Year of the Nurse Educator, we pay tribute to extraordinary nurses who've made significant contributions to nursing education. We dive into the stories of nurse educators who recognized a need, challenged traditional customs, and influenced transformative change.
In our ongoing series on the NLN Curriculum Revolution, our conversations have focused on what was taking shape around nursing education reform in the 80s and 90s. Led by a dynamic cohort of nurse educators focused on revisioning nursing education, they opened the door to new ways to think about curriculum, dialogue, clinical judgment, the power dynamics inherent in the teacher-student relationship, and the theoretical underpinnings
of clinical practice. Simulation as a teaching strategy in nursing education began to find its way with early nurse education innovators in the late 90s into the early 2000s. In our last episode, we focused on the work of Dr Pamela Jeffries, an early visionary who studied simulation and nursing education and developed a simulation framework that guided the use of simulation teaching and learning in nursing education.
In this episode, we will focus on the NLN Jeffrey Simulation Framework's evolution to a mid-range theory and the landmark National Council of State Boards of Nursing study which concluded that simulation can be used to replace up to 50 percent of actual clinical experiences for learners.
In the summer of 2011, the International Association for Clinical Simulation and Learning or INACSL, in consultation with Dr. Jeffries convened a meeting of simulation educators and researchers to study the state of the science of simulation relative to the application of the NLN Jeffries Simulation Framework. The focus was to study the five constructs of the framework: student, teacher, educational practices, simulation design characteristics, and outcomes.
They examined how the concepts or constructs were defined in the nursing literature, the evidence that surrounded the use of these constructs, major knowledge gaps in research opportunities, and important future directions for research surrounding the concepts. In 2012, with funding from Laerdal, Dr. Beth Rogers, an internationally known expert in theory development, was recruited to evaluate the potential of moving the framework to a theory.
Under Dr Roger's guidance, the relationships among the components or constructs were further studied and Dr Katie Adamson joined Dr Rogers to complete a systematic review of the literature, a necessary step to document completed rigorous research that used the framework with the intended outcome to not only clarify the constructs in the framework and their relationships but reveal gaps to identify a clear direction for
further research. Based on this work, the NLN Jeffries Simulation Theory emerged as a mid-range theory in 2016. During this same time frame, the National Council of State Boards of Nursing began work on their landmark study. Sophistication of simulation was growing as well as was the number of schools using it. Changes in health care were resulting in fewer clinical placements available
for students. As a result, boards of nursing across the country were receiving requests from programs for permission to use simulation to replace some traditional clinical experience hours and they reached out to the National Council for guidance. The National Council noted that the existing literature indicated that simulation was an effective teaching strategy but did not provide the level of evidence needed to make a decision
on simulation as a replacement strategy. Therefore, the National Council convened simulation experts across the country to carry out the first landmark nursing education simulation study using the NLN Jeffries Simulation Framework to guide the use and design of the simulation used in this study. The study convened in the fall of 2011 with 10 pre-licensure schools across the country representing 666 students. Across these 10 schools, students were randomized into one
the control group that consisted of students who had traditional clinical experiences and no more than 10 percent of those clinical hours were spent in simulation; the 25 group were students who had 25 percent of their traditional hours replaced by simulation; and the third group represented the 50 group students who had 50 of their traditional clinical
hours replaced by simulation. The study began in the fall 2011 semester with the first clinical nursing course and continued throughout the core clinical courses through graduation in May 2013. During coursework, students were assessed on clinical competency and nursing knowledge. Additionally, students rated how well their learning needs were met in both the clinical and
simulation environments. Learning and competency was assessed at the end of the nursing program with results showing no statistically significant differences in clinical competency, comprehensive nursing knowledge assessments, and no differences in NCLEX pass rates. These students were also followed into the first six months of clinical
practice. Here again, there were no differences in manager ratings of overall clinical competency and readiness for practice as a new registered nurse. This was a remarkable study that for the first time provided the needed evidence to support the use of high quality simulation experiences as a substitution for up to half of traditional clinical hours and achieve comparable outcomes.
The caveat was that it needed to be conducted with well-designed simulations that followed the INACSL standards of best practice, now named the Healthcare Simulation Standards of Best Practice, and that simulation faculty are well trained and use a debriefing method grounded in educational theory. Today, ten years later, simulation pedagogy continues to inform remarkable outcomes and is helping to transform nursing education as a contextual experiential teaching
strategy. It is truly moving nursing education ahead to deliver those important concepts articulated by our curriculum revolutionaries. And so the Saga continues and may our Saga continue as we bring to a close this episode of Nursing EDge Unscripted Saga. Thank you for joining us