I think I may have my keyboard back to English today, which is awesome! I have been in Milwaukee since Wednesday night but haven’t spent much time outside of the event location/hotel. This has been a great conference for networking.

Soaring to Endorsement: A Celebration of INACSL Excellence: Endorsement and The Core Four

Presented by: Laura Gonzalez, PhD, APRN, CNE, CHSE-A, ANEF, FAAN, INACSL President-Elect; Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, Endorsement Program Lead; Penni Watts, PhD, RN, CHSE-A, FSSH, FAAN, INACSL Standards Committee

This session was introduced by Elizabeth Horsley who is one of my favorite session hosts. She introduced Marian and I yesterday too and is so amazing and engaging. Laura talked about the core question of “What is good simulation?” They started talking about the endorsement program as a result. It recognizes institutions, practices, and programs that demonstrate excellence in the four core aspects of simulation.

These people are so welcoming. They just said one you are into simulation you are part of their group, which they described as very supportive.

You need to have high-quality simulation if you are going to replace clinical time with simulation. They have a program to look at demonstration of high-quality simulation (but not really looking at having support for everything).

The application asks for examples of evidence such as videos, scenario templates, policies, narrative text, and scripts. They are looking at how well the application meets the core four INACSL standards. Applications that are not successful get support in becoming ready for recognition because this is a supportive community. They answered questions about the refined process for next year. It seems like a supportive process but the cost is high for next year (at least for a small school like mine). There are cost considerations for people based on their country … but I hope they eventually also consider that in North America there are small institutions that just don’t have the money for something like this (I am from Northern Ontario).

Increasing Rigor by Infusing the Clinical Judgement Model into Virtual Simulation Debriefing
Presented by: Shelly J. Reed PhD, DNP, APRN, CNM, CNE; Stacie Hunsaker DNP, RN, CEN, CPEN, CNE, CNML, CHSE; Daphne Thomas DNP, RN, CNE, CNML, CEN

I decided to run back to my room before this session and found out I lost my key, but luckily I did make it back.

Faculty talked about how they did their best during COVID to use virtual simulation but there were some challenges and a lot of variation in experiences. The presenters shared their journey towards standardizing things to improve practices. They used a literature review and found an existing written reflective clinical debriefing template based on Tanner’s Clinical Judgement Model. They liked the in-depth guidance for student reflection.

They made a standardized way for clinical or course instructors to grade the reflections. They use the same questions for virtual and in-person reflections. They have a handout they said they were happy to share. They walked us through a bit of an example using the picture in the tweet above. Noticing – They asked questions about what we see and what we notice initially. To give customized and specific feedback they use this approach. They talked about their research plan and I was intrigued. They are using a scale to measure debriefing after their reflection. It might be neat to evaluate the debriefing in my course in a similar way.

In the discussion they mentioned the need for students to have time to process information, which is possible with written reflections.

Novel Approach to Developing Clinical Judgment for Practice-Ready Nurses
Presented by: Carol Durham EdD, RN, ANEF, FAAN, FSSH; Susana Barroso PhD, RN; Jennifer T. Alderman PhD, MSN, RN, CNL, CNE, CHSE

They opened with a familiar story of the feelings that new nurses may experience when they start practice and are not sure how to manage a patient care situation. An inability to notice and make clinical judgments is an issue. It is concerning how often nursing students are unable to make good clinical decisions. Initial competency of new registered nurses is declining. An ability to recognize urgency and change in patients is essential for safe practice.

They don’t want to be the nurse, but that is what they ask them to do in this scenario. They need to listen to the patient, observe the surroundings, examine clinical notes, diagnostics, lab results, and medications. Students are actively engaged in the session. The program captures clickstreams so educators can see their actions. Clickstreams shoe the scene, identifier, and time spent on the screen. Educators can use this information to help with debriefing. They have lesson plans that help to guide students through the process. Preventing readmissions is an important part of their debriefs. They want to teach nursing students to anticipate orders (by telling them that all orders are available during the simulation). Anticipating orders helps them be better advocates for patients. They made a word cloud out of student reflections over time. Practice was the largest word in the cloud. They are using the lessons plans to help prepare for the NCLEX and in clinical settings. The showed us a dramatic reduction in failure to rescue from 2021 to 2022 (meaning that they were able to rescue more patients). They were also able to adapt the curriculum based on an assessment of gaps in student knowledge (such as needing to update how they teach certain concepts).


Laura Killam is an experienced nursing educator from Northern Ontario with a keen interest in improving student learning through innovation. For more information please visit http://nursekillam.com/.


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