When Barbara Sinclair started teaching at Western nearly 20 years ago, the old clinical nursing skills laboratory was in “a bad state of disrepair, with not much of a budget, a few body parts and old equipment.”
A veteran University Hospital nurse, Sinclair stepped in, gradually and tirelessly transforming clinical education at Western into the innovative simulation experience her students receive today. In recognition of her work, she was recently awarded the national D2L Innovation Award in Teaching and Learning from the Society for Teaching and Learning in Higher Education.
“I worked for 28 years, but always had a desire to teach. When I came on as a clinical instructor in the early 1990s, there was no simulation suite. But I really liked teaching the students hands-on skills. I taught in the classroom for a number of years but students really responded to this type of learning,” said Sinclair, a lecturer and Coordinator for Simulated Clinical Education in Nursing.
In 2005, when the Arthur and Sonia Labatt Health Sciences Building opened, Sinclair was charged with coordinating a new clinical education suite. Little was known about simulation education at the time, she said. It was widely used in other disciplines, such as aviation, but it was relatively foreign to nursing. Sinclair was granted carte blanche to develop Western’s simulation program.
Aiming to increase student enrolment in nursing, at a time when clinical placements were limited and in high demand, the provincial government invested in simulation, helping establish the first simulation suite at Western. Health care was also becoming increasingly complex, Sinclair noted, and the need to prepare students for placements in hospitals and care settings was crucial.
With the influx of funding came a few mannequins and Sinclair saw an opportunity to engage students in a new and exciting way. She designed a setting that resembled a hospital and a curriculum regarded as unique in the country.
“Clinical placements were insufficient, and you couldn’t always guarantee standardized learning opportunities. We first ran what we think was the first simulation course; students would spend half their time in the hospital and then they got an additional block of time in simulation where we simulated common things like blood transfusions or respiratory distress – things they may or may not get to see in their clinical experience – so everybody would have standardized learning on the major issues,” Sinclair said.
Things blossomed from there as the Nursing curriculum evolved. Today, all Nursing students get time in the simulation lab, with first- and second-year students spending more time in simulation and upper-year students spending more time in placements.
“We were hearing from students they were anxious going into acute care; they were asking for better prep and we wanted to prepare them better.”
Because of this, second-year students get the most time in the simulation lab, spending four 10-hour shifts per term, simulating the shift work in hospitals, particularly the morning shift during which nurses are provided a night report from outgoing staff.
But the simulation experience Sinclair developed is much more than that and her innovations continually add to students’ learning opportunities.
Interactive simulations in nursing education include cameras and microphones above hospital beds. These allow the life-like mannequin patients to speak, respond to students and exhibit symptoms beyond physical ailments and limitations.
Simulations at Western are different from most, which focus on one or two aspects of care and typically run for 20-30 minutes. As Western students advance through the program, encountering some of the same ‘patients’ as their health cases unfold, they gain greater understanding of the trajectory of chronic illness, including mental health.
“Students have to focus on that relationship, not just the psycho-motor skills of nursing,” Sinclair said. “This helps hone their communication skills; they learn how to think critically, ask questions and respond empathetically. We are trying to create simulations that really stimulate thinking, not just teach them to practice a skill.”
In efforts to make the experience resemble a real-life clinical environment, Sinclair has also partnered with a graduate of the program who has a background in computer science to design the faculty’s very own HUGO, an electronic system of dispensing patient medication. The real HUGO was far too expensive, she said, and the faculty could develop its own for a fraction of the cost.
Sinclair creates what needs to be in the database, individual medication packages, bar codes and arm bands – all of the scannable materials. There is a work station on wheels, with a computer that houses all medications – just as it would be in a real-life setting.
Sinclair has also developed an electronic patient record with the former student, inputting the cases and scenarios that she had already designed.
“Our students are already doing electronic charting, which is ahead of some of the hospitals in the area, even, but it is getting them ready,” she said.
“We want to develop simulation around homecare; we recognize that is where care is supposedly moving. We want to do public health and community health simulations. We want to do interprofessional education,” Sinclair continued.
The Faculty of Health Sciences recently provided $100,000 towards gaming-based learning in Nursing, something she has already been working on with funding from eCampus Ontario. Last year, she helped develop a medication administration game, which students could use to learn medication administration sequences and prevent medication errors.
“We want to develop more games, maybe get some virtual-reality simulations. The physical space is great – but not all students learn really well this way. Some students would prefer to do something on their computer, repeatedly, rather than waiting to come in here. We need to tap into the different ways and learning styles,” Sinclair said.
“This is great, but expensive to maintain, so we are trying to branch out and find different ways of teaching nursing students, rather than the traditional lecture style and lab where we learned to give injections into oranges.”